community development and health
TRANSCRIPT
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Increasing inequality
Austerity
A crisis in democratic accountability
Threat to community life
Shrinking the state +
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Communities, power and health
Brian Fisher MBE
Chair of the Socialist health Association
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RESILIENCE UNDER PRESSURE
• Hollowed out communities
• Threat to mental health
• Attenuation of social networks
• Weakening of associational life
• Deterioration in health
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PARTICIPATORY
DEMOCRATIC
ACCOUNTABILITY
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ASSET-BASED WORKING
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ASSET-BASED COMMUNITY DEVELOPMENT
• Statutory services become more responsive• Promotes health protection and community
resilience • Helps tackle health inequalities• Has an impact on behaviour change• Saves money
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CDStronger and deeper SocialNetworks
RESILIENCE
Health protectionResilience to economic adversityBetter mental health
ENHANCED CONTROL
Can negotiate with servicesMore strength for self-careHealth inequalities reduce
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6-Month Survival after Heart Attack, by Level of Emotional Support
0
10
20
30
40
50
60
70
Men Women
Per
cent
die
d 0
1
2 or more
Sources of support
OUTCOMES – HEALTH
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SOCIAL NETWORKS REDUCE MORTALITY RISK
• 50 % increased likelihood of survival for people with stronger social relationships
• Comparable with risks such as smoking, alcohol, BMI and physical activity.
• Consistent across age, sex, cause of death.
• 2010 meta-analysis of data [1] across 308,849 individuals, followed for an average of 7.5 years 1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley Layton.Plos Medicine July 2010, Vol 7, Issue 7. www.plosmedicine.org doi:10.1371/journal.pmed.1000316
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A RESIDENT-LED PARTNERSHIP
LED BY RESIDENTSTHEIR EXPERIENCE DRIVES CHANGEFORMAL STRUCTURES MAY BE NEEDEDA CORE REACHES OUT
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OUTCOMES - RESPONSIVE SERVICES
• Services begin to change within 6 months
• Affects many sectors simultaneously (health, police, education)
• Communities gain confidence and leaders emerge
• Staff enjoy their jobs more
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RESPONSIVE SERVICES
• A new dental service established• Funding of £95k to transform a derelict area into a
playpark awarded • A new GP surgery planned• Well attended social events and football sessions• Relations with the housing department improved and
tenants more satisfied.• Summer holiday activities for all ages • A cooperative plan for social renewal agreed between
the community and public agencies
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Operation Goodnight
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• “This downward trend is more than likely due to the introduction of a permanent PCSO for Townstal and a more regular link with the Dartmouth Community College and the school.”
• “The community involvement of the Townstal Community Partnership giving the residents ownership and a ‘say’ in what they want for Townstal has brought the community together and must be considered as a factor in this reduction of crime.”
• Townstal Beat Police sergeant
CRIME – A CASE STUDY
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SOCIAL RETURN ON INVESTMENT
• With modest gains on the eight indicators, the model posits a saving of £559,000 over three years in a neighbourhood of 5,000 people, for an investment of £145,000: a return of 1:3.8
• For £233,655 invested across four authorities the social return was £3.5 million.
• For every £1 a local authority invests, £15 of value is created.
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NOT BIG SOCIETY
• No intention to substitute statutory services with private or voluntary.
• Does not cut across work on:– Income inequality– A just tax system– A living wage
• This is about responsiveness and effectiveness
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AN OPPORTUNITY
• A new approach to improving population health
• Wraps around primary care• Links LAs and primary care• Challenges the balance of power• A number of models to choose from
– HELP– Altogether Better– Turning Point
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It has transformed the way we practice medicine. It has stopped us seeing our patients as if we were just service providers to people who are ‘needy’.
We now recognise that they can contribute, and when you see people light up when you ask them to do so, it changes your relationship with them.
The culture has changed. The relationships are different, deeper and more therapeutic than they are in the usual doctor’s office.
Dr Abby Letcher
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