DEVELOPING HEALTHY COMMUNITIES: A Five Year Project Report from The CommunityHealth Development Centre Presented at The International Healthy Cities ConferenceSeptember 1994Author(s): TREVOR HANCOCKSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 79, No.6 (November/December 1988), pp. 416-419Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41990554 .

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The Future of Public Health in Canado

DEVELOPING HEALTHY COMMUNITIES A Five Year Project Report

from The Community Health Development Centre

Presented at The International Healthy Cities Conference

September 1994 DR. TREVOR HANCOCK1

The Community Health Development Centre was established in Toronto in 1989 as a collaborative endeavour of an undergraduate faculty of community services, a city public health department and a network of voluntary sector organizations. Core funding was received from national and provincial health promotion programs. The Centre is managed by a multisectoral community board. Our activities are based in a downtown storefront and on the university campus.

Now, 5 years after our establishment, it is appropriate to look back at what we have accomplished and to contemplate our future. Our work has drawn much of its original inspiration from the Healthy Cities movement in Europe and Canada, and from the underlying Health Promotion concepts and principles.

The Basis of Community Health Development There is nothing startlingly original about the idea that

community development is an important part of public health and health promotion. Milwaukee's claim to fame as the healthiest city in the USA in the late 1920s and early 1930s was due as much as anything to effective community development and organization.1 The World Health Organization has consistently called for wider community involvement and participation as essential to attaining Health for All, while the strengthening of community action is one of the five main strategies for health promotion.2 The Canadian Government report Achieving Health for All 3

proposed mutual aid and public participation as important parts of an overall health promotion strategy.

While these policy documents provided the stimulus to the development of the Community Health Development Centre, the theoretical basis comes from Cassel4 who

1. Public Health Consultant, 629 Manning Avenue, Toronto, Ontario M6G 2W2. AUTHOR'S NOTE This scenario reflects a possible future, not necessarily the probable future. It is based upon a combination of current activities, plans under development and my own fantasies.

proposed that there are health consequences to social disorganization; from Berger and Neuhaus,5 who proposed that society's mediating structures (neighbourhood, family, church and voluntary associations) should be utilized to empower people "to address human needs without exacerbating the reasons for animus against the welfare state"; from John McKnight and his colleagues who developed a health action model6 based on the principle that the strength of community capacity to organize and alleviate certain health problems is health promoting in itself; and from Albee7 who believes that many of our health problems can be traced to problems such as powerlessness, poor social competence, low self-esteem and a lack of support networks. From this, we conclude that a stronger and more organized community may promote health and prevent disease through empowering individuals and the community, reducing stress, enhancing social competence and self-esteem and providing support systems and networks. Central to this notion is the idea that individuals are best empowered as part of the community, that an empowered community will include empowered individuals who attain that empowerment through mutual support. In short, as a report on a series of community workshops across Canada put it, "strengthening community health means strengthening communities".8

The Toronto Community Health Development Centre With this philosophical and theoretical background in

mind, and with the experience of both the Faculty of Community Services and the city public health department in community development and health, the Centre was established in 1989. Our staff can call upon community workers and health promoters from the Department of Public Health, members of the faculty of community services and hundreds of students to assist with our activities. Our management board includes a majority ol members from the community, principally from community groups where we have assisted in project development. We

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have expanded our operations with the co-operation and support of other health departments in and around Metro, community groups and organizations and other health and social services agencies.

Our resource centre includes an extensive collection of newsletters and project reports from community health development projects throughout the world, and online access to relevant data bases, including the Ontario Prevention Clearinghouse and the Metro Self Help Clearinghouse. Our quarterly newsletter circulates widely to community groups regionally, nationally and internationally.

In addition to our role in providing learning opportunities for undergraduate students, we provide an extensive range of workshops, conferences, summer school and continuing education programs, in community skills for health professionals and in health skills for community leaders. The mutual learning is one of the strengths of the project.

Our main work is assisting in innovative and integrated community development projects that promote health.

Community Health Development Activities Our primary commitment is to reduce inequalities in

health, by reducing inequities in access to the basic resources for health through community action. These resources include food, shelter, work, education, sustainable resources and a stable ecosystem. We call this approach "basic health development".

A second aspect of our work is recognition that we need an integrated approach to community development for health: to ensure, for example, that food production creates jobs while conserving resources and that the output is healthy food and healthy work in producing that food. The concept of the healthy city is an important organizing principle, particularly when the city is viewed as a human ecosystem consisting of healthy communities and neighbourhoods.

A third focus is fostering and development of community skills and leadership, both among community members and health professionals. We have made a conscious effort to strengthen the community's skills in organization, communication, leadership and action and to increase community knowledge of the basic determinants of health and ways to enhance health locally. We have also made it a point to train health professionals in new skills that emphasize their role as facilitators whose task it is to strengthen community and foster independence. Bringing together community members and health professionals to learn from each other has, not unexpectedly, proved to be of immense value.

Our fourth focus has been to ensure that links between community groups are developed and maintained. Communities can best learn from other communities who have faced and dealt with similar problems, and we have

been able to use our workshops, conferences and summer schools, together with our community exchange programs, to supplement our written and electronic communications with more fruitful person-to-person contacts.

Let us examine some specific activities:

Food We have assisted community groups to establish

community gardens. Some gardens are principally for aesthetic benefit (the creation of green space and leisure opportunities, the re-creation of wilderness and nature); others have produced fruit and vegetables for community members. Some gardens have a co-operative approach, others have individual allotments. Thus we have brought into productive use areas of urban "desert" such as utility corridors, abandoned factory sites, and the "green deserts" of lawns surrounding community facilities such as hospitals, churches, office and business parks.

We have encouraged the development of these gardens on ecological or organic lines, emphasizing the need to avoid the use of pesticides and the potential to recycle organic wastes. The gardens have become places where community groups come to learn about the ecosystem and its preservation.

Few community gardens have provided income, though several specializing in herbs and unusual vegetables have found a market in local restaurants. However, commercial greenhouses have been established to utilize the "waste" heat from incinerators and power generating plants. These operate year round, have created new employment, and produce significant quantities of food for the local market.

Another activity has been development of food co-ops for bulk purchasing of good quality foods, available at lower prices to low income communities. This has been facilitated by combining producer co-ops with consumer co-ops, for the mutual benefit of both, enhancing food self-reliance while providing new jobs.

In all of these efforts, we have made the link between food and health, encouraging the production and consumption of nutritive foods. We plan to develop fish farms and promote consumption of fish. This is important in view of the chemical contamination of fish in Lake Ontario, though our initial plans to put the fish tanks in association with the sewage treatment plants so as to utilize the warm organic rich waters have proved impossible due to the high levels of contamination in the sewage!

Shelter We have worked with community groups to provide

housing for the homeless, for seniors, single people, single parent families and ex-psychiatric patients. We have encouraged and supported community-based co-operative housing and the further development of projects such as Homes First, which provide shared accommodation for single people as an alternative to hostels and other institutional remedies.

November/December 1988 417

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Our concern with shelter goes further. Housing is a complex problem, with important social dimensions. We have undertaken a number of community development projects to ensure that new housing, particularly "social" housing, functions as a community. We have worked with groups to develop community support programs, both voluntary and funded. We have focussed on developing mutual support and self-help networks within these housing developments.

Work We have recognized that unemployment is a major threat

to health. A number of our projects have quite deliberately been intended to create health-sustaining work, particularly in food production and distribution, housing, community support services, recycling and energy conservation. We have been conscious of the emerging "new work agenda" and that our traditional concepts of full employment (a 40 hour week) need to be revised. Work should not be a source of income alone, it should also be a source of health. Thus we have to ensure that the jobs are in and of themselves health promotive. A high quality of worklife, active participation in decisions affecting working conditions and the availability of extended work options are fundamental to health. We work with local enterprises including community and worker co-ops, and with local churches and unions to apply these principles of healthful work more widely.

Basic Education Literacy and levels of basic education are fundamental

determinants of health. Some projects (such as the community gardens) provide an opportunity for children to learn. Another project is development of neighbourhood toxic inventories, by school groups. We have supported the "Kids City" project which has encouraged children to look broadly at what makes the health and ill health in their urban environment.

We have encouraged and supported the health component in adult education and literacy programs, including "English as a second language" classes. These provide important opportunities for new immigrants and functionally illiterate Canadians to learn about the health of their city and their own health, and to understand the principles of basic health development. As with many other projects, our main contribution has been to identify sources of support and other assistance to get these programs under way.

Energy and Resources A healthy city must conserve natural resources and

refrain from destroying its own ecosystem. Conservation of natural resources is good for the ecosystem - and it is efficient. To the extent that a city or community can be more self-reliant in its use of energy and resources, it needs to

spend less on importing those resources and will have more available for local use.

Several projects have aimed to increase local self- reliance.9 These include neighbourhood recycling programs (which are labour intensive) and neighbourhood passive solar heating projects. A network of bicycle paths will reduce air pollution and gasoline consumption, while providing a safer and more healthful means of transport (at any rate in the summer).

How We Work We have been guided by several principles. The first is

that we do not "do", we "enable". Our role is not to carry out community projects; indeed, with our small full-time staff, it would be impossible to cover such a broad range of issues if we were actually doing the projects ourselves. In any case, that would encourage dependence in the communities we are working with. Our role is to be available to community groups or individuals who seek our advice, to develop and strengthen community organizations (including provision of limited support services such as typing, photocopying, mailing and meeting space), assisting with proposal development and identifying potential sources of funding and other assistance.

Our second principle is that in community development work, the community health worker is in the best position to understand the community, its needs, concerns and dynamics. We thus have a "hands off" management style. This encourages a collégial working relationship among the Centre's staff.

Our third principle is that whatever the community project is, it's likely that someone else has done it somewhere else. We attempt to identify examples of similar projects and to put the community groups in touch with each other so that they can learn from each other.

Fourth, we attempt to work with existing community groups and in active co-operation with existing community agencies. The last thing we want to do is to reinvent or re- create a community organization, it is better to strengthen existing community groups.

Future Directions We are happy to note that similar centres have been

established in several other Canadian cities. This network of community health development centres will greatly strengthen our ability to undertake community health promotion activities across the country. We are truly creating a movement, which with its link to the Healthy Cities movement is international in nature. At a local level, we hope to expand and integrate our various community activities so as to develop an integrated urban food system, extensive community economic development activities that provide healthful work and enhance community self- reliance, and community energy and resource suppl> systems that are sustainable and that conserve or enhance the urban ecosystem.

418 Canadian Journal of Public Health Vol. 79

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In short, through strengthening communities we will strengthen community health and create healthy and sustainable cities.

Acknowledgements 1 have been greatly aided by working over the past few years with Bob Alexander,

Maria Herrera, Ron Labonte, Marvyn Novick, Anita O'Connor and Jennifer Welsh.

REFERENCES 1. Leavitt J. The Healthiest City: Milwaukee and the Politics of Health

Reform. Princeton, N.J.: Princeton University Press, 1982. 2. Ottawa Charter for Health Promotion. Ottawa: Canadian Public

Health Association, 1986.

3. Achieving Health for All: A Framework for Health Promotion. Ottawa: Health & Welfare Canada, 1986.

4. Cassel J. An Epidemiological Perspective on Psychological ractors in Disease Etiology Am J Public Health 1974; 64(1 1): 1040-43.

5. Berger P, Neuhaus R. To Empower People: The Role of Mediating Structures in Public Policy. Washington D.C.: The American Enterprise Institute, 1977.

6. McKnight J. Politicising Health Care Social Policy 1978; 9(3): 36-39. 7. Albee G. Preventing Psychopathology and Promoting Human

Potential American Psychology 1982; 37(9): 1043-50. 8. Strengthening Community Health Means Strengthening Communities

(Draft Report). Ottawa: Canadian Public Health Association, 1987. 9. Morris D. The New City States. Washington D.C.: Institute for Local

Self-Reliance, 1982.

Received: August 31, 1987 Accepted: August 31, 1987

November/ December 1988 419

Our readers may like to use the following Grace, which was read before the banquet at the annual conference of the Ontario Public Health Association on November 21, 1988.

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