To understand the role of community development as a potential strategy for addressing health inequalities, this essay aims to provide a discussion of the extent of health inequalities in the population in the UK. The nature and scale of these issues, the different causes of the indifferences, it will also look at how community development will work and how it could help contribute to the policy goal to reduce the health divide. It will look at the different issues concerning such a project and whether it will prove successful.
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Building on from the idea of health inequalities being linked to social class, this section illustrates other rationalisations as to this difference and some clarification as to why this might be. Health inequalities by and large are calculated by socio-economic groups however there maybe other explanations for these differences. There are reasons to believe ethnicity make a differences to health inequalities, it is stated in the Health Inequalities report 2008-9 that ‘in April 2001 Pakistani and Bangladeshi men and women reported the highest rates of both poor health and limiting long term illnesses whereas the Chinese reported the lowest’. This is an alternative to the explanation of the socio-economic difference; nevertheless there are also other justifications. There are also claims that there are gender inequalities which exist “The Men’s Health Forum argue that men’s life expectancy is more severely affected by deprivation than that of women” (House of Common 2009), men are more likely to commit suicide, suffer from obesity and twice as likely to be diagnosed with and die of cancer.
There is also speculation that there is health inequalities between the young and old as the ‘old receive poorer treatment and have less access to certain procedures’ found in the 2008-9 Health Inequalities report. There are also those who are suffering from ‘physical and mental impairments with poorer health outcomes than other parts of society’ therefore they are more likely to suffer from terminal illnesses and coronary heart disease (House of Common 2009). The report has also found that ‘health outcomes also vary according to geographical area’ thus those living in a deprived area are more likely to suffer from worse health problems than those in a more affluent area.
To further understand health inequalities this section explores the causes of these, such as ‘access to healthcare’ (House of Commons 2009). There are a plethora of causes why individuals can not get access to the necessary health care and treatment. ‘The most compelling concern is about access related to age-related inequalities’ (House of Commons 2009). There are however arguments refuting this, there are other mitigating factors. There are a wide spectrum of lifestyle choices which further contribute to the inequalities in the populace, included amongst these are; smoking, nutrition, exercise and weight (House of Commons 2009). Individuals who are over-weight or given to unhealthy habits such as excessive drinking and smoking may display an increased reluctance to access medical treatment, resulting in a deterioration of health and a widening chasm of health inequalities.
It is argued that the lifestyle factors which lead to health inequalities have an underlying socio-economic origin. It is purported that; ’causes of health inequalities reflect what are frequently referred to as the underlying causes-income, socio-economic group, employment status and educational attainment’ (House of Commons 2009). There is a correlation between education and income in relation to the health inequalities. The lower down in the socio-economic hierarchy you are, the higher the probability of health inequalities. There is also a ‘widening gap between poverty and housing’ according to the Heath Inequalities report (2009), those of the low socio-economic group are more likely to have a substantial income therefore they are more likely to live in poor housing which in effect leaves them vulnerable to illnesses such as asthma due to dampness. There are many different aspects which maybe the cause of health inequalities in the population however there are disagreements with some of these findings such as the link ‘between socio-economic inequalities and health inequalities’ (House of Commons 2009). According to a recent publication in Health Economics there is not substantial evidence to say there is an association between socio-economic inequalities and health inequalities. There are no direct links but it is assumed that this is a factor in health inequalities and there is not much that can be done about this, however lifestyle factors play a big role in health inequalities in the population which can be helped to improve these inequalities.
Community development is a way forward, this is one way in which health inequalities can be reduced in the population in the UK. Community development is a set up where communities can amplify their power and efficiency to improve community life, by getting ‘people to recognise and develop their ability and potential and organise themselves to respond to problems and needs which they share’ (Scottish Community development Centre 2010). This would mean the community is in control they are able to ‘participate in public decision making and governances’ (Community development Foundation 2009) as a result they are able to improve their environment for the better which gives them better control in the long run. By using the ‘bottom-up meets top-down’ approach through capacity building the community members are being used to improve the health inequalities of the surrounding areas. In doing so the communities are being ’empowered’ as well as individuals being self empowered consequently the community are more likely to respond than they are if a stranger such as a health professional came in and told the community what they are doing wrong and what needs to be done they have ‘shared values and norms, mutual although not necessarily equal influence, common interests, and commitment to meeting shared needs’ (1998).
Through this approach communities ‘identify and build on strengths, resources, and relationships that exist within communities of identity to address their communal health concerns’ (1998), and do not feel threatened or belittled by health professionals and they are taking the initiative to recognise what they themselves are doing wrong or lacking and how this can be made better. Community development means there is not a victim blame approach so no one is saying a person is obese due to their eating habits and lack of exercise; it is giving the communities the opportunity to voice their opinions as well as giving health professionals the chance to build rapport with the community.
Building on from that, the Scottish Community development Centre (2010) have found that Community development allows communities to plan and ‘have positive prospects for the future as well as creating wealth and giving every member of the community access to its benefits’. This would help reduce health inequalities significantly, the community can come together and feel as one and take care of one another which facilitates a safe environment. Through this people are able to develop their skills, reduce isolation by involving everyone as well as creating social networks and building relationships ‘characterized by trust, cooperation and mutual commitment and mediating’ (1998) with other communities and agencies that affect their community. Community development can prove to be very successful, as an individual a person can be deprived, isolated, intimidated whereas part of a community a person can be rest assured there will always be others, they benefit from community health and feel part of a community ‘by a sense of identification and emotional connection to other members’ (1998), working together to reduce health inequalities and taking control to help maintain their achievements.
It is hard to measure the success of community development as this would have to be looked at case by case however there are success stories such as the March 2010 Rural Community Programme in the Northwest (Northwest Regional Development Agency 2010). The Northwest have strengthened their rural communities and in 3 years have ‘resulted in 57 social enterprises being supported across a range of services including health’ (Northwest Regional Development Agency 2010). By empowering the community they have made a huge accomplishment, together they have reduced health inequalities through providing services therefore there is ease of access. This is a huge success for community development; this evidence shows that community development strategies can be used to help reduce health inequalities.
Community development can be triumphant; by setting up projects in different communities the government can reduce health inequalities in doing so they are reducing numbers of inequalities of health in the population. This can help the NHS; if there is less health problems there will be less expenditure in the NHS and the government save money which they invest in the NHS to help improve their services. Community development allows capacity building for those communities with lack of education and skills this could be life changing as it allows them to build on their own capacities and improve their lives. Communities come together and become a family. Communities are empowered and as a result voice their opinions and help to decide on policies that put in place, “Councils provide local leadership. They know their patch, they bring local knowledge and can help bring people together to breakdown the silos that bedevil public bodies” (Local Government 2010) this way theses policies are more likely to be successful as they are from the community therefore they are more relevant and money is not wasted in making policies and having to make changes so they meet the needs of communities.
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Communities learn how to work with others and build relationships and partnerships with other communities and institutions ‘primary care trusts, voluntary sector bodies and local businesses are proving key partners for many of the projects’ (Local Government 2010). This helps with funding as there is sponsorship coming from different places rather than just from government making it easier on them. With funding from outside deprived communities could become wealthier and the widening gap between the socio-economic groups would decrease and there would be significant improvements in the health inequalities in communities.
However there is a lack of evidence in some community development projects “there is a well recognised gap between research findings and the implementation of evidence based prevention strategies in community settings” (McGinnis and Foege, 2000). If there is no evidence of success within community development projects the government will be reluctant to invest money into the project which would discourage communities from taking part, which inevitably means the community development strategy will prove to be ineffective. If this were the case then health inequalities would not be resolved and communities will still be deprived. There is also the finance side of this strategy; a project like this can be expensive; if government feel its not cost effective there would be limited or no funding available. As this would be new the community and there is no guarantee it will be victorious the community will be disinclined to invest there time or money in the project. Even if there were funding available there is always the chance that communities will chose not to take part, there will also be communities where only part of the community want to get involved therefore would not be as beneficial as possible.
There is a chance ‘these strategies may not meet community needs’ (Green and Mercer, 2001). If a community development strategy is set up in place but does not meet the communities need it would a waste of time and money. Community development needs to be developed around the members of the community, if the project is too multifaceted for the members of the community they will not want to part take or findings could be misleading therefore the project will fail ‘the low level of individual participation rates in studies that recruited from a representative targeted population raises questions about generalisability’ (uel.co.uk, 2010). There would be insufficient research and findings can be misrepresented. The programme needs to be designed around the community and their capabilities. Another issue could be inadequate resources whether that is down to funding or geographical area and such, without resources the community development would be futile.
To conclude, this essay has analysed four key ideas, Firstly it has discussed the extent of health inequalities in the population, the nature and scale of these inequalities. Secondly it has discussed some of the causes for these health inequalities. The third area was the community development and it’s potential as a strategy to reduce health inequalities. Finally this essay discussed the how community development would make a useful contribution to the policy goal to reduce the health divide.
The idea of community development sounds good, many communities would benefit from such projects, this would help change many health inequalities and recent health issues wouldn’t be such an issue. There would not so much pressure on the government to do put provisions in place to reduce health problems such as obesity. If there was a community development project based around obesity, people would learn about the benefits of eating healthy and exercising and how to prepare healthy nutritious food on a budget. This would save the NHS millions if the number of obesity related treatments were reduced significantly. Evidence illustrates community development would be a huge success in reducing health inequalities and improving communities.
In relation to community development it can be seen that projects can be effective however based on the evidence this not necessarily cost effective, there are no guarantees and even if there is funding there is no assurance the community development will be maintained. There are too many risks involved the situation would have to be assessed very carefully and a lot of planning would have to go into the project. This is not ideal for all aspects of health inequalities; there is also the issue of insufficient findings or misleading results. Unless there is a big chance of success there is no use of wasting time and resources.
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