Cognitive and Reflective Analysis - Essay Example

?Applying and reflecting public health Theme B: Community development Sr. # Topic Pg Cognitive Analysis 2 2. Reflective Analysis 10 References 14 Part – I Cognitive Analysis: ‘A community is not a “thing”. It is a number of people who have repeated dealings with each other … What must never be lost sight of, however, is that community life is voluntary and autonomous or it is nothing. Government cannot “produce” it – it can only assist it to produce itself.’ Chanan, 2002 Community development initiatives directed at public health are aimed at enhancing public provision of health services and developing positive health outcomes by establishing frameworks that prevent illnesses (Davies and Kelly, 1993). In contemporary times, there is an increased emphasis on community-level health interventions, and the focus has shifted from government controlled measures to encouraging community participation in developing public health policies. The community based interventions have increased over the years with the rise in awareness regarding the role and impact of various factors which affect public health (Kretzmann and McKnight, 2005). These interventions have sought to eliminate and address a range of social concerns faced by the communities such as lack of educational standards; unemployment; crime in and around their neighbourhoods as these social issues have a direct bearing on the community health. The issue of the role of community level interventions within the arena of public health, can be viewed and described as a continuum between initiatives which are focused on resolving issues directly related to health concerns of the communities and those which have a long-term impact on community health (Evashwick, 2005). The key reasons behind the increased focus on community involvement in developing positive health outcomes can be attributed to the fact that rapidly changing external environment, has brought about a simultaneous change in the attitudes of the people with regard to their health. Such changes, in turn tend to influence the fundamental assumptions regarding the credibility of measures currently implemented versus the most effective and viable alternatives toward improving and enhancing access and delivery of health care services; and the role of community in bringing about such changes (Schein, 1992). These implicit assumptions help the communities to direct their efforts and behaviour towards analyzing and assessing the manner in which certain health issues are perceived by the group members, and use the inputs so derived in framing appropriate interventions. Since most of these issues which affect the communities are generally ignored or overlooked by administrative bodies, community level health interventions aimed at developing and contributing to public health, is perceived as a viable alternative for developing health policies (Hitchcock, Schubert, and Thomas, 2003). This strategy allows the issues critical to the communities to be addressed and confronted effectively; and solutions that seek to eliminate them can be developed resulting in improved outcomes (Rowitz, 2009). Since most of the issues faced at community levels, are implicit in nature, it is highly unlikely for the government or other administrative bodies to address them, and hence community involvement is sought as a favourable measure, to improve overall public health (Schein, 1992). With regard to public health, there is a growing concern about the increased demand for evidence-based practice, and awareness of complex issues in the field of health-care service delivery. The implementation of community led health interventions and inclusion of communities in developing and implementing health policies, is hence imperative for delivering positive health outcomes at community levels. Figure 1: Community development model Source: Sines, Saunders, and Forbes-Burford, (2009, p. 55) Over the years, the awareness and level of knowledge with regard to the various benefits of community development and community led healthcare projects, and its ability to improve the well-being of communities, has increased substantially. The concept of community development which is alternatively referred to as community participation is in essence a public health philosophy. It describes the manner in which health initiatives contribute in co-ordinating the efforts of local groups and healthcare professionals to deliver wide ranging healthcare solutions, aimed at satisfying and resolving health-related concerns of the public (Sines, Saunders and Forbes- Burford, 2009). It aims to address a range of concerns, through measures which include interaction with local communities, and seeking their participation and involvement with local healthcare programs, such as groups which facilitate cessation of smoking, or alcohol or drug abuse. Evidence suggests that local problems can best be resolved through local solutions since the communities are more aware of the key issues concerning them, and hence are better equipped to resolve the same effectively (Rowitz, 2009). Research indicates that the involvement and participation of local groups and/or communities in resolving and addressing local health issues are far more successful in achieving positive health outcomes(Rowitz, 2009; Lopez, 2012; Ivanov & Blue, 2008; Trickett & Pequegnat, 2005). According to the Health and Development Agency (HDA) community participation helps and involvement of local groups in health-planning results in better health outcomes. It leads to increased partnerships and improved rapport between the health-care professionals and the communities and local groups at large. Such participation also results in transferring professional skills to the communities and in influencing change by contributing to policy development initiatives taken by the government (H.D.A., 2002). The significance of community development is being increasingly recognized and acknowledged by the government as is apparent from a range of government policies such as the NHS plans implemented by the government in England, Wales and Scotland (Department of Health, 2000; National Assembly for Wales, 2001; Scottish Executive, 2001). Theoretical Perspectives & Analysis: The issue of community development with regard to public health is discussed with the help of two key theories: the complexity theory and Hart’s ladder of young people’s participation. Complexity theory: There has been a growing need and recognition of the significance of addressing public health issues through a community perspective, which seek to approach the concerns faced by local groups from a sociological as well as biological viewpoints, at the same time taking into consideration, various behavioural and environmental issues affecting community health (IOM, 2003). The advent of this new trend, has redefined the very definition of public health. This has resulted in its complete makeover and transition from a formal government owned and managed structure (IOM, 1988) to a more liberal, inter-sectoral, and complex health system. This new system comprises of various key elements including individuals, communities, and organizations, all of which have a definitive say in enhancing the health conditions of the population in question (IOM, 2003). It is on account of such transformation that there is now an increased emphasis on development of coalitions, and inter-connected webs comprising of special task forces; and increased partnerships and collaborations with organizations all aimed at addressing public health issues (Kreuter, Lezin, and Young 2000). The increased complexity in provision of healthcare due to the changing dynamics within the industry, is reflected and acknowledged by the complexity theory, which states that one of the fundamental traits of such complex systems of healthcare delivery is the fact that they are highly unpredictable in nature, despite the availability of adequate information regarding the issue on hand. This is mainly due to the fact that the collective responses of the communities and the mutual interactions of the individuals within the communities are diverse. It may also result in adverse outcomes, if not predicted accurately and dealt with effectively. The complexity theory offers an improved understanding of these highly unpredictable events which are likely to take place when healthcare policies with social implications are implemented. The implementation of such policies tends to generate reactions among the communities, which seek to challenge the underlying assumptions behind the adoption and application of conventional policies and strategy initiatives (Sanderson, 2001). According to Sanderson (2001, p. 451) “Complexity theory has some important implications for evaluation in the context of policy initiatives to address key economic and social problems ... It requires us to recognise that evaluation is a highly complex endeavour if we accept the realist notion of a multi-layered social reality, the applicability of the concept of dissipative systems and the force of hermeneutic accounts of the role of human agency. It requires us to see evaluation essentially as a craft or “practice” ... comprising a range of methods appropriate to particular circumstances which will provide some understanding of the wider appropriateness of policy initiatives”. He argues that the increase in complexity and the various challenges associated with the same, in turn challenges the general understanding of the assumptions in place, with regard to the conventional evaluation practice. The complexity theory plays a key role in emphasizing the significance of holistic approach to health evaluations whereby various policies and health programs aimed at resolving health-related issues faced by communities are put into practice. The implementation of these diverse policies and health interventions tend to create conflicts due to their diverse nature and approach, and the uncertainty associated with the manner in which policy interventions fare in understanding the key issues critical to communities. Collaborative health care initiatives have been widely adopted and implemented by health care administrators, with mixed reviews and varying degrees of success (Butterfoss 2007). According to research aimed at assessing the influence and effectiveness of collaborative health initiatives and evaluation protocols, only few of them were documented to have a positive health outcome (Kreuter, Lezin, and Young 2000). The failure of such collaborations was largely attributed to the planning process and the wide-ranging conflicts and disagreements between the public health staff and the community members (Butterfoss 2007). Hart’s ladder of young people’s participation: The increasing involvement of youth in community development is indicative of the increasing recognition of this segment of population as a constructive group which is capable of being part of a solution rather than a problem, contrary to popular belief. It also highlights the shift in public perception and attitudes towards the capability of young people in contributing positively towards developing effective solutions for greater public good (Haste, 2004; Furlong, 1997). The bottom-up grassroots approach is used with regard to participatory approach and community development, since it affords greater benefits and mobility to the communities at large. It seeks to afford greater control to the communities in terms of managing their own health, and the receipt of healthcare services. However, the manner, scope and extent of involvement of communities in contributing towards the development of public health policies have been widely debated. Hence, various models and theories have been developed over the years, to assess the level of community involvement and their power to influence decisions. The Roger Hart Ladder of Participation is one such model which describes the youth participation in community development and the likely benefits accrued from the same (Sines, Saunders and Forbes-Burford, 2009). Asset-Based Community Development: This approach to community development is one of the most widely used approaches in the UK. It refers to the use of existing assets within the community for deriving improved health services and outcomes for the community members (McNight, 2003). This approach is implemented to ensure effective resolutions to health issues faced by local community members (Arefi, 2008). This method of community development entails that every community has inherent capabilities, skills as well as opportunities which can be capitalized by them for deriving positive outcomes for their communities. Such method of community development is in stark contrast with the commonly used conventional forms which uses the top-down approach. It is argued that the use of conventional approaches in the field of public health aimed at enhancing health outcomes are highly likely to generate problems, since the issues critical to the local communities, might not be addressed effectively to the best of their satisfaction. This approach tends to focus on capitalizing on the key strengths of the communities and utilizing them in order to establish policies which are most effective in addressing health issues crucial to them. It further states that the foundation of a good community lies on its strengths rather than its weaknesses. Hence, it is of utmost significance for greater public good that the communities contribute towards framing of health policies by using its assets (Mathie and Cunningham, 2003). Community development according to this approach involves the use of human social capital for the greater public good by utilizing urban physical spaces and transforming them into key tools of furthering the cause of enhancing overall public health. In the words of Robinson, (2004): “The 21st Century should be the “century of the community” and the emphasis of efforts to improve theory and practice ought to reflect this paradigm.” PART – II: Reflective Analysis: Description: During this course, I learnt that Community development with regard to public health is crucial for ensuring better health consequences. This course helped me realize the various measures and approaches to developing and enhancing public health and well-being. I have observed that primary health prevention measures are usually aimed at addressing basic issues faced by individuals in the community such as spreading awareness on negative effects of smoking; positive benefits of vaccination. Also, the government initiatives mainly focus on curbing negative health attitudes and behaviour by implementing taxes on harmful products such as cigarette sales to curb excessive use of tobacco; or pass legislations that prevent certain types of behaviour which render certain occupations illegal. The ban on drugs is one way of curbing negative behaviour by individuals which seek to damage their health. I realized that the course was insightful and informative, but at the same time found it a little difficult to comprehend certain issues, such as theoretical perspectives and its application to practice. But a careful study of the same, and discussions and further reading of suggested materials, helped me understand the concepts. I was given timely inputs by the course instructor, which also helped me immensely in understanding various concepts in a better manner. I was initially a little apprehensive about working on this topic, mainly due to the complexity of the issue on hand, but was eventually comfortable with the topic, after I researched on it, and read the course materials. Expansion: I dealt with my apprehensions regarding the topic by relying on the course materials and researching on the topic. While researching on the topic I observed that programs aimed at seeking community involvement and/or participation in enhancing public health outcomes, are highly effective means of improving the overall health and well-being of individuals in the community. I found contradictory opinions on the topic, while researching and during reviewing the literature. My immediate reaction was to seek a change in topic since I was overwhelmed with the information I came across and also confused regarding the actual impact of such programs, since there was extensive literature available both advocating as well as negating the influence of such approach. However, after a thorough assessment of the issue, I realized that the benefits of community development in contributing to improving public health outcomes far outweighed the negative reviews it received. Accounting: The material I researched was overwhelming and got me all worked up and anxious. One of the key issues I had to address was to ensure the credibility of the information I had, and back it up with available literature. Also, I was busy with other previous commitments – both professional as well as academic, and risked the danger of being late for submission or not being able to research thoroughly on the issue. I eventually learned to assign priorities to my work schedule, and arranged it accordingly. This helped me in categorizing the work I was required to do, and accomplish my objectives successfully to the best of my ability and satisfaction. I observed that community development efforts have been made across the globe, with varying degrees of success, however the overall trend was more positive than negative. Distortion: I learnt to deal with my apprehensions, and overcome them eventually, by carefully planning my work schedule. In order to avoid letting such feelings affect my work, I created a systematic schedule and followed it diligently. The key distortions with regard to researching the subject on hand, were related to comprehending the available literature. There was a lot of information which I was required to absorb in order to successfully accomplish the given task. However, with careful planning, I was able to not only research on the topic but also discuss and assess it in a comprehensive manner, thus enabling me a greater insight on the topic. Acceptance: I was highly aware of my shortcomings, and limitations which I was likely to face while working on this assignment. I suffered from poor health during the period of Dec 2011 – March 2012, which severely limited my ability to study and research on the subject on hand, and i found it difficult to catch up with the coursework, post recovery. Hence I took note of them and aimed to overcome them, in order to generate best result. On the whole, I was satisfied with the outcome since I was able to research on all the key topics and learn more about the various ways in which community participation enhances the public health outcomes. I also learned to capitalize on my strengths and overcome my weaknesses, when it comes to researching on the topic on hand, and analyzing and processing the information I collected, in the process. This activity helped me in not only understanding and acknowledging my own strengths and weaknesses but also helped me in understanding the wider concept of community development and its role in contributing to enhancing public health. Consequences: I understand that lack of research and understanding of the topic on hand, is likely to result in a distorted perception of the concept being discussed. This in turn further leads to incorrect analysis and biased view of the issue. Hence it is of utmost significance to ensure that the topic is researched thoroughly and analyzed appropriately in order to derive accurate results and draw precise judgements on the same. The negative effects of lack of awareness of the issue being discussed, are innumerable, but most of all it leads to the formation of a biased opinion on the subject on hand, and distorts one’s vision, thus preventing them from assessing the situation in a non-biased manner. Resolve: My key concerns while working on this assignment were apprehension regarding my ability to deliver the results expected of me, in terms of covering all the key issues we discussed as a part of this module; and including all the important points relevant to the topic. However, after careful planning and scheduling I was able to overcome the same, and discuss, analyze and assess the subject to the best of my abilities and satisfaction. Expectation: Perfection isn’t easy to achieve, although one can always aim at it. I, for one, strived to achieve near perfection, by researching on the topic and skimming through various module materials, in a bid to ensure inclusion of all key points relevant and imperative for this assignment. I have learnt several ways of approaching such topics related to public health and other similar issues, and am sure to deal with them more effectively, in the near future. Rationale A strong and active involvement of the community is a pre-requisite for the accomplishment of a robust health care model. The various topics discussed as a part of this study including key definitions, models, as well as theories were aimed at widening the existing knowledge and awareness regarding the gravity of the issue and the impact and influence of communities in contributing towards an effective healthcare system. This study acted as an important tool for providing information regarding the status of healthcare systems as well as offer meaningful and valuable insight regarding the various ways in which community involvement and team effort can help in enhancing the public healthcare model. References: Arefi, M., (2008). Asset-Based approaches to community development. UN-Habitat Publication, pp. 17-19 Butterfoss, F.D., Goodman, R., and Wandersman, A., 1993, “Community coalitions for prevention and health promotion,” Health Education Research, Vol. 8, No. 3, pp. 315-330. Chanan, G., Gilchrist, A. and West, A. (1999). SRB6 the Community. London: Community Development Foundation Publications. Davies, J.K. and Kelly, M.P. (1993) Healthy cities: research and practice. London/New York: Routledge. DH (2000). The NHS plan (2000). DoH: London www.doh.gov.uk Evashwick, C., (2005). The continuum of long-term care. Cengage Learning Publication, pp. 166-168 Furlong, A. Et Al. (1997) Evaluating Youth Work with Vulnerable Young People. University Of Glasgow. Edinburgh: SCRE Haste, H. (2004) Constructing the Citizen. The International Society of Political Psychology. Blackwell Publishing. HDA (2002). Participatory approaches in health promotion and health planning: a literature review. HDA: London. Hitchcock, J. E., Schubert, P. E., Thomas, S. A., (2003). Community health nursing: Caring in action. Cengage Learning Publications. IOM, (1988). The Future of Public Health, National Academy Press (Washington, DC). IOM, (2003). The Future of the Public’s Health in the 21st Century, The National Academy Press (Washington, DC). Ivanov, L. L., Blue, C. L., (2008). Public health nursing: Leadership, policy, and practice. Cengage Learning Publications, pp. 262-265 Lopez, R. P., (2012). The built environment and public health. John Wiley & Sons Publication, pp. 292-294 Kretzmann, J.P. and McKnight. J. L., (2005). Discovering Community Power: A guide to mobilising local assets and your organisation's capacity. Evanston: Northwestern University Kreuter, M.W., Lezin, N.A., and Young, L.A., (2000). “Evaluating community based collaborative mechanisms: implications for practitioners,” Health Promotion Practice, Vol. 1, No. 1, pp. 49-63. Mathie, A. and G. Cunningham, (2003). From clients to citizens: Asset-based Community Development as a strategy for community-driven development. Development in Practice, 13(5): p. 474-486. McKnight, J.L., ed. (2003). Regenerating Community: The Recovery of a Space for Citizens. The IPR Distinguished Public Policy Lecture Series. Northwestern University: Evanston. National Assembly for Wales (2001). Improving health in Wales: A plan for the NHS with its partners. Cardiff: www.wales.gov.uk Robinson, (2004) cited in Braithwaite, R. L., Taylor, S. E., Treadwell, H. M., (2009). Health issues in the black community. Wiley Publications, pp. 380 Rowitz, L., (2009). Public health leadership: Putting principles into practice. Jones & Bartlett Learning, pp. 211-212 Sanderson, I. 2000, “Evaluation in complex policy systems,” Evaluation, Vol. 6, No. 4, pp. 433-454. Schein, E.H. (1992) Organisational culture and leadership. San Francisco: Jossey Bass. Scottish Executive (2001). Our national health: A plan for action, a plan for change. Edinburg: www.scotland.gov.uk Sines, D., Saunders, M., and Forbes-Burford, J., (2009). Community health care nursing. Wiley Publications, pp. 54-55 Trickett, E. J., Pequegnat, W., (2005). Community interventions and AIDS. Oxford University Press, pp. 91-93 Read More