Community Health Action and Health Development: Facing Challenges in Todays Age - Essay Example

Community Health Action and Health Development: Facing Challenges in Today's Age A Paper Requirement for the of Abcdf Ghjkl Professor Name of College or University January 7, 2008 COMMUNITY WORK: ITS ESSENCE AND MEANING A question is laid to us about what community work is and perhaps, its current state in the UK. In the past, community work was a staggering activity in the UK, dwelling in the youth work and adult education alone. Eventually, 60 per cent were employed in the voluntary sector of some 5,365 community workers. It is said that since then, there has been no substantial survey of community workers. There were however, fundamental changes in the economic and institutional context in which community workers operate (Francis, Henderson, and Thomas 1984). In the Gulbenkian Report (1968), community service includes not only training, but spread its net much wider. Eventually, community work was taken to include the following: - Helping local people to decide, plan, and take action on matters that concern them with the help of available outside resources, - Helping local services to become more effective, usable, and accessible to the needs of the people, and - Forecasting necessary adaptation in order to meet new social needs in constantly changing circumstances. From the above-mentioned description, community work is said to have taken the aspects of direct neighborhood work, closer links between services and people, inter-agency coordination, and planning and policy formulation, which are considered indispensable in community building. Community work function is hence alongside with the professional practice of teachers, social workers, health workers, administrators, and the local church. It is now a full time professional task in the modern conditions of social change (ibid: 149). It was moreover mentioned in the report that community work is conceptualized as part of education, especially adult education. It was merely an education or learning process, which is fulfilled by specialist community workers. There appeared to be a possibility that community work is a part of social work. In the UK experience, it appears that self-help and resident participation are possibilities for the improvement of inner city situations, with a growing recognition of poverty being a major feature of the UK society in the 1960's and early 1970's (Gulbenkian Report 1968). The initiative dwelling on community work is but a substantial and a sought-after remedy in terms of improving people's conditions. COMMUNITY HEALTH ACTION: SETTING A DIFFERENCE Community health action sets a trend towards bettering the conditions of people through viable health support mechanisms that ensure this purpose. With the involvement of the community, a health care program is ensued. The commitment of people with this undertaking is set up, as against the old trend on health care provisions. The reason why the CHA is able to set a difference from past attempts on betterment of community life is its high reliance on people. People are the most important resources in CHA through their indispensable traits of responsibility, capacity for self-help and community-help, commitment, direction, and collectivity. Through these traits, the community is able to achieve its goals on community health care development and other concerns pertaining to this concern. Members of the community are able to develop the aforementioned characteristics through their continuous membership and active participation in community health care programs. Through collective efforts, the community is able to leave the traditional European character of individualism, and resolve health care problems by interacting with the community, participating in programs and projects related to health care development, building tripartite alliances, and realizing community goals. In this way, each one's troubles on health are taken lighter with the idea that through community empowerment, one is empowered against fighting health risks and hazards that could (and may already do) harm the community. Community Health Action provides funding alliances and networks pertaining to healthy living. It normally consists of local community groups and agencies with a goal of enhancing their ability to support health promotion and illness prevention in the community. It likewise involves local communities in a tripartite network of people, agencies, and local government in a quest for creating environmental and policy changes that will be funded to support the community targets towards community health development. PROGRAM GOALS OF CHA The CHA program basically targets projects that will focus on environmental-level and policy-level interventions in support of a comprehensive and sustainable change, which is different from individual-level interventions. The signage that reads "Stairway to Health" in some Kelowna buildings that prompt the public to take the stairs rather than the elevator to help improve their hearts and stamina is an example of this environmental change. The CHA program also encourages people on their healthy lifestyle such as reducing tobacco use, improving nutrition, increasing physical activity, and making healthy choices during pregnancy (Scourfield 2005). The general objective of the Community Health Action is apparently to live a healthy life. However, this may not be a full control of people and individuals, as there are likely causes in the environment that prevents one from living healthily. This is why the CHA is also a social advocacy. It is a social advocacy of the community itself, of concerned groups or individuals, and the state in general. Due to social character of health concepts, we can thus; say that Community Health Action is characteristically social as well. Essentially, the problems of the community pertaining to health should be viably resolved through this tripartite network of concerned groups. COMMUNITY DEVELOPMENT: ITS CONCEPT AND ESSENCE Community Development is a broad term applied to the practices and academic disciplines of civic leaders, activists, concerned citizens, and professionals who aim to improve various aspects of local communities. According to Frank and Smith (1999), community development is the planned evolution of all aspects of community well being such as economic, social, environmental, and cultural. It is a process whereby community members come together to take collective action and generate solutions to common problems. The scope of community development groups can vary from small initiatives to large initiatives, which involve the entire community. Regardless of scope however, effective community development should be long-term, well-planned, inclusive, equitable, holistic but integrated, initiated and supported by community members which the community itself shall benefit, and is grounded to a best practice experience (Ibid: 6). Frank and Smith furthered that the primary outcome of community development is improved quality of life. Through mutual benefit and shared responsibilities of members of the community, development takes place and this outcome is realized in the end. Community development helps to build community capacity where members realize their potentialities and are able to empower themselves in pushing a certain project or solving a particular problem collectively. The outcomes of a viable and effective community development don't just happen. Rather, it requires a certain degree of commitment, accountability, and direction from each member to improve the community. Both conscious and unconscious efforts must be acknowledged, particularly those dealing with balancing competing interests. CHA: ON ITS PROMOTION OF HEALTH HUMANISM VS POSITIVISM An ideology that sparked the Renaissance, humanism places a high value on human beings, human culture and the human experience. Today, humanism in health care reminds us that diseases and recuperation, illness and recovery, living and dying are integral experiences that make up a humanistic human person, reminding him that nothing in this world is permanent or immortal. Health humanism projects an insight that every person - caregiver and patient alike - is a human being, and that everybody experiences the natural process of living and dying, sickness and health in this natural world. Humanistic health professionals believe that they should care for their patients as much as they care for themselves. Because of this, they should touch the humaneness of their patients, give them compassion, and treat them with care because such treatment is a catalyst for healing. To succeed in this field, health professionals should not only possess skills and a keen mind, but also a heart and a human touch (Humanism in Health Care, accessed on Jan. 6, 2008). Health humanism is opposed to health positivism, which is generally based on an insight that the only authentic knowledge is scientific knowledge and such can only come from positive affirmation. Through vast knowledge of health humanism, medical practitioners and health professionals understand the need for a tender loving care as an indispensable remedy for making ill patients recuperate faster, other than relying only on over-the-counter medicines. It is through this knowledge of the humanist concept that health professionals are able to integrate their medical tasks with the goals of the community. COMMUNITY HEALTH ACTION AND SOCIAL CONRUCTIONISM Social constructionism says that social phenomena develop through social constructs, which appear to be natural or common to those who accept it but are actually by-products of people's actions through their invention of a particular culture or society (Buchanan 1998). In the same way, community health action can be a by-product of collective effort of people, which is initiated now but becomes a social construct later through a repeated and constant practice. It is through this repeated practice that members' concern for community health and their corresponding action shall be institutionalized and becomes almost a natural way of life, which they readily accept as part of their social activities. It is apparent that Community Health Action is based on this concept of social constructionism. We may thus, infer that the lives of community members, their outlooks and pursuits (on health) may be improved by their mere participation in community-related tasks and activities, which consequently call for a change of values and paradigms. Community development call upon people's participation, viewing it as a potential catalyst for change, and a permanent concern and obligation of the members of the community, that acting upon community concerns becomes a natural and normal way of life to them. SOCIAL CAPITAL AND COMMUNITY COHESION Social capital is part of labor's community cohesion agenda, emphasizing on its concept of shared values that hold communities (Bruegel 2006). Social cohesion is said to be critical for a society's economic prosperity and sustainable development (Social Capital, accessed on Jan. 6, 2008). The central idea of social capital theory is that relationship matters, delving on the importance of social networks as valuable assets in pursuing an effective and sustainable development of communities. It is thus, not enough for people to work on their own alone and pursue developmental goals in a parochial or exclusive manner, but they should instead build alliances by first recognizing the importance of social capital. It is through this recognition of social capital that community cohesion develops. When people are altogether united towards one goal and mission and realize their objectives with the help of a network of groups that aim for them to realize the same, the concept of social capital is given importance as well as the community cohesion. PRAGMATICS AND DEGREES OF INVOLVEMENT IN COMMUNITY DEVELOPMENT GOALS Community development tasks at times need a certain degree of pragmatics, the ability of natural language speakers to communicate more than that what is explicitly stated. Pragmatics deal with the ways in which our goals are reached in communication (What is Pragmatics Accessed on Jan. 6, 2008). It is through language that people communicate and agree at a certain set of ideas and it is because of language that a miscommunication of ideas happens. Hence, in community development goals, members should use a language that is known to every member and it involves not only the language per se but the cultural context by which this language is spoken. Perhaps, due to cultural considerations, community development scope (how large the membership is) should not be too big because of likelihood for miscommunication. Language plays a vital role in health care development and in community development per se, since community unity must always be ensured at all times by members. Disunity may occur in case this aspect is not properly given attention to. By saying so, we mean the social context by which a language is spoken, which is generally shared by people belonging to the same culture. Hence, the reason for community development to be initiated by the community members themselves; as they are the ones solely knowledgeable of the problems that they encounter and understand their own language under a similar cultural and social context. CULTURAL CONTEXT AND ETHICS OF CHA Health provisions are not simply the service delivery to certain communities that need health and medical support, but it as well entails a great deal of ethics, which generally involves a culture or a subculture of a certain group that needs such health care development. Oftentimes, the injection of ethical knowledge to these program deliveries is not just a matter of "common sense" scenario but involves knowing and learning the culture of the group so as not to offend certain people when extending a community development activity relating to health care conditions. In providing care in multicultural context, professionals who are involved in the areas of health and social work encounter certain situations, which demand ethical insights (Lancashire School 2007/08). It calls for both past and current practitioners of health work and social work to develop themes and values after thorough discussions related to ethical dimensions of their work in a multicultural context. In order for issues to be considered in a reasoned fashion, practitioners should be equipped with the modes of ethical analysis to use (ibid). Understanding the cultural context wherein a health care service is to be delivered will eventually guide one towards acting ethically on the customs and norms of such particular social group. Lack of attention on this matter may jeopardize (even to a slight degree) the community cohesion, a situation no one intends to happen. Thus, giving attention to some ethical considerations is important when facilitating health care developments to communities. A FRAMEWORK FOR COMMUNITY DEVELOPMENT: COMPARING COMMUNITY HEALTH ACTION WITH OTHER APPROACHES TO HEALTH PROMOTION I am using the Behavior Change Approach and the Self-Empowerment Approach for a comparison against Community Health Action in this topic. These approaches pursue different goals and means by which health care development may be achieved even though all of these may be similar in terms of promoting good health and preventing or reducing the effects of ill health. The Behavior Change Approach aims at bringing about changes in individual behaviorthrough changes in his cognitions (Theories and Approaches in Health Promotion accessed on Jan. 6, 2008). This could be undertaken by providing him information related to health risks and hazards, and thus, prevent him from indulging himself into activities and vices that will put him into such. This is with an assumption that humans are rational decision makers of themselves whose actions are based on their cognition and understanding of things. The causes of health and illness alongside with living a healthy life are the aims of Behavioral Change Approach (ibid). This approach however, involves the individual alone, devoid of the group and his membership on it. If change is expected to take place, such is only undertaken by the individual regardless of the environment where he is in, and other factors that may affect his/her speedy (or non-speedy) resolve towards change. Its difference with the development pursued by Community Health Action is that the latter involves the group (without disregarding the individual, however) and the insight that any change or improvement in the community is a general outcome of each member's improvement on his or her commitment, responsibility, and personal decision-making. In effect, it is reflected in the group through improved shared values, collective work, and collective leadership to mention a few. The Behavior Change Approach involves only the individual, regardless of the group. This approach starts with an individual and ends with him, and society is just an environment where his actions are acted. Through collective participation, the individual is empowered as well as the group where he/she is member. The Self-Empowerment Approach, on the other hand, deals with empowering individuals in making healthy choices (Theories and Approaches in Health Promotion accessed on Jan. 6, 2008). This could be done through participatory learning techniques aimed at increasing control over one's physical, social, and internal environments. This is based on the insight that power is a universal resource that can be mobilized by every individual, thus, the term self-empowerment. This approach resonates with self-awareness and skills, which are mandatory in making one be self-empowered (ibid). The self-empowerment approach differs from that of Community Health Action Approach in that the former involves only the self or the individual in the empowerment process, and there is no involvement of the community in such empowerment. This is claming an insight that one can better himself, his state of affairs by developing control over himself through the old concept we call discipline, regardless of his environment and society. With this, we may then conclude that in the Self-Empowerment Approach, if one wants to pursue a healthy lifestyle, there is no way that his external social environment may influence him against it. This is opposed to the concept of Community Health Action where community empowerment, not self-empowerment, is the main goal vis--vis' sustainable development. Community Health Action also acknowledges the influences of the external environment on individuals, which account for the latter's failure to do certain individualized plans of action. Consolidating with the group is thus, a stronghold remedy for things that one deems to be changed. Moreover, using the two models of development against the Community Health Action model prompts us to a comparison that the former two are old and probably antiquated modes of changing society and oneself. They were only within the context that society will eventually improve and change with each one's concern for self-development and conscious effort to train the cognitive aspect in order to control bodily habits that harm one's health. Indeed, this is a very impractical and slow process of achieving change, as one cannot hope that other people's response will be the same as his, or as fast as his. The only practical and easier way to effect, change in all aspects of development (not just health) is still through community development. Here, members are likened to the strands of a sweep, which are altogether bundled and through such, the sweep is able to brush away the dust. COMMUNITY HEALTH ACTION AND SOCIAL CONSTRUCTIONIST EPISTEMOLOGY Community Health Acton has, in several forms and ways, relation with the concept of social constructionism. For constructionists, knowledge is not what one believes, but rather, what social groups or communities believe (Warmoth 2000). It infers that people's ideas are given meaning according to social contexts where they are thought of. In this sense, it is the social context of meaning which counts and which is taken as fundamental, not merely the very ideas themselves (ibid). In CHA, members of the community perceive ideas according to the very essence of the condition whereby the community stands on, in accordance with the needs of the community. As an example, "healthy living" for a member of this community would be grasped not only in terms of a regular exercise and healthy diet but also as a way of living where everybody supports one another in terms of health information, health care support, and network of health alliances in assuring viable community health programs. However, for a non-member without any knowledge of CHA, "healthy living" simply means exercising regularly, eating fruits and vegetables, and taking up multivitamins. Essentially, community health action takes the concept of social constructionist epistemology in this way. Ideas that thrive in the minds of people are spoken and understood according to the prevailing societal condition where they are under. CURRENT AND EMERGING ISSUES N COMMUNITY HEALTH ACTION The great resource presents community health against the ever-changing backdrop of economic, technological, and demographic trends, which affect planning, implementation, and monitoring of programs in various ways. The professional role also poses a challenge as not many practitioners share their services in a voluntary mode through the concept of community service. The environment which is put to hazard by various corporations is also being threatened, alongside with the corresponding effects on the health of the people in the community. There is thus, a challenge to work for a tripartite alliance with policy makers, and the social capital or civil society to address this issue. We will again conclude that community development is a task undertaken by members of the community but the betterment of its actions may be furthered by a conscious and conscientious effort to build stronghold alliances that would aid for advocacy of issues that are put forward by the community. ____________________ BIBLIOGRAPHY Arnstein, S. 1969, Ladder of Involvement , N.Y. Bruegel, Irene. 2006, Social Capital, Diversity. and Education Policy, Families and Social Capital ESRC Research Group London South Bank University. Buchanan, David R. 1998, Beyond Positivism: Humanistic Perspectives on Theory and Research in Health Education, Health Education Research, Vol. 13, No. 3, 439-450. Calouste Gulbenkian Foundation. 1968, Community Work and Social Change. A Report on Training, London: Longman. Francis, D., Henderson, P. and Thomas, D. N. 1984, A Survey of Community Workers in the United Kingdom. National Institute for Social Work. Gabe J. 1995, Medicine, Health and Risk, Blackwell Publishers. Gillies P. 2002, Promoting the Health of Communities, Cambridge Press. Haggart M. 2002, Promoting Health of Communities, N.Y. Jacu R. 1995, Empowerment in Community Care, N.Y. Scourfield, P. 2005, Implementing the Community Care Act: Will the Supply of Personal Assistants Meet the Demand and at What Price Department of Social Work and Social Policy, Anglia Polytechnic University, East Road, Cambridge. Warmoth, Arthur. 2000, Social Constructionist Epistemology, Sonoma State University. Social Capital. MA, PGDip, PGCert Ethics and Cultural Diversity in Health, Lancashire School of Health and Postgraduate Medicine Course Handbook, 2007/08. Accessed on Jan. 6, 2008 from http://www.infed.org/biblio/social_capital.htm Theories and Approaches in Health Promotion accessed on Jan. 6, 2008 from http://www.city.ac.uk/psychology/dps/teaching/David%20Marks/Lecture%203%20-%20theories%20and%20approaches.pdf What is Pragmatics Accessed on Jan. 6, 2008 from http://www.sil.org/linguistics/GlossaryOfLinguisticTerms/WhatIsPragmatics.htm Read More