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All men are caught in an inescapable network of
mutuality, tied in a single garment of destiny. Whatever affects one
directly affects all indirectly. I can never be what I ought to be until
you are what you ought to be, and you can never be what you ought to be until I
am what I ought to be.
Martin Luther King, Jr.
Access
to healthcare services in the EU
In
its 2013 report Impacts of the crisis on
access to healthcare services in the EU, Eurofound shows the impacts of the
2008 financial and economic crisis on access to healthcare public services in
the EU. Through various indicators, this vast research on access to healthcare
services is based on approach of accessibility. “Access to high-quality ‘services of general interest’ is essential for
good quality of life and ‘inclusive growth’, a main objective of the Europe
2020 strategy” (European Commission, 2010). Regarding to the growing
inequalities among EU societies, access to social services and healthcare matters
as significantly as Employment. EU Commission reminds how good access to
quality healthcare can contribute to addressing social exclusion and poverty
(European Commission, 2010).
As a
matter of fact, Investment and improvement in accessibility maintain work
productivity; and in a more practical way, bettering off accessibility will
reduce the costs of care in the longer run (European Commission, 2013a;
European Parliament, 2013). In 2006, the Council of the EU adopted a common value
for EU healthcare systems, and ‘the right
to benefit from medical treatment under the conditions established by national
laws and practices’ was included in the 2000 Charter of Fundamental Rights
of the European Union (Council of European Union, 2006; and entered into force
of the 2009 Treaty of Lisbon).
In
its ‘Voluntary European Quality Framework for Social Services’, the Social
Protection Committee (2010) sets out guidelines with regard to access to
services more generally. It says: Social
services should be easy to access by all those who may require them.
Information and impartial advice about the range of available services and
providers should be accessible to all users. Most Member States have
universal coverage and systems in place to support vulnerable groups in
accessing healthcare. However, in practice many people have problems in
accessing healthcare services when they need them. To solve healthcare issues,
one of the recent approach is to combat the discrimination that people at risk
could be victim of. Usually, Individuals are characterised as “smokers”,
“drinkers”, “drug addicts”, “unemployed”.
Communities are described in terms of
their problems. They are “areas of multiple deprivation” with high levels of
crime, single parent families, and premature mortality (Bovaird T., Loeffler
E., 2013).
People and communities are defined by their deficiencies.
Various
groups have traditionally been at risk of experiencing problems in accessing
healthcare services.
They include ethnic minority groups, women, people who are
unemployed, people who are homeless, people in inadequate or insecure housing,
migrants (especially asylum seekers and undocumented migrants), poor people,
people who live in remote areas, people with low education, and older people
(European Commission, 2008; Sienkiewicz, 2010; Devaux and de Looper, 2012;
Doctors of the World, 2012; Eurofound, 2012c; FRA, 2013a).
Empowered
and co-produced healthcare
Healthcare
accessibility needs to be empowered. In his article on Assets for health,
Professor Sir Harry burns studied the case of Scotland’s Healthcare system. The
Chief Medical Officer for Scotland reminds that many Health campaigns have
promoted changes, encouraging the people at risk to alter their behaviour. But
most of the time, Health promotion campaigns are likely to have little impact
on People at risk’s behaviour. Professor Sir Harry Burns clearly enlightened
what we can call the “vicious cycle of Healthcare accessibility: “risky
behaviours such as smoking and excessive alcohol consumption are often a
response to adverse life circumstances” (Burns H., 2013). Besides all EU
policies and National Healthcare programmes, the improvement of accessibility
and awareness in Healthcare relies on the underlying circumstances which
provoke the behaviour. We argue that Healthcare needs a new approach which
starts with empowerment and, as Burns reported, to allow individuals to feel
more in control of their lives and social circumstances.
Burns
explained that medical professionals are much more focusing on causes of
disease – “the pathogenesis” – rather than studying the factors which create
health in individuals and communities. This second approach based on
Antonovsky’s theory of salutogenesis is ought to identify resources and
capacities which impact positively on health (Antonovsky, 1967). It should
explain whether adverse circumstances have significant consequences on Individuals
and Communities Healthcare, and how to create environment for better health and
well-being. The salutogenesis theory is an open door for co-produced health
care. In fact, Burns reported that “a key
aspect of Antonovsky’s theory is the idea that having control of one’s life and
circumstances is health enhancing. Central to the assets approach is the idea
of helping people to be in control of their lives by developing the capacities
and capabilities of individuals and communities. It draws on existing
approaches that foster effective and appropriate involvement of the people and
the professionals who serve them.”
In their
article on “the role of co-production for
better health and wellbeing”, Bovaird and Loeffler studied the case of
Scotland’s Healthcare system. The two authors exposed their view on so-called
co-production. Co-production is the
process of active dialogue and engagement be- tween people who use services and
those who provide them. It is a process which puts service users on the same
level as the service provider.
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In
responding to beneficiaries demand, the reality of public services’ offer takes
away control from people by making them passive recipients of services. However,
to improve accessibility for Healthcare is have to start with giving back a sense
of control over one’s life, so people at risk should be likely for adopting healthy
behaviours (Burns, 2013). Burns adds that people who are told they are living
deprived, hopeless lives tend to respond with passive acceptance; that is why
Community Empowered and co-produced Healthcare is the key milestone for
improved Healthcare.
Social
researchers have specific interest in Community assets, as a set of collective
resources and outcomes which individuals and communities have at their disposal
(Harrison and co, 2004, Bovaird, Loefler, 2013). These assets can be social,
financial, physical, environmental, or human resources, for example,
employment, education, and supportive social networks. Individuals may not be
aware they pos- sess many assets and, if they are, they may not use them to any
particular purpose. However, everyone has resources at their disposal which can
act to protect them against adverse circumstances and which can promote health
and wellbeing. The asset based approach sets out to work with individuals to
make visible their skills and give them confidence that they are valued.
Community empowerment refers to the process of enabling communities to increase
control over their lives. "Communities" are groups of people that may
or may not be spatially connected, but who share common interests, concerns or
identities. These communities could be local, national or international, with
specific or broad interests. 'Empowerment' refers to the process by which
people gain control over the factors and decisions that shape their lives.
A clear definition of our project requires that we go back to the community
specificity. There are a variety of definitions of what a Community is. The community is a concept that is taken
up by the law, sociology, geography and development (urban communities).
First, a community is
considered as a social unit that shares common values. Although embodied or
face-to-face communities are usually small, larger or more extended communities
such as a national community, international community and virtual community are
also studied. In human communities, intent, belief, resources, preferences,
needs, risks, and a number of other conditions may be present and common,
affecting the identity of the participants and their degree of cohesiveness.
The word "community" is derived from Latin communitas a broad term for
fellowship or organized society. One broad definition which incorporates all
the different forms of community
This concept is used to define a group in general. However, it must explain these features as
structures of social and solidarity
economy, and also as a place where significant establish social ties. However,
the multiplication of interpretations of
the concept of "Community" makes perfect sense in our project. It
provides us a wide range of perspectives, goals and methodologies to achieve
very precise objectives: Inclusion and integration of individuals and
Healthcare accessibility within Community framework. Beyond any considerations, it is the absence of a precise definition that allows Healthcare
programs to adopt flexible and hybrid
strategies, so-called differential.
To build a Community on asset mapping
There is at least two concepts of community: territorial
and relational. The relational dimension of community has to do with the nature
and quality of relationships in that community, and other communities may seem
to be defined primarily according to a territory like neighborhoods or a place
(like community shelter, care houses); but even in such cases, proximity or
shared territory cannot by itself constitute a community; the relational
dimension is also essential. Communities are like families where social ties are renewed to enable people to live in dignity. They
are like house shelters, where
forms of exclusions and risks affecting the
most vulnerable populations are supported. They are like cooperative system, where the members are
employees, volunteers and beneficiaries work together, providing support to each other.
The idea of Community promotes collective
resources. We need to review certain types of economics or sociology to understand the functioning of the
Community. It must be understood that
there has in common, which is pooled.
It has to be questioned if what it works together does not work better individually.
The Community relations model has to be analyzed
and designed in including exchange services and donations,
in considering the helpers and the helped individuals,
in juxtaposing third sectors, public and
private actors, in evaluating risk taking and commitments, compensation and benefits. This model should cover
social, economic, institutional, psychological dimensions.
Community economics is the foundation of the work I want to implement: building and managing communities of ideas,
services and support workers, Institutional partners and solidarity networks,
volunteers and professionals.
Every successful individual and every successful inclusion
processes are due to a community of persons working together. The achievement of Integration (and recovery) within any
larger society or local community
depends on the interconnected resources, on cooperative work of actors or partners, sufficiently motivated and sufficiently
acknowledged about the purpose and the role of each other.
Whether I am providing a detailed information to
several individuals, or facilitating the access to a social service, the
community mapping experience need to be designed to build community feeling,
interconnections, and shared purpose. This process should build capacities to gain access,
partners, networks and/or a voice, in order to gain control.
"Enabling" implies that people cannot "be empowered" by
others; they can only empower themselves by acquiring more of power's different
forms (Laverack, 2008). It assumes that people are their own assets, and the
role of the external agent is to catalyse, facilitate or "accompany"
the community in acquiring power. Community empowerment, therefore, is more
than the involvement, participation or engagement of communities. It implies
community ownership and action that explicitly aims at social and political
change. Community empowerment is a process of re-negotiating power in order to
gain more control. It recognizes that if some people are going to be empowered,
then others will be sharing their existing power and giving some of it up
(Baum, 2008). Power is a central concept in community empowerment and health
promotion invariably operates within the arena of a power struggle.
A
survey produced by the Governance International & TNS Sofres has shown that
changing demographics are an opportunity for increased levels of co-production,
as people are more involved in improving public outcomes and services (Loeffler
et al., 2008). There is a very strong statistical correlation between people’s
willingness to co-produce and their belief that they could make a difference.
To map Community asset is a very good start for improvement and for Health
service management. The
concept of community mapping is to reflect the needs of people. A
“community map” is created by members of a
community or group. The map shows information that you are interested in or
concerned about. It is built from your own local knowledge and
therefore the only expertise you need is what you already know from living in
your area. It creates a comprehensive picture
of the area we live in, and the experiences you go through.
A community map proposed new plans or interconnected activities for any
area and enable both those living in affected areas and those involved in the
plans to get a clearer idea of local concerns and impacts. It enables partners
within the project to add information about their localities, about their
experiences. It provides a resource that highlights what is going on in the
area and can provide other important information relating to health services,
support groups and local service providers.
The
mapping approach gives back all the control to beneficiaries and increases the interaction between the customer and
provider, in order to better off the quality of services. The key
characteristic of mapped services is to be analysed on both sides. That
perspective permits to explore the potential involvement of service users and
communities in services.
To go further
Antonovsky,
A. (1967), “Social Class, Life Expectancy and Overall Mortality”, The Milbank
Memorial Fund Quarterly 45 (2) pp. 31 – 73. in Scottish Government (2009),
Health in Scotland 2008 Shedding Light on Hidden Epidemics : Annual Re- port of
the Chief Medical Officer Health in Scotland 2008’. Available at : http ://
www.scotland.gov.uk/Publications/2009/12/16103619/0 (accessed 6th March 2012).
Bovaird, T.
(2007), “Beyond engagement and participation – user and community co-production
of public services”, Public Administration Review, 67 (5) : 846 – 860.
Bovaird, T.
and Loeffler, E. (2012), “From engagement to co-production : How users and
communities contribute to public services” in Taco Brandsen and Victor Pestoff
(eds.), New public governance, the third sector and co-production. London :
Routledge.
Bovaird, T.
and Loeffler, E. (2012), “The role of co-production for better health and wellbeing : why we need to change” in Loeffler
E., Power G., Bovaird T., Hine-Hughes F. Co-Production
of Health and Wellbeing in Scotland Scottish Co-production Network,
ALLIANCE Scotland, pp 20-27
Burns, H.
(2011), Annual Report of the Chief Medical Officer – Health In Scot- land 2011,
Assets for Health. Available at : http ://www.scotland.gov.uk/Re- source/0038/00387520.pdf
(accessed 6th March 2012).
Burns,
Harry, 2013, “Assets for Healthcare” in Loeffler E., Power G., Bovaird T., Hine-Hughes
F. Co-Production of Health and Wellbeing
in Scotland Scottish Co-production Network, ALLIANCE Scotland, pp28-33
EUROFOUND,
2013. Impacts of the crisis on access to healthcare services in the EU, European
Foundation for the Improvement of Living and Working Conditions, 2013
Harrison,
D. et al. (2004), Assets for health and development : Developing a concep- tual
framework. Venice : European Office for Investment for Health and Devel-
opment, World Health Organization.
CoSLA,
Scottish Government and NHS Scotland (2011), Reshaping care for older people :
A programme for change 2011 – 2021. Edinburgh : Scottish Government.
Kotler, P.
and Lee, N. (2008), Social marketing : Influencing behaviours for good. 3rd
edition. Thousand Oaks, CA : Sage Publications.
Loeffler, E. ; Parrado, S. ;
Bovaird, T. and van Ryzin, G. (2008), “If you want to go fast, walk alone. If
you want to go far, walk together” : Citizens and the co-production of public
services. Report to the EU Presidency. Paris : Ministry of Finance, Budget and
Public Services. Available at : http ://www.govint.org/good-practice/publica-
tions/co-production/ (accessed 30th March 2012).
Loeffler, E. (2009), A future
research agenda for co-production : Overview paper. Swin- don : Local
Authorities Research Council Initiative.
