How to build an innovative Health and social care based on Communities assets?

 

 

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.

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.