1) Communities play a central role in health promotion through social ties and networks that influence health. However, persistent health inequalities remain a challenge. 2) Community-based interventions show promise but it is unclear if their local impacts can address population-level inequalities. Developing an evidence base to support this work is important. 3) Effective community participation in health policy and implementation requires designing health systems that facilitate involvement and connect community voices to decision-making.

1. Health promotion by communities
and in communities: current issues
for research and practice
Jane South
j.south@leedsmet.ac.uk
7th Nordic Health Promotion Research Conference,
17th-19th June, 2013, Vestfold University College

2. Acknowledgements
• ‘People in Public Health’, study funded through National Institute
funded by National Institute for Health Research (NIHR) Service
Delivery and Organisation (SDO) Programme:
http://www.leedsmet.ac.uk/piph
• Evidence reviews & thematic evaluations on community health
champions, commissioned by Altogether Better:
www.altogetherbetter.org.uk
• People Centred Public Health (2012) South, J. White, J., Gamsu, M.
The Policy Press
http://www.policypress.co.uk/display.asp?K=9781447305309&sf1=
contributor&st1=Judy%20White&m=2&dc=2
• A pilot study of the walking for wellness project and the befriender
role,2010-11, commissioned by Natural England.

3. What are the known knowns and the
known unknowns?

4. Communities
• Central place in health
promotion.
• Social ties and networks
are a powerful
determinant of health.
• Community-based
interventions that work
• Challenge of persistent
health
inequalities, exacerbate
d by current economic
drivers.

5. Assuring the
Conditions
for
Population
Health
Health care
delivery
system
Employers and
Business
The Media
Academia
Governmental
Public Health
Infrastructure
Communities
Source: Hunter. D.J, Marks. L, Smith. K (2007), The Public Health System in England
a Scoping Study, Centre for Public Health, Durham University

6. To promote participation in policy-making and implementation
We pledge to:
• (ii) Empower the role of communities and strengthen civil
society contribution to policy-making and implementation by
adopting measures to enable their effective participation for
the public interest in decision-making;
• (v) Consider the contributions and capacities of civil society to
take action in advocacy, social mobilization and
implementation on social determinants of health;

7. Community as..
• a health setting
• a (target)
population
• a health resource
• an essential part of
a health system
• as part of public
health action

8. Local action – population effects?

9. Contemporary challenges
1. What is the place of communities in a public
health system?
2. How can community-based action impact on
health inequalities at a population level?
3. Can we develop a convincing evidence base
to underpin the work?

10. Community Health
Champions
• Empowerment
approach
• 15,000 + champions
recruited and supported
in one region
• Roles vary in intensity
from talking to people
as part of their daily
lives through to
organising community
activities

11. The community
contribution
• Skills, knowledge and
experience
• Bridging and connecting to
address inequalities
• Pathways for individuals
can build capacity in
communities
• Small scale at local
delivery level

12. Walking for Health
• Volunteer–led
walks
• In 2010, 11,000 +
active walk leaders
• Volunteers receive
1 day of
standardised
training

13. How would you describe your group?
We’re a big group of friends, social
people who happen to walk on a
Monday morning. Again it’s like
secondary really, the walking.
Helpful as well. If you
see somebody
struggling we look after
each other.
It’s a talking group that goes for
walks.
A couple of hours well
spent in the morning.

14. A spectrum of participation
South, J., et al (2012) Health Education Research, 27, (4) pp. 656–670
‘Power over’ ‘Responsibility for’

15. Implications for research
“Ecological and Systemic
thinking, then, not only considers
the community as a multi-
level, multisectoral, and
multicultural context but also
considers how structural and
interpersonal relationships between
the intervention and relevant
community components affect the
development and success of the
intervention.”
Trickett, E.J., et al., Advancing the science of
community-level interventions. American Journal
of Public Health, 2011. 101(8): p. 1410-1419.

16. Implications for practice
• Design health systems that
facilitate involvement; and
have a connection between
what people do in
communities and how
decisions are made.
• Create interfaces where
relationships can be formed
and community voices can
be heard.
• Invest in community infra-
structure.

17. Concluding remarks
“Lay involvement is possible at all
levels, planning, design, delivery and
governance of public health activities . . . but
requires people to think differently and be
prepared to demonstrate trust”. (Expert
hearing 3)
South, J., Meah, A., Branney, P. (2011)
Health Promotion International. 27: 2: 284-294.