A presentation from Tevor Hopkins from Asset Based Consulting (http://www.assetbasedconsulting.co.uk) on an Asset Based Approach to mapping Health and Wellbeing. This presentation was organised by the LGA to support West Midlands Health and Wellbeing Boards.

1. The asset based approach to health
and wellbeing in communities
Monday 5th November 2012
Birmingham
www.assetbasedconsulting.net

2. Trevor Hopkins
Freelance Consultant
Asset Based Consulting

3. Never doubt that a small group of thoughtful, committed
citizens can change the world. Indeed, it is the only thing
that ever has.
Margaret Mead – US Anthropologist 1901 - 1978

4. Introductions and outline
• What are the „Deficit‟ and „Asset‟ approaches?
• “A glass half-full”
• Principles, Values & Key themes
• “What makes us healthy?”
• Evidence, Action, Evaluation
• How could this help us strategically?
• How to develop the JSNA to include asset mapping
• Using Appreciative Inquiry to develop the H&WB Strategy
• Co-production for health
• Outcomes based commissioning
• How could this help us locally?
• Appreciative Scrutiny
• Asset Based Community Development
• Community Health Champions
• Resilient Places

5. The dilemma . . .
Clients and consumers
have deficiencies & needs
Citizens have
capacities and gifts

6. A deficit approach
• Much of the evidence currently available to describe health
and address health inequalities is based on a deficit model
• This is a „pathogenic‟ approach to health and well-being
• The deficit approach focuses on the risks, problems, needs
and deficiencies in individuals, families and communities
• Professionals then design services to „fix‟ the problems
• As a result the community and individuals can feel
disempowered or can become dependent
• People become passive recipients of expensive services

7. Features of a deficit approach
• Policymakers see professional systems or institutions as the
principal tool for the work of society
• In Public Health practice this approach has focused on „risky
behaviours‟ and „lifestyle factors‟
• “The collective term for these behaviours is the subject of
much debate, with professionals from different fields preferring
different terminology, each having a view about what is
pejorative and what is not.” (Clustering of unhealthy behaviours over time – King‟s Fund , August 2012)
• Services are targeted at specific needs & problems,
communities and individuals become „segmented‟

8. An assets approach
• Values the capacity, skills, knowledge, connections and
potential in individuals, families and communities
• It is a „salutogenic‟ approach which highlights the factors
that create and support resilience and well-being
• It requires a change in attitudes and values
• Professional staff have to be willing to share power
• Organisational silos and boundaries get in the way of
people-centred outcomes and community building
• Never do for a community what it can do for itself

9. Features of an assets approach
• Changing from servicing people‟s needs to facilitating
their aspirations
• Redressing the balance between needs and assets
or strengths
• A shift in emphasis from the causes to „the causes of
the causes of the causes‟
• A move from targeted to universal approaches
• Solutions that are developed by people and
communities not by specialists and professionals

10. Key messages 1.
• Asset principles help us to understand what gives us
health and wellbeing in a new way.
• The theoretical and research evidence for the positive
impact of community and individual assets is well
known and at least comparable to that of more familiar
behaviour and life-style determinants of health
• Asset thinking challenges the predominant framing of
health as the prevention of illness and injury rather than
the promotion of wellness.
• Asset working can promote mental well-being which is
both a cause and a consequence of inequality and
physical ill health.

11. Key messages 2.
• Work to improve health enhancing assets has not only
to focus on the psychosocial assets such as resilience
and confidence, but also on the social, economic and
environmental factors that influence inequalities in
health and well-being.
• Asset based approaches complement services and
other activities that are intended to reduce inequalities
in life chances and life circumstances and which meet
needs in the community
• Assets are simultaneously an input, a measure and an
outcome. This has implications for the design and
evaluation of asset based working.

12. A glass half-full:
How an asset approach
can improve community
health and well-being
http://www.assetbasedconsulting.co.uk/Publications.aspx

13. The Principles
• Assets: any resource, skill or knowledge which
enhances the ability of individuals, families and
neighbourhoods to sustain health and wellbeing.
• Instead of starting with the problems, we start with what
is working, and what people care about.
• Networks, friendships, self esteem and feelings of
personal and collective effectiveness are good for our
wellbeing.
“Focusing on the positive is a public health intervention in its own right”
Professor Sarah Stewart-Brown, Professor of Public Health at Warwick Medical School speaking at a conference on „Measuring Well-being‟
19 January 2011 at Kings College

14. Values for an Asset Approach
• Identify and make visible to health-enhancing assets in a
community
• See citizens and communities as the co-producers of
health and well-being rather than the recipients of
services
• Promote community networks, relationships and
friendships
• Value what works well
• Identify what has the potential to improve health and
well-being
• Empower communities to control their futures and create
tangible resources

15. Key themes
The defining themes of asset based ways of working are
that they are:
• Place-based
• Relationship-based
• Citizen-led
...and that they promote social justice and equality

16. “What makes us healthy?”
The assets approach in practice:
• Evidence
• Action
• Evaluation
http://www.assetbasedconsulting.co.uk/Publications.aspx

17. Evidence 1.
• There is growing evidence for the importance of health
assets, broadly defined as the factors that protect
health, notably in the face of adversity, and for the
impact of assets based approaches
• Individuals do not exist in isolation; social factors
influence individuals‟ health though cognitive, affective,
and behavioural pathways.
• The quality and quantity of individuals social
relationships has been linked not only to mental health
but also to both morbidity and mortality. It is comparable
with well established risk factors for mortality

18. Evidence 2.
• Stress buffering – relationships provide support and
resources (information, emotional or tangible) that
promote adaptive behavioural or neuoroendocrinal
responses to acute or chronic stressors e.g. illness, life
events.
• Social relationships may encourage or model healthy
behaviours, thus being part of a social network is
typically associated with conformity to social norms
relevant to health and social care. In addition being part
of a social network gives individuals meaningful roles
that provide self esteem and purpose to life.

19. Action 1.
• Assets require both whole system and whole
community working.
• Instead of services that target the most disadvantaged
and reduce exposure to risk, there is a shift to
facilitating and supporting the wellbeing of individuals,
families and neighbourhoods.
• It requires all agencies and communities to collaborate
and invest in actions that foster health giving assets,
prevent illness and benefit the whole community by
reducing the steepness of the social gradient in health.

20. Action 2.
• Asset mapping
• Toronto framework for mapping community capacity
• Joint Strategic Assets Assessment
• Timebanking
• Social prescribing
• Peer support
• Co-Production
• Supporting healthy behaviours
• Community development to tackle health inequalities
• Network building
• Resilient Places
• Appreciative Inquiry
• Asset based service re-design
• Assets – embedding it in the organisation
• Workforce and organisational development

21. Evaluation
• To evaluate health asset based activities requires a
new approach. Instead of studying patterns of illness,
we need ways of understanding patterns of health and
the impact of assets and protective factors.
• Methods that seek to understand the effects of context,
the mechanisms which link assets to change and the
complexities of neighbourhoods and networks are
consistent with the asset approaches.
• The participation of those whose assets and capacities
are being supported will be a vital part of local reflective
practice.

22. How could this help us strategically?
• How to develop the JSNA to include asset
mapping
• Using Appreciative Inquiry to develop the
H&WB Strategy
• Co-production for health
• Outcomes based commissioning

23. Community asset mapping
The actual and potential assets of:
• Individuals – heart, head & hand
• Associations
• Organisations
In a community this can also include:
• The physical assets
• The economic assets
• The cultural assets

24. Analysis of community assets
Potential
Assets
Secondary Assets
Primary Assets

25. http://www.idea.gov.uk/idk/core/page.do?pageId=18364393

26. Community asset mapping/JSAA
http://www.assetbasedconsulting.co.uk/Publications.aspx

27. Appreciative Inquiry
“Good organisations know how to preserve the
core of what they do best.
Preserving the right thing is key.
Letting go of other things is the next step”
David Cooperrider

28. Principles
Reflection – remembering times when our culture, values
and identity made us proud.
Affirmation - inquiring into those strengths and how we
can use them to create the future
Action – practical planning towards the future

29. Characteristics
• Appreciative - AI looks for the „positive core‟ of the
organisation and seeks to use it as a foundation for future
growth
• Applicable - AI is grounded in stories of what has
actually taken place in the past and is therefore
essentially practical.
• Provocative - AI invites people to take some risks in the
way they imagine the future and redesign their
organisation to bring it about.
• Collaborative - AI is a form of collaborative inquiry. It
always involves the whole system or a representative
cross-section of the whole system.

30. The appreciative cycle
Deliver Define
Design Discover
Dream

31. ...building the path as we walk it

32. CITY OF STOKE-ON-TRENT MANDATE FOR HEALTH AND WELLBEING 2020
STOKE-ON-TRENT IS A VIBRANT, HEALTHY AND CARING CITY,
WHICH SUPPORTS ALL PEOPLE TO LIVE FULFILLING,
INDEPENDENT AND HEALTHY LIVES
Vibrant City: Everyone will live,
Healthy City: All children enjoy
work and play in an
the best start in life and
environment which supports
everyone will live longer and
them to live healthy and fulfilling
healthier lives.
lives.
Caring city: Everyone is supported to
live independent lives with fair access to
high quality integrated health and social
care services when needed.

33. Strategic Outcomes
Healthy City: Children will enjoy the best start in life and everyone will live longer and healthier lives
Vibrant City: Everyone will live, work and play in an attractive environment which supports them to live healthy
and fulfilling lives
Caring City: Everyone is supported to live independent lives with fair access to high quality integrated health
and social care services when needed
Starting Well: Developing well: Working Well: Living Well: Ageing Well: Staying well:
Children flourish Everyone is able to Business thrives in Everyone lives in a good Everyone has a positive Everyone has
achieve their the city and quality home, in an area experience of ageing in access to
and feel loved,
potential and enjoy everyone has which they like and in an the City and people are preventative health
valued and safe maximum environment in which they
opportunity to be supported to live and wellbeing
independence and involved in feel safe across all independent, inclusive services and are
positive mental meaningful activity generations and fulfilling lives supported to live
wellbeing (work, volunteering, throughout the life healthy lives
caring) course
Achieved through: Achieved through: Achieved through: Achieved through:
Achieved through: Achieved through:
X% less children Improved levels of % of greenspace in the x % reduction in
% increase in
live in poverty satisfaction with City is rated good quality Increase in literacy smoking
volunteering/comm
life and is accessible and numeracy in prevalence
X% unity champions
Reductions in activity All major plans for adult population x% reduction in
Improvement in
number of NEETs regeneration of the City improved health obesity
teachers Reduction in
identifying Reductions in sickness absence are subject to an HIA related quality of x% reduction in
children as pupil absence rates % reduction in fuel life for older people hospital
ready for school Reduction in the % increase in poverty % reduction in hip readmissions for
X% children number of 15 year number of people % reduction in statutory fractures in older LTCs
breastfed until at olds who smoke with LTC in homelessness people Reduction in
least 6 – 8 Reduction in employment – social connectedness Reduction in number of excess
weeks of life number of hospital including people % self-reports of number of falls and winter deaths
% reduction in admissions as a with a mental feeling safe in the injuries in over 65‟s
low birth weight result of self-harm, illness or learning community
babies unintentional and disability
deliberate injuries
in under 18‟s

34. Co-production
“Co-production means delivering public services in an equal
and reciprocal relationship between professionals, people
using services, their families and their neighbours. Where
activities are co-produced in this way, both services and
neighbourhoods become far more effective agents of
change.”
The Challenge of Co-production – David Boyle & Michael Harris, December 2009
“Services do not produce outcomes – people do.”
Co-production and social capital; the role that users and citizens play in improving local
services – Jude Cummings and Clive Miller – October 2007

35. Further reading on co-production
http://www.neweconomics.org/publications/public-services-inside-out
http://www.nesta.org.uk/events/assets/features/the_challenge_of_co-production

36. The principles of co-production
• Recognises people as assets
• Build on peoples existing capabilities
• Promote mutuality and reciprocity
• Build peer support and social networks
• Break down barriers
• Facilitate rather than deliver

37. Co-production of health & well-being

38. Co-production for health
• Exploit the opportunities created by
the integration of public health and
local government.
• Use the new structures, approaches
and democratic accountabilities to
deliver public health outcomes and a
reduction in inequalities.
• Maximise the new commissioning
structures to improve health outcomes
and reduce inequalities when money
is tight.
http://www.sph.nhs.uk/sph-documents/local-government-colloquium-report

39. Key messages
• Use the transition to start to develop a new co-production model for
health and wellbeing.
• Establish focused, agreed priorities which have meaningful
outcomes for all partners.
• Use intelligence dynamically, creatively and succinctly and in
relevant forms for different audiences.
• Promote an asset based approach to communities to understand
and harness their assets and resource.
• Adopt a new approach to partnership and leadership whilst building
on what has worked.
• The public health workforce has to change – a new business model
needs adopting that is pragmatic, practical and delivers solutions to
commissioners and providers.

40. Outcomes-based commissioning
• The transformative potential of co-production and assets
approaches is not best served by traditional procurement
models.
• The approach of co-production can be incorporated
across the entire commissioning framework.
• Providers are usually contracted to deliver a service
defined by its inputs and outputs with little reference to
wider outcomes
• There is little or no requirement to identify and build on
assets and capacity within the community
• Commissioning should be designed around outcomes

41. Combining commissioning &
co-production
• The commissioning framework defines long-term
outcomes
• Potential providers are incentivised to be innovative and
flexible about achieving outcomes
• Co-production is specified as an approach that providers
must develop
• New providers can emerge
• Commissioners can specify that providers develop
preventative approaches to service delivery
• Wider social and environmental outcomes can be built
into the assessment of value for money

42. Bringing it together
Kirklees Mental Health Partnership used an outcomes-based specification for the
mental health advocacy service and mental health carers‟ options service.
• The providers were required to base the service on the „principles of co-
production‟ and recognising „the assets of the individual‟.
• The specification sets out a number of expectations of the service. It set out that:
people will not be seen as passive recipients of the service; that they have „assets
with value and expertise‟; they will be enabled to „explore their potential to the
fullest, push the boundaries, take risks and maintain or regain increasing control
over their daily lives‟.
• The six co-production principles underpin the specifications, and each one
details the expected outcomes under those headings.
• The service is monitored through a consultative forum with 50 per cent
representation of service users and 50 per cent from the different agencies, using
quantitative data on client details, a framework of personal, community and
economic outcomes
www.yhip.org.uk/silo/files/mental-health-carers-options-service--service-specification.doc

43. How could this help us locally?
• Appreciative Scrutiny
• Asset Based Community Development
• Community Health Champions
• Resilient Places

44. Appreciative Scrutiny
• By using a solution focused
perspective participants in the
inquiry could see how successful
tobacco campaigns have been
with non-smokers.
• Public sector tends to focus on
negative behaviour and looking
at ways to change this, rather
than looking at the positives.
• That Appreciative scrutiny can
energise officers, politicians and
residents when working together
on an issue.
http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/L12_658_CIFPS_Appreciative_Scrutiny_FINAL_Sept_2012_for_web.pdf

45. Asset Based Community Development
The C2 Connecting Communities Project • Co-learning: through conversations and
open discussions communities and staff
• Locating the energy for change: through
came to realise that they both have the
face-to-face conversations, door knocking,
same aims and they need each other if they
meetings with local groups and
are to realise those aims
associations, finding the (small) group of
people who could initiate and lead the • Learning from similar areas that have been
community successful: residents and agency staff
visited other estates to see what could be
• Listening events: co-hosted by the
done and to be inspired by the possibilities
community and the agencies, the
– they now host many visits from developing
professionals listened to what was positive
communities
on the estate, what the community thought
the priorities were and what needed to • Challenging the negative image of the
change estate, held by both residents and staff, so
that they all believed they could make
• Creating places and spaces for residents
changes
to connect, build relationships, have
conversations and share knowledge, and • Supporting the community to lead the
encouraging local activities such as street partnership and to determine what the
parties, outings, raffles and so on priorities were and what would work.
http://www.healthcomplexity.net/content.php?s=c2&c=c2_background.php

46. Community Health Champions
• Altogether Better has developed an
award-winning, evidence based
approach to engaging and supporting
individuals in communities to become
Community Health Champions.
• Their ambition to to work to create
social value by unlocking the assets
and resources of individuals and
communities to create healthier
communities and better quality health
services.
• Work together to activate the full
potential of Community Health
Champions to improve the health and
well being of their communities
http://www.altogetherbetter.org.uk/amazing-stories-collection

47. Resilient Places
“At the beginning of autumn, the Jewish community
celebrates the festival of Succos, translated as
Tabernacles - with its many colourful laws and customs.
One of those customs involves using a type of pine, a
type of fern, called cypress.
This story begins as much as twenty years ago at the
end of Succos. As we had done for many years
previously, we discarded all the cypress we had used
for the festival and thought no more about it.
Unbeknown to us, a branch of cypress has escaped the
black bin bag, and seeded itself in the crack between
the paving stones in our garden. Without anyone
knowing a tree began to grow which is now over 30 feet
tall.
The years passed. Our family grew, our community
grew and the tree grew. Good times came and went
and times of trial and difficulty came and passed.
Throughout it all, I tried my hardest, somehow trying to
control a life that no-one can ever control.
The tree is a gift G-d sent me to teach me just that. It
grows and flourishes without me. I didn‟t plant it, I didn‟t
tend it, yet its beauty and power is there for everyone to
see. It‟s G-d‟s way of reassuring me that He can do so
much without me and that He takes control of that
control which will always elude us.”

48. Resilient Places
Postscript – An „ill wind‟
A day after the picture on the front of this report was taken, it was gone. The tree, which had inspired Mrs
Gardner, her friends and family for so many years had been felled. Unseasonably bad weather in early April
2012, including strong winds, had unsettled the roots and it was threatening to fall down in the direction of the
adjoining College buildings. The photograph shows it was already starting to lean.
A pessimist would doubtless say this was something of a „bad omen‟, giving a lie to the appreciative message
inspired by the tree‟s remarkable development from the seeding of a discarded branch. However it is
interesting to note the diametrically opposite view was taken.
Mrs Gardner and others involved in the consultation process, remarked on the poignancy of the tree‟s demise
so soon after it was used as a powerful metaphor for the consultative process on improving health and well-
being in a cohesive, faith-based community. The growth of the tree was an allegory for those things in life that
individuals can‟t control but which can be achieved against the odds by a combination of pulling together,
positive thinking, and the strength drawn from shared faith, values and beliefs.
After surviving many storms the final wind had blown, the axe had fallen and the tree was a thing of the past.
But its message survives and will linger in the memory of many. It is an enduring message of hope against
adversity and the inspiration that can be drawn from the world around us. This is a recurring cornerstone of
Jewish teaching and appreciative thinking, illustrated just a few hundred yards from where the story of the tree
had been told.
The message had been delivered – the tree had served its purpose.

49. “The asset approach is a set of values
and principles and a way of thinking
about the world.”
It takes everyone to build a
healthy, strong and safe
community.
www.assetbasedconsulting.net