Community action for health promotion and prevention

Abstract

Introduction: According to the Ottawa Charter for Health Promotion of 1986, “[h]ealth promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities”. [1, p.1] In communities, various problems and challenges arise in public, semi-public and private settings. Addictions, littering, vandalism, but also violence, other social problems and even mental health are challenges that communities have to face. Aims: Community-oriented work is an approved method for putting health promotion and prevention into practice. Here, it is essential to work in and with the setting. A setting is a social context that is relatively permanent. This relationship is embodied in a formal organisation (e.g. business, school), a regional situation (e.g. municipality, district or neighbourhood), a common life situation (e.g. retirees), common values and preferences (e.g. religion, sexual orientation) or in a combination of any of these attributes [2]. But there is much more to the setting approach, beyond simply reaching the target group within the setting. The following key points are equally important:  Participation of members: Concerned persons have to become active participants  Process of organisational development in the setting or community  Empowerment of the people and the administration  Public health action cycle: 1. Identify and analyse health problems in the population (assessment); 2. Develop health-policy intervention strategies (policy development); 3. Implement the strategies in the health care system (assurance); 4. Evaluate acceptance and effectiveness (evaluation) [3]  Setting-oriented and behavioural elements  Cooperation and communication with all persons involved and affected Various methods are available for conducting situation analysis and determining needs. In the community context, “bedarfserhebung.ch Health Promotion and Prevention Planning in the Community” has proven its worth in Switzerland. According to this method, 20 to 30 key persons in the community attend a three-hour, structured workshop and determine local risks and problems, resources and potentials, and develop ideas in three steps. Through this participatory method, the viewpoints of the persons concerned are documented and commitment and initial steps toward networking are strongly promoted [4]. International Journal of Integrated Care – Volume 14, 26 May – URN:NBN:NL:UI:10-1-116232– http://www.ijic.org/ Community Integrated Care and Social Services, Romania, February 21 st , 2014. Results: Based on diverse experiences in community-oriented projects in the area of alcohol and tobacco prevention, and in early detection and early intervention projects, as well as some evaluations, various quality factors could be determined at the level of structure, process, and result. These are, namely: structure quality (political mandate, organisational structure, network), process quality (process control, discussion of attitudes and positions, participation) and result quality (needs assessment, action plan, action guidelines) [5,6]. Conclusions: Local community-oriented projects that work with realistic goals and defined but locally adaptable structures and processes have the potential to be effective. For example, it was found that tobacco prevention projects can implement measures locally that are small in scale but have lasting effect [6].