Developing and implementing a robust asset-based approach to public health.

Abstract

An asset approach to public health in the United Kingdom is gaining momentum nationally with its focus on developing existing assets within the community to improve health. At its core, the approach is intended to be part of a culture shiftfrom a deprivation to a positivist model, identifying local strengths in order to develop community resilience and cohesion. In the face of ongoing public sector budget reductions, this is an attractive model. However, evidence on the perceived benefit of asset-based approaches is often anecdotal, and where outcomes are measured, the indicators have little commonality, preventing a direct comparison of effectiveness.In Bristol, we set about researching the evidence base for asset-based approaches with the intention of identifying the most robust method of implementation. This was trialled with an asset mapping exercise, and the recommendations were tested in stakeholder workshop settings.WHAT IS AN ASSET-BASED APPROACH?Asset-based community development builds on the information gathered through an asset mapping process to focus on grass-roots commissioning: determining what each individual area or community group needs to improve health and wellbeing, or to encourage a community environment. This approach requires active community participation,1 and the current literature on asset-based community development appears to gravitate around small-scale change processes rather than any larger, city-wide development of multiple communities.This approach has been documented to be beneficial in promoting responsible communities within small and clearly defined geographical areas, but there does not appear to have been many successful accounts of any attempts to scale-up the process - with the exception of the Ford Foundation in the United States, which uses a methodology of policy change and grass-roots projects on a global scale (although this process is a lot of small changes rather than one big change). A large proportion of the literature on asset-based community development centres on rural community development2 and attempts to tackle poverty and anti-social behaviour rather than health and wellbeing (although it can be argued that poverty and anti-social behaviour fundamentally reduce a community's wellbeing). Friedeli3 argues that there is a lack of a holistic approach to asset-based public health, with the focus and the budgetary direction firmly on health and the development of psycho-social assets, while critically ignoring the economic aspects of health inequalities that public health is not able to affect, such as income inequality. Friedeli's critical view of an asset approach is in the minority of the literature on assets (the majority supporting of the process), which makes it all the more vital; if an asset-based approach to community development is to succeed, we need to be realistic of the many limitations of the approach. Public health funding on asset-based approaches will have little effect in the wake of rising income inequality and reductions in welfare benefits for the population's most vulnerable, and both policy and practice must be developed in a holistic and wellrounded manner as part of a larger Capabilities' Approach.4IMPLEMENTATION OF AN ASSET- BASED APPROACHAttempting to undertake asset mapping on a city-wide basis highlighted a number of limitations. For example, attempting to map all community buildings produced a list of over 500 buildings, and an investigation into the use of WellAware (an online mapping tool) for mapping voluntary sector organisations brought up a starting point of 3,688 organisations that consider themselves to be accessible to residents in Bristol. Mapping assets on a citywide basis without a narrower focus appears indiscriminate, and reduces the ability to be able to develop into more detail around what is available for specific groups of people. …