Healthy Communities

A healthy community is created through improvements in health and wellbeing and achieved by addressing the many social, cultural, environmental, biological, political and economic determinants of health. 

Following is a table that in brief sets out the elements that determine the health of people and their community. 

The social model of health

A social model of health is a conceptual framework for thinking about health. Within this framework improvements in health and wellbeing are achieved by addressing the many social, cultural, environmental, biological, political and economic determinants of health.

Health and wellbeing is more than responding when a person is ill. It is about what is needed to keep people well, safe and able to live a good life.  This might include regular health services such as access to doctors. It might also include supports and services related to such things as housing, getting around one’s community, having access to social activities, looking after the environment and people’s employment needs.

Our understanding about social determinants of health may be assisted by an awareness of the following determinants discussed by The World Health Organisation:

·          The need for policies to prevent people from falling into long-term disadvantage

·          How the social and psychological environment affects health

·          The importance of ensuring a good environment in early childhood

·          The impact of work on health

·          The problems of unemployment and job insecurity

·          The role of friendship and social cohesion

·          The dangers of social exclusion

·          The effects of alcohol and other drugs

·          The need to ensure access to supplies of healthy food for everyone

·          The need for healthier transport systems

Website: http://www.health.vic.gov.au/healthpromotion/foundations/determinants.htm

 Ottawa Charter for Health Promotion (1986)

            World Health Organisation (WHO) http://www.phac-aspc.gc.ca/ph-sp/phdd/pdf/charter.pdf

 The first World Health Organisation International Conference on Health Promotion was held in Ottawa, Canada, in 1986. The Ottawa Charter for Health Promotion was developed as a clear statement of action for health promotion, aiming to increase the relevance of the primary health care philosophy for industrialised countries. Building on the Declaration of Alma-Ata, the Ottawa Charter defines health promotion as:

 ‘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 realise 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. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being.’

At a more practical level, the Ottawa Charter groups health promotion strategies and techniques into five action areas:

Jakarta Declaration on Leading Health Promotion into the Twenty-First Century (1997)

http://www.who.int/healthpromotion/conferences/previous/jakarta/declaration/en/index1.html 

 This declaration identifies the importance of health promotion as an investment, and reiterates the need to address the significant social determinants of health (see page 63). While emphasising the five action areas listed in the Ottawa Charter, the declaration goes further to set five priorities for health promotion in the twenty-first century:

Bangkok Charter for health promotion                      

http://www.who.int/healthpromotion/conferences/6gchp/hpr_050829_%20BCHP.pdf

The Bangkok charter builds on the values principles and action strategies established in the Ottawa Charter. It calls for integrated policy approaches across sectors and settings, strong political action, broad participation and sustained advocacy in order to progress towards a healthier society (WHO 2005a:3). 

            The Bangkok charter focuses on four commitments to make the promotion of health

 Social capital and community strengthening

Social support and civic engagement in activities such as community group meetings, childcare arrangements with neighbours, neighbourhood watch schemes and voting all work to produce a resource often called social capital. This resource is critical to the health, wealth and wellbeing of populations.  

Social capital is a key indicator of the building of healthy communities through collective and mutually beneficial interaction and accomplishments, particularly those demonstrated by social and civic participation. Research has linked these types of activity to improved health outcomes.

 The notion of social capital represents a way of thinking about the broader determinants of health and about how to influence them through community-based approaches to reduce inequalities in health and wellbeing.  A focus on social capital supports using a balance of behavioural change strategies with those that focus on the settings in which people live, work and play.

 The implication for health promotion practice is that more emphasis is needed on efforts to strengthen the mechanisms by which people come together, interact and, in some cases, take action to promote health. Simple measures, such as providing space in which people can come together and meet, may be as health promoting as providing health information in an effort to change behaviour.

 Service providers can also enhance the social capital within a community by facilitating community projects that bring neighbours together to achieve a mutually beneficial goal, such as beautifying the environment of a public housing estate or establishing a community fruit and vegetable garden.

 Developing social capital is often thought to be an extension of the notion of community development. Service providers should also consider their relationships with community groups and networks. These groups are an invisible resource for health promotion, and developing strong, mutually beneficial relationships with such groups can be a sound investment for health.

 Resource:         Australian Bureau of Statistics on Social Capital – Australian  framework, data, papers. http://www.abs.gov.au/ 

Health and Wellbeing Indicators    www.ourcommunity.com.au

 An indicator is ‘a measure of something that matters, an important issue or policy. It’s usually a statistic, but a special kind: it’s a ‘key measure’.

 VicHealth is currently involved in a project to establish a sustainable system for the development and use of local community wellbeing indicators throughout Victoria. The measures of wellness are designed to support local governments in measuring health, wellbeing and sustainability. These tools are also designed to support improved citizen engagement, community planning and policy making. VicHealth has commenced working with a group of Partner Councils to pilot the project throughout 2005 and 2006. (Wodonga Council is a member)

Community Indicators Victoria (CIV) http://www.communityindicators.net.au/ is a project being hosted by VicHealth to identify indicators for measuring wellbeing in Victorian Communities. This project requires a significant resource commitment from many government and non-government entities to meet the costs involved in the sharing and management of data. Sitting alongside this data collection process will be the Victorian Community Survey (VCS). The purpose of this survey is to collect additional data and information relating to wellbeing that is not currently available through existing government data sources. The VCS will be conducted as a telephone survey using Random Digit Dialling of residential households. The sample size will equate to 300 adult residents from each LGA and will be conducted every second year. The scheduled start date is during 2006.

 Upper Hume PCP and our member local governments intend to build on this work and develop shared indicators to measure and health and wellbeing in our region.

Other key places to find information 

Australian Health Promotion Association
New South Wales branch at http://www.healthpromotion.org.au/branches/nsw/social.php has a great list of publications and journal articles