The National Institute for Health and Clinical Excellence has published public health guidance designed to help communities get more involved in the planning, design and delivery of services aimed at boosting the health and well-being of the country.
Nationwide strategies to help promote good health and tackle health inequalities are heavily focused on the involvement of communities, in particular disadvantages ones, by encouraging them to take part in activities such as short-term consultations or the planning, development and management of local health services.
Although the idea of engaging communities has been kicking around for several decades, there have been many obstacles to its effective implementation, such as “dominance of professional cultures and ideologies in imposing their own structures and solutions on communities, the skills and competencies of staff working in public services and the capacity and willingness of service users and the public to get involved (Pickin et al. 2002),” according to NICE.
“There is already plenty of guidance on how to engage communities, but this represents the first concerted attempt to draw together evidence on what is most likely to affect the underlying determinants of health,” commented Anna Coote, Head of Patient and Public Involvement at the Healthcare Commission and Chair of the Programme Development Group. “The guidance makes it clear that much depends on statutory organisations being prepared to change the way they think and act, in order to redress imbalances of power between those who provide services, and those for whom the services are intended,” she added.
Four key themes
The new guidance is directed at those working in the National Health Service and other sectors with a role in community engagement, and is centred on four “interlocking themes” key to the effective implementation of related initiatives: prerequisites for success; an optimal infrastructure; approaches; and evaluation.
Prerequisites for success include an emphasis on joint working to put in place relevant policy initiatives, openness to organisational and cultural change and a willingness to share power. Once these have been met, the Institute claims it will be much easier to put in place an appropriate infrastructure to achieve the central aims of local engagement, for which it will be crucial to provide appropriate training and development of those working with the community.
Recommendations for approaches to boost levels of community engagement outline how they can be used to encourage local communities to become involved in health promotion activities and local initiatives to address social factors in health. And finally, the guidance makes recommendations about the best ways to assess programmes to boost understanding of how community engagement might impact on health and social outcomes.
Liam Hughes, National Adviser, Healthy Communities, at the Improvement and Development Agency for local government, said the guidance “chimes well with the government’s drive for social inclusion, and the role of local government in promoting healthier places for the local population”.
He went on to say: “In areas of profound and multiple deprivation, progress depends on the active participation of local people, and the internal generation of the motivation to change’, and stressed: “It is likely that strong, engaged and empowered communities will be healthier communities”.
