building community capacity

Community Capacity - what is it?

Community capacity building is a vital component of the way in which NHS Lothian delivers Health improvement.

There is a direct link between good physical and mental health and high levels of community capacity. Current evidence suggests that participation in community networks brings with it benefits for health whilst social exclusion has a damaging effect on health. The World Health Organisation's most recent statement, the Bangkok Charter states that:

"Well organised and empowered communities are highly effective in determining their own health". 1

In common with many social concepts, community capacity has been defined in different ways. The Charity Commission defines community capacity as:

"...developing the capacity and skills of the members of a community in such a way that they are better able to identify, and help meet, their needs and to participate more fully in society." 2

Whilst this places the focus firmly on individuals within a community others have taken a more collective approach. Others place the emphasis on empowerment and the ability of the community to work together. These various aspects of community capacity link in well to our understanding of the range of factors which contribute to improving health. Economic and social factors for example are contributors to people's health and are unequally distributed across society. Disadvantage is associated with feelings of isolation, low self esteem, low perceived power and self efficacy and loss of meaning and purpose. These and other psychosocial risk factors, including poor social networks, damage physical health both directly and indirectly via health damaging behaviours such as drug and alcohol abuse and smoking. To improve health therefore it is necessary to build community capacity and empower individuals to take control over their lives and develop social structures.

Building Respect

When building community capacity, it is also important to build a sense of respect and responsibility. Respect for self, others and difference is essential in developing strong communities with a collective spirit. Social and community networks, alongside good living conditions are important determinants in achieving good health.

Respect and responsibility go hand in hand. When balanced, they can help to protect the rights of individuals, and strengthen active citizenship. Promoting the values of respect and responsibility can have a positive impact upon a range of areas, including sexual health and relationships, and the prevention of violence against women and children.

NHS Lothian and our partners are working to build a sense of respect and responsibility through a range of educational programmes. These include work with primary school children in the active prevention of domestic abuse, and programmes with secondary school pupils in the development of respectful relationships. Our health services are also building a sense of respect and responsibility through the provision of information on rights and responsibilities for young people accessing health drop-ins. NHS Lothian's Zero Tolerance policy on violence and aggression is another successful element in our work around respect and responsibility.

Social marketing campaigns play a key role in taking these messages out into the wider community. For example the recent 'Respect Difference' campaign from Healthy Respect targeted young people through bus and radio adverts.

Community Development and Health in Lothian - What's been achieved?

NHS Lothian Health Promotion Services and its partners in local authorities and the voluntary sector work together to implement a community development approach to health promotion. These approaches prioritise work with communities that are disadvantaged, excluded or disempowered in order to build their capacity to identify the issues that affect them and to act to improve their lives. This involves taking a broad definition of health; working with the issues communities themselves identify and using the energy and leadership of people within the community to empower them to tackle these issues.

A variety of community development and health projects exist within Lothian. Some are based within local communities, particularly within deprived areas. (See case study Westerhailes Health Agency) Others work with communities of interest, for example the black and minority ethnic community or seek to promote community capacity across wider areas in relation to particular topics, for example Edinburgh Community Food Initiative's work on access to healthy food.

Independent projects are in a strong position to work with local communities or communities of interest. However, there is an important role for NHS Lothian in promoting and developing a community development way of working. Health practitioners, in particular health visitors, are increasingly adopting aspects of this way of working. Training in community development and health is available to support this. This course is accredited by Queen Margaret University College and is offered by a network of trainers either within localities or as part of NHS Lothian Health Promotion Services Capacity Building Programme. (See the case study Bridgend below).

Local people can benefit from "Health Issues in the Community", a flexible course which develops individual and group skills and confidence, good practice in community development and health and provides more accessible routes into learning and employment. A recent evaluation of this course carried out in West Lothian found that it benefited individuals taking part, the communities where the course ran and the organisations charged with planning for health promotion and community development. Individuals gained in confidence, self esteem and well being and often felt able to go on to further study or education. Participants also took on enhanced roles within their local communities. (See case study Bridgend below.) Health Issues in the Community has raised the profile of community health needs and assisted with public involvement in the NHS and is becoming a useful component of local involvement in Community Planning.

Each local authority area is served by an intersectoral group dispersing small grants to promote developmental work in community development and health. Although only small sums of money are involved, much creative work is possible and the grants system plays a useful part in developing new initiatives.

Case study 1

Westerhailes Health Agency

Weigh 'n Get Fit is a community initiative which aims to address the health issues associated with obesity and poor lifestyle choices. The group takes a holistic approach and tackles both healthy eating and physical activity.

The group has developed from a group run by a local community dietitian. This group grew in popularity and at the same time the Westerhailes Health Agency, working with local people, identified a need for expanded opportunities for physical activity in the area. The Agency created the post of Physical Activity Coordinator. The idea of a Weigh 'n Get Fit group emerged.

Questionnaires were sent out to local people including those who had attended the healthy eating group, along with other service users, to find out what benefits people would like to get from a weight management group. Based on these needs, a group was set up at the Westerhailes Health Agency offering a Weigh-in and advice session, a 40 minute exercise class and a healthy lunch.

Local people accessed the group directly but partnership working in the area also meant that health and physical activity services in the area made referrals. The group met regularly with good attendance for two years, recruiting new members at the start of year two. A health walk was included as an alternative choice to a fitness class since some members were not able to cope with the exercise class. A food co-op was set up to help tackle the barriers of affordability and availability of healthy food in the area.

Being weighed is potentially a solitary experience but at the group participants were able to share how they felt about their weight with others in similar situations. Weighing thus brought people together and the group support that developed built capacity within this particular group, several of whom suffered from poor mental health and benefited from this extra support.

The original group has now come to an end. Some of the participants of this group are currently accessing other activities within the local Physical Activity Project (Latino Aerobics, Tai Chi, Circuit Classes and the Walking Groups) or have joined in other opportunities for physical activity. Two have gained in confidence and trained to lead walks themselves, thus developing their own skills.

Meanwhile many new people were approaching the Health Agency asking to join the group and a new group has now been set up in Clovenstone, another area of the Westerhailes Community. It is hoped that running a popular activity in the Clovenstone Community Centre will boost the use made of this centre by the local community.

Case study 2

Bridgend, West Lothian

West Lothian has developed strategic links between staff training in Community Development and Health, Health Issues in the Community and small grants available to promote developmental work in community development and health. These three key elements combined had a significant effect within a rural community, as well as enhancing professional roles.

The local health visitor worked with a health promotion specialist and a community development facilitator to deliver a Community Development and Health Training Course in West Lothian, which was attended by a local Surestart worker. As a result of the increased knowledge and skills the Surestart worker and health visitor worked with the Bridgend community to establish a food co-op. Five lay people in the community of Bridgend completed 'Health Issues in the Community' training. As part of the course the participants worked on a group project around housing issues and campaigned for improvements to their homes. The group also made links with the local food co-op and identified the lack of a local exercise class. Public transport restrictions precluded accessing a leisure centre. Together with the health visitor and the Surestart worker, a successful bid was made to the community health development small grants scheme for funding to establish an exercise class locally.

The exercise class now takes place in a local school with no cost for the venue. The cost for the teacher is funded by donation from participants. The numbers at the class and the level of donation exceeds the cost of the teacher and subsidises an exercise class for local elderly people. Links have been made (via the health visitor) to the local GP practice. GP referrals are now made to both classes.

Local people have benefited not only from the newly available exercise class but also from the knowledge and increased confidence that acting together can bring. A committee has now been formed by local people to manage current and future developments.

The health visitor has continued to take an active part in a community planning group and work with the locality health promotion specialist to develop new materials for the Community Development and Health Course. This course has now been promoted to multi-sectoral groups and has had participants from West Lothian Council (e.g. locality planning & policy officers, sports & leisure policy officers, community education officers) and voluntary sector (e.g. West Lothian Drugs & Alcohol Service) as well as primary care staff, thus contributing to community planning capacity.

References

1. World Health Organisation. The Bangkok Charter for Health Promotion in a Globalized World, (online) accessed September 2006. Available from URL http://who.inthealthpromotion/ conferences/6gchp/bangkok_charter/en/print.html

2. Charity Commission: Nov 2000.RR5 The Promotion of Community Capacity Building, (online) accessed September 2006. Available from URL www.charitycommission.gov.uk/publications

3. Chapman, ,M and Kirk, K. Lessons for Community Capacity Building: A Summary of Research Evidence, July 2001, (online) accessed September 2006. Available from URL www.scothomes. gov.uk/pdfs/pubs/

4. Northern Ireland Department for Social Development, North Belfast Community Action Report Dunlop report, (online) accessed September 2006. Available from URL www.dsdni.gov.uk