A Strategy For Addressing Health Inequalities Social Work Essay

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This essay looks at community development approaches, and will critically discuss its potential as a strategy for addressing health inequalities in the population.

Community dev background.

By the late 1960s, it was becoming widely recognized that the post-war British welfare state was failing to redistribute income from the rich to the poor. In fact, social policy analysts were able to demonstrate that any redistribution that did take place was of a vertical nature within classes. In particular, it was shown the middle classes gained more from the health and education services than the working classes. Furthermore, there was an increasing realization that the welfare state appeared to have failed those in greatest need. Social policy analysts, and in particular the research undertaken by Abel-Smith and Townsend (1965), demonstrated poverty was still prevalent despite the existence of a growing economy. In response, pressure and interest groups, such as Shelter and the Child Poverty Action Group, emerged to document and analyse this trend and to advocate for policy changes. Overall, many public groups and figures, supported by official reviews and reports confirming failures in the welfare state, began to question the absence of alternative approaches to what many claimed were negative local circumstances (Midwinter, 1994).

As a result of this concern, the Labour government commissioned what were to become pivotal and influential reports advocating more interventionist approaches to social problems. A core theme in these reports was the need to bring public services closer to neighbourhoods. There was of course a further and hidden agenda to these interventions which was to ensure that the improved surveillance by government agencies of working class communities and areas. To resource these new intervention's, public spending was increased which had the result of developing new practices to support vulnerable and, in the government's view, 'troublesome' and 'difficult' communities. The main targets for additional spending were the declining urban areas that were presenting severe problems of housing decay, educational disadvantage and discrimination against the newly arrived black and Asian immigrants (Pickvance 1976). There was also a greater recognition of poverty as measured by individual and family income (Townsend, 1971).

One outcome of this new government approach, which was to influence the UK community development theory and practice, was the establishment in 1969 of the government's community development projects (CDPs). Twelve geographical areas were identified as in need of specific additional resources and improved coordination of local services. The government's hope was that by intervening in these localities, the Projects could address internal community and individual personal problems. The CDPs, together with the newly established Urban Programme and the application of community development techniques in social service and education departments, were to support the growth of community development. This led to the establishment of a number of specialist training courses with professional youth work courses including community development theory and practice in their training programmes (Davies, 1999).

The Choosing Health White Paper made a commitment to improve the health of people living in deprived communities. These pilots have shown that putting local people first in planning and delivery enables disadvantage to be overcome and health improved. They have ensured the success of Communities for Health, and now all of the Spearhead areas can benefit not only from new funding, but also from the support of colleagues from the pilot areas.

What is Community development?

Community development seeks to empower individuals and groups of people by providing these groups with the skills they need to affect change in their own communities. These skills are often concentrated around building political power through the formation of large social groups working for a common agenda.

Good community development is action that helps people to recognise and develop their ability and potential and organise themselves to respond to problems and needs which they share.  It supports the establishment of strong communities that control and use assets to promote social justice and help improve the quality of community life.  It also enables community and public agencies to work together to improve the quality of government. http://www.scdc.org.uk/who/what-is-community-development/

how community dev helps combat health inequalities in uk

The term "community" is used to describe the common bonds that arise as a result of living in the same neighbourhood or having some common identity through, for example, ethnicity, sexual orientation or faith.

Effective community development work engages a wide cross-section of the population on a range of issues, so that they can influence the decisions affecting their local area and the development of services to meet local needs. It achieves better outcomes through more effective and targeted allocation of scarce resources.

Community participation

Community involvement has been a growing aspect of government policy over the last 10 years. Inspection regimes underpinning performance management frameworks for public sector service providers, particularly local authorities increasingly require evidence of consultation and the active participation of users in designing and developing services.

The guide develops the idea of a 'ladder' of participation with rungs ranging from information and consultation to substantial support for community initiatives.

Social capital

Putnam speaks of two main components of the concept: bonding social capital and bridging social capital, the creation of which Putnam credits to Ross Gittel and Avis Vidal. Bonding refers to the value assigned to social networks between homogeneous groups of people and Bridging refers to that of social networks between socially heterogeneous groups. Typical examples are that criminal gangs create bonding social capital, while choirs and bowling clubs (hence the title, as Putnam lamented their decline) create bridging social capital. Bridging social capital is argued to have a host of other benefits for societies, governments, individuals, and communities; Putnam likes to note that joining an organization cuts in half an individual's chance of dying within the next year

Social capital development on the Internet via social networking websites such as Facebook or Myspace tends to be bridging capital according to one study, though "virtual" social capital is a new area of research.

A growing body of research has found that the presence of social capital through social networks and communities has a protective quality on health. Social capital affects health risk behaviour in the sense that individuals who are embedded in a network or community rich in support, social trust, information, and norms, have resources that help achieve health goals. For example, a person who is sick with cancer may receive information, money, or moral support he or she needs to endure treatment and recover. Social capital also encourages social trust and membership. These factors can discourage individuals from engaging in risky health behaviours such as smoking and binge drinking.

Inversely, a lack of social capital can impair health. For example, results from a survey given to 13-18 year old students in Sweden showed that low social capital and low social trust are associated with higher rates of psychosomatic symptoms, musculoskeletal pain, and depression. Additionally, negative social capital can detract from health. Although there are only a few studies that assess social capital in criminalized populations, there is information that suggests that social capital does have a negative effect in broken communities.

In Chicago, during the Summer of 1995, there was a heat wave in which temperatures exceeded 120 degrees Fahrenheit, over 700 people died. Eric Klinenberg has looked at which factors contributed to an individual's likelihood of survival in these conditions. He found that social contact was a significant factor, many of the victims were elderly and isolated, living in poor, run down areas with few visitors and little contact with family or neighbours. The social isolation of many of these individuals was underlined by the fact that over a hundred bodies remained unclaimed at the end of the emergency.

The idea that social isolation is bad for health is also supported by self-report studies that show housewives, the unemployed and the retired as reporting significantly poorer health than those who are employed.

Health inequalities in UK

Socio-economic class has been linked to health inequalities for many years. Edwin Chadwick published his 'General Report on the Sanitary conditions of the Labouring Population of Great Britain' in 1842. This showed that the average age at death in Liverpool at that time was 35 for gentry and professionals but only 15 for labourer's mechanics and servants. Although life expectancy has improved for all classes in Britain since this time, inequalities have remained.

Health inequalities are the UK's most visible public health challenge. The health of people in the more affluent areas of the country is among the best in the developed world, but the health of the most disadvantaged rivals the worst. Health inequalities are most marked in areas where deprivation is most acute. People living in poorer communities die younger and experience poorer physical and mental health throughout their life than those living in more affluent communities.

There is an abundant body of evidence demonstrating the key determinants of health, and the social determinants which give rise to health inequalities. The health of individuals and populations is associated with a variety of factors, including socioeconomic status, gender, age, ethnicity and locality. The interplay of these factors leads to variations such that some groups in society experience poorer health outcomes than others for instance according to ……………….. Gypsy communitie has poorer health due to lack of education, poor diet and unable to access the services therefore are less likely to receive good health care and increased mortality and morbidity.


according to the world health organisation health promotion is to enable people to gain control over their lives (cited in naidoo & wills 2000) communities who are empowered and able to change the world with their actions.

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighbourhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalisation. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

Community empowerment refers to the process of enabling communities to increase control over their lives. "Communities" are groups of people that may or may not be spatially connected, but who share common interests, concerns or identities. These communities could be local, national or international, with specific or broad interests. 'Empowerment' refers to the process by which people gain control over the factors and decisions that shape their lives. It is the process by which they increase their assets and attributes and build capacities to gain access, partners, networks and/or a voice, in order to gain control. "Enabling" implies that people cannot "be empowered" by others; they can only empower themselves by acquiring more of power's different forms (Laverack, 2008). It assumes that people are their own assets, and the role of the external agent is to catalyse, facilitate or "accompany" the community in acquiring power.

Community empowerment, therefore, is more than the involvement, participation or engagement of communities. It implies community ownership and action that explicitly aims at social and political change. Community empowerment is a process of re-negotiating power in order to gain more control. It recognizes that if some people are going to be empowered, then others will be sharing their existing power and giving some of it up (Baum, 2008). Power is a central concept in community empowerment and health promotion invariably operates within the arena of a power struggle.

Community empowerment necessarily addresses the social, cultural, political and economic determinants that underpin health, and seeks to build partnerships with other sectors in finding solutions.

(WHO http://www.who.int/healthpromotion/conferences/7gchp/track1/en/)


according to WHO (2009) The common goal of these research and development initiatives is to create development policies and directions that are supportive to health, community empowerment, local governance to ensure health equity and quality of life.

The fundamental principal of these approaches are based on placing health at the core of the development process. These approaches aim to find ways to address the disparities found in the health care system and create equitable solutions for health care delivery.

Evaluation (jus notes)

Education, housing, alcohol-related and obesity-related harm, and numerous other social factors, are causes of this gap - meaning that in a significant way, other important social problems are in effect also health inequality problems.

Experienced practitioners, involved in developing the guide, emphasised the length of time necessary for successful participation processes. Much of this time should be spent in preparation within organisations promoting initiatives, before contact is made with the wider community.

Increasing the spiritual, political, social, or economic strength of individuals and communities. It often involves the empowered developing confidence in individual capacities.



WHO (2009) http://www.emro.who.int/cbi/

Abel-Smith B., Townsend P. (1965) The Poor and the Poorest. London: Bell.

Midwinter E. (1994) The Development of Social Welfare in Britain. Buckingham: Open University Pres.

Popple K. (1995) Analysing Community Work: its Theory and Practice. Buckingham: Open University Press.

Popple K. (2003) The Community Development Journal: a history'. In: Gilchrist R., Jeffs T., Spence J., editors. Architects of Change: Studies in the History of Community and Youth Work. Leicester: National Youth Agency.

Pickvance C. (1976) Urban Sociology: Critical Essays. London: Tavistock Publishers.

Townsend P. (1971) The Concept of Poverty. London: Heinemann Education

Davies B. (1999) From Voluntarism to Welfare State: A History of the Youth Service in England Volume 1, 1939-1979. Leicester: Youth Work Press.