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Community development and public health

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It is widely documented that Indigenous Australians have poorer health outcomes than non-Indigenous Australians (Dempsey & Zhao 2006; Germov 2002; Zhao, Guthridge, Magnus & Vos 2004). According to the Australian Indigenous Health InfoNet website (2009), Indigenous Australians have the poorest health status of all populations living in Australia with contributing factors, including but not limited to, education, employment status and socio economic status. There are also a number of social determinants which contribute to poor health outcomes such as dispossession, social supports and gender (Germov 2002). Community development and public health play significant roles in the promotion of health and in the reduction in the health disparities which exist between Indigenous and non-Indigenous Australians.

Community development, has been found to be a successful method to improve public health and health outcomes in places of poverty where populations have extreme health disparity (Baum 2008). Conversely, there have been many examples where community development has been aversive to improving public health (Ife & Tesoriero 2006 p 234). In answering the question: 'what is the meaning of community development and public health?', this essay will explain the various existing definitions of community development and related terms such as community building, capacity building and social capital; provide examples of how community development approaches to public health have been implemented in Indigenous communities; and how Government and non-Government Organisations utilise these methods in practice.

As evidenced in this essay, community development as an approach to improving public health is an effective method where it is implemented accurately. One must question how often community development approaches to public health are effectively implemented due to the disheartening life expectancy of Indigenous Australians, which is up to 20 years lower than that of non-Indigenous Australians (Oxfam Australia 2007). We need to stop and listen to the Traditional Owners of this land; this country we call Australia. They will guide us, show us and teach us the way to improve their health and wellbeing.

Defining Community Development and Public Health

Community development within public health seeks to empower individuals and groups within communities to take control over and improve health outcomes through working with community members from the ground up, referred to as a "grassroots approach" (Ife & Tesoriero 2006, p. 121; Ife 1995, p. 96-97). It is a contemporary practice used by practitioners to promote wellbeing and enhance lifestyle and has been shown to play an important role in developing public health across Indigenous populations of Australia (Campbell, Pyett & McCarthy 2007).

Community development is a strategy which can be used in public health to improve health outcomes through the implementation of programs and projects within communities. Baum (2008) views community development as the ability to improve health among populations by working directly with communities to empower them to take control over circumstances that play a role in effecting health outcomes. Successful community development involves identifying needs then working with members of the community to promote empowerment to make long term sustainable development changes. In support of this statement, Campbell, Pyett & McCarthy (2007) promote the idea that developing healthier Indigenous communities involves enhancing existing community capacity through empowerment. Laverack (2006) reinforces this notion through his use of the 'domains' approach, with one domain focussing on encouraging local leadership through enhancing existing community capacity. Ife (2005) supports this idea with the application of a number of principles which must be applied in practice including empowerment, sustainability, ownership and participation. Community changes must take place from the very local level and can therefore be a very long and intricate process.

In defining community development, social capital is a term often used in a positive sense to enhance community development practice. It is believed to bring about change by bringing community members together, creating engagement and social support which can promote public health and enhance community development (Baum 2008). In promoting community development it can therefore be said that the utility of social capital can improve health status among communities. Carson et al (eds. 2007 p. 110) discusses the potential of social capital to provide insight into improving health standards of indigenous populations despite varying contentions surrounding the notion. Creating positive social engagement of community members assists in the development of relationships between people and the ability to work together to achieve a common goal, an important aspect of defining community development.

In following from this, Bryson & Mowbray (2005) associate social capital with the term community capacity building, another concept related to community development in public health. The term is used by individuals as a strategy to improve community development and or as a similar alternative to community development initiatives and interventions. The Australian International Health Institute promotes community capacity as increasing health by 'strengthening the ability of a community through increasing social cohesion and building social capital' (Arole, Fuller & Deutschman n.d) Community capacity building enhances the capacity of community members to take control in bringing about change. The use of these strategies and its approach can pave the way for health improvements in Indigenous communities.

Community Development and Public Health in Indigenous communities

Community building is used by individuals and organisations to enhance the process of community development. Ife & Tesoreiro (2006) explain that community building is an important factor in influencing successful community development which involves bringing community members together through small projects. The idea that community members are joining together to work towards a common goal contributes to 'group process, inclusiveness, building trust and developing a common sense of purpose...critically important in community building' (Ife & Tesoreiro 2006, p. 185). Community building is often used to promote public health within Indigenous communities through bringing individuals together to identify a problems or needs. Community members therefore share a common goal and work together to address the issue.

Senior & Chenall (2007) demonstrate the way community building can enhance community development in 'Stopping Sniffing is Our Responsibility'. The Aboriginal community members identified petrol sniffing as a health and social problem so a common goal was identified and the people developed a program to help combat the problem, contributing to development of the community. Although success of the intervention was not long lived, due numerous factors, including lack of resources it demonstrated to the community members that they were able to work together to make positive changes. Community development in relation to Indigenous communities requires specific, intricate approaches. Approaches must be conducted in a culturally sensitive manner which 'enables indigenous people to have genuine control over their own community and their own destiny' (Ife & Tesoreiro 2006, p. 2350). If community development approaches in indigenous communities must therefore incorporate cultural understanding.

The definitions and approaches evident in Many Ways Forwards: report of enquiry into capacity building and service delivery in Indigenous Communities, House of Representatives standing committee on Aboriginal and Torres Strait Islander Affairs, June 2004

The government report Many Ways Forward, the Report of the Inquiry into Capacity Building and Service Delivery in Indigenous Communities (2004) provides a political view of community development in relation to Indigenous health. The report looks at the effectiveness of and ways to enhance and increase in the participation of services delivered to Aboriginal and Torres Strait Islanders within their communities through building community capacities.

Throughout the report a number of organisations express their own views on the meaning of community capacity. The Department of Family and Community Services (FaCS) define community capacity as incorporating four elements including commitment, resources, knowledge and skills. Whilst Aboriginal Affairs Victoria define community capacity as 'strategies/programs/initiatives which seek to empower, motivate and enable individuals, families and communities...to pursue their own development goals' (House of Representatives Standing Committee On Aboriginal and Torres Strait Islander Affairs, 2004 pg 15). This is just a small example of a number of definitions, which emphasises that the practice of community development can mean different things to individuals.

The utilisation of community development in practice by Governments & non-Government Organisations (NGOs)

The political report 'Many Ways Forward Report of the Inquiry into Capacity Building and Service Delivery in Indigenous Communities' identifies a number of government approaches to community development and the need to enhance government capacities including the 'COAG Trial,' Indigenous Whole of Government Initiative. The program is aimed at improving the delivery of programmes and services to Indigenous communities, based on a concept of 'shared responsibility' where 'condition and wellbeing of Indigenous communities is one shared by the community, its families and individuals with Governments' (Department of Education, Employment and Work Place Relations website, 2010). The commencement of this trial took place in 2002. Another whole of government approach is The Waterloo/Redfern Partnership Program which has a number of smaller programs including community strengthening activities designed to develop communities of Redfern and Waterloo (NSW) which advocate the implementation of social capital (Redfern-Waterloo Community Safety Plan, 2004). Along with these programs there are a number of state and territory government programs including ***

Along with the small example of government programs, The Northern Territory Government's Emergency Response (NTER) has had a big impact on Indigenous public health within communities and should not go without mention. The NTER was established in 2007 by the Howard government which has implemented a number of measures with a target of five years to improve future prospects of Indigenous Australians living in the NT and promote community safety and the protection of children (Department of Families, Housing, Community Services and Indigenous Affairs website, 2009). As part of the program the government implemented eleven measures in order to reach goals with the addition of another measure involving the NT only, abolition of the community development employment program (CDEP) (Altman, 2007). Whilst the intervention has been put in place to develop Indigenous communities many individuals and organisations have either supported or strongly criticised this approach.

Oxfam Australia is one of the organisations which made a critical response to the intervention, in particular relation to proposed amendments to the Aboriginal Land Rights (Northern Territory) Act 1976. Oxfam Australia argues the effectiveness of implementing two of the measures, (measures 5 and 10) reporting that they will hinder development in the form of empowerment among communities (Altman, 2007). Oxfam Australia is a non government organisation which promotes development through implementation of programs providing community members with knowledge and the resources to assist community members to identify problems and encourage them to find their own solutions through sustainable development (Oxfam Australia website, 2009). Oxfam have a number of community development projects focused on developing the capacities of Indigenous communities within Australia. An example of this is through working alongside Aboriginal Community Controlled Health Organisations and supporting Aboriginal Health Workers with a focus on promoting community ownership of health issues (Oxfam Australia website, 2009).

World Vision Australia adopts similar approaches to community development in practice. The organisation is focused on improving living conditions of people living third world circumstances. The organisation advocates core principles of community development including working with communities to promote self-sufficient, sustainable development. World vision conducts work in Australia to assist in community development in Indigenous communities with a primary focus on developing long-term community development programs and enhancing future prospects of young Indigenous Australians through training and education programs (How World Vision works, 2007).

Problems associated with the various definitions, such as difficulties concerning feasibility or inconsistencies between the terms of the definitions and actual practice

As can be seen there a various definitions to concepts surrounding community development in public health. A number of authors illustrate the problems which can exist in the theoretical idea of community development and putting the process into practice. The term 'community' alone proves to offer differing meanings to individuals and organisations, often conflicting (Baum 2008; Bryson & Mowbray 1981; Ife & Tesoreiro 2006). Makuwira (n.d) discusses how the term community capacity building can have many discourses and often contradiction in meaning and practice and how this can negatively impact on capacity development of Indigenous communities. The Community development Resource Association (Makuwira n.d, p. 3) poses the question that perhaps a lack of written meaning on the term community capacity building contributes to the poor ability to effectively implement the processes. The House of Representatives Many Ways forward report emphasises that a number of different definitions of community building and community capacity building exists and is recognised to have cause implications in moving forward with community development within Australia.

It should also be noted that difficulties concerning the feasibility of implementing the principles of community development can be observed through the way organisations, both Government and non-Government, work in the NT. It can be noted anecdotally that attempts at community development occur through a centralised support system. Most organisations operate from central locations, such as Alice Springs, Tennant Creek, Katherine, Gove and Darwin, with staff 'visiting' communities to provide support. Yes, this system can work effectively, but it is not implementing principles of community development in their raw intentions. These intentions are to work alongside people to enable them to take control over their lives and to and promote sustainable changes. The support is often temporary providing a bandaid approach which is inconsistent and therefore limits the effectiveness of long term sustainable changes occurring.

Conclusion

Community development is a term which possesses a variety of different definitions with associated concepts and practices. The discourse highlights the conflict which results from the confusion associated with a variety of definitions and practices. Too often, community development practitioners become too engaged in the rhetoric and lose sight of the meaning behind the principles and way of working. As evidenced in this essay, there is a lot of theory on community development practice, however limited evidence of success in developing Indigenous communities. Community development practice needs to focus on consistent methods that do work and how these can be implemented across the board if we are to see improvements in public health and the health outcomes of Indigenous Australians. Ultimately, where community people (who are involved in the community development process) are starting to take control over factors affecting their health, community development in practice is working.


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