We all know it: our friends, colleagues and family make a huge difference to our lives. They can help us in bad times and celebrate in good. They can help us practically, emotionally as well as challenge when needed.
And the evidence confirms and extends what we feel. These face to face social networks have a powerful influence on our resilience, our confidence and our health. In fact, the more social networks we have and the deeper they are, the longer we live and the healthier we stay. These links with others protect our mental health, our cardiac health and can support us towards changing our behaviour, stopping smoking, for instance.
And now, we can also see that a technique called community development (CD) can help communities build connections, networks and thus gain confidence and resilience. In fact, evidence suggests that community development can:
- Help tackle health inequalities
- Help services become responsive to the populations they serve
- Improve community health protection and resilience
Experience over many years shows us that CD is relatively cheap and, used intelligently, has a huge impact on the communities that harness the technique. The Health Empowerment Leverage Project and many other organisations working in the field can show that communities can become health-sustaining. Not only that, they begin to define the issues that matter to them and work together not only to solve them themselves, but many also set up resident-led partnerships. These bring together residents and the statutory agencies who serve their area. We often see police, housing, health, schools in the same room exploring solutions with residents and with each other. They often have never met each other before. Community led partnerships are a great example of how residents and services coproduce and co-plan together in a way that everyone benefits.
Services on tap – not on top
CD is one way of putting into place the kind of participatory democracy that Ed Miliband and Jon Cruddas and Yvette Cooper are talking about in recent speeches. It puts into practice a process of sharing power that enhances the lives of both residents and agencies. This is something that the state should be supporting with the NHS as a key mover.
And yet – the NHS has a long way to go. Which is where the Charter comes in.
The Charter for Community Development in Health
The NHS understands the importance of the social determinants of health but does little about them. Every GP can see how important the background of our patients is to their health, but we can see few ways of influencing those powerful forces. Public health often focuses on dealing with problems in silos: smoking, exercise, teenage pregnancy – rather than starting with the assets of our communities.
And there is little evidence that public services in general and the NHS in particular would be prepared to support participatory democracy and coproduction with residents of solutions to real problems identified by communities themselves.
Although the theory is well understood, the practical responses are often rejected, perhaps because they offer a power-sharing approach, difficult for public services to embrace.