Participative and collaborative approaches to support local public health action

Stephen Peckham Principal Lecturer in Social Policy and Dr Margaret Godel Research Fellow

Department of Sociology and Social Policy Oxford Brookes University

Presented at our Health Inequalities Conference 2003

The face of primary care in the UK is changing. Primary Care Organisations and Primary Care Act Pilot Projects are at the centre of primary care development in the UK. These organisation are providing new opportunities for examining the role and structure of primary care, and have a central role in implementing current health care policy. As well as commissioning and service provision roles, primary care organisations now have a significant public health role and are expected to take the lead to improve the health of their local populations (Department of Health 2000).

Since 1974 responsibility for public health has been split between the environmental health function of local authorities and Health Authorities which identify health need, commission health care services, and monitor notifiable diseases. Development of these roles over the past 25 years has been largely uncoordinated despite initiatives such as Health for All, the Healthy City movement, and Agenda 21. Current policy calls for greater co-ordination of strategy and action between health and local authorities, and gives primary care organisations (PCOs) specific public health responsibilities emphasising local, community based developments such as Health Living Centres, Health Actions Zones, Health Parks, and community based regeneration projects. These public health activities require that traditionally separate statutory organisations, including primary care, work jointly with each other, with other organisations, both private and voluntary, and with the individuals and groups comprising local communities.

This change in the way the health of the public is addressed requires a wider understanding of ‘public health’ ? one that encompasses the circumstances and social reality of people’s lives, and their perceptions and experiences of these as factors that contribute to their illness and their health. To date, however, little attention has been paid either to the public health role of PCOs (LeGrand, Mays and A 1998; Mays, Goodwin, Killoran et al. 1998) or to the role of communities in determining public health strategy and action (Chief Medical Officer 1997; Department of Health 1998).

A research team based at Oxford Brookes University will be exploring these issues over the next 2 to 3 years. The aim is to understand the issues and the realities of the relationships between PCOs and the communities they serve, in the context of national and local health and social policies. The research will also examine the way differing lay and professional perceptions of public health inform local public health action.

The project, funded by the National Lottery Charities Board, is a joint venture between the UKPHA, Oxford Brookes University and the University of the West of England. It builds on earlier work undertaken by members of the current project team. The Public Health Model of Primary Care (Taylor et al., 1998, Peckham et al, 1998) describes the overlap between Primary Health Care, Public Health Action and the Health Action of Communities, and highlights the importance of equity, collaboration and participation in action to improve the health of local communities.

This research found that participative approaches provided a helpful framework for including the different groups that exist in any one geographical location, and were more likely to achieve long term beneficial health outcomes. Importantly, a focus on participative community based health activity increased the likelihood that marginalised groups would become involved.

In the three years since these findings emerged there has been a greater understanding of health inequalities, and a recognition that social deprivation and social exclusion need to be tackled if better health for all is to be achieved. The causes of social deprivation and social exclusion, are multi-facetted, however, and, as a result, health policy now focuses on the need for partnership and collaborative working between health agencies, other statutory organisations and community based voluntary organisations. Policy also addresses the need to improve public health by increasing user and public involvement in decisions and action to reduce inequalities and promote social inclusion.

Although, the government is reluctant to dictate how partnerships tackling these complex issues should work in practice, performance against centrally determined criteria and targets will affect future funding. Traditional ways of demonstrating effectiveness, however, may not suite community based projects and may even be a barrier to effective joint working (Taylor et al 1998).

Against this demanding policy context, this new research will involve individuals, community groups, and organisations located in nine PCO areas, in a variety of mutually informative activities. Each case study will explore how organisations and individuals interface and interact over public health issues and activity. In particular, the team will focus on five key areas:

  • the relationship between community, or lay, understandings and professional approaches to public health, and the extent to which these perspectives can be reconciled,
  • the role of PCOs and primary care professionals in promoting community participation aimed at influencing public health strategy and action,
  • identify different models of community influence on the public health strategies actions of PCOs,
  • examine how well these different models fit with national and local government initiatives designed to address health and social issues,
  • the education, training and support needs of professionals, community organisations, and individuals involved in public health activity

While the research will be primarily focusing on work within the three case study areas we are interested in other activity and research on public health and primary care which adopts or involves a community perspective. If you would like to know more about the project or have information to share with the project team please contact the authors.

References:

Chief Medical Officer (1997). Strengthening the Public Health Function. London: HMSO.

Department of Health (1998). Our Healthier Nation. London: HMSO.

Department of Health (2000). The NHS Plan. London: HMSO.

LeGrand, J., N. Mays and M. J. A, Eds. (1998). Learning from the NHS Internal Market: A review of evidence. London: King’s Fund Publishing.

Mays, N., N. Goodwin, A. Killoran, et al. (1998). Total Purchasing: A step towards Primary Care Groups. London: King’s Fund Publishing.

Peckham S, Taylor P, Turton P (1998) ‘An unhealthy focus on illness’ Health Matters 33, 8-10.

Taylor, P., S. Peckham and P. Turton (1998). A public health model of primary care: from concept to reality. Birmingham: Public Health Alliance.

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