Dr Ann Hemingway
EACS MEMBER
Public Health Lead for Research and Enterprise
Centre for Practice Development
Centre for Wellbeing and Quality of Life
Bournemouth University
Sept 2010
www.bournemouth.ac.uk
Articulating humanisation
for public health research
and practice
Why are humanising
principles valuable for public health?
Valuing the individual
Valuing the community
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This paper will focus on community
development to reduce inequities in health as a
key public health research and policy focus
and will critique it in relation to the
humanising value framework for research
proposed by Todres, Galvin & Holloway
(2009).
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Background
When we study communities we tend to record and
describe `needs` or `problems` (health needs
assessment) and calculate risks (epidemiology). This has
created a research and practice focus on labelling and
`problematising`.
Public health research is poor at coming up with
solutions for all these `needs` and `problems` (for
instance, poverty, high crime rates, joblessness, high
rates of teenage pregnancy, high levels of obesity, high
levels of chronic disease, poor educational attainment,
vandalism etc) although we are excellent at describing
them (Marmot 2010, Hunter 2005, Nutbeam 1999).
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There is a tendency in public health research
and practice to drift to a medical model for
answers and think of interventions and
measuring effects with little thought given to
studying action (Hunter 2005) with its roots in
local communities. Indeed by its very nature it is
hard to `measure` an intervention accurately in
several communities and compare them
because they are `unique` with unique assets
and contexts within which people live.
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This tension has resulted in the
valuing of qualitative research within
public health policy and practice to a
degree although overall `guidance` for
practice in the UK has its roots in the
National Institute for Health and
Clinical Excellence which is
dominated by evidence derived from
Randomised Controlled Trials.
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A key concept for this paper
From Clients to Citizens: Asset-Based
Community Development as a strategy for
community-driven development
(Kretzmann & McKnight 1999)
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An Overview of Asset Based
Community Development
Based on extensive enquiry into successful
community initiatives in the U.S. ABCD is articulated
as a way of counteracting the predominant needs
based approach to development (Kretzmann &
McKnight 1999). In the needs based approach the
well intentioned efforts of organisations have
generated needs surveys, analysed problems and
identified solutions to meet needs. In the process
however they have presented a one sided negative
view of communities rather than contributed to
capacity building.
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This paper will consider how this `cup always
half empty` process mirrors the way that
individual patients in health care are labelled
as a disorder or list of needs and their
individual humanity and strengths are lost in
the process.
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In the initial phases of ABCD the approach to
mobilising communities has much in common with
appreciative enquiry which is a process that promotes
positive change by focussing on the successes of the
past. It relies on interviews and stories to collect these
positive memories and on a collective analysis of the
elements of success. Communities that have been
defined by their problems internalise this negativity,
research demonstrates extensively that children`s
performance is shaped by teachers and parents
expectations more than it is by their own innate
ability (World Bank).
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Consider the dimensions of humanisation
(Todres Galvin & Holloway 2009) in
relation to public health research and
ABCD
Insiderness/objectification
Agency/passivity
Uniqueness/homogenization
Togetherness/isolation
Sense making/loss of meaning
Personal journey/loss of personal journey
Sense of place/dislocation
Embodiment/reductionist view of the body
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However, the consideration of these elements
will be undertaken in this presentation with a
focus on action, actions that we can research
and take in practice in order to have a positive
impact on inequalities in health.
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Consider a personal and community
policy based perspective on
humanisation
Agency/Passivity
A persons or communities ability to take
action is a strength, how do we influence it?
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Uniqueness/homogenisation
How can we promote wellbeing for unique
people in the context of their local community?
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Togetherness/Isolation
Does that person have any support, how can we
maximise it? How does the local community
provide support for those living there how can
we maximise it?
Arguably by treating relationships as assets,
ABCD is a practical application of the concept
of social capital (Puttnam)
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Sense making/loss of meaning
How do we help to make sense of an issue for
an individual or community?
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Personal journey/loss of personal journey
This manifests itself in an excessive emphasis
on how the community is (poor, jobless, beset
with needs and problems) rather than who they
are, what are their individual and group assets?
How can we help grow these?
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Sense of place/dislocation
This is relevant for displaced groups or
individuals for instance refugees or the
homeless but also resonates in relation to
how wellbeing cannot be separated from the
`atmosphere` created by the built environment
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Embodiment/reductionist views
How can we view well being as a positive
thing to plan for and not just the absence of
illness?
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Insiderness/objectification
How can we build self and community esteem
and not destroy it with labels and judgements
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Do Methods which focus on
humanisation and community assets
give us a possible way forward to
guide public health research and
practice?
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References
Hunter D. & Griffiths S. 2007 New Perspectives in Public Health. Radcliffe
Publishing Oxon
Kretzmann J. & McKnight J. 1999 Leading by Stepping Back: A Guide for
City Officials on Building Neighbourhood Capacity. Chicago, IL: ACTA
Publications
Marmot M. 2010 Fair Society Healthy Lives: The Marmot Review. London:
The Marmot Review
Nutbeam D. (1999) Theory in a Nutshell: A Guide to Health Promotion
Theory. Australia: McGraw Hill
Todres L., Galvin K. & Holloway I. 2009 The humanization of healthcare:
A value framework for qualitative research. International Journal of
Qualitative Studies on Health and Well-being. 1-10 iFirst article
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Dr Ann Hemingway
Public Health Lead for Research and Enterprise
Centre for Practice Development and
Centre for Wellbeing and Quality of Life
[email protected]
01202 962796
www.bournemouth.ac.uk