New ways of thinking about communities – the driving force for radical change and positive health outcomes

Janet Muir recently contributed to the Health and Social Care Alliance’s publication ‘Scotland – small country, big ideas, Imagining the future…..’ The publication features the thoughts of many senior managers in the community and third sector and Janet highlights her vision for community-led health.

You can download the full edition here.

Let me fast forward to a Scotland that has banished its decades of poverty and inequality and has a vision and practice of social policy embedded in a commitment to social justice. That vision demands that our health services and our sense of wellbeing are shaped and determined through the direct engagement of, and with, our communities at national and local levels.

Community members and groups are being supported and empowered to influence decision making at all levels and articulate the health benefits brought to them personally and the wider community.

While retaining the critical role in the delivery of essential medical services, health practitioners are working jointly with community and voluntary organisations to plan and deliver services responsive to expressed need. This is bringing radical change to the landscape of approaches to local health needs together with the resource allocation necessary to support and capitalise on a community-led approach.

Not mission impossible, but this vision is not without challenge

The economic and structural change required to eradicate poverty and reduce health inequalities can be found in political and academic analysis elsewhere. 2 My focus is on building healthy communities with local people who are in control of their lives and living circumstances, who are treated as equals by others, who manage things in ways that avoid stress or dependency, enjoy networks of support and mutual interest with others, have confidence and skills to engage as equal partners with service providers and who have expertise to bring creativity and inspiration to joint solutions for improving health. 3

The last three decades in community-led health work have demonstrated important insights and produced evidence of the nature and extent to which communities’ involvement can positively influence health outcomes. 4

But current evidence highlights a type of postcode lottery in levels of commitment to, and understanding of, this approach, and of coherent strategic thinking. There is too much dependency on champions to advocate the case for community led health and for those advocates too often to be on the periphery of influence and decision making processes. We seem to have limited success in passing on the lessons learned from good practice and being able to scale up that practice. 5

This situation can be turned round with a political will and a coherent strategy that ensures community-led health plays its full part in preventing ill health as well as building local strengths that lead to healthier and more prosperous communities.

What can we do to achieve our vision? Here are my top tips for practical action at a local level that I believe will lead to lasting change:

  • Invest in processes that help us gain a clear understanding of community needs and issues.
  • Develop the evidence and knowledge that a community-led approach is contributing to good health and wellbeing.
  • Build confidence and skills e.g. organisational, alliance building and negotiating that unleash community assets that in turn lead to a healthier community, thereby decreasing gaps in health inequalities.
  • Invest in building a culture of collaboration and participation leading to sustainable change.
  • Implement tried and tested, effective and inclusive methods for working with communities.
  • Work with people in empowering ways, which will lead to positive change for them, their families and the wider community.
  • Devise and implement processes robust enough to effectively share learning and scale up good practice.

The vision is achievable and within a timescale that is immediate rather than long-term. The above actions can help create an environment that not only prevents people becoming ill, but improves their quality of life and leads to better health outcomes for all. Working in this way with communities is only one part of the range of measures needed to tackle health inequalities, but it will be critical in turning today’s vision into tomorrow’s reality.


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