Dr Ann Hemingway

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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

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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 childrens
  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
• ahemingway_at_bournemouth.ac.uk
• 01202 962796