Turning healthcare on its head

Full report – The glass half full

The context for this report is a growing concern over the widening gap in health inequalities across England in 2010. Its publication is timely, just six weeks after Fair Society, Healthy Lives – The Marmot Review. One of the Review’s key messages on challenging health inequalities is that “Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities”. The asset approach provides an ideal way for councils and their partners to respond to this challenge.

The emphasis of community-based working has been changing. Among other aims, asset based working promotes well-being by building social capital, promoting face-to-face community networks, encouraging civic participation and citizen power. High levels of social capital are correlated with positive health outcomes, well-being and resilience.

Local government and health services face cuts in funding. Demographic and social changes such as an ageing population and unemployment mean that more people are going to be in need of help and support. New ways of working will be needed if inequalities in health and wellbeing are not to get worse.

The first part of this publication aims to make the case that as well as having needs and problems, our most marginalised communities also have social, cultural and material assets. Identifying and mobilizing these can help them overcome the health challenges they face. A growing body of evidence shows that when practitioners begin with a focus on what communities have (their assets) as opposed to what they  don’t have (their needs) a community’s efficacy in addressing its own needs increases, as does its capacity to lever in external support. It provides healthy community practitioners with a fresh perspective on building bridges with socially excluded people and marginalised groups.

The second part of this publication offers practitioners and politicians, who want to apply the principles of community driven development as a means to challenge health inequalities, a set of coherent and structured technique for putting asset principles and values into practice. These will help practitioners and activists build the agency of communities and ensure that an unhealthy dependency and widening inequalities are not the unintended legacy of development programmes.

• The asset approach values the capacity, skills, knowledge, connections and potential in a community. In an asset approach, the glass is half-full rather than half-empty.
• The more familiar ‘deficit’ approach focuses on the problems, needs and deficiencies in a community. It designs services to fill the gaps and fix the problems. As a result, a community can feel disempowered and dependent; people can become passive recipients of expensive services rather than active agents in their own and their families’ lives.
• Fundamentally, the shift from using a deficit-based  approach to an asset-based one requires a change in attitudes and values.
• Professional staff and councillors have to be willing to share power; instead of doing things for people, they have to help a community to do things for itself.
• Working in this way is community-led, long-term and open ended. A mobilised and empowered community will not necessarily choose to act on the same issues that health services or councils see as the priorities.
• Place-based partnership working takes on added importance with the asset approach. Silos and agency boundaries get in the way of people-centred outcomes and community building.
• The asset approach does not replace investment in improving services or tackling the structural causes of health inequality. The aim is to achieve a better balance between service delivery and community building.
• One of the key challenges for places and organizations that are using an asset approach is to develop a basis for commissioning that supports community development and community building – not just how activities are commissioned but what activities are commissioned.
• The values and principles of asset working are clearly replicable. Leadership and knowledge transfer are key to embedding these ideas in the mainstream of public services.
• Specific local solutions that come out of this approach may not be transferable without change. They rely on community knowledge, engagement and  commitment which are rooted in very specific local circumstances..