Health Assets in a Global Context (eBook)

Maggie DaviesMaggie Davies is the Principal Advisor on International Health Improvement at the Department of Health, England. She is on secondment from the National Institute of Health and Clinical Excellence (NICE) where she is Associate Director of Development. Maggie is also the lead tutor on the Distance Learning MSc in Health Promotion for the London School of Hygiene and Tropical Medicine. Maggie is President of the Pan-European network Eurohealthnet, which deals with equity and health issues, and is Global Vice President for Conferences for the International Union of Health Promotion and Education.Previously a lecturer in semiotics, Maggie has over 20 years experience of work in the field of public health which has ranged from managing local services to large-scale international projects. This includes work for organisations such as World Health Organization (WHO) and the World Bank.Maggie has also been a volunteer for non-government agencies and has been a Director of the Terrence Higgins Trust and Rape Crisis, Croydon.Maggie has a record of publication in the field and most recently has edited two books for the Oxford University Press on Health Promotion Theory and Practice.Maggie has post graduate qualifications in health management and is a fellow of the Faculty of Public Health.Antony MorganAntony Morgan is an Epidemiologist and is currently an Associate Director at the Centre for Public Health Excellence, National Institute for Health and Clinical Excellence (NICE), England. Originally an applied chemist, Antony later trained in information science and epidemiology and has worked in Public Health in the English NHS for the last 25 years, at district, regional and national level. Antony is a Fellow of the UK Faculty of Public Health and has Honorary Research Appointments at the Universities of Hertfordshire and Edinburgh. At NICE he is currently responsible for producing public health guidance across a range of public health topic areas, including inequalities, community engagement, mental well being and children, and sexual health. Special areas of research interest and expertise include social action for health (using the concept of social capital); assets approaches to health and development (particularly in relation to adolescent health) and new methodologies for building an evidence base on the social determinants of health. Antony is currently the Principal Investigator for England on the World Health Organization (WHO) Health Behaviour in School Aged Children Study.Erio ZiglioDr Erio Ziglio is currently Head of the World Health Organization (WHO) European Office for Investment for Health and Development in Venice. He has worked for over 15 years in the academic world both in Europe and in North America. Between 1978 and 1990, he lectured for the Department of Social Policy at the University of Edinburgh and carried out research at the University’s Research Unit in Health and Behavioural Change. In 1985, he was awarded his PhD at the University of Edinburgh. In North America he was Visiting Professor at the University of Toronto, Department of Community Medicine (1983) and at Carlton University, Department of Social Studies, Ottawa, (1986). Dr Ziglio was also a member of the International Faculty of the School of Public Health at Yale University from 1996 to 2003.Dr Ziglio has lectured internationally and published widely on subjects such as: health promotion; health policy and planning; social determinants of health; health inequities and health and development issues. He held an Honorary Professorship from the University of York, and has been an Honorary Research Fellow at the University of Edinburgh. In the late 1980s he worked for three years as a Public Health Consultant for the European Commission in the early 1990s, joined the WHO Regional Office for Europe in Copenhagen taking on responsibility for Health Promotion and the Investment for Health Programme. Since 2002, Dr Ziglio has headed the WHO European Office for Investment for Health and Development in Venice. During his professional career he has had the opportunity to conduct extensive field work in many countries, including the United Kingdom, USA, Canada, Finland, Slovenia, Hungary, Romania, Czech Republic, Malta, Spain, Portugal, Italy and Brazil. Dr Ziglio’s work has been published and translated into several languages including English, German and Italian.

The Chapters 11
Chapter 1: Revitalising the Public Health Evidence Base: An Asset Model 41
1.1 Introduction 41
1.2 What Are Health Assets? 43
1.3 Developing the Asset Model 44
1.4 Using Salutogenesis to Build an Evidence Base for Health 45
1.5 Assets in Action 47
1.6 Assets and Evaluation 49
1.7 Conclusions 51
References 52
Chapter 2: A Salutogenic Approach to Tackling Health Inequalities 55
2.1 Introduction 55
2.2 Background 56
2.3 The Present: From Modernity to Post-Modernity 56
2.4 The Issue of Health Once Again 57
2.5 An Interdisciplinary Framework to Health? 58
2.6 Welfare as a Prerequisite for Well-Being 59
2.7 Can Learning Be Conducive to Mental Well-Being? 62
2.8 Positive Concepts of Mental Health Within Social Psychology 63
2.9 Methodological Problems in Assessment of Happiness, Well-Being and Quality of Life 66
2.10 The Concept of Resilience 68
2.11 The Salutogenic Framework 70
2.12 Contemporary Evidence on SOC and Especially in Relation to Culture and/or Mental Well-Being, Quality of Life and Healt 72
References 75
Chapter 3: A Theoretical Model of Assets: The Link Between Biology and the Social Structure 78
3.1 Introduction 78
3.2 Vectors of Causation 79
3.2.1 The Population Vector 79
3.2.2 The Societal Vector 80
3.2.3 The Organization Vector 83
3.2.4 Environment Vector 84
3.3 Lifecourse and Lifeworld 84
3.4 Coping in the Lifeworld 86
3.5 Conclusion: Assets to Control the Lifeworld 90
References 92
Chapter 4: Asset Mapping in Communities 96
4.1 Introduction 96
4.2 A Twenty-First Century Map for Healthy Communities and Families 97
References 113
Chapter 5: Assets Based Interventions: Evaluating and Synthesizing Evidence of the Effectiveness of the Assets Based Approach 114
5.1 Introduction 114
5.2 The Assets Based Approach 115
5.3 Implications for Evaluation 121
5.4 Implications for Evidence Synthesis 124
5.4.1 Evaluation vs. Effectiveness1 124
5.4.2 The Realist Critique of Meta-Analytical Systematic Reviews 126
5.4.3 The Realist Critique of Narrative Systematic Reviews 127
5.4.4 The Realist Synthesis Approach 128
5.5 An Example: The Effectiveness of Community Interventions Project 129
5.5.1 Components of the Framework 131
5.5.2 Candidate Mechanisms of the Framework 132
5.5.2.1 Component 1: Collaborative Planning 132
5.5.2.2 Component 2: Community Organization & Action
5.5.2.3 Component 3: Transformational Change 132
5.6 Conclusion 133
References 134
Chapter 6: Resilience as an Asset for Healthy Development 137
6.1 Introduction 137
6.2 Resilience Capability and Freedom 140
6.3 Sources of Resilience and “Healthy Choices” 141
6.4 Diet as a Source of Resilience: the Importance of the Social Context 142
6.5 Deindustrialization: Health Risks and Resilience 144
6.6 Capability and the Production of Well-Being 146
References 149
Chapter 7: How to Assess Resilience: Reflections on a Measurement Model 152
7.1 Mental Health of Children and Adolescents Within the New Morbidity 152
7.1.1 The New Morbidity and Its Consequences for Our Understanding of Health Determinants 152
7.1.2 The Rising Importance of Mental Health Problems in Childhood and Adolescence 153
7.1.3 Beyond Mental Ill-Health: The Importance of Positive Mental Health 155
7.2 Risks, Resources and Resilience: Promoting the Capacity to Cope with Adversity 156
7.2.1 Different Levels of Mental Health Determinants 156
7.2.2 Findings on Risk Factors for Mental Health and Shortcomings of the Risk Approach 157
7.2.3 How to Maintain Health Despite Adverse Conditions: Taking a Look at Resources 158
7.2.4 Resilience: Some Further Conceptual Clarifications 160
7.2.5 Models of Resilience 162
7.3 Identifying Health Assets in Order to Foster Resilience 164
7.3.1 The Potential of Population-Based Studies 164
7.3.2 Measuring Adversity: Risk Factors Assessment 165
7.3.3 Measuring Resources: Protective Factors Assessment 167
7.4 Assets in Socioeconomically Disadvantaged Children: An Example from the BELLA Study 168
7.5 Conclusions 172
References 174
Chapter 8: Measuring Children’s Well-Being: Some Problems and Possibilities 179
8.1 Introduction 179
8.1.1 Summary of UNICEF Report 180
8.1.2 Why Are We Writing This Chapter? 181
8.2 What Is “Well-Being”? 182
8.3 Measuring Well-Being 185
8.3.1 Dimension 1: Material Well-Being 186
8.3.2 Dimension 2: Health and Safety 187
8.3.3 Dimension 3: Educational Well-Being 187
8.3.4 Dimension 4: Family and Peer Relationships 188
8.3.5 Dimension 5: Behaviours and Risks 190
8.3.6 Dimension 6: Subjective Well-Being 190
8.3.7 Discussion of These Dimensions 191
8.3.8 Overall Comments 191
8.4 Rights: The UN Convention on the Rights of the Child 193
8.5 Conclusions 194
References 196
Chapter 9: The Relationship Between Health Assets, Social Capital and Cohesive Communities 200
9.1 Social Cohesion and Health: Theoretical Links to Health 200
9.1.1 Collective Socialization 201
9.1.2 Informal Social Control 202
9.1.3 Collective Efficacy 202
9.2 The Measurement of Social Cohesion 203
9.3 Social Cohesion and Health: Empirical Findings 205
9.4 Is Investing in Social Cohesion a Practical Strategy for Health Promotion? 208
9.5 Conclusions 210
References 210
Chapter 10: Community Empowerment and Health Improvement: The English Experience 214
10.1 Introduction 214
10.2 Community Empowerment, Development and Involvement 215
10.3 Community Empowerment and Health Improvements 217
10.4 Community Engagement in Public Health Policy and Practice 219
10.5 The Challenge of Community Empowerment and Engagement for Health Development 220
10.6 Reviewing Evidence on Good Practice in Community Empowerment, Community Engagementand Community Development an 221
10.7 Evaluative Evidence on Community Engagement/Development 223
References 224
Chapter 11: Strengthening the Assets of Women Living in Disadvantaged Situations: The German Experience 227
11.1 Introduction 227
11.2 The Concept of Movement in a Health Promotion/Health Assets Framework 228
11.2.1 Beyond Sport and Physical Activity 228
11.2.2 Movement and Social Inequality 233
11.2.2.1 Movement: Social Support and Inequality 233
11.2.2.2 Movement: Community Connectedness and Inequality 234
11.2.2.3 Movement: The Built Environment and Inequality 234
11.3 Assets for Movement 234
11.3.1 Individuals as an Asset for Movement 235
11.3.2 Organisations as an Asset for Movement 235
11.3.3 Infrastructures as an Asset for Movement 236
11.4 Assessing Assets for Movement 236
11.4.1 Methodology of Asset Assessment 236
11.4.2 Implementation of Asset Assessment 236
11.4.3 Results of Assets Assessment 238
11.5 Applying Assets for Movement in the Planning Process 240
11.5.1 Methodology of Asset Application 240
11.5.2 Implementation of Asset Application 240
11.5.3 Results of Asset Application 241
11.6 Evaluating the Use of Assets for Movement for the Development of the Interventions 241
11.6.1 Methodology of Evaluation 241
11.6.2 Results of the Evaluation 242
11.7 Conclusions 245
References 246
Chapter 12: Sustainable Community-Based Health and Development Programs in Rural India 250
Box 12.1 Jodhpur 252
12.1 Background 250
12.2 Introduction 250
12.3 Health Inequities in India 254
12.4 Policy Environment 255
12.5 Community-Based Health and Development Programme – Khoj: An Innovation for Further Adoption 257
Box 12.2 Definitions of Key Characteristics Ensuring Community Health and Development 258
Box 12.3 Khoj – A Vision for Progress in Community Health and Development Partnerships 259
12.6 Khoj Initiative – Programme Approach and Outreach 258
12.6.1 Khoj Strategies 258
12.7 Work-in-Progress and Lessons Learned 260
12.8 Khoj Thrust Areas of Work 260
12.9 Health Interventions 261
12.9.1 Women and Health 261
12.9.2 Specific Health Issues 261
12.9.3 Health Promotion 262
12.10 Community Organization 262
12.10.1 Education 263
12.10.2 Community Development 263
12.10.3 Capacity Building 263
12.10.4 Income Generation Programme 264
12.10.5 Formation of Self Help Groups 264
12.10.6 Livestock Improvement 264
12.10.7 Environment 264
12.10.8 Collaboration with the Government 264
12.10.9 Sustainability 265
12.10.10 Monitoring, Reporting and Evaluation 265
12.10.11 Impact and Achievements 266
12.11 Key Learnings 267
12.12 Conclusion 269
12.13 Annex: Success Stories 271
12.13.1 Towards a Culture of Preparedness and Sustainability 271
12.13.1.1 Aparajita Orissa 271
12.13.2 Long Term Development Through Community Participation 275
12.13.2.1 Sambhav Social Service Organisation, Shivpuri, Madhya Pradesh 275
References 277
Chapter 13: The Application and Evaluation of an Assets-Based Model in Latin America and the Caribbean: The Experience wi 279
13.1 Introduction 279
13.2 Background 281
13.3 The Healthy Municipalities, Cities and Communities Movement in LAC 283
Municipal Governments as a Strategic Health Asset: The Experience of a Malaria Prevention and Control Initiative in Central Am 284
13.4 Building the Evidence of the Effectiveness of Interventions that Incorporate an Assets-based Approach in LAC 286
13.5 PAHO’s Evaluation Initiative 286
13.6 The Application of the Participatory Evaluation Guide in LAC 287
The Application of the Participatory Evaluation Methodology to the Tai Chi in the Parks Program, in Miraflores, Peru2 291
13.7 Discussion 293
References 294
Chapter 14: Parents and Communities’ Assets to Control Under-Five Child Malaria in Rural Benin, West Africa 296
14.1 Introduction 296
14.2 International and National Context at the Time of the Study 297
14.2.1 The Heads of State and Government Summit in Abuja on Malaria 297
14.3 The Millennium Development Goals 299
14.4 Approaches Used in Benin to Control Malaria 299
14.5 How to Deal with the Persistence of Malaria? 300
14.6 Intervention (Houéto and Deccache 2008) 301
14.7 Results 303
14.7.1 At the Individual Level 303
14.7.2 At the Community Level 304
14.7.3 Health Data 304
14.8 The Critical Conditions Required to Ensurethe Effective Implementation of Assets Based Policy at a Community Level 305
14.9 New Methodologies for Constructing the Evidence Base on Assets Approaches to Health and Development 306
14.10 Conclusion 309
References 309
Chapter 15: Strengthening Asset Focused Policy Making in Hungary 314
15.1 Introduction 314
15.1.1 Health Policy Environment 314
15.1.2 Main Characteristics of Health Promotion in Hungary 315
15.1.3 The Main Assets of Promoting Health in Hungary 316
15.2 Setting the Scene 316
15.2.1 Background, Main Trends of Economic Development 316
15.2.2 Budgetary Restrictions 317
15.2.3 Facing the Uncertainties of an Economic and Financial Crisis: The Nature of Challenge 317
15.3 The New Hungary Development Plan as an Asset for Promoting Health at Central Government Level 318
15.4 Specific Features of Community Development in Eastern Europe 319
15.5 Integrating Health in Local Development Plans 321
15.5.1 The City Health Promotion Plan of Békéscsaba 321
15.5.2 The Socioeconomic Profile of Békéscsaba 321
15.5.3 Experience in Health Promotion Prior to the City Health Promotion Plan 322
15.5.4 The Development Plan of Békéscsaba: A General Framework 322
15.5.5 Setting up the City Health Promotion Plan 323
15.5.6 Key Objectives of the City Health Promotion Plan 323
15.5.7 Main Assets of the City Health Promotion Plan 324
15.6 Conclusions 326
References 326
Chapter 16: How Forms of Social Capital Can Be an Asset for Promoting Health Equity 328
16.1 Introduction 328
16.2 Types of Social Capital in Relation to Health and Health Equity 329
16.3 Bonding, Bridging and Linking Social Capital 330
16.3.1 Bonding 330
16.3.2 Bridging 332
16.3.3 Linking 333
16.4 Social Capital and Equity 333
Box 16.1 Features associated with more equitable societies likely to promote health 335
16.5 Policies, Forms of Social Capital and the Creation of Health Equity 336
16.6 Linking Social Capital and Policy 337
16.7 Bonding and Bridging Social Capital and Policy 342
16.8 Conclusion 343
References 343
Chapter 17: Internal and External Assets and Romanian Adolescents’ Health: An Evidence-Based Approach to Health Promoting Sc 346
17.1 Introduction 346
17.2 Mapping Internal and External Assets in Romanian Adolescents 347
17.3 Research Methods 350
17.4 Results 351
17.5 Internal and External Assets and AdolescentMental Health 352
17.6 Internal and External Assets and Health Behaviour 354
17.7 The “Asset Promoting School”: Providing a Framework for Policy Development 355
17.8 Conclusions 359
References 359
Chapter 18: Bringing It All Together: The Salutogenic Response to Some of the Most PertinentPublic Health Dilemmas 363
18.1 Introduction 363
18.2 The Theory of Salutogenesis 364
18.3 Asset Mapping 365
18.4 Asset Indicators 370
References 373
ConclusionsAntony Morgan, Maggie Davies, and Erio Ziglio 376