Читать книгу For the Love of Community Engagement - Becky Hirst - Страница 7

The ear’s hearing something is not as good as the eye’s seeing it; the eye’s seeing it is not as good as the foot’s treading upon it; the foot’s treading upon it is not as good as the hands differentiating it.

― Chinese proverb⁸

After an incredibly enriching and motivating 12 months at the Matson Neighbourhood Project, I was looking for my next challenge. Not that opportunities did not continue in Matson (and the funding for my position was secure). It was time for me to move on. The day that I realised that I needed to leave was my first glimmer of my love for moving from project to project… I discovered something about my true nature: I never sit still for long.

And luck was with me. I found a new role within the local health promotion department as their Food & Health Projects Officer. I surprised myself and others, as I won this job over a qualified nutritionist. On paper, they appeared much more suited to preaching the do’s and don’ts of dietary requirements to the people of Gloucestershire. However, as with many things in the early 2000s, approaches to health promotion were changing. And fast!

I got the job because of my experiences in Matson. They were looking for someone who knew how to work together with people in finding health solutions, as opposed to expert-led solutions. That leads me to a story about soap. Back in the 1930s, if a public health message was that mothers needed to wash their children to prevent all sorts of doom and gloom and spread of various diseases, the health promotion people would simply deliver bars of soap to each household. That might seem like a very practical approach, but it had little educational value.

I imagined that nobody would have thought about whether mothers knew when to use the soap, how to use it properly, why soap was important for the health of their community, or what would happen when soap ran out. I also wondered who was going to pay for the ongoing use of the soap. Could the families even afford the soap? Nobody appeared to have considered the socio-economic circumstances of the family or household receiving the soap, or the effectiveness of these ‘paternalistic’ behaviour-change campaigns.

I began work in that department while their big yellow health promotion bus was travelling around communities across Gloucestershire providing all kinds of messages about health. There was so much to do. So, they’d progressed from giving out soap. Now health promotion was all about pamphlets and models of digestive tracts. But it was not working: this top-down, information-heavy approach to behaviour change. I found what seemed to be an assumption that if you gave someone the information on how to eat a healthy diet, they would embrace it. As anyone who’s ever attempted a healthier lifestyle knows, that isn’t necessarily the case!

So, as a young practitioner, I received the most amazing opportunity to apply a different lens to the age-old information-giving approach to health promotion. That approach focussed on the community at the centre of processes and initiatives to improve health.

My hometown of Gloucester is a relatively diverse city, with areas such as Barton Street (where I have many happy childhood memories of performing with my dance school at the local theatre) and Tredworth, said to be home for 45 different ethnic communities, with as many as 50 languages. I became involved in nutrition and health-promotion activities. And one of my projects aimed to improve the nutrition of the South Asian community. Statistics showed significant health inequalities, particularly around mortality and morbidity, compared to the broader population. Research also confirmed a range of likely influences on nutrition, including community and cultural norms, household income, as well as the availability and affordability of food, and more.

Pulling up in Barton Street in our big yellow bus was simply not going to work. Expert information-giving would backfire. So we searched for a more ‘bottom-up’ approach, flipping previous expert-led models of health promotion on their heads. We needed culturally sensitive interventions that would build on positive food practices and adopt both family-centred and community-centred approaches. My work began with a simple conversation with the right people. Simple as it seems, this time-honoured approach almost always works.

It’s important to note here that those ‘right people’ were not the local Council or the nutritionists. Further, as you can imagine, that conversation most certainly did not take place inside the big yellow bus! The conversation occurred when I contacted the Roshni Asian Women’s Centre, located in the heart of Barton Street. The Centre, which opened in 1995, was a place for women to meet and interact in a safe environment. Before that, the women met in their own homes.

I knew nobody at the Centre, but I didn’t think twice about contacting them, as it seemed the most natural place to start. We needed a way to connect with this specific community about food and nutrition issues. I often laugh that decades later in my community engagement training and workshops, I emphasise the importance of contacting relevant community organisations. It makes such good sense. Participants always nod and take notes, embracing the concept like it’s rocket science.

The staff member at the Centre welcomed me warmly and we chatted about the Centre, the women who regularly attended, and the community as a whole. We were comfortable with each other so we discussed the various possibilities before we agreed that she would discuss with the women the potential for food-related programs to be part of the Centre’s programs.

Before long, we were running a series of cookery classes, led by a well-known local Asian cookbook author. However, these classes were not simply about teaching women how to cook. They were a forum where participants could share recipe ideas and discuss where they shop, how they budget and so on. We easily introduced a shared, peer-to-peer learning experience in a safe and familiar location. Our targeted approach was a far cry from the top-down ‘I’m the expert, listen to me tell you what to do’ methodology. Here, again, as can be seen in the news coverage in the image overleaf, I learned about the importance of involving people in decision making and problem solving about issues that affect them at a household level.

Image 5 - Media coverage of the work undertaken in partnership with the Roshni Asian Women’s Centre, Gloucester Citizen, 25 October 2001.

Of course, there is a role for traditional engagement approaches. And I had my share of them in that job. Sometimes I felt out of my depth, such as when I was delivering nutrition training to a team of NHS Direct call centre nurses. I was so nervous, young, and unqualified. One man was kind enough to give me feedback that I said ‘OK’ too many times. What the?! Maybe it was my discomfort showing. Or maybe he was just being a moron.

My bosses in the health promotion centre knew I was totally new to health promotion, let alone food and nutrition. They offered to support me through a Graduate Diploma in Health Education Promotion at the University of Gloucestershire. What a wonderful opportunity for a young woman who had been thrown in at the deep end. A day per week from my work life to hang out at the local university and be paid… super indulgent! I made the most of it.

Three significant pieces of learning during that Graduate Diploma year matured my perspectives about community engagement (at the time and ever since). While we had a huge reading list and a diverse range of essays and projects, all three lessons came from the same textbook (that still sits on my desk today: Health Promotion - Foundations for Practice⁹).

Lesson One was about models and approaches to health promotion. Beattie’s structural analysis of the repertoire of health promotion approaches was the first time I had encountered the various approaches (authoritarian, ‘top-down’ and expert-led), as opposed to negotiation, ‘bottom-up’ and valuing individual autonomy. Beattie’s model (page 106) explained differences in persuasion interventions aimed at individuals but led by experts, compared to legislative interventions led by experts but intended to protect whole communities. I also learned about personal counselling type interventions (client-led and focused on personal development), with the expert being more of a facilitator. Finally, I learned about the community development approach, which seeks to empower or enhance the skills of a group or local community, helping them to recognise what they have in common and to take action together.

I particularly loved that Beattie’s analysis included references to the political ideologies of each of these approaches, from conservatism to reformist, to libertarian, humanist to radical ideology. In my mind, I summarised parts of this model quite simply as the left versus right on a political spectrum, with left equalling collective action and the right being a more individualistic in approach.

I was so open to these concepts at this point in my educational and professional journey. I greatly valued opportunities to explore theoretical concepts of interventions within a health promotion paradigm. I began to connect the dots about my love for community. I remembered that in my early years, New Labour told me that things could only get better. It was all starting to come together and make sense.

Of course, my studies were about approaches of health promotion. However, those approaches equally apply to community engagement.

While I was reading about different political approaches to health promotion, I was aware of my own political leanings. I’ve always found myself very much in the centre of the political spectrum. Perhaps this is because I spent years being an independent facilitator or advocate. Or perhaps I’ve always been conscious that my client, the government, could change in an instant at any election and my business always needed to be ready to adapt to suit the policies of the current term. Or perhaps it is that my Dad’s parents were traditional working-class conservative ‘Tory’ supporters, and my Mum’s parents were socialist Labour party supporters. Or maybe I just want to be liked by everybody.

Then again, maybe it’s that I’ve always had fairly centralist view of the world. Whatever the reason, I believe it’s important to consider that community engagement is not about political persuasion. Left or right doesn’t matter as much as whether we are authentic and principled in the work we do.

These days, governments cannot decide whether or not they engage communities. Twenty-first century communities ask to be involved. At times, they demand it. They want governments to be representative of them and their needs and to listen to what they are saying. In recent years working with both left-wing and right-wing governments (and the left, right and central factions within them), I notice that engagement methodologies remain pretty much the same.

In the same Naidoo and Wills book, I discovered Dahlgren and Whitehead’s Determinants of Health model (1991). That was my second huge revelation. The model explained, layer by layer, the influences on an individual’s health. Starting at a very individual level, the authors explained that the first layers of influence are our age, gender, and other hereditary factors. These are closely followed by lifestyle factors, such as levels of support and influence within communities which can sustain or damage health. The next layer is about a person’s living and working conditions, as well as their access to facilities and services. And the final layer notes the importance of general socio-economic, cultural, and environmental conditions.

This model referred specifically to layers of influence on a person’s health. However, for the young Becky, it opened me to a depth of understanding of the concept of ‘community’ that I’d never considered. It communicated that a person doesn’t simply live in a community. There are so many layers to that person’s interactions with that community, whether the layers are of local or global significance.

These days, I use this model to help me consider which layer a particular community project or initiative is addressing. For example, a group of volunteers who meet to plant trees in their neighbourhood once a month may be addressing both the layer regarding their living and working conditions (providing more greenery, better shade). Equally, they may be addressing broader environmental conditions (such as tackling climate change). They are also, of course, individually working on their own lifestyle factors (being active, meeting new people) and building social and community networks.

These layers fascinated me so much that in 2013, I developed my own version of this model. I’d been working intensively across South Australia with several different government clients on a range of different topics. And one of the joys of being a community engagement specialist is that you get to hear a lot of interesting stuff!

What I heard, particularly from people in metropolitan Adelaide, was repetitious. It didn’t matter whether my client was the health department asking me to seek contributions for a new policy, or a Council asking me to engage with people to design a new garden as part of the Adelaide parklands, or the Premier’s Department working on a new Strategic Plan for the entire State, people were telling me things that were deeply interlinked. Locating the common themes within a model based on the layers within Dahlgren and Whitehead’s Determinants of Health provided an ideal platform for my analysis and I put together the ‘Healthy Communities’ graphic below in Image 6.

Image 6 – Healthy Communities – A collection of common themes that I was hearing people tell me as their visions for community through my work on a range of initiatives, based on Dahlgren & Whitehead’s Determinants of Health model. Hirst, B. 2013.

Now, in 2021, I experience much joy (and equally much frustration) when I consider that these same matters are still being discussed by people in metropolitan Adelaide today. I bet this applies to the whole of the world. We have been talking about these issues for a long time.

The third and final big concept that inspired me during my Graduate Diploma studies was Maslow’s famous Hierarchy of Needs. When I studied Maslow’s model, it had not been the subject of as much scrutiny as it is today. I learned the basics and they really affected how I looked at my work – and my life. Maslow’s original Hierarchy of Needs built on my understanding and values that a person cannot reach their full potential if their basic needs are not met.

We cannot achieve self-esteem if we lack a feeling of belonging. We cannot feel like we belong without having our safety needs met. And before we have our safety needs meet, we need our basic physiological needs met. I’ve since learned that Maslow’s Hierarchy has been critiqued over the decades. And with good cause. I have a close friend who lost his livelihood and home in the last few years. Yet he still holds the ability to seek out deep learning, understanding, and self-awareness; often regularly helping others by way of a higher state of transcendence. This experience reminds me that the hierarchy is not necessarily as straightforward (or constraining) as it seems.

The model has also evolved over time to include cognitive, aesthetic, and transcendent needs, as shown in image 7.¹⁰ Not only did Maslow’s model further enrich my deep understanding, as did other models, providing a much deeper understanding of individuals and community, but it also reminded me of another of my passions in the world of community engagement… the basic need of a sense of belonging.

As with my fascination with a real-life game of Sim City and the relationships among everyone living in communities of place, in her book Belonging,¹¹ Toko-pa Turner notes that, as humans, we are remembering how to be an ecosystem. She suggests that we must look after each other, reconstituting the world through many small contributions, collaborations, and general sense of togetherness.

Image 7 - Maslow’s Extended Hierarchy of Needs further inspired by understanding of people and community, triggering my interest in a sense of belonging being a basic human need. McLeod, S. 2020.

I believe that good community engagement not only contributes to considered decision-making (that in turn leads to thriving communities), but also when community engagement is done well, it can build a strong sense of belonging. Maslow’s model confirms as it was for me that feeling like you belong somewhere isn’t just a ‘nice-to-have’ feeling, but a critical need for our overall well-being as individuals.

Health promotion was good for me and I was good for it. I loved the food and health-related community projects. Working across the county of Gloucestershire meant traveling between meetings in the depths of the Forest of Dean with school principals to support establishment of breakfast clubs, to visiting the urban suburbs of Gloucester to work with Neighbourhood Projects setting up food cooperatives so local people could bulk buy staple food items. I loved my work establishing the Gloucestershire Food in Schools group, a multi-disciplinary collective of professionals who met regularly to work on healthy eating initiatives in schools. Membership ranged from school nurses to principals, to qualified nutritionists and local GPs. There I learned about the importance of people meeting regularly together to tackle a community issue.

I also participated in a fantastic multi-disciplinary team of health promotion specialists, learning about initiatives to reduce high teenage pregnancy rates, to programs about reducing sexually transmitted diseases. I was grateful to witness the exciting smoking cessation movement of fully trained Stop Smoking Advisors at the time being available to the public at no cost.

This era also provided an anchor for me in a rapidly changing world. By 2001, we had computers on our desks and had joined the twenty-first century! I revelled in being allowed to choose the colour of my office walls. I felt like a very modern professional. The joy of having my very own computer in my brightly painted office was tragically eclipsed by witnessing via my newly installed Internet, the collapse of the Twin Towers at the World Trade Centre in New York, on 11 September 2001.

That was the first I’d heard of Al-Qaeda. Sadly, it would not be the last. For our global community, that was a defining moment for me, as a young professional. Together, the global community witnessed an outpouring of love, support and camaraderie for America and beyond.

Conversation Starters

 WHO could you be having a conversation with about something important: a person you haven’t yet had a conversation with?

 WHAT fascinates you about communities? Is it the people? The infrastructure? The environment? Health needs? Housing? Or the whole ecosystem?

 WHY is it important to put communities at the centre of everything we do? How can we do this better?

 WHEN have you witnessed a community or communities demanding to be heard?

 WHERE do you sit on the political spectrum? How does this affect your perception of communities and/or community engagement?