31
Community development
The National Occupational Standards in Community Development Work (2009) (available online at: https://www.fcdl.org.uk/learning-qualifications/archive/
community-development-national-occupational-standards-2009/) state that Community development is a long-term value based process which aims to address imbalances in power and bring about change founded on social justice, equality and inclusion.
In doing so it promotes participation and partnership working that facilitate people to
•
Identify their own needs and aspirations•
Take action to exert influence on the decisions that affect their lives•
Improve the quality of their own lives, the communities in which they live and societies of which they are a partPotter and Will (2013) identified that community development projects aim to involve vulnerable and socially excluded people in decision-making processes. In other words, it aims to promote and foster empowerment at both individual and community levels, however, projects and goals are often determined by health or political agendas as well as evidence.
Assessing population need
There are three main approaches to needs assessment in public health, characterised as epidemiological, comparative and corporate. See Box 2.3.
Stevens and Raftery (1994), recognising the limitations of each of the three ap - proaches above, developed the pragmatic approach to needs assessment. This process combines all of the above approaches, drawing upon evidence from a variety of sources.
Identifying individual and public health needs through the use of assessment and assessment tools affords nurses the opportunity to promote health and well-being in the communities within which they work at individual and local levels, with more advanced community nurses informing at local and national levels.
Class 3: Intermediate Occupations, e.g. Secretaries, Clerks
Class 4: Small Employers and Own Account Workers, e.g. Publicans, Playgroup Leaders, Farmers, Taxi Drivers
Class 5: Lower Supervisory and Technical Occupations, e.g. Printers, Plumbers, Butchers, Train Drivers
Class 6: Semi-Routine Occupations, e.g. Shop Assistants, Traffic Wardens, Hairdressers
Class 7: Routine Occupations, e.g. Waiters, Road Sweepers, Cleaners, Couriers
Class 8: Never Worked and Long-Term Unemployed Office for National Statistics
33
Influencing Factors
In recent years, there has been an increased fusion between health and social care services. Generally systematic methods of identifying the health and healthcare needs of an individual or population and making recommendations for changes to meet these needs is carried out by both agencies using a tool or model that provides practitioners with a framework for undertaking this complex and important needs assessment in a structured way (Public Health England, 2013).
People, through the influence of social determinants, have measurable differences in their health status. All too often this is compounded by inequitable access to healthcare. Disadvantaged individuals and groups, despite having the greatest overall need, are the least likely to access services (Levesque, 2013). However, it is important that service delivery reaches these groups as it is generally viewed that a need, if met, will result in an improvement in people’s health (Haughey, 2008);
however, what constitutes need is widely contested. Needs are variable; they can be objective and measurable, obvious or hidden. Conversely, they too are subjective, personal and interchangeable according to context (Cowley, 2008a). Taxonomies of need exist, for example, Bradshaw (1972), as also discussed in Chapter 7, and are essential to improve and protect health and well-being as a result of meeting the public health agenda. From your reading and practice experience, you will have a good understanding of the importance of holistic health needs assessment in your role as a community practitioner and understand that to attain an accurate health
Box 2.3 Approaches to Public Health Assessment
Epidemiological The word ‘epidemiology’ means ‘studies upon the population’
(Fine, 2015). Epidemiological trends are studied and recorded and used as key drivers of change in public health and health service provision. Trends can be identified, policy influenced and services adjusted to meet future demands. An epidemiological approach to needs assessment, proposed by Williams and Wright (1998), combines the three elements of identifying health status through incidence/prevalence data, effectiveness and cost-effectiveness of interventions and the current level of service provision. The benefit of this approach is that its systematic and objective method quickly identifies specific problems; however, it can assume standardised prevalence and focus upon medical rather than social need (Haughey, 2008).
Comparative A comparative approach can be used cross-nationally and locally and compares levels of service provision between these localities, for example, the service provision in one town compared with another of similar demography. Thus, it is often used to provide a timely and inexpensive assessment.
Corporate. A corporate approach considers making the needs assessment responsive to local concerns. This approach collects the knowledge and views of the stakeholders of the issues being addressed in the needs assessment. The stakeholders can be a collective of practitioners, in both primary and secondary care settings, health and social care service managers, commissioners of services, experts in the field and service users.
needs assessment of a case, assessment might have to be carried out at different levels from the individual, to the family/group and the community in which the individual lives, depending on the purpose.