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Health-Oriented Community Work

Waldemar Süß, Alf Trojan

(last update 01 March 2015)


At its core, community work should be seen as a method and working principle of social work. Whereas it was originally defined as a third method of social work alongside social work with individuals and social group work, the dominant understanding of community work today is as a working principle, i.e. a basic orientation, a perspective and an approach to social problems in a smaller socio-spatial area, the neighborhood, the district, the municipality or a particular ‘milieu’. The fundamental principles of community work are local orientation, co-ordination and networking, tapping into the resources in a living environment, mobilizing self-help, participation, activating affected individuals, communicating between macro and micro-levels, as well as interventions designed to empower and activate.

Community work as a working principle is traditionally applied

  • especially in particular problem areas, such as homeless shelters, new and rundown estates, disadvantaged neighborhoods, neighborhoods with a particular need for development etc.
  • in work with children, young people and old people as well as in drug work and other areas of social work
  • in areas of action outside of the traditional areas of social work, such as school, adult education and healthcare, as well as health promotion.

The community work relating to this last-named area can be characterized as health-related community work. In addition, the aforementioned basic principles can also be taken as crucial working principles for health promotion in the broad sense of the WHO definition.

Historically speaking, community work goes back to settlement work that started in England in the mid-nineteenth century and took hold in Germany with the economic boom of the industrial age and the increasing impoverishment of workers. Even in those days the starting point was that not just housing and education were completely inadequate for this class; so too was healthcare. The goal was to liberate the needy from material privation through education, organization, neighborhood work and self-help (empowerment). After the Second World War, community work was imported into West Germany - especially from the United States and the Netherlands - as a new approach in the 1950s. Major activities included working in settlements for the homeless and in estates needing refurbishment, often under the motto ‘helping people to help themselves’. In the early 1970s there were many well-known projects of community work in urban problem areas (e.g. Osdorfer Born in Hamburg, Märkisches Viertel in West Berlin and Bockenheim in Frankfurt).

Since the mid-1970s there has been an observable decline in community work, especially in its conflict-oriented form. During this period, community work has become almost unrecognizable as a self-contained working area, or as a ‘third method of social work’. As a basic orientation and ‘working principle’ community-related activities have infiltrated many areas of social work and the work of other professional disciplines (psychology, urban planning).

More recently, urban planning departments have revived the approaches of community work: The keywords are district and neighborhood management. The national support programme ‘Stadtteile mit besonderem Entwicklungsbedarf - die soziale Stadt’ (www.staedtebaufoerderung.info) has contributed decisively to this. This title, ‘neighborhoods with a special development need - the social town/city’, shows that old problems are being addressed by a new name. However, it is also new that the focus is not just on social challenges; promoting the local economy and particularly job creation are also receiving greater consideration.

Focusing on a core problem of social injustice (not least with regard to health) and strengthening the local economy are completely compatible with other integrated programmes such as ‘Gesunde Stadt’ (‘Healthy Town/City’) and ‘Agenda 21’. A greater professionalization of health-related community work ought to bring positive benefits in the long term. However, at the moment it is not possible to say definitively whether the resources deployed for these programmes for specified periods are in any way sufficient, whether the desired effects are actually being achieved, or what unwanted side-effects may arise.

At the annual conference of the Deutsches Netzwerk gesundheitsfördernder Städte (www.gesunde-staedte-netzwerk.de) (German Network of Health-Promoting Towns/Cities) in Berlin in 2001, the ‘Lokale Agenda 21’ and ‘Soziale Stadt’ programmes were presented for the first time in this context. The representatives of these programmes announced they would intensify collaboration with the ‘health’ area and exchange experiences from the different approaches of socio-spatial orientation in the future. There is now close and stable co-operation between the ‘Gesunde Städte’ network and the ‘Soziale Stadt’ programme on the level of health promotion in disadvantaged neighborhoods. The ‘Gesunde Städte’ network is a member of the co-operative alliance ‘Gesundheitsförderung bei sozial Benachteiligten’ (‘health promotion among the socially disadvantaged’, www.gesundheitliche-chancengleichheit.de).
In health promotion, community-based approaches go back to developments in the early 1980s. Three lines of action are to be distinguished:

  • At the start of the German cardiovascular prevention study, DHP, a large multicentric community intervention study (risk factors, community focus), the foundation for later activities was laid in some places through the use of methods of community work such as neighborhood analysis, activating surveys and other investigations. In some neighborhoods of Mannheim (Baden-Württemberg) and Bremen such activities were successfully established as a structure in ‘health meeting places’, i.e. a kind of community health center, for a few years.
  • Several projects run by a research association called ‘Laienpotential, Patientenaktivierung und Gesundheitsselbsthilfe’ (Lay Potential, Patient Activation and Health Self-Help), which started at around the same time in the late 1970s, also developed and studied approaches that correspond to community-based health work. These activities come together as a core area in health promotion, which is usually summarized under the terms self-help promotion and support.
  • A third source of health-based community work is the health movement that arose in the 1980s, with its many local projects of self-organization and social action.

All three of the lines of actions mentioned overlap as to content and can now largely be found in local approaches and co-operation structures, for example as they were developed further as part of the ‘Gesunde Städte’ projects (Health Promotion and the Healthy / The Social City / The Perspective of Local Politics).

While fewer stimuli have come from these areas in recent years, there is more extensive material in the American health-based community work, regarding participatory survey methods of the deficits and resources of a community, goal determination, activation, education and nurturing of coalitions and the empowerment of the residents. Projects focus, for example, on a ‘STOP AIDS’ program with homosexual and bisexual men or on a program with poor elderly people in San Francisco’s inner city. One example from Germany would be that of the outreach social work all around Vinetaplatz in Kiel (Schleswig-Holstein), where the focus of the activities was on health-based community work with people suffering from addiction (www.gesundheitliche-chancengleichheit.de/good-practice/aufsuchende-sozialarbeit-rund-um-den-kieler-vinetaplatz/). The ten-year disease-prevention program ‘Lenzgesund’ (ended in the middle of 2012) run by the Eimsbüttel local health authority in Hamburg can basically be seen in terms of health-based community work, especially since the majority of the major protagonists came from the various fields of activity represented by the term ‘social work’(http://www.gesundheitliche-chancengleichheit.de/good-practice/praeventionsprogramm-lenzgesund/).

References:
Deutsches Institut für Urbanistik (Difu) et al. (ed.), Kinder- und jugendbezogene Gesundheitsförderung im Stadtteil, Difu-Arbeitshilfe, Berlin 2009;
Kuhn D et al. (eds.), Gesundheitsförderung mit sozial Benachteiligten. Erfahrungen aus der Lebenswelt Stadtteil, Frankfurt/M. 2009;
Merzel C/D’Afflitti J, Reconsidering community-based Health Promotion: Promise, Performance and Potential. American Journal of Public Health 93, 2003, 557
-574;
Minkler M (ed.), Community organizing and community building for health. New Jersey 2005;
Ortmann K/Waller H (eds.), Sozialmedizin in der Sozialarbeit, Berlin 2000;
Seippel A, Handbuch Aktivierende Gemeinwesenarbeit, Gelnhausen 1976;
Trojan A/Legewie H, Nachhaltige Gesundheit und Entwicklung, Frankfurt/M. 2001;
Trojan, A/Süß W, Prävention und Gesundheitsförderung in Städten und Gemeinden, in: Hurrelmann K. et al. (eds.), Lehrbuch Prävention und Gesundheitsförderung, Bern 2014
Trojan A et al (eds.), Quartiersbezogene Gesundheitsförderung - Umsetzung und Evaluation eines integrierten lebensweltbezogenen Handlungsansatzes, Weinheim 2013

Internet addresses:
www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/
www.iuhpe.org/index.php/en/social-determinants-of-health-sdh/community-health-promotion

Links: Health Promotion and the Healthy / The Social City / The Perspective of Local Politics


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