Working with community strengths and leadership can be transformative but takes time, effort and a commitment to constructive relationships and new ways of working.
The importance of working with community strengths and leadership was a recurring theme throughout the Congress, and many speakers called for a focus on developing and amplifying citizen power.
“Organise and mobilise” was one of the strong calls to action, while the power of networks especially in the networked digital era was also repeatedly highlighted.
Professor Bettina Borisch, Executive Director of the World Federation of Public Health Associations, stressed the importance of solidarity, based on the concept that people can unite across their differences for the common good.
Professor Borisch described solidarity as a real network of trust and reliability and “a lifelong learning process” that was vital during times like these when, as other speakers highlighted, the rise of populist movements is encouraging division and “othering” of minority groups.
Community strengths and cultural solutions
Many speakers highlighted the need to work with community strengths and urged a shift away from focusing on the perceived deficits of communities.
A conference highlight was a First Nations Suicide Prevention World Leaders Dialogue featuring Professor Pat Dudgeon from the University of Western Australia; Michael Naera, Kia Piki te Ora Project Leader for Te Runanga o Ngāti Pikiao Trust in New Zealand; and Carol Hopkins, Executive Director of the Thunderbird Partnership Foundation in Canada.
Mr Richard Weston, CEO of the Healing Foundation, facilitated the discussions, which identified suicide among First Nations people as a symptom of trauma caused by colonisation, and emphasised the need for strengths-based cultural solutions.
Professor Dudgeon stressed the importance of identity and culture, and culturally determined relationships to land, family, kin and community as great sources of mental health and resilience to Indigenous Australians and their social and emotional wellbeing.
She said: “In order to address suicide prevention, we know that there are two important principles: firstly, self-determination – the community must own and be in charge of any solution. Secondly, culture – programs must be culturally appropriate in order to be effective.”
Mr Weston also supported cultural solutions, and said: “Sharing knowledge will help us find solutions that are rooted in our ancient wisdom about how we are in the world, rather than looking to the western systems that have so severely interrupted our cultures through colonisation.
“The Healing Foundation has found the solutions that work best are those that are led by communities to design, develop and deliver projects that are rooted in the strength of our living culture and that strengthen our cultural identity.”
In another presentation that generated great interest, Ms Michelle Deshong, a scholar at James Cook University in Townsville and Chief Executive Officer of Indigenous Governance and Best Practice, called for a focus on the successes and strengths of Indigenous people, rather than on deficits and disparities.
The ability of Indigenous peoples to “survive, transform and adapt over generations” should be celebrated, she said.
Ms Summer May Finlay, a public health practitioner, PhD candidate and a Yorta Yorta woman, received a standing ovation for a powerful address challenging non-Indigenous public health professionals to work under the leadership of Indigenous people.
“I want to see Indigenous people not just at the table but at the head of the table, leading. I don’t want to continue to see the token black. I want our mob designing, implementing and evaluating our business,” she said.
“No one should be speaking on our behalf. I expect to see Indigenous people’s voices preferenced and prioritised. We shouldn’t just be consulted on issues affecting us. We should be making the decisions ourselves.”
Power imbalances and deficit-based approaches were stopping this from happening, she said.
“It’s time non-Indigenous Australians stopped pretending they are the solution and realise we are,” she said.
Community leadership to tackle obesity
The importance of community leadership was also acknowledged in other areas. In particular, a number of speakers said that for real progress to be made in tackling obesity and chronic diseases more broadly, communities must be supported and empowered to take leadership roles.
Professor Steven Allender, one of the leaders of the Global Obesity Centre (GLOBE) – a research group based in the Centre for Population Health Research at Deakin University and a designated World Health Organization Collaborating Centre for Obesity Prevention – said there was now sufficient evidence to know what works in preventing childhood obesity; the question was how to make the changes happen – and community leadership is central to this.
Professor Allender and colleagues are working with schools, district health services, sporting groups, local councils and other community groups as well as local ‘champions’. He described communities in Victoria that had taken ownership of tools provided by researchers to implement, work with and evaluate complex strategies based in system science.
Professor Allender discussed how the people of Portland had done their own mapping of the factors contributing to obesity in their area. Other communities were engaging with debates around a sugar tax, and other strategies for reducing access to sugary drinks and promoting the benefits of drinking water.
“Our role is to provide the tools for communities to respond in the best way,” he said.
GLOBE’s work with population-level interventions begins by fostering a shared understanding of the systemic determinants of non-communicable disease and asking how existing systems can be strengthened or new systems created to better promote health and prevent disease.
Systems thinking, a prominent focus at the Congress, is characterised by attempts to identify the most important cause and effect relationships within a specific system that create feedback and so amplify or stabilise change across a system.
Communities moving towards healthier food environments
Momentum is gathering for effective action against obesity as community norms are changing, according to another leader of the GLOBE group, Professor Anna Peeters, Professor of Epidemiology and Equity in Public Health.
She said there was a real shift in attitudes occurring in communities, public debate and the media regarding the everyday immersion of children in unhealthy food environments.
“People are ready for change,” she said, “It’s starting to make sense that we should be providing our children with healthy food environments.”
To accelerate the changes that are occurring, she said it was important to harness leadership.
Professor Peeters showed a map of Victoria revealing a rapid increase in the number of organisations taking leadership in reducing access to sugary drinks. These included hospitals, local government jurisdictions and sport centres.
It was important the public health sector helped to build upon the real changes that are occurring, and applauded when positive changes occurred.
“These examples give me hope,” she said.
Professor Sharon Friel also highlighted the importance of community engagement and mobilisation in creating hope for fairer, more sustainable futures.
She said reasons for hope included the rise of systems-oriented evidence, and the development of a shared collective vision built upon rising political consciousness, organised strategy and networked civil society.
Community participation matters
Many presentations highlighted the importance of community participation at all stages of the development, implementation and evaluation of research, advocacy, policy and programs.
Professor Luis Eugenio De Souza, President of the Brazilian Association of Collective Health, described the impact of austerity policies in undermining population health, democratic norms and the social contract.
Community participation was vital, particularly in such times, in identifying and responding to local health priorities, he said.
Other speakers identified key principles for working with communities as shared values, respect, holism, partnership, community ownership control, and empowerment.
Also noted was the importance of ensuring gender and other power relations are considered and accounted for in community priority setting processes.
The importance of working with communities was also highlighted during a World Leaders Dialogue on Child Health.
Professor Paul Freeman, from the University of Washington, who has worked in many countries, said community-based work was critical for preventing maternal and early childhood deaths as it has “a multiplier effect”.
Supporting community priorities
The Congress heard about the development of a designated Health Zone in Victoria’s Latrobe Valley following concerns associated with the closure of the Hazelwood Power Station and the Hazelwood mine fire.
The Latrobe Health Assembly, which met for the first time earlier this year, has been established to ensure the community is central in identifying health priorities and innovating health services in the region.
The Health Zone will focus on preventive health initiatives, mental health services, chronic disease management and local access to specialist services. Importantly it is based upon co-design principles and locally driven solutions.
At a national level, similar approaches are being taken with the Prevention Tracker project, which is helping communities to identify local issues important for improving chronic disease prevention.
Prevention Tracker is working with four communities – Albany in WA, Glenorchy in Tasmania, Broken Hill in NSW and the Gold Coast in Queensland – to describe, guide and monitor systems change at community level.
Prevention Tracker researchers, working with partners and a local advisory group, collect and analyse data to map the local prevention workforce, including which organisations are involved with prevention action, and how they are connected and share information.
Project co-lead Dr Therese Riley, a Senior Research Fellow with the Australian Prevention Partnership Centre, said this process often enabled communities to develop a clearer understanding the systemic or underlying issues that enable or constrain prevention effort.
She said some communities had identified ways of strengthening their local prevention system that they could not have predicted before the research began, including through a focus on how to better engage diverse voices.
“By first describing and better understanding how the prevention system works in local communities, we derive new insights that enable us to create opportunities for change in a local system,” she said. “It’s about creating new knowledge and insights in the context in which that knowledge can turn into action.”
Dr Alex Ezeh, the Executive Director of the African Population and Health Research Center, also underscored the expertise of communities.
“Women and communities know what’s best for them,” he said, stressing the need to understand the realities of the constraints upon peoples’ lives, especially for those living in poverty.
He stressed the importance of images and graphics in making research evidence accessible to communities, to enable them to make decisions.
The importance of working in partnerships
Many presentations underscored both the importance of working in partnerships, as well as the effort and complexity this can entail.
General lessons were shared by policymakers and academics involved in the Australian Prevention Partnership Centre, which aims to increase the uptake of evidence in complex policy and practice issues through cross-sectoral multi-disciplinary research.
Professor Adrian Bauman, Sesquicentenary Professor of Public Health and Director of the Prevention Research Collaboration at the University of Sydney, described some of the challenges involved, including that partnerships did not always endure.
Working in partnership required a long-term investment and vision as it takes considerable time for partners to develop trust, reciprocity and mutual understanding, he said.
Professor Billie Giles-Corti, Urban Futures Enabling Capability Platform Director at RMIT University, described the importance of developing long-term, formal relationships between policy makers and practitioners, as well as the need for trust and an understanding the constraints and priorities of each other’s position.
Dr Paul Kelly, Deputy Director General of Population Health, and Chief Health Officer, ACT Health, also stressed the importance of taking proper time to develop partnerships.
“You can’t just add water and have a partnership,” he said.
- Stronger Indigenous culture would cut suicide rates, health congress told: The Guardian
- The Globe Obesity Centre
- The La Trobe Health Zone
- Prevention Tracker