How to avoid good public health work from disappearing down the cracks of community planning….

1. How to avoid good public health work from disappearing down the cracks of community planning…. Barbary Cook, Director Community Development and Health Network

2. How to avoid good public health work from disappearing down the cracks of community planning…. • CDHN’s mission is to end health inequalities using a community development approach. By this we mean campaigning, influencing policy and developing best practice work which shows that communities, both geographical and of interest & identity, can define their own health needs and design and implement preventative and radical solutions.

3. How to avoid good public health work from disappearing down the cracks of community planning…. • Values: • Social model of health • Community development • Communities as co-designers, co-planners and co-commissioners • CDHN believes that community planning’s effectiveness depends not on the structural model but on the values that underpin it. • Therefore must: • Act on the power of well-being as a manifestation of the social model of health • Mainstream a community development approach • Ensure local services are planned and commissioned where communities are co-designers, co-planners and co-commissioners

4. How to avoid good public health work from disappearing down the cracks of community planning…. • What is the adaptive challenge – i.e. what is the change we’re trying to bring about? • With community planning we’re trying to get local government to develop local government services with communities, not for them.

5. How to avoid good public health work from disappearing down the cracks of community planning…. • We need to support local government/District Councils to see public health and the power of well-being as their business and not only the business of HSS; • We need to support local government/District Councils to understand the social model of health and the need to tackle the root causes of ill-health so that public health and well-being will improve; • We need to increase understanding of how well-being can be lens through which environmental improvements, better education, better transport, better housing can be viewed, rather than necessitating a whole new set of services; and • We need to support local government/District Councils to think that communities should be involved as peers in the planning and commissioning of services.

6. How to avoid good public health work from disappearing down the cracks of community planning…. • What barriers exist to these adaptive challenges? • Unfamiliarity with public health policy, the power of well-being and the social model of health; • Unfamiliarly with community development and health approaches; • Fear of duplicating services that should be/are already being provided by HSS; • The scale of the change process itself makes local government/District Councils less likely to want to deal with the adaptive challenge; and • Elected politicians prefer representative democracy to participative democracy and are therefore unlikely to see communities as co-designers, co-planners and co-commissioners.

7. How to avoid good public health work from disappearing down the cracks of community planning…. • Thinking about planning and commissioning in different ways • The purpose of thinking about planning and commissioning in different ways is to show that: • Co-terminosity mixed with the power of well-being means that if all three public sectors can think of their planning and commissioning as simultaneously and complementarily having an impact on improving public health and well-being then it makes it more likely that public health won’t fall down the cracks. • If planning and commissioning is underpinned by community development approaches then we think of communities as co-designers, co-planners and co-commissioners and if we do this we have more effective services and better value services and, we believe, a higher likelihood of improving public health. • If planning and commissioning expands its idea of community engagement, through a multiplicity of structures, then services will be more responsive and therefore more likely to improve public health and well-being.

8. How to avoid good public health work from disappearing down the cracks of community planning…. • When it comes to public health the original IfH policy clearly envisaged root cause work on the wider determinants of health. IfH was also established as an inter-departmental public policy. Unfortunately, not all departments have fulfilled their IfH responsibilities, which has weakened the intended impact of the policy on the wider determinants of health in Northern Ireland. • Under community planning, can IfH deliver work on the wider determinants of health, which must be addressed by community planning if the health and well-being of communities is to be improved in a meaningful way? • When an IfH partnership or a HAZ have had high level support at a regional level they have been able to do excellent work.

9. How to avoid good public health work from disappearing down the cracks of community planning…. • Recommendations • CDHN makes the following recommendations on how to ensure that good public health work doesn’t fall down the cracks of community planning: • Expand understanding of planning and commissioning as one interlocking system for the delivery of public services, which is capable of avoiding duplication; • Ensure that planners and commissioners across the sectors work together to mainstream community development into their planning and commissioning processes; • Education and training on the social model of health for District councils and all partnership agencies, so they see their work as an effective and efficient way to have an impact on the wider determinants of health, in order to improve public health and well-being;

10. How to avoid good public health work from disappearing down the cracks of community planning…. • Recommendations • Commitment from Dept of Health, DOE, Dept of Education, HSSA and Assembly to work at strategic, inter-departmental level on implementing fully existing public health policy (IfH); • Ensure that we use the expertise and critical mass of existing partnership structures but that they are underpinned by commitment to social model of health, mainstream community development and have a high level of support and decision-making authority from regional level, or delegated to them; • Investigate the ways in which the community and voluntary sector can support the sub-regional 777 structure and can develop expertise on planning and commissioning, the social model of health and community development approaches; and • Put values before structure.