Oxford: Oxford University Press, 2008, pp 291,
ISBN 978 0 19 555835 7 (paperback)
Community development approaches to integrated health care planning and delivery has had a chequered history—both in ‘Western’ economies and developing nations. As the authors point out: “As [health] practitioners we are aware that the rhetoric about the importance of engaging communities and building community capacity is not always matched with resources….The re-orientation of governments and organisations towards a greater focus on working with communities has resulted in the need for a new set of skills.”
As community development returns to the health arena, ‘Working with Communities in Health and Human Services’ is a timely publication. Whilst it is based largely on the Australian experience and literature, it does have a much wider relevance to ongoing debates about the balance of ‘soft’ community intelligence and ‘hard’ epidemiological data in health service development and delivery.
The book is clearly structured and covers a series of important themes, including: understanding communities, conceptual approaches, models and skills in working with communities. This includes useful introductions to ideas of partnership working, leadership, community planning, community based action research techniques and aboriginal concepts of community and well being—though, interestingly this last section is almost wholly narrative in form. Further, there is an interesting debate on the tensions between top down, target driven, Government sponsored initiatives in health and social welfare and the time taken to develop community capacity in addressing local health issues. The authors also reflect thoughtfully on the dilemmas faced by practitioners where community perceptions of need and service priority differ from those of sponsoring agencies, Government directives or the interests of health experts or particular health disciplines.
These discussions have resonances far beyond Australia and ‘Working with Communities’ will be of particular interest to practitioners and researchers working with minority and indigenous communities as the authors ground much of the debate in the experiences of Aboriginal groups and the persistent failure of past investments in health services to radically address chronic health inequalities in what are often referred to as ‘hard to reach’ communities. They argue passionately and concisely that interpretations of the term community which are ‘imposed from above’ and interventions that “are focused on the individual” will result in continuing failures to address the wider social determinates of health—although those from more radical community development perspectives may want to challenge some of the community based planning models advocated.
Overall, Taylor, Wilkins and Cheers manage that difficult balance between theory and practice well. Concepts such as capacity building, social infrastructure and social capital are grounded in a series of case study materials and the theoretical constructs are introduced in accessible language. They also provide a number of helpful ‘toolkits’ (such as the community capacity assessment template) as well as summarising and critiquing different models of community development though practice based experience and realities.
For those who have been involved in community development approaches to health, ‘Working with Communities’ will have little new to say. It is, however, a useful reference point for those wishing to develop a more international understanding of key debates in health and social welfare and explore the different languages that have emerged in recent years from different parts of the globe around community development and health theory and practice. The organisation of the book is both its strength and its, potential, weakness. It consists of a series of 12 relatively short chapters, subdivided into brief sections on key themes. It can, at times be a little repetitious—but equally, each section has the capacity to ‘stand alone’ and allows the reader to dip into specific topics that may be of particular personal, professional or academic interest.
‘Working with Communities’ is a thoughtfully designed publication containing a wide range of case study materials, web based resources and reflective exercises ideal for use with students across a range of qualifying professional programmes in the health field and practitioners new to the concept of working with communities within a social, rather than medical, model of planning and intervention. What is refreshing is the balance the authors bring to current controversies and, ultimately their commitment to: “Whatever [theoretical] frameworks we are using, the skills involved in participatory decision making, forming and making partnerships, supporting community leadership and undertaking community planning are all essential…Otherwise we will never achieve what we set out to do—improving health and social well being through working at the community level.”