This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Environmental Science. Please check back later for the full article.
The burden of ill health has shifted, globally, from communicable to non-communicable disease, with poor health clustering in areas of economic deprivation. However, for the most part, public health programs remain focused on changing behaviors associated with poor health (such as smoking or physical inactivity) rather than the contexts that give rise to, and influence, the wide range of behaviors associated with poor health. This way of understanding and responding to population ill health views poor health behavior as a defining “problem” exhibited by a particular group of individuals or a community, which needs to be solved by the intervention of expert practitioners. This sort of approach determines individuals and their communities in terms of deficits, and works on the basis of perceived needs within such communities when seeking to address public health issues.
Growing recognition that many of the fundamental determinants of health cannot be attributed solely to individuals, but result instead from the complex interplay between individuals and their social, economic, and cultural environments, has led to calls for new ways of delivering policies and programs aimed at improving health and reducing health inequalities. Such approaches include the incorporation of subjective perspectives and priorities to inform the creation of “health promoting societal contexts.” Alongside this, asset-based approaches to health creation place great emphasis on valuing the skills, knowledge, connections, and potential within a community and seek to identify the protective factors within a neighborhood or organization that support health and wellbeing.
Connecting Communities (C2) is a unique asset-based program aimed at creating the conditions for health and wellness within very low-income communities. At the heart of the program is the belief that health emerges from the patterns of relations within neighborhoods, rather than being a static attribute of individuals. C2 seeks to change the nature of the relations both within communities and with service providers (such as the police, housing, education, and health professionals) to co-create responses to issues that are identified by community members themselves. While many of the issues identified concern local environmental conditions, such as vandalism or safe out-door spaces, many are also contributory determinants of ill health. Listening to people, understanding the social, cultural, and environmental context within which they are located, and supporting new partnerships based on reciprocity and mutual benefit ensures that solutions are grounded in the local context and not externally determined, in turn resulting in sustainable health creating communities.
Introduction to the Symposium: Causal Inference and Public Health