Assets Based Approach to Health Improvement - October 2012 Assets Based Approach to Health Improvement Carol Owen – Principal Health Promotion Specialist

Assets for Health Aim to stimulate discussion and explore how Pubic Health Wales our (Public Health Wales’ ) contribution to an assets based approach to health improvement in Wales. Theoretical Framework -Salutogenesis Carol Owen, Principal Health Promotion Specialist

Going back to basics ! Ottawa Charter (1986) Principles:- Participation , Equity and Empowerment This presentation has forced me as a Health Promotion Specialist to go back to basics . I wanted to explore the ‘fit’ between the assets based approach and the Ottowa Charter. Underpinnng principles being about ‘enabling’, participation, equity and empowerment. Carol Owen, Principal Health Promotion Specialist

Salutogenesis Antonovsky (1979,1987) Salutogenic question : “What creates health rather than what causes disease”? Talks about health and wellbeing rather than disease Its not new and infact has been around for approx 30 years Antonovsky was interested in how some people can cope with extremely stressful events (a group of israeli women who survived the Holocaust- these became his study group) He did not believe that the outcome of such horrendous circumstances was a matter of chance. Centre for Salutogenesis Research in Helsinki in Finland Focuses on two main concepts – sense of cohernce and general resistance resources The origin of salutogenesis derives from the interviews of Israeli women with experiences from the concentration camps of the Second World War who in spite of this stayed healthy. Carol Owen, Principal Health Promotion Specialist

Salutogenesis Comprises : Sense of Coherence – (SOC) General Resistance Resources Antonovsky believed that it was down to in the main two factors. A person’s sense of coherence and the availabilty to general resisitance resources Carol Owen, Principal Health Promotion Specialist

Sense of coherence Comprehension Manageability Meaningfulness Measure this using the SOC Scale Comprehension – individuals understand their world , their world has a sense of structure and predictability. Manageability – that people believe that they have the resources to deal with life’s challenges Meaningfulness –that people believe that the challenges are worth overcoming and therefore worth the time and effort involved Carol Owen, Principal Health Promotion Specialist

Generalised Resistance Resources GRR- resources (both internal and external) that help move people in the direction of positive health. The are acquired through life experiences which include what we would consider the norm – positive parenting, good quality home life, education, exposure to moderate stress , social networks etc. Carol Owen, Principal Health Promotion Specialist

Health Asset Assets can be described as the collective resources which individuals and communities have at their disposal, which protect against negative health outcomes and promote health Glasgow Centre for Population Health 2011 Now when we look at assets , they can be described....... Carol Owen, Principal Health Promotion Specialist

Carol Owen, Principal Health Promotion Specialist When we have a look at what is coined the salutogenc umbrella they assets are viewed as a combination of soc, and grr and depening on the discupline that we come from will use words to explain what infact is commen sense in reality. If we as individuals and communities are in possession of any of these ‘asset’s’ we are more likely to fell healthy and well. Our perception of our own health will undoubtedly improve. i.e we will feel good about ourselves and proud of our community. We will be Carol Owen, Principal Health Promotion Specialist

Is it good old fashioned community development ? Probably – but it focuses on using the assets and strengths of individuals and communities – empowering them to make a difference for themselves. I know we like to think that this is what we do, however I feel that sometimes our interventions over professionalise life. From my experience we tend to focus on the deficits – ie. needs assessments – informing people how deprived and ill they are or are likely to be , what they need to do to address their risks. I think we need a combined approach, and work upstream to focus our attention on soc , raising aspirations , Carol Owen, Principal Health Promotion Specialist

Assets for Health Deficits Model Assets Model Negative Paradigm Positive Paradigm Pathogenesis Salutogenesis Move away from the deficits approach – where we measure risk, identify need and develop interventions to fill the gap. ‘do to /for ‘ people – This approach searches for the protective factors Carol Owen, Principal Health Promotion Specialist

Why the change “....Policy development has focused too much on the failure of individuals and local communities to avoid disease rather than their potential to create and sustain health and continued development “ Source :Morgan and Ziglio (2007) ) Carol Owen, Principal Health Promotion Specialist

Health Assets Although health assets are an integral part of individuals and communities of (hand , heart and mind) Q- How do we unlock these assets in each community in Wales? What is our unique contribution? Glasgow Centre for Population Health 2011 Carol Owen, Principal Health Promotion Specialist

What are we measuring Again it focuses on measuring deprivation, ill health , risk factors etc. Q- Should we be measuring empowerment, sense of coherence, resilience ? What is our unique contribution to this work? Local vs national Carol Owen, Principal Health Promotion Specialist

Carol Owen, Principal Health Promotion Specialist

Evidence sythesis At its core, salutogenesis asks: • What external factors contribute to health and development? • What factors make us more resilient(more able to cope in times of stress)? What opens us to more fully experience life? What produces overall levels of well being? Source Morgan and Ziglio (2007) Too often we say there is insufficent evidence to support, can i suggest that it is our job as public health practitioners is to undertake the research, ask the right questions and generate the evidence. Carol Owen, Principal Health Promotion Specialist

Assets - Action “Good health needs assessment should provide a means of identifying the health assets and needs of a given population to inform decisions about service delivery.” (Morgan & Ziglio 2007) Rebalance between needs and assets Carol Owen, Principal Health Promotion Specialist

Assets - Action Asset Mapping on 3 levels Primary building blocks Secondary building blocks Potential building blocks: Primary building blocks: assets and capacities located inside the neighbourhood and largely under neighbourhood control (e.g. skills, talents and experience of residents, citizen associations etc). • Secondary building blocks: assets located within the community but largely controlled by outsiders (physical resources such as vacant land, energy and waste resources; public institutions and services). • Potential building blocks: resources originating outside the neighbourhood outside the neighbourhood controlled by Secondary building blocksoutsiders (e.g. public capital improvement expenditures). Carol Owen, Principal Health Promotion Specialist

Assets Evaluation We need to develop a new set of indicators Evaluation based on theoretical context on which programmes are developed Assets/salutogenic approach to evaluation may help us understand what creates health rather than what causes disease. Carol Owen, Principal Health Promotion Specialist