In response to the pressures on public health and human services, the Healthy Development Model was conceived as a training and learning process to address the disconnect between economic development and human well-being. It presents an innovative, integrative model that addresses determinants common to a successful economy and healthy population - human capital and social capital. The slogan: "Creating a culture of prevention" encapsulates the program's goal of building the "immunity of the community" by utilizing and strengthening its inherent human and social capital. It advocates a primary prevention orientation to public policy-making.
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| Nilesh (facilitator on left) leading a training session |
Healthy Development calls for recognition of the conflict between the forces of the market and the needs of population health by using a public health lens to review policy-development and community programming. The Healthy Development Model enables facilitators to ask questions related to democratic deliberation in the training sessions such as:
- How can we align the health and wellness of the people with the demands of the economy?
- What is the purpose of economic and technological development?
- How can we create social arrangements that enable educated choices and participation for the people within a community and prevent problems rather than fix them?
- Can a renewed public health be the reagent that enables democracy and commerce to co-exist in a manner that allows achievement of human health, human rights, and human potential?
Healthy Development methods are entrenched in community planning methods such as ZOPP from the German term "Zielorientierte Projektplanung" meaning "Objectives-Oriented Project Planning" and community based participatory research methods. Healthy Development Project ultimately aspires to increase a community's buy-in and ownership of decisions, actions, and programs that impact their own community's health and development.
A Healthy Development Case Study in Coahuila, Mexico
This project was unique because of the personal involvement of then-governor Enrique Martinez y Martinez in engaging the ministries of his government. Two separate orientation sessions involving the governor and secretaries of education, health and social development were conducted at Texas A&M University in fall 2003. A special Inter-Institutional Technical Committee was established as a direct result of those meetings. This committee reported directly to the governor's office and focused on integrated action of three different ministries (secretariats) of the state government (namely health, education, and social development), between the state level secretariats and local municipality departments, and between government and local communities. The Coahuila project spanned the borders of two sovereign nations (United States and Mexico), and reached across disciplinary boundaries of sociology, public health, medicine, education, community development, and political science.
The Healthy Development process engaged important sectors of society in Coahuila. About 12 to 16 members of 12 selected municipalities (including local leaders from three government ministries and community leaders) met for eight sessions, each session lasting for two hours at the public plaza of the municipality. Members defined problems prioritized by the community, and created an action plan that was addressed collaboratively by community and government secretariats.
The Healthy Development Manual specifics and provides participatory and consensus building tools and methods. In Coahuila, participants created their unique vocabularies for health and development; identified roles and interaction of state, market, and civil society in creating pressures on health and welfare sectors; discussed the importance of civil society in addressing public health problems; and thought of ways to align economic development with population health goals and foster a culture of primary prevention.
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| Community member being interviewed |
Community leaders and local government staff from health, education, and social development ministries in each municipality identified a specific public health problem in their community from a broad spectrum including unemployment. They listed its underlying causes and consequences, and incorporated community input they had gathered as part of homework exercises. Community-based and group exercises helped participants understand disparities and vulnerabilities; differentiate multiple, interconnected consequences and causes (visible and invisible) of a specific local public problem; identify and tap local human and social capital resources; analyze stakeholders; and prepare and commit to an action plan addressing the local problem.
After completing the training, participants implemented the action. They received technical assistance from the academic unit, and were also promised help from local and state governments. However, the crucial goal was to increase local capacity and self-reliance.
Participants from all 12 municipalities attended a conference in Saltillo, the state's capital city, and presented their plans to the governor and the secretaries of health, education, and social development. All the action plans and the training manual will soon be available on the web at http://www.healthydevelopment.net . The completion of the objectives identified in the action plan will serve as outcomes for evaluation purposes. Participants received certificates and also badges designating them as local promotors/promotoras of Desarrollo Saludable.
Process monitoring revealed beneficial effects of training on interactions between community members and governmental staff. Despite positive feedback for the training itself, there are challenges to action plan implementation. These include apathy in communities, lack of trust in institutions, and inadequate follow-up from governmental liaison. Intensive measures combining morale boosting, trust-building, and civic engagement are required from community and government leaders to sustain a culture of prevention.
Conclusion
Healthy Development is a community engagement process. We found that communities were more committed to the change process, while policy- and decision-makers had stakes that impeded public health oriented policy-making. New models of community health planning and policy development such as Healthy Development will have to continue to work at three levels:
- Academic institutions should develop and test similar models that align economic development with population health.
- Re-education of policy-makers and decision-makers on the importance of aligning population health goals with economic development is required.
- Public health agencies should supply local communities with planning tools and participatory opportunities for creating comprehensive and acceptable solutions for community problems.
References:
Israel BA, Schulz AJ, Parker EA, Becker AB. "Review of community-based research: Assessing partnership approaches to improve public health." Annual Review of Public Health, 1997; 19:173-202.
Minkler M. (2000). Using participatory action research to build healthy communities. Public Health Reports 115: 191-197.
United Nations Development Program (UNDP) (2002). Deepening democracy in a fragmented world.Human Development Report, 2002,UNDP.
Wallerstein N. (1999). Power dynamics between evaluator and community: research relationships within New Mexico's healthier communities. Social Science Medicine, 49:39-53.
By Nilesh Chatterjee, PhD, MA, MA, MBBS, PGDPC
nileshchatterjee2@gmail.com ; nileshchatterjee@yahoo.com
Director, Kalyani Media Group, Mumbai, India and Adjunct Asst Professor, University of Texas School of Public Health, Houston.
Nilesh has worked in various capacities in the academic institutions, in the media, in the non-profit and for-profit sector, including on various contracts from U.S. federal agencies. Until January 2006 he served as national coordinator of The Loka (samagraha) Institute (www.loka.org), a non-profit agency dedicated to making science and technology, and development responsive to democratically-decided social and environmental concerns. He has served as assistant professor of public health education and promotion in the Division of Health & Safety, College of Education and Human Development, Texas A&M University, adjunct faculty of medical sociology at Texas Woman’s University, and facilitator of problem-based learning at University of Texas Health Science Center. He is currently adjunct asst. professor in behavioral sciences at University of Texas School of Public Health, Houston and Director, Kalyani Media Group, Mumbai. Nilesh has a PhD in Public Health from the University of Texas School of Public Health, Houston, two masters’ degrees in social sciences from the University of Maryland Baltimore County Campus, where he obtained a fellowship in 1993 to study sociology of health, illness and medicine, and quantitative social research, and from Nehru Institute of Social Studies in Pune, India in 1994 where he studied sociological theories. He also has a medical degree from Bombay University, Mumbai, where he worked as private practitioner, resident in psychiatry, and lecturer in preventive & social medicine.