Measuring and Analysing Community Action for Health: An Indicator-Based Typology and Its Application to the Case of Barcelona

Abstract

Social welfare systems face major challenges, particularly in a context of social transformation, austerity and growing inequalities. This process is highly visible in the health sector. In this context, many voices ask for public sector reforms and community action for health as a relevant practice. However, analyses and evaluations of this kind of practices are still limited, particularly beyond the cases of single community health actions or interventions. We still need to identify key indicators for measuring and characterising what community action for health consists of, as well as to what degree this kind of intervention has been developed across a city. Based on a research about 49 neighborhoods in Barcelona, this paper creates an index to measure and characterize community action for health, using different indicators: citizen engagement programs in community health, organizational transformation of the health and social protection systems, stable participatory structures with specific teams, and urban health policies. We apply the index to the case of Barcelona and build a map of community action for health in the city using 4 categories: strong community health development (one neighbourhood), middle (9 neighborhoods), emergent (25 neighborhoods) and without specific community health promotion (14 neighbourhoods). We find that community action for health is extensive within the city of Barcelona, have great potential as a response to the need for change in the relationship between the public (health) sector and the citizenry, but is still implemented unequally across the urban territory in terms of types and methods.

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Fig. 1

Notes

  1. 1.

    Barcelona is divided into 73 neighbourhoods.

  2. 2.

    The household income index is prepared by the Barcelona City Council. It is a theoretical measure of the income of residents in neighbourhoods of the city, compared to the city average which is set at 100 (see http://bit.ly/2559E4U for details). In our study, we consider only neighbourhoods below 90.

  3. 3.

    For example, the case of the Xafarines Primary Healthcare Centre in the Trinitat neighbourhood since 1997.

  4. 4.

    These differences are analysed in the next section of the article.

  5. 5.

    http://www.aspb.cat/quefem/salut-als-barris.htm.

  6. 6.

    The COMSALUT (comunitat and salut, community and health) is a program developed by the Catalan Government including different Primary Healthcare Teams (EAPs), under the logic of the Catalonia Health Plan (Plan de Salud de Catalunya).

  7. 7.

    For example, the health school in the Carmel neighbourhood (see http://bit.ly/2bQj0ho).

  8. 8.

    For example, the activities encompassed in the program A Roquetes fem salut in the Roquetes neighbourhood (see http://bit.ly/2c2tNUd). Another example is the Els divendres al Pou project, which aims to offer new spaces for healthy leisure activities and training for first work experiences (see http://bit.ly/2bLvuoo).

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Acknowledgements

The authors represent the research team Salut Comunitària: María José López Medina, Nuria Calzada Lombana, Xavier Blancafort Sansó, Felipe Herrera, Glòria Muniente, Carles Valero Garcia, Montse Petit. This work was supported by RecerCaixa, a program driven by “La Caixa” in collaboration with the Catalan Association of Public Universities.

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Barbieri, N., Gallego, R., Morales, E. et al. Measuring and Analysing Community Action for Health: An Indicator-Based Typology and Its Application to the Case of Barcelona. Soc Indic Res 139, 25–45 (2018). https://doi.org/10.1007/s11205-017-1703-4

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Keywords

  • Community action
  • Health
  • Public sector
  • Indicators
  • Barcelona