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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Notes
Barcelona is divided into 73 neighbourhoods.
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.
For example, the case of the Xafarines Primary Healthcare Centre in the Trinitat neighbourhood since 1997.
These differences are analysed in the next section of the article.
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).
For example, the health school in the Carmel neighbourhood (see http://bit.ly/2bQj0ho).
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).
References
Baggot, R. (2000). Public health: Policy and politics. Basingstoke: Macmillan Press Ltd.
Balcazar, H. G., de Heer, H., Rosenthal, L., Aguirre, M., Flores, L., & Puentes, F. A. (2010). A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population. Preventing Chronic Disease, 7, A28.
Barcelona City Council. (2005). Marc municipal per l’Acció Comunitària. Bases conceptuals i metodològiques. Barcelona: Ajuntament de Barcelona.
Barcelona City Council. (2012). Eumed cities 2010–2012. Barcelona: Ajuntament de Barcelona.
Barcelona City Council. (2014). Guia operativa per a l’avaluació de l’Acció Comunitària. Barcelona: Ajuntament de Barcelona.
Barcelona Public Health Agency ASPB. (2012). Pla de Salut Comunitària i Promoció de la Salut de Barcelona. Barcelona: Agència de Salut Pública de Barcelona.
Barcelona Public Health Agency ASPB. (2015). La salut a Barcelona 2014. Barcelona: Agència de Salut Pública de Barcelona.
Bartoll, X., Palència, L., Malmusi, D., Suhrcke, M., & Borrell, C. (2015). The evolution of mental health in Spain during the economic crisis. European Journal of Public Health, 24(3), 415–418.
Bauman, Z. (2012). Times of Interregnum. Ethics and Global Politics, 5(1), 49–56.
Borrell, C., Marí-Dell’olmo, M., Palència, L., Gotsens, M., Burström, B., Domínguez-Berjón, F., et al. (2014a). Socioeconomic inequalities in mortality in 16 European cities. Scandinavian Journal of Public Health, 42(3), 245–254.
Borrell, C., Muntaner, C., Benach, J., & Artazcoz, L. (2004). “Social class and self-reported health status among men and women: What is the role of work organisation, household material standards and household labour? Social Science and Medicine, 58(10), 1869–1887.
Borrell, C., Muntaner, C., Solà, J., Artazcoz, L., Puigpinós, R., Benach, J., et al. (2008). Immigration and self-reported health status by social class and gender: The importance of material deprivation, work organisation and household labour. Journal of Epidemiology Community Health, 62(5), e7.
Borrell, C., & Pasarín, M. (2004). Desigualdad en salud y territorio urbano. Gaceta Sanitaria, 18(1), 1–4.
Borrell, C., Pons-Vigués, M., Morrison, J., & Díez, E. (2013). Factors and processes influencing health inequalities in urban areas. Journal of Epidemiologic Community Health, 67(5), 389–391.
Borrell, C., Rodríguez-Sanz, M., Bartoll, X., Malmusi, D., & Novoa, A. M. (2014b). The suffering of the population in the economic crisis of the Spanish State. Salud Colectiva, 10(1), 95–98.
Bovaird, T. (2007). Beyond engagement and participation—User and community co-production of public services. Public Administration Review, 67(5), 846–860.
Brugué, Q., Blanco, I., & Boada, J. (2014). Entornos y Motores para la Innovación en las Políticas Públicas. Revista del CLAD Reforma y Democracia, 59, 5–34.
Cahuas, M. C., Wakefield, S., & Peng, Y. (2015). Social change or business as usual at city hall? Examining an urban municipal government’s response to neighbourhood-level health inequities. Social Science and Medicine, 133, 366–373.
Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization.
Cortès-Franch, I., & González López-Valcárcel, B. (2014). Crisis económico-financiera y salud en Españaa. Evidencia y perspectivas. Gaceta Sanitaria, 28(1), 1–6.
Cyril, S., Smith, B. J., Possamai-Inesedy, A., & Renzaho, A. M. N. (2015). Exploring the role of community engagement in improving the health of disadvantaged populations: A systematic review. Global Health Action, 8, 1–9.
Dalghren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health. Stockholm: Institute for Future Studies.
Diez, E., Pasarín, M., Daban, F., Calzada, N., Fuertes, C., Artazcoz, L., et al. (2012). Salut als barris en Barcelona, una intervención comunitaria para reducir las desigualdades sociales en salud. Comunidad, 14(2), 121–126.
Diez, E., Villalbi, J. R., Benaque, A., & Nebot, M. (1995). Desigualdades en salud materno-infantil: impacto de una intervención. Gaceta Sanitaria, 9, 224–231.
EurohealthNet. (2012). Re-Orienting health Systems: Towards modern, responsive and sustainable health promoting systems. http://eurohealthnet.eu/publications/background-papers. Accessed August 16, 2016.
Fischer, F. (1993). Citizen participation and the democratization of policy expertise: From theoretical inquiry to practical cases. Policy Sciences, 26(1), 163–187.
Franklin, C. M., Bernhardt, J. M., Lopez, R. P., Long-Middleton, E. R., & Davis, S. (2015). Interprofessional teamwork and collaboration between community health workers and healthcare teams an integrative review. Health Services Research and Managerial Epidemiology, 2, 1–9.
Fuertes, C., Pasarín, M. I., Borrell, C., Artazcoz, L., Díez, E., & the Group of Health in the Neigbourhoods (Calzada C, Cortés X, García L, Galofré E, Herrera F, Muniente G, Pérez G, Petit M, Núñez S, Ríos A, Rodríguez-Sanz M, Sotus N). (2012). Feasibility of a community action model oriented to reduce inequalities in health. Health Policy, 107(2–3), 289–295.
Fung, A. (2006). Varieties of participation in complex governance. Public Administration Review, 66(s1), 66–75.
Gervits, M., & Anderson, M. (2014). Community-oriented primary care (COPC) in Barcelona, Spain: An urban COPC experience. International Journal of Health Service, 44, 383–398.
Gofin, J., & Foz, G. (2008). Training and application of community-oriented primary care (COPC) through family medicine in Catalonia, Spain. Family Medicine, 40, 196–202.
Gofin, J., & Gofin, R. (2010). Essentials of global community health. Sudbury, MA: Jones & Barlett Learning.
Hall, P. (1993). Policy paradigms, social learning and the state: The case of economic policymaking in Britain. Comparative Politics, 25, 275–296.
Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, D., et al. (2013). Financial crisis, austerity, and health in Europe. Lancet, 381(9874), 1323–1331.
Kenny, S. (2016). Community development today: Engaging challenges through cosmopolitanism? Community Development Journal, 51(1), 23–41.
Koppenjan, F., & Klijn, E. (2004). Managing uncertainties in networks. Londres: Routledge.
Loeffler, E., Power, G., Bovaird, T., & Hine-Hughes, F. (2013). Co-production of health and wellbeing in Scotland. Birmingham: Governance International with Scottish Government.
Malmusi, D., Borrell, C., & Benach, J. (2010). Migration-related health inequalities: Showing the complex interactions between gender, social class and place of origin. Social Science and Medicine, 71(9), 1610–1619.
Marchioni, M. (2014). De las comunidades y de lo comunitario. Espacios transnacionales: revista latinoamericana-europea de pensamiento y acción social, 2(3), 112–118.
Mehdipanah, R., Manzano, A., Borrell, C., Malmusi, D., Rodriguez-Sanz, M., Greenhalgh, J., et al. (2015). Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach. Social Science and Medicine, 124, 266–274.
Montaner, I., Foz, G., & Pasarín, M. I. (2012). La salud: ¿un asunto individual…? AMF, 8, 374–382.
Nebot C., Escosa A., Sala-Álvarez C. M., & Paasrín M. I. (2016). La salud comunitaria en los equipos de atención primaria: objetivo de dirección. Una experiencia singular en Barcelona. Atencion Primaria. doi:10.1016/j.aprim.2015.10.009.
Nuño, R., Coleman, K., Bengoa, R., & Sauto, R. (2012). Integrated care for chronic conditions: The contribution of the ICCC Framework. Health Policy, 105, 55–64.
O’Mara-Eves, A., Brunton, G., Oliver, S., Kavanagh, J., Jamal, F., & Thomas, J. (2015). The effectiveness of community engagement in public health interventions for disadvantaged groups: A meta-analysis. BMC Public Health, 15, 129.
Osborne, S., & Strokosch, K. (2013). It takes two to tango? Understanding the co-production of public services by integrating the services management and public administration perspectives. British Journal of Management, 24(S1), 31–47.
Padilla, J., & López Ruiz, M. (2016). Repercusiones de la pobreza sobre la salud de los individuos y las poblaciones. FMC, 23, 50–60.
Parker, H., & Glasby, J. (2008). Transforming community health services: English lessons on not relying on organisational reform. Health and Social Care in the Community, 16(5), 449–450.
Parrado, S., Van Ryzin, G., Bovaird, T., & Löffler, E. (2013). Correlates of Co-production: Evidence from a five-nation survey of citizens. International Public Management Journal, 16(1), 85–112.
Pasarín, M. I., Forcada, C., Montaner, I., De Peray, J. L., & Gofin, J. (2010). Salud comunitaria: una integración de las competencias de atención primaria y de salud pública. Informe SESPAS 2010. Gaceta Sanitaria, 24(S1), 23–27.
Rebollo, O. (2012). La transformación social urbana. Gestión y Política Pública, 21, 159–186.
Rebollo, O., & Morales, E. (2013). Hacia una política pública de acción comunitaria: límites y oportunidades. In R. Canal (Ed.), Ciudades y Pueblos que puedan durar. Barcelona: Icaria.
Renedo, A., Marston, C., Spyridonidis, D., & Barlow, J. (2015). Patient and public involvement in healthcare quality improvement: How organizations can help patients and professionals to collaborate. Public Management Review, 17(1), 17–34.
Restrepo Vélez, O. (2003). Salut comunitaria: ¿concepto, realidad, sueño o utopía? Avances en Enfermería, 21, 49–61.
Ritter, H., & Webber, M. (1973). Dilemmas in general theory of planning. Policy Sciences, 4(2), 155–169.
Ross, M. G. (1955). Community organization: Theory and principles. New York: Harper & Bros.
Rydin, Y., Bleahu, A., Davies, M., Dávila, J. D., Friel, S., & DeGrandis, G. (2012). Shaping cities for health: Complexity and the planning of urban environments in the 21st century. London: The Lancet/UCL.
Sheikh, M. R., Afzal, M. M., Ali, S. Z., Hussain, A., & Shehzadi, R. (2010). Multisectoral development for improved health outcomes: Evaluation of community-based initiatives in the Islamic Republic of Iran. Eastern Mediterranean Health Journal, 16(12), 1231–1236.
Sierra, I., Cabezas, C, Brugulat, P., & Mompart, A. (2008). Estrategia ‘Salud en los barrios’: actuaciones focalizadas en territorios de especial necesidad social y de salud. Medicina Clínica, 131(S4), 60.64.
Soler, R., Orenstein, D., Honeycutt, A., Bradley, C., Trogdon, J., & Kent, C. K. (2016). Community-based interventions to decrease obesity and tobacco exposure and reduce health care costs: Outcome estimates from communities putting prevention to work for 2010–2020. Preventing Chronic Disease, 13, 150272.
Subirats, J. (2011). Otra sociedad, ¿otra política?. Barcelona: Icaria.
Taylor, M. (2007). Community participation in the real world: Opportunities and pitfalls in new governance spaces. Urban Studies, 44(2), 297–317.
Thompson, S., Figueras, J. Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., et al. (2014). Economic crisis, health systems and health in Europe: Impact and implications for policy. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.
Varea, C., Terán, J. M., Bernis, C., Bogin, B., & González-González, A. (2016). Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003–2012). Annals of Human Biology, 43(2), 169–182.
Weber, E. P., & Khademian, A. M. (2008). Wicked problems, knowledge challenges, and collaborative capacity builders in network settings. Public Administration Review, 68(2), 334–349.
Wood, D. (2016). Community indicators and collective impact: Facilitating change. Community Development, 47(2), 194–208.
World Health Organization. (1998). Promotion of health. Glossary. Geneva: World Health Organization.
Zapata Moya, A. R., Buffel, V., Navarro Yáñez, C. J., & Bracke, P. (2015). Social inequality in morbidity, framed within the current economic crisis in Spain. International Journal for Equity in Health, 14, 131.
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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DOI: https://doi.org/10.1007/s11205-017-1703-4