one - Introduction

Summary

The public health system forms a framework encompassing all the different sectors that contribute to the public's health (Hunter et al, 2010). Despite the undisputed place of communities within that system, the contribution of civil society to meeting health goals receives minimal attention within public health policy and practice in England. Instead, public health effort has tended to focus on gathering evidence and working through organisations primarily in the health sector to deliver interventions supported by specialist practitioners. Communities can end up defined by their problems and therefore become the deserving ‘target’ of public health interventions, rather than being seen as part of the solution. Yet, at a more abstract level, community as a resource and a setting for public health continues to have importance, and support for increased community participation in health is reflected in national and international public health policy (Secretary of State for Health, 2010b; Department of Health, 2011b; World Health Organization, 2011). The mismatch between theory, policy and practice leaves scope for greater understanding of how the rhetorical value of ‘community’ can be translated into pragmatic strategies for social action on health. This book concerns one strategy for community engagement: the involvement of members of the public in delivering public health programmes and related community services.

Lay health worker and other peer-based interventions have a place in public health practice, and have been applied in many international contexts. The active involvement of lay people in service delivery draws in experiential knowledge, enhances social support processes and improves connections between services and individuals (Dennis, 2003; Rhodes et al, 2007). In England, increased citizen involvement in planning and running services (Secretary of State for Communities and Local Government, 2008) has been linked to the personalisation of health and social services and the patient and public involvement agenda (Department of Health, 2005b, 2008b). Indeed, community engagement has been described as ‘an embedded feature of government policy, an act of faith that now extends across all the political parties’ (Campbell et al, 2008, p 6). Coalition policy on the Big Society has given renewed emphasis to volunteering, social action, localism and citizen empowerment (Cabinet Office, 2011), but since this is occurring within a period of fiscal crisis, it poses a risk that communities will become the fallback when state services shrink.