From evangelism to system change? Citizen Led Approaches to Wellbeing

(With Acknowledgements to Mr Lowry of course.)

I recently had a good chat with Simon Rippon who with Trevor Hopkins wrote an article on assets for this blog. We agreed that it is positive that there is a growing debate about how we develop a more citizen led approach to co-producing wellbeing. In part this is because the issue has moved into the mainstream, its no longer – why should we do this but how? Another reason is because of the undoubted success that some players have had in promoting their ideas – in particular those of Asset Based Community Development.

Nonetheless, this debate will have passed most people by, largely because its between a very small group of people who promote and develop citizen led change in health and care.

I think that this small group consists of four main types of stakeholder – and it is the nature of this work that some individuals (like me!) occupy more than one of these roles. These roles are:

• Academics
• Practitioners – often professionals within the health or voluntary sector
• Consultants and some voluntary organisations – who are funded to promote and develop citizen led approaches to wellbeing.
• Citizens who are active within their communities – ironically, I think that this is the smallest group at the moment.

They all share a strong personal commitment to citizen led approaches to wellbeing, but it is also true that the overwhelming majority of those above earn some or all of their income from the local or national state – in other words many are Asset Based Change Professionals.

The Debate

This seems to circle around the following areas:

• A reliance on services provided by the state disempowers people and creates dependency
• Asset Based approaches can provide a useful and necessary challenge to professional self interest
• Asset Based approaches could allow governments to justify reducing statutory support to the most vulnerable
• Asset Based Community Development was developed in a different social and political context (the USA) and does not reflect the hard fought for public services that we have in the UK
• The UK has its own traditions of Asset Based working that is rooted in community work and in collective social movements such as trade unionism, tenants movements, elements of the voluntary sector etc, these have been and are under attack

Some of this discussion is set out in more detail in the following:

• Scottish Community Development Centre – Community Development in Contradictory Times – looking beyond Asset Based Community Development.
• Neoliberalism with a community face? A critical analysis of Asset- Based Development in Scotland – MacLeod and Emejulu
• Lynn Friedli in her article ‘What we’ve tried, hasn’t worked: the politics of assets based public health’
• Kevin Harris in the Guardian in 2011-Isn’t all Community Development Asset Based?

Does any of this matter?

As I said this debate is happening largely within a tiny group of people so; it is tempting to say that the debate does not matter at all. By definition most citizen led activity is happening already within communities – and most of those activists are oblivious to this debate. Indeed as Trevor and Simon say in their earlier article ‘go down the pub and no one would know what you mean by participatory budgets’ in my view the same applies to terms like Asset Based Community Development!

Its about power

In centralised states like the UK (England in particular) a tiny group of leaders in Public Health England and NHS England determine future policy and funding. The rise in interest in citizen led approaches has generated a desire by some of these and their equivalents in Scotland to drive this work forward.

Many of these people would not claim to have more than a limited knowledge of grass roots citizen led change, they are insufficiently aware of the rich histories, struggles and scale of what already exists. They work in an environment that likes clear models and requires simple messages that can be given to politicians.

Its contradictory – but a tiny number of leaders at a national level can have a profound influence on approaches to citizen led change at a local level.

The Money

There is little funding available to promote development and system change, so access to resources is hotly contested. While there are positive examples of thoughtful and inclusive attempts to commission work there are also cases where national health agencies have instead chosen to develop funded collaborations without any recourse to transparent commissioning.

I think that this often happens when the evidence base is not very clear and people are searching for innovation, enthusiasm and simplicity.

… and the grass roots?

There are many organisations who have long track records of successfully supporting citizen led change, but they have their heads down; getting on with working on the ground.

Some of these feel frustrated and threatened by the way that policy makers appear to be too easily seduced into backing and promoting specific models rather than recognising the diversity and strength of existing good practice at a local level.

As Jane South notes in said in her recent publication (A guide to community-centred approaches for health and wellbeing) for Public Health England and NHS England:

“A diverse range of community interventions, models and methods can be used to improve health and wellbeing or address the social determinants of health. UK community health practice is rich and diverse, encompassing national programmes through to small local projects.”

I am not convinced that leaders in Public Health England and elsewhere are sufficiently clear about the actions they need to take to respond to Jane’s analysis.

What do you think?