RESILIENT ROTHERHAM?

The notion of community resilience is complicated in part because both terms have many aspects. We have distinguished three types of community: of purpose, such as a political association, of culture, such as religion and of locality, such as a neighbourhood. Our primary interest in this report is with communities of locality. We have suggested a three-faceted model of resilience in which it is described as: of something, to something (a stressor), to an endpoint. Thus (local) community resilience is: of a neighbourhood or locality, to a stressor, such as an earthquake, to an endpoint, such as back-to-normal. The stressors faced by a community can be acute, such as an earthquake or the shutdown of a local employer, or chronic, such as long-term poverty and unemployment. Community resilience is most easily seen in relation to acute stressors in part because both the stressor and endpoint are fairly clear. It is less clear with chronic stressors mainly because the endpoint cannot be back-to-normal. We therefore suggested a distinction between as-you-were and as-you-should-be endpoints. An example of as-you-should-be resilience is where someone becomes a well-functioning adult despite abuse as a child. In relation to communities of locality, the as-you-should-be endpoint is roughly that they will provide places which enable rather than impede their members to live well, to flourish and to be happy. A local community is resilient to the extent that it does this in the face of stressors, such as poverty. Resilient communities can be identified by combining measures of individual wellbeing, such as quality of life and health, with indicators of stressors, such as deprivation. A resilient community is one that is deprived but in which people do better than average in regard to these measures. This method of identifying resilient communities is an outlier method; it depends on finding those better than average. One problem with this is that it does not give an objective measure of resilience; we could use it only to show that one community has become more resilient in relation to another, not that it has become more resilient per se. Final v7 23 This problem links to a more general problem with the literature on measuring, characterising and enhancing community resilience. This is that insufficient distinction is made between measures of how well people within a community are doing, i.e. their wellbeing, and of how resilient they are, i.e. their wellbeing given particular stressors. Thus most of the measures we identified in the literature as possible contributors to resilience were more like contributors to wellbeing. For example, measures to improve the built environment or social networks are better characterised as enhancing social capital and wellbeing rather than resilience. In practice, there seems likely to be a link between resilience and wellbeing. An individual or community without resilience to likely challenges would have precarious wellbeing

An argument against the focus on community resilience in public health

Background - It has been suggested that Public Health professionals focus on community resilience in tackling chronic problems, such as poverty and deprivation; is this approach useful? Discussion - Resilience is always i) of something ii) to something iii) to an endpoint, as in i) a rubber ball, ii) to a blunt force, iii) to its original shape. “Community resilience” might be: of a neighbourhood, to a flu pandemic, with the endpoint, to return to normality. In these two examples, the endpoint is as-you-were. This is unsuitable for some examples of resilience. A child that is resilient to an abusive upbringing has an endpoint of living a happy life despite that upbringing: this is an as-you-should-be endpoint. Similarly, a chronically deprived community cannot have the endpoint of returning to chronic deprivation: so what is its endpoint? Roughly, it is an as-you-should-be endpoint: to provide an environment for inhabitants to live well. Thus resilient communities will be those that do this in the face of challenges. How can they be identified? One method uses statistical outliers, neighbourhoods that do better than would be expected on a range of outcomes given a range of stressors. This method tells us that a neighbourhood is resilient but not why it is. In response, a number of researchers have attributed characteristics to resilient communities; however, these generally fail to distinguish characteristics of a good community from those of a resilient one. Making this distinction is difficult and we have not seen it successfully done; more importantly, it is arguably unnecessary. There already exist approaches in Public Health to assessing and developing communities faced with chronic problems, typically tied to notions such as Social Capital. Communityresilience to chronic problems, if it makes sense at all, is likely to be a property that emerges from the various assets in a community such as human capital, built capital and natural capital. Summary - Public Health professionals working with deprived neighbourhoods would be better to focus on what neighbourhoods have or could develop as social capital for living well, rather than on the vague and tangential notion of community resilience.</p

Positionality, Access to the Social Space and Place of Research: Narratives from Research in Low Middle Income Settings

Research on positionality and accessing field work for researchers studying their own communities in Lower Middle-Income Countries (LMICs) is scant. The majority of the literature on this topic emanates from High-Income Countries (HICs). Drawing on ethnographic field work conducted in Kenya and Pakistan, the authors have explored ways in which dialectic relationships between the researcher and participants in various social spaces (SSs) within the place of research (PoR) influences access to the field and data quality. The authors analysed reflective narratives from their fieldwork using Gibbs’s Reflective Cycle (GRC). The findings show that, accessing field work in LMICs where the research agenda is not fully developed with respect to funding and government support presents not only social and practical issues concerning the fieldwork but also ethical dilemmas. SSs in a PoR are powerful in determining both access to the field and data quality. For researchers returning from HICs to study the communities of their origin, being a native does not grant automatic access to research spaces. Gender and power dynamics are not only crucial for accessing the communities which are studied and from which data are collected but can also bring a degree of bias to the data collected. This paper sheds light on issues around positionality, access and doing field work in these contexts. The findings show the complex context in which research is conducted and how positionality is contested. This paper is useful for professionals from LMICs, early career researchers and professionals working in international development

Universal healthcare in the Philippines and the scope for therapy and rehabilitation

This discussion paper highlights some of the findings from an international workshop where researchers examined literature relating to universal healthcare in the Philippines. These findings included the complexity of the healthcare system, possible barriers experienced and service coverage, and are explored in relation to rehabilitation which may broaden debate and discussion in this area. Development of the Filipino healthcare system is outlined and the possible benefits of rehabilitation, including vocational rehabilitation, are examined especially in relation to work-related injuries and wheelchair use. There is a focus on understanding disability as a health, development and human rights issue and the possible benefits of rehabilitation to improve the quality of life for disabled people. Future research initiatives to confirm the number of people living with disability and the nature of their disability and information relating to the therapy workforce in the Philippines is recommended. This paper may inspire research also relating to the objective of securing universal healthcare in the Philippines with greater consideration of the needs of disabled people and the benefit of rehabilitation

Honour based violence as a global public health problem: a critical review of literature

Purpose : 'Honour' Based Violence (HBV), a form of Gender Based Violence (GBV), has received increasing interest from media, human rights organisations, academics and public. A significant increase in the occurrence and reporting of HBV in many parts of the world and its detrimental impact on health and wellbeing of women, girls, communities and wider society; marks it a major public health concern. However, awareness and recognition of HBV in field of public health is low in many countries and there is little known about its nature, roots and distribution. Aim : The aim was to analyse existing literature to understand what is HBV; how it is understood, its nature and distribution. Methods : The literature was searched using the Scopus database and a series of search terms related to HBV, gender based violence and health and wellbeing. Findings : Definition of HBV and its forms is varied across cultures. There is a lack of consensus on how HBV can be identified over other forms of violence and no explicit theoretical perspectives have been sufficiently developed to deepen our understanding of HBV. Although findings from the review suggest that HBV forms and patterns may be regionally distinct, causes emanate from gender based and socio-economic inequalities. Value of findings : Findings from the review highlight the complexity of tackling HBV in a globalised world. Findings also provide insights on how public health model can be used to analyse causes and prevention of HBV. Further, a non-culturalised, unprejudiced and inclusive definition is required to flag-up and record HBV cases. Keywords : Honour-based violence, female genital mutilation, gender-based violence, public health, honour killin

'It's about giving yourself a sense of belonging’: community-based history and well-being in South Yorkshire

Community-based history is a highly popular activity in neighbourhoods across the UK. The practice of participants doing history, often their own, for themselves, marks its difference from other forms of public history. This article explores the potential of involvement in community-based history in the South Yorkshire region to contribute to social identity and well-being and to inform public policy concerning health and well-being. We demonstrate the role of community-based history in building social capital and creating social links, tackling the negative effects of isolation, providing meaning, generating public and self-esteem and contributing to personal identity and belonging, as well as improving and strengthening local communities. Our findings reveal the relevance of community history in shaping notions of place and a sense of well-being through citizen engagement, with implications for community governance. At the same time, the limitations of our sample, particularly in relation to 'race' and whiteness, mirror an overwhelmingly White British participation in the wider heritage sector. This confirms that issues concerning whose history is represented, by whom, for what purpose and in what context, require consideration and raises questions regarding the role of community history in enabling a nostalgic and exclusive place-making with negative implications for non-British and/or non-white inhabitants

Karo Kari : the murder of honour in Sindh Pakistan : an ethnographic study

This paper aims to discuss the wider context, in which honour murders occur, the social structures which contribute to the occurrence and perpetuation of the practice of honour murders. An ethnographic fieldwork was conducted in Jacobabad Sindh, Pakistan. The study found that honour murders were not solely driven by customs and traditions, but also by a feudal culture, male-dominated social structures, the complicit role of state institutions and law enforcement agencies and a web of vested interests. Therefore, honour murders may be prevented by reducing the influence and interference of feudal lords on state institutions, in particular law enforcement agencies, and by promoting education that challenges a patriarchal and feudal mind-set in the community

Weight gain following stroke : its everybody's business

Introduction: Approximately 900,000 people in England live with the effects of stroke (NICE 2010). Health behaviour modification can be crucial in stroke rehabilitation. Local stakeholders identified a problem of increased numbers of patients experiencing long term weight gain following a stroke. Method: Mixed method study incorporating i) survey of South Yorkshire Health Cohort participants (n=87); ii) interviews with staff (n=18) and stroke patients (n=10). Data analysed using framework analysis. Results: Weight gain post stroke is not monitored routinely and prevalence is therefore unknown. Findings from this study indicate that post-stroke weight gain is a problem for some people. Contributing factors identified include social isolation, depression and loss of control in cognition and communication affecting ability to manage diet and weight. Ambiguity was seen to arise because weight gain following stroke can be both a sign of progress and of a problem. Results indicate fragmented communication between health care professionals across care pathways limits opportunities to address weight gain. Additional limiting factors include limited availability of specialist support and funding cuts to community based services. Conclusion: Health care professionals need to be mindful of the risk of long term weight gain following stroke. Whether in acute, intermediate, rehabilitation or primary care settings, systems should be in place to identify opportunities for advice and support regarding diet and physical activity by, for example, embracing initiatives such as Making Every Contact Count (MECC). A large cohort study would provide population based data on prevalence and causes of weight gain following a stroke

Equity analysis by community; and addressing the unpredictable terrain

In Pakistan, the local government is organized into three tiers. The smallest unit is a Union Council (UC). A number of UCs constitute a Taluka (sub-district level), and a district consists of a number of Talukas. Each level has a council, which decides on the development needs of its area and constituency. The council members are elected, and at each level the Council has a Nazim and Naib-Nazim (akin to a ‘president’ and vice-resident’) The District council is composed of all the Nazims, and the Taluka Council is made up of all the Naib-Nazims. This framework of Local Government, introduced in 2001, provides opportunities to influence the district government plans and allocation through the elected representatives and to influence the elected representatives through community mobilization. The Equity Project Pakistan (as part of Global Equity Gauge Alliance), of Aga Khan University, is taking forward the equity related work that led to the discovery of three effective steps of community mobilization through equity analysis. The three steps being: (a) Equity Analysis by community groups, leading to identifying and prioritizing disparities that need to be removed. (b) Priority setting, for the UC, of the disparities identified at the village level. (c) Advocacy training for influencing district development plan for reducing disparities. Once the three steps of equity analysis were completed, several new issues were encountered: 1. Continuity of focus on equity. Local government election brought in a new set of elected councilors. 2. Increasing women’s involvement. Elected women are often represented by male members of their families. How to facilitate women’s direct involvement in taking the equity agenda forward. 3. Dealing with differences in learning abilities. There is a considerable difference in the learning ability of the elected representatives. What strategies would be effective in taking forward these different groups. In order to address the above three concerns, some strategies have been initiated. These are # New concerns New Strategies 1 Continuity of focus on equity Creation of an Equity Forum at the district level 2 Increasing women’s involvement Special attention to women; increasing spaces for their involvement. 3 Dealing with differences in learning abilities. Different strategies would be tested and documented, and analyzed to assess their effectiveness. The three new strategies have been initiated, and preliminary outcomes are encouraging. The paper will share the process and findings, and on the basis of the findings will discuss what is viable in a context that is politically unstable, and rife with tribal conflicts