Can asset-based community development help to address health inequalities?

Assets approaches to addressing disadvantage have become popular in recent years. What does the term mean, and how do the different interpretations of an 'assets approach' impact on their outcomes?

To conclude in our short series about asset-based community development, What Works Scotland PhD student Sarah Ward discusses the benefits of using the capabilities framework to identify clear objectives for asset-based work.

Assets approaches have become popular in community development policy and in Scotland and UK-wide since the mid-1990s, and have appeared within Scottish public and health policy over the past five years. Both the Chief Medical Officer's report Health in Scotland 2011 and the Christie Report identify assets approaches as an important tool in addressing social  inequality and disadvantage.

Asset-based community development (ABCD) aims to provide an alternative to the traditional needs-led model of community work. Rather than a focus on what's 'wrong' with communities, ABCD seeks out local strengths, by asking residents what they feel passionate about, and supporting them in taking action for themselves. Resources may take the form of physical assets such as a community centre, school or neighbourhood project but, more importantly, represent the skills, time and (crucially) energy of local residents, to build local alliances and articulate their own vision for change. ABCD practitioners argue that the professionalisation of community problems has led to local residents feeling disempowered and ignored in identifying local priorities for action. The benefits of such an approach are seen to be doubly beneficial: to empower communities in setting the agenda, and to mobilise local resources at a time when public sector budgets are being significantly reduced.

However, when examining the perceived goals of an assets approach in Scotland, there appears to be a range of understandings across policy-makers and practitioners as to the key aims or benefits. Indeed, the attraction of using such broad concepts in public policy may be that they appear to offer a consensus across policy-makers and practitioners by remaining fluid and open to interpretation. Analysing the different interpretations of an assets approach can help us to understand the effects these are likely to have on project and policy outcomes.

The literature on assets approaches suggests five main understandings of the assets concept. In brief, these are:

1. A focus on the behaviours which are seen to promote good health, including the strengthening of social networks.
2. An opportunity for service user involvement in public services.
3. The mobilisation of local resources at a time of diminishing resources.
4. The strength factors enabling communities to overcome vulnerability and disadvantage.
5. The opportunities to link to macro-level change through community empowerment and a locally led agenda for social change.

Whilst there is some overlap between these aims, the differences in perceived objectives can cause tension within partnership projects, particularly since these differences often go unarticulated, leaving staff puzzling over the gap between the outcomes they had hoped for and what is actually happening on the ground. Tackling health inequalities raises complex issues; clear, empirical objectives amongst policy-makers and practitioners are an important first step in working to address them.

There is a broad consensus among research literature on health inequalities of their socio-economic causes (Fair Society Healthy Lives - The Marmot Review, 2008). Sridhar Venkatapuram argues that health equality should be considered a basic human right. However, alongside this is a recognition that much of health policy continues to focus on lifestyle change, stopping short of a meaningful engagement with socio-economic causes because they are just too complex to fix in an era of short-termism and media soundbites.

What, then, can we hope to achieve using ABCD to address inequalities in Scotland? 

This is likely to depend on the assets definition employed. A project that supports local residents to articulate what they really want to change will have different outcomes from one that uses assets as a means of local consultation on public service delivery. Indeed, there is likely to be some conflict between the two. What’s more, a project aiming to address poverty and disadvantage within an environment of austerity cuts needs to take account of that context in plotting its likely outcomes.

In teasing out the possible outcomes of asset based community development, the Capabilities Approach (CA) offers a useful framework (see the What Works Scotland publication What can the capabilities approach add to policy analysis in high-income countries?). The Capabilities Approach identifies the key requirements for addressing social injustice at an individual level but also examines the personal, social and global factors that either support or hinder the achievement of these freedoms. A crucial feature is that the group affected defines these requirements, or 'domains'. Domains might encompass areas such as lifespan, emotional and physical health, and political and material control.

By using research evidence to define what local residents and practitioners see as the most important requirements of an assets approach, we can begin to plot pathways that move towards more complex socio-economic concerns, rather than stopping short with lifestyle behaviours. Such an analysis can also help to understand the areas in which an assets approach may not be effective, and where alternative policies are required to meet the range of capabilities constituting a life of dignity and health justice.

For further reading on the Capabilities Approach, developed by Amartya Sen and Martha Nussbaum, see the recommended reading on the Human Development and Capability Association website.
 

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Other blogs in this series on asset based community development:

• Asset-Based Community Development: Sustainable development is about discoverables; not deliverables
• Positive conversations, meaningful change: learning from Animating Assets