Editor : To see the British Medical Journal, follow two recent
editorials (1,2) which have looked at the wider public view of health and
the role of local people in creating health, dedicating an edition to
patient partnership (BMJ no 7212) is heartening.
The lead editorial (3) describes the intent to "consider the scope
for
creating meaningful partnerships between doctors and patients and between
health policymakers and local community". We would argue however that the
journal explores a narrow understanding of patient partnership. The
majority of contributions focus on patients participating in their own
care, in clinical decisions about their illness, in the doctor-patient
consultation and in medical research.
This neglects a tradition of work in this country to nurture the role
of
local communities in influencing health policy and in creating and
pursuing their own health agenda. This tradition involves a shift from an
individual illness based model to a collective model, which is concerned
with addressing the underlying determinants of ill health. This approach
is exemplified by work in West Newcastle over the last 5 years (4), where
the Locality group and then the PCG have funded an independent community
development project that is directed by a committee of local community
representatives. The approach maintains a constant focus on health
inequalities and challenges discrimination. Its work with minority groups
was recognised last year with the award of an NHS Equality award. A
recent evaluation of this initiative (5) demonstrated that the community
development approach has been successful in creating and sustaining links
with a large number of local community groups and individuals and
significant new innovations have resulted, as have changes in peoples
commitment to meeting the needs of minority groups.
Examples of such work, which may be highly valued locally, are often
disadvantaged in terms of dissemination because they do not fit within the
rigorous evidence based framework required for publication in refereed
journals. This is partly because it is difficult to define an intervention
whose success is often dependent on being responsive, flexible and
adaptable, but also because in a developmental process outcomes cannot be
pre-set.
The renewed interest in community development to be found in Our
Healthier
Nation(6) and in Health Action Zones suggests that the next step for the
British Medical Journal would be an issue dedicated to exploring best
practice in this difficult and challenging area.
References :
1. Fisher B, Neve H, Heritage Z. Community Development, user
involvement and primary health care. BMJ 1999; 318:749-50.
2. Richards T. Patients' priorities. BMJ 1999; 318:227.
3. Coulter A. Paternalism or partnership ? BMJ 1999, 319. 719-720.
4. Freake D, Crowley P, Steiner M, Drinkwater C. Local Heroes. Health
Services Journal, 10 July, 1997, 28-29.
5. Green J. Community Action on Health. Newcastle: Social Welfare
Research Unit, University of Northumbria at Newcastle, 1999.
Rapid Response:
Patient partnership
Editor : To see the British Medical Journal, follow two recent
editorials (1,2) which have looked at the wider public view of health and
the role of local people in creating health, dedicating an edition to
patient partnership (BMJ no 7212) is heartening.
The lead editorial (3) describes the intent to "consider the scope
for
creating meaningful partnerships between doctors and patients and between
health policymakers and local community". We would argue however that the
journal explores a narrow understanding of patient partnership. The
majority of contributions focus on patients participating in their own
care, in clinical decisions about their illness, in the doctor-patient
consultation and in medical research.
This neglects a tradition of work in this country to nurture the role
of
local communities in influencing health policy and in creating and
pursuing their own health agenda. This tradition involves a shift from an
individual illness based model to a collective model, which is concerned
with addressing the underlying determinants of ill health. This approach
is exemplified by work in West Newcastle over the last 5 years (4), where
the Locality group and then the PCG have funded an independent community
development project that is directed by a committee of local community
representatives. The approach maintains a constant focus on health
inequalities and challenges discrimination. Its work with minority groups
was recognised last year with the award of an NHS Equality award. A
recent evaluation of this initiative (5) demonstrated that the community
development approach has been successful in creating and sustaining links
with a large number of local community groups and individuals and
significant new innovations have resulted, as have changes in peoples
commitment to meeting the needs of minority groups.
Examples of such work, which may be highly valued locally, are often
disadvantaged in terms of dissemination because they do not fit within the
rigorous evidence based framework required for publication in refereed
journals. This is partly because it is difficult to define an intervention
whose success is often dependent on being responsive, flexible and
adaptable, but also because in a developmental process outcomes cannot be
pre-set.
The renewed interest in community development to be found in Our
Healthier
Nation(6) and in Health Action Zones suggests that the next step for the
British Medical Journal would be an issue dedicated to exploring best
practice in this difficult and challenging area.
References :
1. Fisher B, Neve H, Heritage Z. Community Development, user
involvement and primary health care. BMJ 1999; 318:749-50.
2. Richards T. Patients' priorities. BMJ 1999; 318:227.
3. Coulter A. Paternalism or partnership ? BMJ 1999, 319. 719-720.
4. Freake D, Crowley P, Steiner M, Drinkwater C. Local Heroes. Health
Services Journal, 10 July, 1997, 28-29.
5. Green J. Community Action on Health. Newcastle: Social Welfare
Research Unit, University of Northumbria at Newcastle, 1999.
6. Saving Lives: Our Healthier Nation. London. HMSO 1999
Philip Crowley
Newcastle Community Development in Health Co-ordinator
14 Great North
Road, Newcastle upon Tyne, NE2 4PS
Chris Drinkwater
Senior Lecturer in Primary Health Care
University of Newcastle, Medical
School, Framlington Place, Newcastle upon Tyne, NE2 4EH
Competing interests: No competing interests