Looking on the positive side...

While we Scots have been known to accentuate the negative, at present we don’t need to look very far to find growing evidence, emphasis and appetite for the importance of strengthening the skills and resources that exist within individuals and communities to improve health and wellbeing. The recent GCPH winter seminar series presentation by Antony Morgan, Associate Director at NICE and one of the editors of the book ‘Health Assets in a Global Context’, highlighted the need to start thinking and acting differently.  We must find new ways of doing things if we are to achieve the step gains in health improvement which have not been achieved to date, especially in our most deprived communities.

As a new comer to the field of community based approaches but an old timer in the field of evidence based public health, I welcome this opportunity to blog, and look forward to engaging in the ongoing debate, discussion and opportunity for learning that the introduction and interest in asset based approaches has generated.

So what are health assets? These are said to be the collective resources that people and communities have - internally, externally and collectively - which help protect against poor health and also support the development and maintenance of good health and living. Assets can be social, financial, physical and environmental.  They are not just the things you can put a price on.  They are also about people, skills and opportunities. Central to the assets approach is the idea of people in control of their lives through development of their capacities and capabilities. This enables people to become better connected with each other and encourages a spirit of cooperation, mutual support and caring. The approach is focused on equipping individuals with the skills and competencies for living which help us to manage difficulties in our lives when they arise.

So this all sounds lovely but what does it mean in reality for individuals, communities and staff? For me the approach embraces the need to move away from defining people in terms of what they don’t have (their needs) to what they do have (their assets) and acknowledging that communities and individuals often labelled deprived are rich in relationships, resourcefulness and social, personal and material assets.  For individuals this should mean that the services they engage with are more receptive and responsive to their needs and wishes and are more person centred – where people have the opportunity to be actively involved in the co-production of services that they use. On the other hand, for staff and public services a move towards an assets based approach will mean a change in individual and organisational attitudes and practice. No small challenge. Instead of doing things ‘to’ or ‘for’ communities, services need to develop a mindset which sees them working ‘with’ individuals and communities to co-create health and wellbeing. However, it remains to be seen how the underpinning assets concept will translate into effective practice and affect the every day delivery of vital services.

There is rapidly growing interest in ‘asset based approaches’ in Scotland, but it has been stated by many that the approach is not new and that it is simply ‘old wine in a new bottle’. Within the GCPH seminar, Antony responded to this claim by acknowledging that the approach is building on what has been done already, readily embraces the notion of ‘positive health’ and is providing a new language to move the conversation forward.  However despite this upsurge in local and national interest in asset based approaches, a number of central questions remain unanswered. How do we reliably and validly measure assets? Are asset based approaches effective in reducing health inequalities? What are the differential impacts of the approach for different population groups? What will be the effects on workforce capacity at a time when services are already stretched?  The need for a clear political response and direction to the debate also remains absent.   

I continue to believe that the recognition and enhancement of an individual’s strengths, skills, resources, assets and connections can only be a good thing, but where this approach sits within the wider public health landscape remains to be determined. 

A promising new potential approach or one too fraught with the dangers of individualism? What do you think?