Miért van szükségünk közösségalapú egészségfejlesztésre? [Why do we need community-based health promotion?]

Benyó Béla

Összefoglaló


Összefoglaló: Az Ottawai Nyilatkozat lendületet és teret adott a közösségalapú egészségfejlesztési elméletek és gyakorlati politikák megfogalmazásának. Azóta számos elmélet és bizonyítottan hatásos beavatkozási módszer látott napvilágot e témakörben. Ezek közül néhány kiállta a gyakorlat próbáját és a jó gyakorlatok sorába került. A kutatók kimerítő vitát folytattak a közösségi bevonódás szintjeiről, módjairól, jellemzőiről, azok egymáshoz való kapcsolódásukról. Tisztázták a közösségi részvétel, felhatalmazottság mibenlétét és folyamatjellegét, amely végül munkadefinícióként a WHO Európai Regionális Irodája által is elfogadást nyert. A közösségi felhatalmazottság fogalmának tisztázása gyakorlati jelentőséggel bír, mert meghatározza a közösség szerepét az egészségfejlesztés során, melynek jelentőségét nehéz túlbecsülni. Ennek eredményeképpen válhat valósággá az az elv, hogy a közösség egészségét alapvetően meghatározza azt a tény, hogy milyen mértékben képes a közösség kontrollálni az egészségkockázati tényezők alakulását. A változás igénye elérte hazánkat is, a népegészségügy intézményrendszerének reformja a figyelem középpontjába helyezi a közösség szerepének értelmezését. Éppen ezért aktuálissá vált a téma elméleti áttekintése, összefoglalása. A cikk erre tesz kísérletet.
Abstract: The Ottawa Declaration gave an impetus and space to the development of the community-based theories and to the practices of health promotion. Numerous evidence-based methods have emerged since than in this field. Some of them were satisfactory in practice and became part of the good practices. The researchers made exhausted debates on the level of community involvement, ways, characteristics and their relationships. These debates finally led to the clarification on the meaning of the community participation and empowerment arriving at the idea of being a continuum. This finally became accepted by the WHO European Regional Office as working definition of the empowerment. The clarification of the community empowerment has practical benefits too taking into account its important role played in the process of health promotion, therefore, it is hard to overestimate its significance. As a result of this new approach, it is easy to understand that the health of a community is merely depending on to what extent the community is able to control of these risk conditions. Hungary is affected by the need for changes and the planned reform of the public health made the role of the community and the community-based empowerment into the centre. These changes have led to the need to summarize the theories related to the community involvement. The article made an attempt to this.

Kulcsszavak


egészségfejlesztés; közösségi részvétel; felhatalmazottság; hatalomnélküliség; kapacitásfejlesztés [health promotion; community participation; empowerment; powerlessness; capacity building]

Teljes szöveg:

Teljes szöveg

Felhasznált szakirodalom


Az Ottawai Egészségfejlesztési Charta. In: Az egészségfejlesztés alapelvei. http://regi.oefi.hu/alapelvek. pp 9 -14. (Elérve: 2017.11.13.)

Dzsakartai Nyilatkozat. In: Az egészségfejlesztés alapelvei, http://regi.oefi.hu/alapelvek.pdf. pp 29 -34. (Elérve: 2017.11.13.)

WHO Regional Office for Europe HEALTH 21 - The Health for All Policy Frame-work for the European Region. WHO Regional Office for Europe, Copenhagen, 1998.

Bracht, N. and Tsouros, A. Principles and strategies of effective community participation. Health promotion International, 1990; 5:199–208.

Smithies, J. and Webster, G. Community Involvement in Health: From Passive Recipients to Active Participants. Ashgate, Aldershot, 1998.

WHO Regional Office for Europe. Community Participation in Local Health and Sustainable Development: Approaches and Techniques. Centre for Urban Health, WHO Regional Office for Europe, Copenhagen, 2002. http://apps.who.int/iris/bitstream/10665/107341/1/E78652.pdf (Elérve:2017.11.30.)

Israel BA, Schurman SJ. Social support, control, and the stress process, in: GlanzK, Lewis F, Rimer B (eds.): Health Behaviour and Health Education: Theory, Research and Practice. San Francisco, CA, Jossey-Bass, 1990.

Haan MN, Kaplan GA, Camacho-Dickey T. Poverty and health: Prospective evidence from the Alameda County Study. Am J Epidemol, 1987; 125:989-998.

Israel BA, Rounds KA. Social networks and social support: A synthesis for health educators. Advanced Health Education Promotion, 1987; 2:322-351.

James, C. Empowering Communities in the Development Process: Participatory Rural Appraisal as an Approach. University of Bristol, Bristol, 1995.

Rifkin, S. B. Community participation in maternal and child health/family planning programmes. World Health Organisation, Geneva, 1990.

Jane Dailly and Alan Barr. Understanding a Community-led Approach to Health Improvement, 2008.

Kindervatter S. Nonformal education towards empowering. Chapter VII in Nonformal Education as an Empowering Process. Amherst, MA, Center for International Education, 1978.

Gutierrez LM. Coping with Stressful Life Events. An Empowerment Perspective. Working Paper. School of Social Work, University of Michigan, Ann Arbor, MI, 1988.

Zimmerman MA, Rappaport J. Citizen participation, perceived control, and psychological empowerment. Am J Community Psychol 1988; 16:725-750.

Zimmerman MA. Empowerment theory. Psychological, organizational and community levels of analysis, In: Rappaport J, Seidman E (eds.). Handbook of Community Psychology. New York, 2000.

Zimmerman MA. Taking aim on empowerment research: On the distinction between psychological and individual conceptions. Am J Community Psychol, 1990; 18:169-177.

Kieffer CH. Citizen empowerment: A developmental perspective. Prev Hum Serv, 1984; 3:9-36.

Schulz AJ, Israel BA, Zimmerman MA, Checkoway BN. Empowerment as a multilevel construct: Perceived control at the individual, organizational and community levels. Health Education Research, 1995; 10:309–327.

Gerschick TJ, Israel BA, Checkoway BN. Means of Empowerment in Individuals,Organizations, and Communities. Report on a retrieval conference, Ann Arbor, University of Michigan, 1990. https://deepblue.lib.umich.edu/bitstream/handle/2027.42/51259/493.pdf;sequence=1 (Elérve: 2017.11.13.)

Bernstein, E., Wallerstein, N., Braithwaite, et al. Empowerment forum: a dialogue between guest editorial board members. Health Education Quarterly , 1994; 21:281–294.

Torre, D. Empowerment: structured conceptualisation and instrument development. PhD thesis, Cornell University, 1986.

Rappaport, J. Terms of empowerment/exemplars of prevention. Toward a theory of community psychology. American Journal of Community Psychology , 15, 121–147.

Swift, C. and Levin, G. Empowerment: an emerging mental health technology. Journal of Primary Prevention , 1987; 8:71–94.

Friedmann, J. Empowerment: The Politics of Alternative Development. Blackwell Publishers, Oxford.

Craig, G. and Mayo, M. (eds.) Community Empowerment. A Reader in Participation and Development. Zed Books, London, 1995.

Wallerstein, N. Powerlessness, empowerment and health. Implications for health promotion programs. American of Health Promotion, 1992; 6:197–205.

Rissel, C. Empowerment: the holy grail of health promotion? Health Promotion International, 1994; 9:39–47.

Laverack, G., Walleistein, N. Measuring Community empowerment: a fresh look at organisational domains. Health Promotion International, Oxford University Press, 2001; 16:179-185

Goodman et al. Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Education and Behavior, 1998; 25:258–278.

Eng, E. and Parker, E. Measuring community competence in the Mississippi delta: the interface between programme evaluation and empowerment. Health Education Quarterly, 1994; 21:199–220.

Geyer, S. Some conceptual considerations on the sense of coherence. Social Science Medicine , 1997; 44:1771–1779.

Putnam, R. D. Bowling alone: Americas declining social capital. Journal of Democracy, 1995; 6:65–78.

Modra, C. Exploring social capital: levels of participation, trust and health in a suburban region of Adelaide, South Australia. Celebrating Public Health: Decades of Development, Decades of Opportunity, Public Health Association of Australia, Hobart, 1998.

Wilkinson, R. G. Income inequality and social cohesion. American Journal of Public Health, 1997; 8:104–106.

Bell, C. and Newby, H. Community Studies. George Allen and Unwin, London, 1978.

Ward, J. Community development with marginal people: the role of conflict. Community Development Journal, 1987; 22: 18–27.

Israel, B. A., Checkoway, B., Schultz, A. and Zimmerman, M. Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational and community control. Health Education Quarterly, 1994; 21:49–170.

Zakus, J. D. L. and Lysack, C. L. Revisiting community participation. Health Policy and Planning, 1998; 13:1–12.

Laverack, G. Addressing the contradiction between discourse and practice in health promotion. PhD thesis, Deakin University, Melbourne, Australia, 1999.

Everson, at al., Interaction of workplace demands and cardiovascular reactivity in progression of carotid atherosclerosis: population based study. British Medical Journal, 1997; 314:553-558.

Geyer, S. Some conceptual considerations on the sense of coherence. Social Science Medicine, 1997; 44: 1771–1779.

Asthana, S. Community participation in health and development. In Phillips, D. and Verhasselt, Y. (eds) Health and Development. Routledge, London, 1994.

Gordon, G. Participation, empowerment and sexual health in Africa. In: Craig, G. and Mayo, M. (eds.). Community Empowerment. A Reader in Participation and Development. Zed Books, London, 1995, pp. 181-193.

Taylor, V. Social reconstruction and community development in the transition to democracy in South Africa. In: Craig, G. and Mayo, M. (eds) Community Empowerment: A Reader in Participation and Development. Zed Books, London, 1995; pp.168–180.

Raeburn, J. How effective is strengthening community action as a strategy for health promotion? ParticiACTION. No. 3. University of Toronto, Toronto, 1993.

Baistow, K. Liberation and regulation? Some paradoxes of empowerment. Critical Social Policy, 1995; 42:34–46.

Zimmerman, M. A. Taking aim on empowerment research: on the distinction between individual and psychological conceptions. American Journal of Community Psychology, 1990; 18:169–177.

Zimmerman, M. A. Psychological empowerment: issues and illustrations. American Journal of Community Psychology, 1995; 23:581–599.

Jackson, T., Mitchell, S. and Wright, M. The community development continuum. Community Health Studies, 1989; 8:66–73.

Labonte, R. Health Promotion and Empowerment: Reflections on Professional Practice. Health Education Quarterly, 1994; 21:253–268.

Cracknell, B. E. Evaluating development aid. Evaluation, 1996; 2:23–33.

Goodman, R. M. Evaluation of community-based health programs: an alternate perspective. In: Schneiderman, N., Speers, M., Tomes, at al. (eds.). Integrating Behavioural and Social Sciences with Public Health. American Psychological Association Press, Washington DC, 2000.

Patton, M. Q. Toward distinguishing empowerment evaluation and placing it in a larger context. Evaluation Practice, 1997; 18:147–163.

Fetterman, D. M., Kaftarian, S. J. and Wandersman, A. (eds.). Empowerment Evaluation. Knowledge and Tools for Self-Assessment and Accountability. SAGE publications, 1996.

Jewkes, F. and Murcott, A. Community representatives: representing the ‘community’? Social Science and Medicine, 1998; 46:843–858.

Kahssay, H. and Oakley, P. (eds.). Community Involvement in Health Development: A Review of the Concept and Practice (Public Health in Action, No. 5).World Health Organization, Geneva, 1999.

Morgan, L. Community participation in health: perpetual allure, persistent challenge. Health Policy and Planning, 2001; 16: 221–230.




DOI: http://dx.doi.org/10.24365/ef.v58i4.209

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