By Javier Segura del Pozo
health doctor
Today we will finish editing the text “Introduction to Community Health” that we have been sharing in nine installments, started on August 28, 2022. We will close with the six examples that we still had to see of the ten selected community health projects and methods: healthy walks, community gardens, maps of health assets, maps of healthy eating, investigations with Photovoice, group workshops, etc.
5. Healthy walks
They are group activities in principle designed for the promotion of physical activity regulated in people at risk of sedentary lifestyle, obesity or diabetes, but who can incorporate more complex goals and varied, such as the prevention of unwanted loneliness and social isolation or empathy between different social, cultural and age groups: rapprochement of the gypsy community to the paya, of immigrant groups to “natives”, of people older to younger, from people with a diagnosis of mental illness or disability to people without that diagnosis, people with different sexual orientations or gender identities, etc. The walks thus end up becoming an instrument in the fight against discrimination or stigma and in favor of cooperation between unequals.
These cooperation ties are not only forged by agreeing on a common activity, but by sharing the emotional and historical memory of the neighborhood or community where one lives, identifying and reinforcing a feeling of belonging to that territory, above other identity elements. . By way of Jane’s ride[1] [2], the walkers stop at significant places and corners of their biography that is shared with the rest of the group. Therefore, it also serves to share the story and emotional geography of the neighborhood (mental maps) and map its resources and health assets [3].
Video «Emotional walk through Villaverde» carried out by OMC radio de Villaverde, which illustrates the emotional walk of a group of women of different ethnic and migratory origins, organized by the Villaverde Municipal Community Health Center (CMSc). They show, like a work of art in a living museum, their stories of the neighborhood and its most significant corners.
6. healthy orchards
As with healthy walks, community gardens have uses beyond the apparent. Although they are designed to provide healthy food, grown in an environmentally sustainable manner, they can meet other community objectives: both pedagogical (school gardens), as well as establishing links between unequals and promoting social participation. It is not infrequent that the same space where the urban garden is located is used to hold all kinds of neighborhood meetings. In the case of the municipal community health centers in Madrid, the availability of outdoor space in some health centers was used to build healthy gardens, becoming a powerful tool for community revitalization and health promotion.
Community garden of the Los Patriotas neighborhood of Tunja (Boyacá-Colombia), promoted by Professor Angela Maria Guerra Cordero, community health specialist from the Pedagogical and Technological University of Colombia, and Dr. Oscar Virgüez, tutor of family medicine residents at that university. The beautiful project, which I was lucky enough to meet a few weeks ago, has managed to link a group of neighborhood residents around their agro-horticultural skills and is an instrument not only for food sovereignty (in a neighborhood where hunger and malnutrition are present), but rather neighborhood cooperation (in a community where mutual distrust reigned) and community training of family medicine residents (whose majority of training on “primary health care” is clinical-hospital)
7. Maps of health assets
We will limit ourselves here to only mentioning the methodology of maps of health assets, since there are already multiple resources to approach it.[4] [5]. As is known, it is based on the concept of salutogenesis and, as has been said before, it aims for the people who inhabit a territory to be able to identify the elements of it that have been or are a positive resource for the health of individuals, families and other social groups. The maps of assets, more than an end, are a means for establishing links between people, organizations and professionals during their preparation, which can be put into play at any time of need or opportunity for the health of the neighborhood.
Mapping Carabanchel Alto It has been one of the pioneering projects for mapping health assets in Madrid, from which many others have been generated. It has been a source of training for hundreds of professionals and activists, based on the teachings of people initially linked to it, such as Jara Cubillo or Gema Casero (Carabanchel Community Plan), among others.
8. Healthy Eating Maps (Food mapping)
They are a variant of asset maps applied to food. They identify shops and food resources and the level of access to healthy and affordable food. As such, they can also be an urban planning tool that identifies and addresses food deficits.[6]
Healthy and accessible food mapping of Sandwell (England). Figure 1 (left): shows access to food stores of any kind. Streets in bold are streets with homes within “reasonable walking distance” of at least one business. In other words, most of the houses in the neighborhood have access to grocery stores. However, most of them sell foods that are high in fat, sugar, and salt. Translation of the text of the legend: streets less than 500 meters away; streets to more than 500 meters.; railroad tracks, canals, and streams; zip codes with one or more businesses. Figure 2 (right): shows access to shops that sell at least 8 types of fresh fruits and vegetables at reasonable prices. Streets and homes within “reasonable walking distance” are shown in bold. Having access to 8 of these foods is a modest requirement. However, the map clearly shows that most of the stores that sell within reasonable price ranges do not offer this number of fruits and vegetables. Source: Dowler, E., Rex, D., Blair, A., Donkin, A., and Grundy, C., Measuring Access to Healthy Food in Sandwell, University of Warwick and Sandwell Health Action Zone, 2001
9. Photovoice applied to the investigation of environments of health habits
Photovoice is a participatory social research technique that incorporates photography taken by neighbors of a community, to identify the elements of the environment of people and communities that facilitate or hinder the change of significant behaviors for health (healthy eating, active mobility , consumption of tobacco or alcohol, etc.)[7] or that bring us closer to the daily realities of poverty (see the experience of the “Active Communities in Health” project, carried out with the “crossing of knowledge” approach of ATD Fourth World, mentioned above[8]).
After giving a basic photographic instruction, cameras are lent to the members of a group of neighbors so that they collect significant images of these environments, which are later presented and discussed in the group. In such a way, that the knowledge of daily life is incorporated into the classic health diagnoses made with professional knowledge and logic.
Other artistic techniques (theater, video, painting-drawing, performances, etc.), mentioned in the first example, can be used to achieve the same purposes.
10. Group workshops on health problems or situations of discrimination
As we have said before, health problems (obesity, addiction, chronic disease, depression, etc.) or discrimination (by gender, age, ethnicity, sexual orientation, immigration status, functional diversity, etc.) generate strong bonds between people who suffer from them and favor social participation. In our experience, this has been the reason for the success of group workshops such as those for pre-diabetic or obese people (who learn to eat differently and have more active mobility), groups of women or men (who reflect on their roles of gender and its relationship with their health), of people with addictions (who find mutual support to get out of them), of older people, transgender people or immigrants (who find strategies to face discrimination and its impact on their health). , to give just a few examples.
Many of these groups, which have been created for more limited purposes and at the initiative of professionals, end up having an autonomous life and becoming important health assets in their community and pressure groups in favor of collective health.[9].
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FIN.
I hope that this shared material on community health, based on my experience, will be useful to you in your practice and training. A health and community hug on this hopeful day for my land (massive demonstration of 13 N for public health in Madrid)
[1] Susana Jimenez. How to do a Jane Walk. http://laaventuradeaprender.intef.es/guias/como-hacer-un-paseo-jane
[2] Susana Jimenez, Ana Useros. “Jane’s walk. Weaving networks at street level” Modernito Books. 2017
[3] “An emotional walk through my neighborhood.” Public Health and other doubts, March, 2019. https://saludpublicayotrasdudas.wordpress.com/2019/03/17/un-paseo-emocional-por-mi-barrio/
[4] Aviñó D, Benedé CB, Botello B, Cubillo J, Morgan A, Paredes-Carbonell JJ, Hernán M. Asset-based health promotion: how to work with this perspective in local interventions? GacSanit. 2016. Disponible en: http://dx.doi. org/10.1016/j.gaceta.2016.06.004
[5] Guide for the preparation of the map of health assets in the Balearic Islands (DG Public Health and Health Service of the Balearic Islands) http://e-alvac.caib.es/documents/mapa_de_activos_en_salud.pdf
[6] Javier Segura del Pozo. Food mapping: measuring access to healthy foods. In: “Community”. Public Health Editions and other doubts.
(https://saludpublicayotrasdudas.wordpress.com/). Tres Cantos, January 2018.
[7] HHH Project. https://hhhproject.eu
[8] Weaving Health. Guide for Collective Action from Realities of Poverty (Madrid Salud), 2018 https://madridsalud.es/publicaciones/saludpublica/Guia_Tejiendo_Salud.pdf
[9] An example is the original “men with care” workshop developed in Madrid Salud with the collaboration of the Marie Langer association. See: https://www.madridsalud.es/gruposdehombres.php