Working 'With' Communities, Not 'On' Them: A Changing Focus for Local Government Health Planning in Queensland

Abstract

The challenges facing public health professionals in the twenty first century are likely to encompass a pressing need to address effectively new health dilemmas posed by rapid urbanisation, environmental degradation, massive social change and economic instability. The Healthy Cities movement was initiated in 1986 to implement the health promotion action areas of the Ottawa Charter in local settings. It offers a meaningful framework and set of principles to construct a socio-ecological approach to the planning for future healthy and sustainable communities. The parameters of a socio-ecological approach to health and its congruence with the philosophy and principles of the Healthy Cities movement are described. The application of this approach to health planning in nine local communities in Queensland is illustrated through the development of local government facilitated Municipal Public Health Plans (MPHPs). An overview of the seven stages of the planning process underpinned by Healthy Cities principles, reveals the specific tasks of working 'with' communities as opposed to working 'on' them. These stages are identified as: (i) doing the groundwork, (ii) managing the project, (iii) community needs assessment, (iv) setting priorities, (v) developing strategies, (vi) writing the draft plan, and (vii) monitoring and reviewing the plan. Specific difficulties encountered by the projects during the process are identified, as well as achievements. The challenges faced by those intending to formulate similar plans are listed, and how primary health care professionals can have a significant partnership in the design and implementation of locally relevant Municipal Public Health Plans is discussed.