community participation or manipulation

Community Participation or Manipulation?

Discuss the role and effect of community participation in public health

Describe how community participate in public health responses paying particular attention to community development strategies. Discuss the benefits and limitations of community participation and describe any inadvertent consequences of community participation as a public health response.

Community participation can be defined as people from a community or place of interest, coming together in groups for planning activities, fundraising or even attending consultations (Guterbock, 1999). It is commonly stated as a collective involvement of people in a community or place, who are trying to access their needs and organise meeting and strategies to meet those needs (Zakus & Lysack, 1998). Communities and groups of people determine their health priorities and pursue them on basis of successful services and programs to maintain as well as improve their health. Social capabilities and the physical effort are important for communities to plan and execute a service or program which would be important to maintain and improve their health (National Rural Health Alliance, 1998). Community participation is the success factor for improving combined advance to health and planning. Baum (2000) stated that community participation is greatly important for the improvement of health promotion, it is a tangible process and more physical work needs to be done to ensure that the outcomes are the best. Community participation involves community development, community involvement, community mobilisation, community capacity building and community engagement (Andrews and Felton 2004; Wewers, 2004).

Community Development Strategy

Community participation is multileveled and a complex process and is able to be measured as a health intervention which affects health outcomes (Byrne & Henderson, 2003). Community participation in health planning is difficult to establish (Rifkin, 1990). The participants influence and control the decision making process, they influence the actions that take place as well as the outcomes. Arnstein (1969) wrote about the ladder of community participation which includes from the bottom of the ladder is manipulation, therapy, informing, consultations, placation, partnership, delegated power and citizen control at the top of the ladder. The bottom of the ladder is usually meaningful and useful as long as the community participation process is vocalized and clear. The top position of the ladder involves the community and public control and the actions that follow (WHO, 1999).

Community development assists the citizens to recognize their needs and wants and ways to obtains them. Collectively people would have more control over their lives and hence have better outcomes in health. They would require a democratic involvement of the community decision making. There would be a community development and an establishment as legal organisations require community involvement in their decision making (WHO, 1999)

Community involvement includes various activities which provide the communities with various opportunities to plan, develop and evaluate health plans for the present and future (Eagar, 2001). Involvement in community health requires time, commitment and cultural change. An innovative approach will be necessary for public and patients to develop better quality and more appropriate health services (Department of Health 2002). Chu and Simpson (1994) explain that the type of community has a type of participation and a strategy promotion plan set out. For example, the type of participation is community control, the type of community is the local community and so the health promotion strategy that would be recommended is community development. For community involvement, the type of community would be a network of interested professionals and health promotion strategy would include a community based initiative (Andrews, 1994).

Community engagement is a term which is usually used in health systems and governments which is used in policy implementing and consultations (Andrews, 1994). Evidence shows that powerful communities are healthier communities (Wilkinson, 1999). Powerful communities can control decision making processes about their lives and are able to access health records for their needs through various social support networks, while non-powerful communities have no decision making powers and hence have no access to health care and health resources (Wallerstein, 1992). Community development strategies contribute to the development of powerful communities within the society and therefore can address inequalities in health (Marmot & Wilkinson, 2001).

Community health plans for developing a healthy city includes involves the development and formation of various strategies (WHO, 1997). A health care model which shows such a strategy includes a seven step plan. The first includes increasing awareness and increasing and gaining commitment from the community. Followed by managing the project, needs assessment, determining priority issues, developing strategies, plans, and lastly implementation, monitoring and evaluations (Chapman & Davey, 1995). Local health staff and state public health units have been helpful in developing and utilising the model locally (Queensland Health, 2000).

Benefits in Community Participation

Community participation in health is very useful. Community health a strategy includes legitimised decisions, allowing people to questions and change ideas in health and helps develop consultations and have valuable outcomes (WHO, 1997). Community consultations have a collective approach in health for development and planning (Chu & Simpson, 1994; WHO, 1999). This involves communities and professionals such as health authorities to increase powerful people, democracy, resources, to achieve better decisions and have more effective services (Smithies and Webster, 1998).

Barriers in Community Participation

Community participation is known for improving health planning and programs but achieving this is a major challenge (Arnstein, 1969). Successful planning procedure in public health planning requires overcoming such barriers. Some barriers include, finding active participants who are comfortable in working in large groups and communities (Eagar et al, 2001).

Time, trust, responsibilities and resources are necessary, but would be difficult to manage without if not available. The stakeholder's commitment to their community's health and the trust and leadership they have with the local community (Rifkin, 1990). The attitude of the professionals and the structure of the health system might cause some worry for the active participants and the availability of local human resources as well as resources for community participation (Bracht and Tsouros, 1990). Administrative support, political support, health governance, information, communication and the will to participate is very important and lacking this would cause a major drawback in community participation (WHO, 1999)


Evidence proves that community participation does improve health outcomes and no community participation. There are many benefits to community participation but the main barrier is achieving participation. Improvement in primary health care and public health care is noticeable but the strategic plan to undertake the process is long a tedious but community participation has beneficial outcomes.


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Baum, F. (2002) The New Public Health, Oxford University Press, South Melbourne, Australia.

Bhuyan, K. K. (1994). Health promotion through self-care and community participation: Elements of a proposed programme in the developing countries. BMC Public Health.

Chu, C. and Simpson, R. (1994) Ecological Public Health: From Vision to Practice.

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Johnson, M. M. (2001). Community Participation Can Improve America' Public Health Systems.

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World Health Organisation (1997) Health and Environment in Sustainable Development: Five years after the Earth Summit.

World Health Organisation (1999) Community Participation in Local Health and Sustainable Development: A Working Document on Approaches and Techniques.

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