1.1 Building an initial picture and profile of the community
Assessing local need and profiling the local community is the first step towards developing a local plan. However, simply ‘jumping’ into the community without first considering its social, demographic and environmental make-up is likely to result in failure. Communities are not simply homogeneous, but consist of a range of social and cultural groups. People’s thoughts, ideas, perceptions and needs may therefore differ.
In order to open doors, it is necessary to build up an initial picture and profile of the community.[…] The aim of a community profile is to develop a written snapshot of the community’s natural and built environment, together with the social, economic, political, cultural and religious structures of support within this. A health needs assessment can then inform local plans by looking at unmet need for services, and provide information that will allow services to be tailored to local populations.
Planning an effective strategy of entry armed with the necessary information is, therefore, an essential part of the community public health worker’s role. For example, there are a number of quantitative sources – both nationally, such as the census data which gives information on a regional basis, and more locally, such as health authority and public health reports – which can help develop a picture of the community in question (see Sidell and Lloyd, 2007). Similarly, using qualitative data, such as vignettes or face-to-face interviews, provides valuable local insights into the likely impact of community-based initiatives and interventions.
Community profiling uses social research in a community primarily in order to listen to the voice of (often) marginalised people and then to feed that voice into an assessment of their collective needs, with a view to creating what Moran and Butler (2001, p. 60) refer to as a ‘living health profile’.
A community profile draws on the following information:
- the demographic and social mix of the people – taking into account such factors as age, class, gender, ethnicity, religion and disability
- the housing available to them in the area
- access to jobs, training and income in, and accessible from, the areapublic services and facilities, schools, colleges, health centres, police services, etc., in the area and accessible nearby
- shops, entertainment, sport and culture in the area and nearby
- voluntary organisations and services, local associations and political parties
- family and community networks to which people contribute and on which they can call.
In assessing the health needs of a particular community, the following questions need to be asked:
- How healthy is the community?
- What does it need to be healthier?
- What does it need to stay healthy?
- What are the best ways to accomplish these goals?
An example of a community profile and needs assessment is given in Table 1.
Table 1 Key factors affecting health, social care and wellbeing in one community: Powys, Wales
|United Kingdom||Ageing population, more people living alone|
|Decline in public transport, increasing cost of private transport|
|Smoking, alcohol abuse – including among children – and drug misuse|
|Cardiovascular disease, cancer, diabetes and mental illness, obesity|
|Wales||Extreme rurality: large mountainous area, sparse population, agricultural dependency|
|Powys||Small communities with diverse character and health and social care needs, no large towns or major shopping centres|
|Breakdown of traditional communities and social support networks, accelerated by migration trends|
|Vulnerable workforce: low incomes, seasonality, high self-employment, long hours of work|
|Frail agricultural economy, highly vulnerable to market forces and external catastrophe: for example, foot and mouth disease|
|Cost and potential inefficiency of service delivery to scattered small settlements|
|Mainly ‘rural deprivation’ (housing deprivation, transport poverty, isolation, low income) with pockets of ‘urban deprivation’ (unemployment, benefits dependency) in some towns|
|Transport poverty: lack of public transport; dependence on cars for work, shopping and healthcare; burden on household budgets; cars often old and in poor condition; road traffic accidents|
|Added risks of isolation, food poverty and health inequality for residents without use of car (e.g. children; older people; people on low incomes; disabled people; those who are sick; and those who are the second adult in a one-car household)|
|Rural stress a major influence on health and wellbeing|
|Housing deprivation: poor condition of private housing stock, high house prices relative to incomes, high dependence on private rental, fuel poverty|
|Lack of anonymity in small communities leads to health inequality and isolation forvulnerable groups and deters take-up of benefits. Combined with high self-employment, this tends to delay the seeking of both medical and financial advice|
Activity 1 Thinking about community needs
Review Table 1 and note down issues and areas where taking action might help to improve people’s health. For how many of these would more than one service or sector need to be involved?
Here are the conclusions drawn from the regional profile in Table 1 about which issues/areas required action in the short and long term:
- geographical access and transport
- poverty and deprivation; in particular, child poverty
- restricted employment opportunities
- poor quality private sector housing, and other housing issues
- physical exercise and sport
- substance misuse; in particular, alcohol misuse
- community development
- lifelong learning
- care and support for the most vulnerable groups
- caring for carers
- retaining and attracting young people back to the county
- sexual health; in particular, teenage pregnancy
- coronary heart disease, cancer, cerebrovascular disease, obesity, mental health and emotional wellbeing, accidents and diabetes.
An audit of local skills is also an important aspect of needs assessment and community profiling. There will be a need for appropriate personal and professional development for a wide range of people. This will include not just health professionals, but other professional groups involved in planning and delivering services (e.g. local authority officers, teachers, social workers, youth leaders and voluntary sector staff) and members of the public involved in needs assessment and in delivering community-based programmes.
Having carried out a provisional community profile and health needs assessment, it is necessary to get to know the community better.