Community Gardens for Improved Community Health

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

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Source: Communitygardens.org

Community Gardens in Developed Regions

Community gardens are either individual plots or collectively cultivated gardens, and there is often some form of public ownership (Jermé & Wakefield, 2013). There are various levels of commitment from local citizens. For example, NeuLand, a community garden in Cologne, Germany is run by a charitable organization with five paid staff members, a managing committee, about 20-30 committed gardeners, and about 40 occasional gardeners (Follmann & Viehoff, 2014).

In the Western World, community gardens have become popular because they are often viewed as a way to advocate for sustainable social and ecological change through a bottom-up approach (Follmann & Viehoff, 2014). Thus, they have proven to have an important impact on the health of citizens in various regions.

Health Benefits

Community gardens have specifically increased access to healthy foods in marginalized regions, consequently, alleviating issues of food poverty (Jermé & Wakefield, 2013). In order to increase the consumption of fresh vegetables, the Victory Garden program was founded in the United States during World War II (Armstrong, 2000; Chan et al., 2015). This led to a 40 percent increase in the consumption of fresh vegetables (Armstrong, 2000). Today, community gardens are still used to ensure that everyone has equitable access to fresh produce. One study revealed that households who did not participate in community gardens consumed fruits and vegetables 3.3 times per day (Alaimo, Packnett, Miles, & Kruger, 2008). In comparison, households with an individual involved in community gardens had a daily consumption rate of 4.4 (Alaimo et al., 2008).   

When community gardens are properly implemented and utilized, they can be an important source of empowerment for local citizens (Follmann & Viehoff, 2014). They can provide a space for productive work, interaction with each other, intercultural engagement and knowledge exchange (Follmann & Viehoff, 2014; Armstrong, 2000; Chan et al., 2015). Thus, they become a symbol of unity and increase neighborhood pride (Armstrong, 2000). This social capital is important to increase psychological support (Chan et al., 2015). As a result, community gardens have been established as a component of health promotion (Armstrong, 2000).

Policy Development and Citizen Engagement

Overall, the focus on community gardens is to foster a greater quality of life and community rather than consumption and individualism (Follmann & Viehoff, 2014). In order to continue to foster sustainable community gardens, policy development processes must be examined (Jermé & Wakefield, 2013). Local citizens must be able to participate in the development of policies, and the policies must ensure that citizens have access to gardens that are fairly allocated (Jermé & Wakefield, 2013). Success also depends on a collaborative approach between the various government agencies involved (Jermé & Wakefield, 2013).

References:

Alaimo, K., Packnett, E., Miles, R. a., & Kruger, D. J. (2008). Fruit and Vegetable Intake among Urban Community Gardeners. Journal of Nutrition Education and Behavior, 40(2), 94–101. doi:10.1016/j.jneb.2006.12.003

Armstrong, D. (2000). A survey of community gardens in upstate New York: Implications for health promotion and community development. Health & Place, 6(4), 319–327. doi:10.1016/S1353-8292(00)00013-7

Chan, J., DuBois, B., & Tidball, K. G. (2015). Refuges of local resilience: Community gardens in post-Sandy New York City. Urban Forestry and Urban Greening, 14(3), 625–635. doi:10.1016/j.ufug.2015.06.005

Follmann, A., & Viehoff, V. (2014). A green garden on red clay: creating a new urban common as a form of political gardening in Cologne, Germany. Local Environment, 20(10), 1148–1174. doi:10.1080/13549839.2014.894966

Jermé, E. S., & Wakefield, S. (2013). Growing a just garden: environmental justice and the development of a community garden policy for Hamilton, Ontario. Planning Theory & Practice, 14(3), 295–314. doi:10.1080/14649357.2013.812743

Health Promotion: An Effective Approach to Achieve the Sustainable Development Goals

~Written by Karen Hicks, Senior Health Promotion Strategist & Lecturer, New Zealand (Contact: karen_ahicks@hotmail.com)

In September 2015 the United Nations adopted seventeen sustainable development goals (SDGs) (Figure 1) as part of the 2030 Agenda for Sustainable Development; which aims to end poverty, fight inequality, injustice, and tackle climate change. These SDGs are acknowledged as going beyond the previous Millennium Development Goals (MDGs) as they aim to address, ‘The root cause of poverty and a universal need for development that will work for all people’ (United Nations, 2015).

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Figure 1. Sustainable Development Goals. Source: http://wfto.com/sites/default/files/field/image/2015-07-21-SDGs.png

Each of the SDGs relate to health and wellbeing with aims, approaches and principles that are concomitant to the discipline of health promotion; a discipline that acknowledges the complexity of health and is based on the principles of human rights, equity and empowerment (Williams, 2011). Consequently, such principles imply that health promotion is an effective approach toward achieving the SDGs. This approach is supported by the global framework and described in “The Ottawa Charter for Health Promotion” (WHO, 1986) (Figure 2) which identifies five key action areas: building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills and reorientating health services through advocacy, enabling mediation for effective practice.

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Figure 2. The Ottawa Charter for Health Promotion Logo. Source: http://www.who.int/healthpromotion/conferences/previous/en/hpr_logo.jpg 

An example of a collaborative initiative that illustrates health promotion as defined in the Ottawa Charter is the International Network of Health Promoting Hospitals & Health Services (HPH). The initiative works to reorient health care towards an active promotion of health for patients, staff, and communities. Further detail on the approach can be accessed on the HPH website.  

The principles and actions illustrated alongside the interdisciplinary approach of health promotion that empowers people and communities (Health Promotion Forum of New Zealand, 2014) and focuses on equity and the broader determinants of health (Davies, 2013) is acknowledged by the World Health Organisation, “Health promotion programmes based on principles of engagement and empowerment offer real benefits. These include: creating better conditions for health, improving health literacy, supporting independent living and making the healthier choice the easier choice” (WHO, 2013 p 16).  The value associated with the approach clarifies how health promotion can effectively contribute to achieving the seventeen SDGs where the SDGs can guide the delivery of effective health promotion to improve health, wellbeing and personal development throughout the global community.

References:

Clinical Health Promotion Centre. The International Network of Health Promoting Hospitals & Services.  http://www.hphnet.org/ Accessed 22/1/2016. Bispebjerg University Hospital Denmark.

Davies, J.K. 2013. Health Promotion: a Unique Discipline? Health Promotion Forum of New Zealand.

Health Promotion Forum of New Zealand. 2014. http://www.hauora.co.nz/defining-health-promotion.html#sthash.5sStc8VF.dpuf.

United Nations. 2015. http://www.un.org/sustainabledevelopment.

Williams, C. 2011. Health promotion, human rights and equity. Keeping up to date. Health Promotion Forum of New Zealand.

World Health Organisation. 1986. The Ottawa Charter for Health Promotion. WHO.

WHO (2013) Health 2020: a European policy framework and strategy for the 21st century Copenhagen, World Health Organisation.

The Role of the Built Environment in Reducing the Incidence of Type 2 Diabetes

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

Diabetes is a chronic disease that affects many people worldwide. Type 1 diabetes is an autoimmune deficiency that often develops in childhood and impacts about 10 percent of those with the disease (Canadian Diabetes Association, 2009). However, type 2 diabetes develops later in life, is influenced by environmental and lifestyle factors, and is prevalent among nearly 90 percent of those with diabetes.  While Type 2 diabetes used to be considered a “disease of the West”, it has now spread to more countries; thus, more efforts need to be made to reduce the incidence of this disease. As healthy diets and regular physical activity are key components to reducing the prevalence of type 2 diabetes, the built environment needs to be taken into consideration. The built environment includes all of the aspects of an environment created by humans, such as neighborhoods and cities, and consequently plays an important role in ensuring that people can access healthy food, and increase physical activity.

The Importance of Community Gardens

The accessibility of healthy foods can increase with the implementation of community gardens. Preliminary studies reveal several benefits of community gardens, including the associated increased intake of produce. One study examined the benefits of community gardens in South-East Toronto, concluding that those who participated in the maintenance of the garden increased their intake of vegetables and fruits and bought fewer produce from grocery stores (Wakefield, Yeudall, Taron, Reynolds, & Skinner, 2007). While these community gardens were established by non-governmental organizations, city planning officials still have a large role to play, as they could ensure that there is land in urban areas specifically designated for community gardens.   

Gardens could also be incorporated into schoolyards. One example of this was in California where the “Garden in Every School” program was implemented, and vegetables and fruits were grown on school property.  The kids helped to maintain the garden and this promoted healthy eating and an overall increase in the local food supply (San Mateo County Food System Alliance, 2010; Dannenberg, Frumkin, & Jackson, 2011).

The Role of Active Transportation

Encouraging physical activity is also a key component in reducing diabetes prevalence and this can be done through changes in the built environment by encouraging active transportaiton. This would involve increasing the walkability of communities through the implementation of pedestrian infrastructure, such as sidewalks and safe crossings, to ensure that these places are easily accessible.  

Encouraging “Smart Growth” would also be important. This concept was developed in the 1990s by initiatives that were being implemented by various organizations, including the American Planning Association (Dannenberg et al., 2011). “Smart Growth” policies encourage the preservation of open space, and making communities more walkable. This could be done through the implementation of mixed-land use development, which would ensure that employment, schools and shops were within close proximity and walking became one of the main methods of transportation.

Another key component of Smart Growth is developing a variety of transportation methods through the implementation of Transit-Oriented Development, which also became prominent in the 1990’s. This would be another way to encourage physical activity and reduce reliance on cars. Implementing bike lanes also encourages biking as a means of transportation. In Portland, Oregon there was an increase in biking after several miles of bike lanes were added, as a quadrupling in bikeway miles resulted in a quadrupling of bicycle bridge traffic (refer to Figure 1).

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Figure 1: An increase in bikeway miles in Portland, Oregon was led to an increase in bicycle traffic (Dannenberg et al., 2011).

There are other factors to consider when examining type 2 diabetes, such as biological factors among certain ethnic groups, and the difficulties associated with trying to make behavioural changes. However, by making sustainable changes to the built environment to increase accessibility to healthy foods and encourage active transportation, government officials and non-governmental organizations can begin to greatly reduce the prevalence of type 2 diabetes.  

References:

Canadian Diabetes Association. (2009). An economic tsunami of the cost of diabetes in Canada. Retrieved March 28, 2015, from http://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/economic-tsunami-cost-of-diabetes-in-canada-english.pdf 

Dannenberg, A. L., Frumkin, H., & Jackson, R. J. (2011). Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability. Washington: Island Press.

Hu, F. B. (2011). Globalization of Diabetes: The role of diet, lifestyle, and genes. Diabetes Care , 34 (6), 1249-1257.

San Mateo County Food System Alliance. (2010). A Garden in Every School. Retrieved March 25, 2015, from Ag Innovations Network: http://aginnovations.org/images/uploads/call-to-action_GBL_final.pdf 

Wakefield, S., Yeudall, F., Taron, C., Reynolds, J., & Skinner, A. (2007). Growing urban health: Community gardening in South-East Toronto. Health Promotion Internationl , 22 (2), 92-101.

The Complexity of Health and Wellbeing

~Written by Karen Hicks - Senior Health Promotion Strategist, Auckland New Zealand (Contact: Karen_ahicks@hotmail.com)

Achieving health and wellbeing goes beyond the absence of disease as it is determined by a range of factors such as the environment, culture, gender, biology, and politics and is in fact complex and multi-dimensional.

As a health promoter I suggest that to address such a complex issue requires:

•  An understanding of what being healthy means to those with whom we are working
• An understanding of the social determinants of health
• A holistic approach to health

For practitioners wishing to improve health outcomes we need to explore what being healthy means to those individuals and communities with which we are working. Practitioners often have their own ideas of what healthy means and our contracted outcomes and outputs may also identify what this means but it may not be the reality of our communities. To achieve sustainable health outcomes we need to ensure that we are meeting the needs of our communities.

We also need to understand what affects people’s health and communicate this effectively to the communities with which we work and our colleagues both within and outside of the health sector. The Dahlgren and Whitehead diagram is a few years old but is effective in explaining the range of determinants that influence health both positively and negatively and the interconnectedness of each determinant. 

Another effective resource is the Robert Wood Johnson Foundation frame developed in 2010 to effectively talk about the social determinants of health which has involved translating determinants of health messages for lay audiences such as Health starts where we live, learn, work and play.  For detail on the research and process- http://www.rwjf.org/en/research-publications/find-rwjf-research/2010/01/a-new-way-to-talk-about-the-social-determinants-of-health.html

As practitioners we need to stop working in silos and with topic or issues based approaches. A holistic approach to health is the most effective approach to achieving sustainable health outcomes. Within New Zealand there is a holistic health model named Te Whare Tapa Whā (Durie, M. 1998). A Māori health model that supports a holistic approach to health and identifies the four cornerstones (or sides) of Māori health. With its strong foundations and four equal sides, the symbol of a house illustrates the four dimensions of well-being which are physical, mental and emotional, social and spiritual well-being.  Should one of the four dimensions be missing or in some way damaged, a person may become unbalanced and unwell.

The approaches identified are ways in which to undertake effective health promotion that reflect its values and principles of empowerment, inclusiveness and respect based on evidence and effective health promotion competencies. The approaches above provide opportunities to communicate with communities and work with them to provide solutions to the complex and multi-dimensional health and wellbeing issues affecting us all locally, nationally and globally.

Reference:

Durie, M. 1998. Whaiora: Maori health development, Auckland: Oxford University Press

Capacity Building to Address Global Health Challenges

~Written by Karen Hicks – Senior Health Promotion Strategist, Auckland New Zealand. (Contact: Karen_ahicks@hotmail.com)

Increasingly the world is challenged with complex health problems. Developing a competent health promotion workforce is essential to addressing the related inequities and global health challenges.

Global health issues provide both a challenge and an opportunity for a competent health promotion workforce to work across cultures and settings with an international perspective.  An approach requiring an understanding of the determinants of health and the vital role health promotion has in achieving sustainable health gains.

At times health promotion has been challenged by the belief that anyone can undertake health promotion. This is partly the result of its strategy to promote its principles across the community making it everyone’s business. However health promotion is increasingly acknowledged as a discipline with specific knowledge, skills and distinct approaches that challenges such beliefs. 

Health promotion competencies have been developed as a capacity building tool that has successfully defined the knowledge and practice for effective health promotion, ensuring that health promotion principles, values and philosophy are reflected.

There are a number of international health promotion competencies frameworks that can be used to:

• Guide planning, implementation and evaluation of initiatives
• Provide the base for accountable practice and quality improvement
• Inform education, training and qualification frameworks
• Clarify health promotion roles and develop relevant job descriptions
• Improve recognition and validation of health promotion
•   Further reading and examples of some health promotion competency frameworks:

References:

http://www.iuhpe.org/images/PROJECTS/ACCREDITATION/CompHP_Project_Handbooks.pdf

http://www.hauora.co.nz/assets/files/Health%20Promotion%20Competencies%20%20Final.pdf

http://www.healthpromotion.org.au/images/stories/pdf/core%20competencies%20for%20hp%20practitioners.pdf

http://www.healthpromotercanada.com/competencies-development/

The Politics of Health Promotion

~Written by Karen Hicks, Senior Health Promotion Strategist (Contact: karen@hauora.co.nz)

As an individual with over twenty years’ experience in the health sector in clinical, managerial and health promotion roles, I am passionate about the role of health promotion as an approach to reduce health inequities.

In addressing health inequities, health promotion is very political, as people’s health is influenced by the resources and opportunities available to them.  As health promoters we need to question who is responsible for such resource allocation, how are allocation decisions made, and who has the power to allocate these resources?

As health promoters we witness how the approach of health promotion is increasingly affected by neoliberalism, where neoliberal governments promote minimal government interaction with a person’s freedom to choose.  The result is that some communities experience victim blaming when ‘choosing’ unhealthy health behaviours and the government’s health outcome graphs don’t improve. Such communities are identified as failing and accountable for their ill health and poor lifestyle choices.  

Effective health promotion places people and communities at the centre, working with communities to find their own solutions in influencing the determinants of their health and wellbeing. As health promoters we have declarations and reports such as the Ottawa Charter for Health Promotion and the WHO Commission on Social Determinants of Health that identify best practice health promotion.

The WHO “Closing the gap in a generation, health equity through action on the social determinants of health” report clearly identifies that:

"..inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces."

So while we know that empowering communities and addressing the social determinants of health is the best health promotion approach, why do governments continue to provide contracts that focus on individual behaviour change? 

• Offering contracts with behavior related outcomes are easy to measure e.g. how many individuals attended the health day, how many individuals have lost weight or become smoke-free. While these outcomes are laudable we know that such health outcomes and behaviour change are often unsustainable if a person’s environmental, socioeconomic and cultural settings also do not change. 
• Short term contracts focusing on behaviour change also fit neatly into electoral terms so governments have something to report against in the hope of being re- elected for such commendable work.
• Committing to long term planned outcomes in partnership with the community to address the social determinants of health takes time and does not generate the same media coverage as purchasing hospital beds or employing doctors.
• Focusing on personal responsibility also means that governments can continue their relationships with large multinational companies such as the food industry, relationships that could be put under strain if healthy eating legislation was put in place.

What can we do?

• As health promoters wishing to address health inequities and improve the health and wellbeing of our communities we must communicate that health inequity is a moral and justice issue, and the role of governments in addressing these.
• We need to communicate with and involve our communities in addressing the social determinants of health that continue to influence their health and well-being.
• We need to strengthen the capacity of the health promotion workforce ensuring they understand their vital role in improving health locally, regionally and globally.

As health promoters we have a role in providing evidence on best health promotion practice to strengthen the value of health promotion in the wider public health field and to clarity its role and ability to respond to global health challenges.