Review

A need for community

IDENTIFYING LOCAL HEALTH NEEDS: new community based approaches
Paul Burton and Lyn Harrison (eds)
Policy Press, 1996, £13.95

Health needs assessment has been moving up the agenda throughout the 1990s. Four key methods have been defined – using routine data such as that provided by the Office of National Statistics, practice derived data, patient surveys or community based approaches such as rapid appraisal. It is the last, which has received least attention, that is covered by this collection of essays by five contributors with wide experience in the field of community development.

Lyn Harrison’s introduction is an astute analysis of recent developments in the NHS and changes in social policy. Health authorities have to undertake more than simply technical aspects of needs assessment. The rhetoric of HAs as ‘champions of the people’ has prompted a recognition that more links are need with ‘the community’. Although HAs have the power to take decisions on, for example, hospital closures, they are non-elected bodies and do not appear to have the legitimacy to make such highly sensitive decisions. With purchasing decisions increasingly made at practice or locality level, attempts to gain the confidence and trust of local communities are crucial. These changes are put in the context of the fundamental principles of the WHO Healthy Cities Project.

Paul Burton’s ‘ten steps to producing a community health profile’ is a practical guide which would be very useful for anyone embarking on such a task. Using the approach he suggests, a community health profile will be as much a product of the community as a description of it.

The following chapter describes the lessons learnt from an action research project to identify ways in which local people and service users could become more effective in influencing local health services and become involved in decisions about the provision of future services. Hilary Neve brings her experience in primary health care projects in Africa, which are clearly community based, to UK general practice, a very doctor-led service.

Although the community development approaches described in this book may be old hat to community workers, their application to health projects and linking them to health needs assessment is novel. For health workers in primary care interested in needs assessment and trying to establish better links with the communities they serve this book is a worthwhile read.