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Publications
Griffith University and the Department of the Environment, Sport and Territories, 1997
Helen Spork
Griffith University
Australia
If we are to consider environment and development issues with the broadest of perspectives, then we will ultimately be brought to focus on the rights of humans and nature and the inequitable distribution of wealth and power within and between people, communities and nations. Similarly, if we are to view health issues in the broadest sense, we will come to the same essential points of focus.
The solutions to environment, development and health issues are closely entwined and reflect the complex links between the social, economic and political factors that play a major role in determining the well-being of people, populations and nature. The development of communities at local, national and global levels through the equitable distribution of resources and power is increasingly being acknowledged as the common goal for those working towards health, peace and sustainability for all.
This workshop provides an introduction to the nature of health and community development and considers the interrelationships between achieving healthy people, healthy communities and healthy natural environments. These interrelationships suggest new relationships between environmental education, development education and health education.
This workshop aims to address three key questions:
1. What is 'health'?
2. How is health achieved?
3. Who achieves health?
It is from these three key questions that the following workshop objectives are derived:
Emerging from the workshop key questions and objectives are a range of central themes. The major ones are:
The total workshop is divided into eleven activities which have been developed to flow in the suggested sequence below.
A brief introduction to the workshop title and rationale.
An activity which promotes some initial discussion about the major issues which will arise during the workshop. This activity also provides a framework for the evaluation component of this workshop.
An overview of the key questions to be addressed in the workshop and the related workshop objectives.
A facilitator-led, information-giving session which aims to set the scene for the following workshop components by developing a broad working definition of 'health'. In particular, the concept of health being multidimensional and a dynamic process will be highlighted. The interconnectedness of healthy people, healthy communities and healthy natural environments will also be introduced.
An activity which involves all participants in constructing a web of wool during their active exploration of the connections and interrelationships between the various dimensions (physical, social, emotional, intellectual, cultural, spiritual, ethical, ecological) and areas of health (personal, community, natural environments).
A simulation game which reinforces the interconnectedness of healthy people, communities and natural environments and introduces the issue of inequality in health. The underlying reasons for some individuals and groups having less access than others to the resources and conditions that promote health will be explored during the game.
A facilitator-led, information-giving session which defines the nature of community development, explores its possible contributions to addressing health inequities and health problems in communities and identifies the wide range of strategies used in the community development process.
An activity which involves participants in small groups reading, discussing and analysing a case study of community development. Using key questions, participants will identify the strategies of community development that were involved in addressing the health issue faced by the particular group in the case study as well as the overall outcomes for the community. Several case studies are provided for selection to illustrate the community development process in a range of social contexts.
In pairs or individually, participants review the key workshop themes or concepts by developing their own concept map. The concept map should reflect each participant's personal understanding and appreciation of the meaning and interconnections of the key themes.
A connection is made to Module 4, Exploring the Links - Environment and Development, to stimulate some thought about health education having many things in common with 'The Four Educations'. The question is posed - should it be 'Five Educations? One Education?'
This activity uses the same questions and process as for the warm-up activity. Each question is now discussed in the light of new understandings from the workshop. Participants review personal developments in learning.
Some suggestions regarding how the activities may be divided into workshop sessions are:
A. Running the workshop in 2 sessions
Session 1: Workshop Activities 1-6
Session 2: Workshop Activities 7-11
B. Running the workshop in 3 sessions
Session 1: Workshop Activities 1-5
Session 2: Workshop Activities 6-7
Session 3: Workshop Activities 8-11
Overhead Transparency Masters
OHT 1: Workshop Questions and Objectives
OHT 2: A New View of Health
OHT 3: Healthy People
OHT 4: Healthy Communities
OHT 5: Healthy Natural Environments
OHT 6 : Linking it all Together
OHT 7A & s7B: Reflections of Fundamental Principles
OHT 8: Working Towards Health For All
OHT 9A & 9B: What is Community Development?
OHT 10: Case-Study Questions
OHT 11: Workshop Themes
OHT 12: Personal Concept Map A
OHT 13: Personal Concept Map B
Resources
Resource 1: Tea Party
Resource 2: Card Labels for 'Woolly Health Web'
Resource 3: Making the Links: Negotiating and Recording Sheet for 'Woolly Health Web'
Resource 4: Your Health Shopping List
Resource 5: Let's Go Health Shopping: The Game
Resource 6: Let's Go Health Shopping: Auctioning Table
Resource 7: Case Study 1: The Village Development Committee: Community Participation in Development in Papua New Guinea
Resource 8: Case Study 2: Participatory Design Project in San-Chung, Taiwan's Hou-Chu-Wei-Park
Bauman, A. (1989) The Epidemiology of Inequality in 2020 A Sustainable Healthy Future: Towards an Ecology of Health, La Trobe University, Melbourne, pp. 43-67.
Brown, V.A. (1994) Health and Environment: A Common Framework and a Common Practice, in C. Chu and R. Simpson (eds.) Ecological Public Health: From Vision to Practice, The Institute of Applied Environmental Research, Griffith University and Centre for Health Promotion, Toronto, pp. 52-61.
Colquhoun, D. and Robottom, I. (1990) Health Education and Environmental Education: Toward a Shared Agenda and a Shared Discourse,Unicorn, 16(2), 109-118.
Kickbusch, I. (1989) Good Planets are Hard to Find: Approaches to an Ecological Base for Public Health, Future, 13, 29-32.
Labonte, R. (1990) Econology: Health and Sustainable Development, in C. Chu and R. Simpson (eds.) Ecological Public Health: From Vision to Practice, The Institute of Applied Environmental Research, Griffith University and Centre for Health Promotion, Toronto, pp. 19-35.
Rootman, I. (1988) Inequities in Health: Sources and Solutions, Health Promotion, Winter, 2-8.
World Health Organisation, Health and Welfare Canada and Canadian Public Health Association (1986) Ottawa Charter for Health Promotion, WHO, Copenhagen.
(1987) Then and Now: Reflections on a Quarter-Century of Change, Health Promotion, 15, 2-7.
Introduce the title of the workshop - 'Health, Environment and Community Development'. Briefly outline the rationale for investigating health, environment and community development issues within the context of development and environmental education (See introductory statement on first page).
This activity seeks to promote some initial discussion about the major issues which will arise during the workshop. It also helps to provide a framework for workshop evaluation in which participants are invited to review personal developments in learning.
This mini-lecture defines the broad meaning of the term 'health', and highlights the interconnectedness of healthy people, healthy communities, and healthy natural environments.
5. Workshop Activity: Woolly Health Web
This activity is a practical way of exploring in detail, the connections and inter-relationships between the various dimensions (physical, social, emotional, intellectual, cultural, spiritual, ethical, ecological) and areas of health (personal, community, natural environments).
'Woolly Health Web' involves participants in identifying and negotiating links between the various areas (personal, community, natural environment) and dimensions of health (physical, social, emotional, intellectual, cultural, spiritual, ethical, ecological). Participants become representatives of the various health components and when links are found between them, these are indicated by wrapping wool around the representative. By the end of this activity, a web of different coloured wools offers a very effective visual representation of the interconnected nature of health. (This activity is adapted from 'Woolly Thinking' in Pike, G. and Selby, D. (1988) Global Teacher, Global Learner, Hodder and Stoughton, London, pp. 141-2,).
The following facilities/materials are required:
The following instructions are written for a group of up to 24 participants. If your group is larger, you will need to make adjustments along the way.
Note: If there are more than 24 participants, divide these health components further to add additional groups to the activity. For example, social-emotional community health can be divided into social community health and emotional community health.
6. Workshop Activity: Let's Go Health Shopping
This game has a number of objectives:
The following materials and preparation are required for this game.
Materials
Resource 4 'Your Health Shopping List'
Resource 5 'Let's Go Health Shopping: The Game'
Resource 6 'Let's Go Health Shopping: Auctioning Table'
OHTs 7A and B 'Reflections of Fundamental Principles'
Envelopes (one per participant)
Plastic counters or cardboard squares (health units). You'll need approximately 144 counters per group of six.
Preparation
Put envelopes into sets of six. For each set of six:
Instructions
For example:.
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Item |
Standards |
Health Units |
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1. |
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Housing - space, safety, warmth, security, amenities, aesthetics, hygiene, location |
excellent average poor |
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2. |
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Work and Employment - occupation safety, job security, work satisfaction, autonomy, hygiene, job opportunities, working hours, sick and holiday benefits, social interaction |
excellent average poor |
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3. |
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Environmental Surroundings (natural and built) - aesthetics, levels of pollution, location, safety, sense of place, space, design, ecological diversity and balance |
excellent average poor |
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Participants should be made aware of aim (a) of the game: To be as healthy as you can. This activity should once again highlight the interconnectedness of healthy people, communities and natural environments. That is, that one cannot be achieved without the others.
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Item |
Standards |
Health Units |
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1. |
3 |
Housing - space, safety, warmth, security, amenities, aesthetics, hygiene, location |
excellent average poor |
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2. |
2 |
Work and Employment - occupation safety, job security, work satisfaction, autonomy, hygiene, job opportunities, working hours, sick and holiday benefits, social interaction |
excellent average poor |
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3. |
6 |
Environmental Surroundings (natural and built) - aesthetics, levels of pollution, location, safety, sense of place, space, design, ecological diversity and balance |
excellent average poor |
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At this point, those participants with 35 or 25 health units will be able to allocate several health units to each list item while those participants with only 12 health units will be able to allocate only one unit for most items.
Participants should be made aware of aim (b) of the game : To use up all your health units.
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Item |
Standards |
Health Units |
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1. |
3 |
Housing - space, safety, warmth, security, amenities, aesthetics, hygiene, location |
excellent average poor |
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2. |
2 |
Work and Employment - occupation safety, job security, work satisfaction, autonomy, hygiene, job opportunities, working hours, sick and holiday benefits, social interaction |
excellent average poor |
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3. |
6 |
Environmental Surroundings (natural and built) - aesthetics, levels of pollution, location, safety, sense of place, space, design, ecological diversity and balance |
excellent average poor |
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It is during this auctioning stage that participants will become aware that some people have more health units than others, and therefore, that advantaged and disadvantaged groups exist in the community when it comes to achieving health.
The facilitator plays a key role here in being aware of how each community is reacting to this realisation. Some communities may play on regardless or some communities may express concern about the existing inequities and decide to redistribute health units amongst members in some way. In the latter case, the facilitator should encourage this process of action. In the former, it is at the facilitator's discretion to either not interfere or to gently suggest that the community could do something to make the process more equitable.
The following points of analysis may also be useful in linking the experiences of the game (column A) with the various points on OHT 7 (column B):
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When going health shopping it is difficult to prioritise/compromise on the items because they all seem essential to health. |
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This mini-lecture focuses on three themes:
Some explanation of each of the five strategies may include the following points:
Building Healthy Public Policy
Create Supportive Environments
Strengthen Community Action
Develop Personal Skills
Re-orient Health Services
Highlight that these strategies involve the cooperative and joint efforts of governments and communities to promote health for all. In particular, note that strategies 3 and 4 have a strong focus on community development. Therefore, community development must be regarded as an important process for achieving health.
In this activity, participants work in small groups to discuss and analyse a series of case-studies of community development.
This activity reviews the key workshop themes by helping each participant draw a concept map.
Two examples of a personal concept map are provided on OHT 12 and OHT 13.
This final section aims to relate the experiences of the workshop to the context of development and environmental education. Given this workshop's detailed exploration of the complex links between the well-being of people, populations and nature, the educational implications are many. To consider these implications:
The workshop concludes with a second tea party (Activity 2). It helps participants to review their personal developments in learning as a result of the workshop.
Using the same resource and process as for the tea party (Activity 2), participants 'revisit' each question and discuss how (or if) their understandings of the related issues have changed or developed as a result of the workshop activities.
As well as participants reviewing their own personal developments in learning through this evaluation activity, the workshop leader can gain insight into the effectiveness of the workshop in achieving its aims and objectives.
Health and Community Development
Key Questions
1. What is health?
2. How is health achieved?
3. Who achieves health?
Objectives
For participants to:
A. develop a broad understanding of the nature of health
B. examine the links between healthy people, healthy communities and healthy natural environments
C. consider the issues of sustainability, social justice and equity as they relate to achieving health for all
D. consider the process of community development as it contributes to healthy people, healthy communities and healthy natural environments.
E. consider the links between environmental education, development education and health education
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1. Health is the absence of disease or illness. It is a medical concern. |
Health is also a positive concept of well-being and balance and is a resource for everyday living. It is also a social and personal concern. |
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2. Health has to do with physical well-being of the body's structure and function. |
Health is also to do with social, emotional, intellectual and ethical well-being. |
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3. Health is to do with the well-being of individuals. |
Health is also to do with the well-being of communities and natural environments at local, national and global levels. |
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4. It is the responsibility of the individual for his/her own health |
It is also the responsibility of individuals, communities, governments and entire societies to help others achieve health. |
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5. Health is dependent on the personal lifestyle choices which an individual makes. |
Health is also dependent on a range of social and ecological factors. |
Basic characteristics:
Basic characteristics:
Basic characteristics:
The health of people, the health of communities and the health of natural environments are inextricably linked. Health is multi-dimensional and interrelated, requiring a balance of all dimensions.
1. Health is a fundamental right for all people, communities and environments.
2. Health is multi-dimensional and interconnected.
3. To achieve health means much more than people having access to medical health services and making healthy lifestyle choices.
4. Health status is determined just as much by social, economic and environmental factors as by individual health and lifestyle choices and medical advances.
5. When it comes to achieving health, some people and communities are disadvantaged due to inequitable access to the resources and conditions that promote health.
Opportunities for the health of people and communities at local, national and global levels are distributed unequally according to factors such as:
6. Reduced access to health resources and conditions by disadvantaged people/communities (e.g. rural populations, women, aged, lower socio-economic groups/countries, indigenous people) can be explained more by social, economic and political reasons than by individual's actions. The causes of reduced health are generally out of the individual's control.
7. Health for all is achieved when an equitable distribution of health resources and conditions occurs.
This means:
1978
THE DECLARATION OF ALMA ATA
World Health Organisation and United Nations
1979
GLOBAL STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000
World Health Organisation
1986
OTTAWA CHARTER FOR HEALTH PROMOTION
World Health Organisation
Source: Bill Lee, quoted in Butler, P. (1992) Reflections on 'Good' Community Development, Community Quarterly, No.24, September.
Some basic aims
Some general aspects
Some practical strategies
1. What are the community problems/issues?
2. What did the community do to address their problems? List the range of strategies or actions used.
3. What were the outcomes (positive, negative, short term, long term) for the community as a result of the process?
4. Which aspects of community development does this case-study reflect? (see OHT 9A)
5. What are your personal reactions to the community development process illustrated in this case-study?
Health
People and Community
Environment
Interconnectedness
Social Justice
Equity
Sustainability
Community Development
Participation
Action
Cooperation
Commitment
1. Some things that make me healthy are
2. Some things that make me unhealthy are
3. Some things that make a healthy community are
4. If I was to define 'health' I would say it is
5. I think one of the most serious health problems that confront humankind today is
because
6. Some people are more healthy than others because
7. To achieve health for all people it is vital that communities and governments work towards
because
8. Some things shared between environmental education, development education and health education are
The physical health of the natural environment
(land, water, air, sunlight, cycles)
The bio-ecological health of the natural environment
(living things and their interrelationships)
The physical health of the community
(the human-made structures - houses, buildings, roads, cities, parks, farms - and their functions for the community)
The social-emotional health of the community
(social relationships, community cohesion, communication systems, support and guidance,welfare, cultural patterns, economic and political systems, social feelings, group emotions, community belonging)
The intellectual-cultural-ethical health of the community
(education, learning and decision-making systems; societal values, beliefs, morality, spirituality)
The physical health of the individual
(the structure and function of the body)
The social-emotional health of the individual
(the ability to make and maintain relationships with others, to recognise and express needs and feelings to self and others)
The intellectual-spiritual-ethical health of the individual (the ability to learn, think, make rational decisions, critique; the development of values, beliefs and principles of morality)
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The physical health of the natural environment |
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The bio-ecological health of the natural environment |
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The physical health of the community |
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The social-emotional health of the community |
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The intellectual-cultural-ethical health of the community |
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The physical health of the individual |
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The social-emotional health of the individual |
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The intellectual-spiritual-ethical health of the individual |
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Item |
Standard |
Health Units |
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Housing - space, safety, warmth, security, amenities, aesthetics, hygiene, location |
average poor |
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Work and Employment - occupation safety, job security, work satisfaction, autonomy, hygiene, job opportunities, working hours, sick and holiday benefits, social interaction |
average poor |
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Environmental Surroundings (natural and built) - aesthetics, levels of pollution, location, safety, sense of place, space, design, ecological diversity and balance |
average poor |
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Sense of Family/Community - belonging, communication, support, understanding, acceptance, cohesion, networks, relationships, autonomy and control |
average poor |
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Clothing - warmth, protection, variety, availability and access |
average poor |
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Food and Nutrition - quality, quantity, variety, availability and access |
average poor |
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Education - relevance, quantity, quality, availability and access |
average poor |
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Recreation, Leisure, Fitness - availability and access, quantity, quality |
average poor |
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Health Care/Medical Services - availability and access, quality, quantity, relevance. |
average poor |
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Aim of the Game:
(a) To be as healthy as you can
(b) To use up all your health units
Procedure:
Prioritising
1. Consider how important you regard each item on the shopping list as contributing to your health. Using the left top box, tick those items that you regard as absolutely essential and would not compromise on standard. Cross those items that you would compromise on standard if you had to.
Counting
2. Find out how many health units you have by opening your envelope and looking on the inside flap. Keep this amount to yourself at least until step 4.
Allocating
3. Allocate all your health units to the items on your shopping list and record them in the left bottom box. Your allocation of health units should indicate the level of importance with which you regard each item as contributing to your health. One health unit is the lowest value when buying an item but you can choose to allocate zero units to an item if you wish. These allocations can act as a guide for bidding in the auction. You may change these allocations at any time.
Auctioning
4. Form your community of six people. As a group, work sequentially through the shopping list, item by item, as you auction off the purchase of excellent, average and poor standards. For each item, each person in the community has a turn to bid how many units they are willing to pay for the excellent standard. The item at excellent standard goes for the highest bid each time. More than one person may buy at a time as long as they all buy for the same highest amount. The highest bid for 'excellent' now sets the unit price for 'average' and 'poor' standard. Refer to the auctioning table (Resource 6) to identify consequent prices. Those who do not purchase 'excellent' standard can elect to buy either 'average' or 'poor' at the set price. When an item is purchased each person should record the payment in the health units box at the right of the sheet. Then, put the correct number of units into the centre of the community, and inform the community of the standard you have purchased.
Debriefing
5. When the game is finished, as a community write down five major 'happenings' in the activity. These happenings may recount such things as community feelings, actions taken by all or some of the members, final health profiles of each community member, agreements/disagreements/pacts that occurred. Report these five happenings to the whole group.
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Authors: David Patterson and Kaoga Galowa
Source: Case example 20(a) in C. Chu, and R. Simpson, (eds.) (1994) Ecological Public Health: From Vision to Practice, Institute of Applied Environmental Research, Griffith University and Centre for Health Promotion, Toronto, pp. 239-241.
The national Department of Health in Papua New Guinea is strongly committed to the concept of community participation in development. The health and well-being of local communities rest in large part on their ability to take control of the development process and direct it to meet their own needs. The sustainability of any intervention including those in health is contingent on the commitment to and ownership of the project by the community. Consistent with the insights provided by health promotion, the Department also understands that improving the health of a community is not purely a medical problem. It also requires the consideration of broader social and economic factors that provide a supportive environment for health. These may include such diverse factors as improving infrastructure, education or employment. Recognition of the critical role of these factors has prompted the Department of Health to identify the Village Development Committee (VDC) as an appropriate vehicle for involving community members in broad based development activities which will improve the overall health and well-being of the community.
The Village Development Committee is a community based organizational mechanism through which people at the local level in Papua New Guinea are empowered to participate in the process of developing their communities. The VDC is intended to be a permanent element of community organization through which community members can take a sustained part in guiding, making decisions and contributing time and resources to building their communities. These committees, made up of community members, meet regularly to guide the process of development based upon their own understanding of their community's needs and upon the Integrated Human Development Model (IHD). The Integrated Human
Development approach emphasizes meeting Basic Human Needs (BHN). The IHD/BHN is a balanced and synergistic approach to development that focuses not merely on economic development, or improving health, but upon obtaining the fundamental human requirements for a life for all members of the community. Thus, under this approach, development must embrace the following areas:
It is not necessary that a community work upon all these areas simultaneously. Rather, the community selects projects that focus on the most pressing of these needs as perceived by the community itself.
The VDC concept is not new in Papua New Guinea. VDCs were first introduced as part of an experimental primary health care project in New Ireland Province in 1979. In 1984 the Province accepted PHC and the Village Development Committee as the vehicle for delivery of health care services to the community throughout the Province. Subsequently all provinces in PNG developed programs and plans to promote PHC/VDC. Despite these plans to promote the VDC concept not all provinces introduced the program at the local level. Lack of commitment by provincial officials and lack of organizational capacity prevented many provinces from instituting the program. As a result, in 1988, the Department began the implementation of a national program to help the provinces promote the formation of Village Development Committees.
The Health Department decided to support the organization of Village Development Committees by conducting village leadership workshops. These workshops are conducted by national health staff with assistance from provincial health officials. The purpose of the workshops is to provide village leaders with the necessary knowledge and organizational skills to establish VDCs.
The content of the workshops include:
Follow-up review workshops for participants are also held to discuss problems and successes.
After village leaders have received this training, they return to their villages where they hold a general meeting to discuss the VDC concept with the other members of the community. Following this, representatives are selected and the VDC begins the process of organizing development activities in the community.
The following provinces have already participated in the Village Leadership Training Programs and have VDC programs in full swing:
East Sepik with 90% of all communities covered;
West Sepik with 75% of all communities covered;
Southern Highlands with 60% of all communities covered.
These three provinces have each held four training workshops for village leaders. Leadership training workshops have also been recently held in Milne Bay and New Ireland. In total, about 200 village leaders have been trained and 180 VDCs have been formed in the five provinces.
Although VDCs may be organized for a single village or embrace several villages, contingent on local requirements, all VDCs are organized on common principles:
1. VDCs must be representative. VDCs must be organized so as to represent all major social groups in the community. A typical VDC will have representatives from church groups and from women's, men's and youth organizations.
2. The VDC group representatives must be selected by members of that community group. Thus, for instance, the women's group will identify and send a member of their own choosing. This is done by all community groups.
When the VDC has been constituted, its first task is to establish a set of development priorities for the community. This is done through discussion within the VDC, and in consultation with the community. When development priorities are agreed upon, projects to achieve them are designed and an action plan for carrying out the projects is the developed. This plan specifies what resources are required, what segments of the community will contribute these resources, and the timetable to be followed in implementing the project. After the initial development plan has been finalized, the VDC works with the community to carry out the plan and monitors the progress of the projects. Most projects are carried out using volunteer labor and local resources and materials. Typical projects undertaken might include building a meeting hall for a woman's group, levelling a playing field for sports events, or putting in fencing to keep pigs out of gardens. If additional resources are needed, representatives of the VDC meet with appropriate government officials, local, provincial or national, to obtain technical assistance or funding. In the past, government has provided the following types of assistance:
1. Technical feasibility studies including water system selection, site selection for water systems, rubbish and excreta disposal systems.
2. Transportation of material through the regular government transportation network or by boat or plane charters.
3. Technical training Workshops, e.g. training in water system maintenance.
4. Costing for projects.
5. Matching funds for water systems.
If a VDC, for example, choses to implement clean water projects for the community, VDC members may meet with representatives of the environmental health unit of the provincial health department to obtain technical advice on well placement, water storage and distribution, and other questions. Officials will help the community organize itself to provide the contributions of matching funds, materials and labor required by the government for such activities. The VDC continues to meet after the completion of the first project. It conducts ongoing discussions of community needs and sets priorities and plans for future projects.
Although the VDC program has not yet been systematically evaluated, plans have been made to conduct a formal evaluation. Nevertheless, much anecdotal information is already available about the progress of the VDC program.
1. VDCs, once initiated, have successfully planned and implemented community-based projects.
2. In areas where VDCs exist, there are often drastic decreases in the number of cases appearing at health posts with common preventable illnesses.
3. VDCs will often compete with the VDCs of other communities in starting and completing projects thereby galvanizing the development efforts of both communities.
4. Community leadership is strengthened through participation in VDC activities. VDC members attending review workshops report that they have gained confidence in their leadership abilities. A few have gone on to become provincial or national politicians.
5. People have developed greater self reliance and have realized that there is much they can do on their own without having to wait for the government to direct them. 6. VDC support the existence of indigenous culture and institutions.
7. The VDC provide an increased flow of external assistance in development activities in two ways:
The following areas of the VDC program need further support and development:
1. Follow-up support by appropriate government agencies is necessary to the success of new VDCs. It has been found that if the government does not support new VDCs either by failing to respond to requests for assistance, or by not holding review workshops, communities often lose interest in the program.
2. Rapid turnover of provincial personnel with responsibility for the VDC program at their level results in poor performance and stagnation of the program.
3. Commitment of provincial level officials must be secured. If provincial level officials lack commitment to the program, it is difficult to make progress in introducing the VDC program. Obtaining the support of provincial officials is therefore critical.
4. At both the national and provincial levels, the cooperation of all branches of the government is important for the success of the program. The Health Department should not be solely responsible for the implementation of the VDC program. Success in the long run will depend on the support of all relevant units of the government.
Authors: Pei-ju Yang and Marshall Johnson
Source: Case example 20(b) in C. Chu, and R. Simpson, (eds.) (1994) Ecological Public Health: From Vision to Practice, Institute of Applied Environmental Research, Griffith University and Centre for Health Promotion, Toronto, pp. 242-243.
The social significance of our project, the Hou-chu-wei community park, might be seen m the transformations of its name. Hou-chu-wei (which originally was translated as "The Bamboo Garden out back") was a small peasant community near what is now Taipei, Taiwan. Through the fifty year Japanese occupation of Taiwan, the community was distinguished locally by its temple and patrilineage social life and the stand of bamboo on the margin. A new state, the Chinese Nationalists, arrived in 1945 and ruled under martial law for forty years, continuing the Japanese and Ch'ing policy of excluding ordinary people from decision-making. The new government changed the name to sound similar to the traditional name, but the characters are different. The homonym is actually a political name chosen by the regime as an aid in changing the identity of the community. During the following forty years the new Hou-chu-wei was engulfed by the unplanned growth of Taipei and its attendant nightmarish disorder of space, pollution, and alienation. The bamboo patch became a dividing between the longstanding residents and recent migrants. Gradually in the 1990s the bamboo grove was turned into a garbage dump. With the end of martial law, new opportunities for local planning and design were created. The people of the Hou-chu-wei neighbourhood petitioned the new reform government of their city to clean up the eyesore that had displaced the original "bamboo garden out back". At that point, people who had taken the initiative in the community contacted activist professionals from the National Taiwan University's Building and Urban Planning Graduate Institute beginning a process of collaboration, conflict, negotiation and redefinition of health, space, society, citizen and professional.
The space is approximately one city block situated between a community in place since the Ch'ing Dynasty and one only thirty years old. The concrete box flavour of the surrounding apartment complexes is muted by a green L shaped corridor leading into the park. A derelict Ch'ing Dynast farmhouse, the only building on the site is being restored as a connection to the area's past and as a multi-use public place. The majority of the remaining space is organized to provide for four different activities associated with four different groups: a basketball court and softball field for older children and young adults; a playground for younger children; a shaded area for chatting,} drinking tea and quiet rest for the elderly; and a moderately secluded space for traditional Chinese exercises for the women of Hou-chu-wei. The remaining spaces are given over to activities that tend to bring all groups together, i.e. a communal musical entertainment area; a family barbecue area; and a public garden in the corner of the park which buffers a particularly noisy street.
The initiative for the park came not from those who are the recognized local leaders, but rather from the more marginal young people and women. Contact was made with the professionals and the question became how to build broad support for a new use of the de facto dump. The central problem was one of social responsibility, i.e. who/what is society and what is the responsibility to it? The answer developed in the participatory design process.
Young people took the lead in spreading the word that the community could design the park. They held a parade to urge people to join in the planning process. Action was then required to show the potential of the site. A clean up was carried out by students/professionals and women from the local area. The public transformation from dump to open space was favourably observed by many and the project became the main topic of conversation in both the older centre and bordering new community.
Activities appreciated by the residents (e.g. a karaoke singing program), were organized to realize the possible uses of the space. Whilst the activities were organized collectively by the local core and the people from the Graduate Institute, success came through contact with the existing local organizations that defined "social"- the area council and the temple association. Once these men, the 'insiders' from the old Ch'ing Dynasty community, put out the word, the residents joined in.
The planning then began in earnest. The core group and" the professionals faced two sorts of contradictions. As the karaoke event had shown, networks organized around long term male residents could bring people into the present but tended to reproduce the inequalities that constituted their authority. The definition of community and society, however, included young people, newer residents, and women. The other contradiction centred on the transformation of professional knowledge into social power. Residents felt that their lack of technical knowledge made nonparticipation in planning a natural outcome. These were local manifestations of problems in the society at large and the solution was to mobilise ail residents, both informally and through existing networks, into a situation in which each person had an equal voice and professionals served to translate their felt needs into technical plans which everyone could understand.
Two activities were organized to prepare for the actual planning by tapping residents' senses of time, both as social memory and daily routine. In one action, the elders of the community gathered in the future park space to tell stories of Hou-chu-wei's past, not to a planning group but to everyone who cared to listen. The core group members encouraged everyone to think of what that might mean for the space of the park itself. In the other action a long sheet of paper was divided into times of days and then the residents drew scenes keyed to a daily routine.
During the final stages of planning the professionals/students and resident activists agreed that community participation and social empowerment meant recognizing social power within the community was an obstacle as well as a resource. Final planning was therefore conducted in four separate groups: women, older men, middle aged and young men, and children. Each group produced a plan; the role of the professional was to help materialize their wishes on the paper provided. All the groups were brought together and their final discussion was mediated by the core group. Eventually, all parties gave a little and took a little. Women relinquished the demolition of a dilapidated house which was viewed by the older men as historical. The professionals and students pushed for a vegetable garden, a site for collective responsibility, but none of the residents could cope with this as it was seen to be connected with peasant labour, individualized and hardly appropriate for a leisure space. The suggested tool shed was rejected as looking too much like the ubiquitous little shrines to the earth god. The consensus design was then transformed into a more formal model and presented to another open meeting for ratification. Negotiations then commenced with local administration for permits and funding.
In this first community based planning project in Taiwan, there was a redefinition of the meaning of society and responsibility to that society. To empower people requires recognition of divisions within a social formation between the local area and the centre and within the local area. Participation in the actual planning was surprisingly widespread. By the end of this process, the government's political name for Hou-chu-wei had been replaced back to the original "THE BAMBOO GROVE OUT BACK". On the basis of that success however, we all had to forms - dividing the final planning groups into four; spreading the word through women's networks; relying on the enthusiasm of children; and linking the male dominated temple association to the larger question of what kind of society Taiwan was and ought to be - that were variably effective in creating a more equitable distribution of power. Equally clear, however, were the hierarchical limits of gender, age and class which the residents cannot help but come up against.
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