Traditionally a community is seen as a group of interacting people living in a common location. The word is often used to refer to a group that is organised around common values and social cohesion within a shared geographical location, generally in social units larger than a household. Essentially, a community is a network of people. The link between them may be:

The people in the network come together on the basis of a shared experience or concern, and identify for themselves which communities they feel they belong to. Networks may be formal or informal and since the advent of the Internet, the concept of community no longer has geographical limitations, as people can now virtually gather in an online community and share common interests regardless of physical location (see http://en.wikipedia.org for a full discussion of the nature of community from a range of disciplinary perspectives).

This means working with community groups and organisations to overcome the community’s problems. Community work aims to enhance the sense of solidarity and competence in the community. For example, a community development worker may take on a health promotion role by working with particular communities in order to collectively bring about social change and improve quality of life. This involves working with individuals, families or whole communities to empower them to:

(For more details see http://www.prospects.ac.uk.)

This is community work with a focus on health concerns, but generally health is defined broadly to include social and economic aspects, so that community health work may encompass almost as broad a range of activities as community development work.

This means activity carried out by members of the community under their own control in order to improve their collective conditions. It may involve campaigning, negotiating with or challenging authorities and those with power.

This is about involving the community in health work that is led by someone outside the community; for example a worker employed by a statutory agency. The degree of participation may vary.

This means working to stimulate and encourage communities to express their needs and to support them in their collective action. It is not about dealing with people’s problems on a one-to-one basis; it aims to develop the potential of a community as a whole. A community development approach to health involves working with groups of people to identify their own health concerns, and to take appropriate action. Community development health workers are essentially facilitators, locally based, whose role is to help people in the community to acquire the skills, knowledge and confidence to act on health issues. They are usually community workers by background, rather than health professionals.

This is a loose term applied to programmes of work that are organised by agencies for the improvement of health in a community, or to local organisations aiming to improve health by supporting some combination of community activity, self-help, community action and/or community development. To read more on terms and projects linked to the community go to the Community Development Foundation (CDF) website (http://www.cdf.org.uk). The CDF is the leading source of community development expertise and delivery. As a public body and a charity it bridges government, communities and the voluntary sector, and has a range of information on the types of projects that lead to community cohesion, community engagement and community development.

Finally, it is worth mentioning that in the health service the word community is often used as an adjective to describe anything that is not based in hospital. Examples are community care, community nurses and community services.

It is the community which defines its own needs. Community-based work is essentially a bottom-up process, rather than being top-down expert led where those with power and authority make the decisions. Health promoters recognise and value the health experience and knowledge that exists in the community, and seek to use it for everyone’s benefit. Both legislation and policy recognise the importance of community involvement in their own affairs (see Department for Communities and Local Government 2006).

Community health promoters do not perceive themselves as experts in health, but as facilitators whose role it is to validate, encourage and empower people to define their own health needs and to meet them. They start where the community is, recognising and valuing people’s own abilities and experiences. They involve people in community health work from the very beginning, encouraging and supporting them in working together. Knowledge and skills are shared and demystified. Community health promoters aim to complement as well as challenge statutory services by making people’s access to statutory agencies easier, and making the agencies more accountable to the people they serve.

See Chapter 1, section on inequalities in health.

A central concern in community-based health promotion work is the need to challenge and change the many forms of disadvantage, oppression, discrimination and inequalities that people face, and which adversely affect their health.

Work therefore has focused particularly on the needs of disadvantaged groups. A central way of working is to bring people in such groups together for support and information sharing, and to enable them to bring about change through collective action. The work can be political, because it often involves working towards equality, social inclusion and social justice with people who experience powerlessness and inequality as part of their everyday lives.

Health is perceived broadly and holistically as positive wellbeing including social, emotional, mental and societal aspects as well as physical. It is not seen merely as the absence of disease, and is not limited by medical or epidemiological views of what constitutes a health problem or issue. Health is seen to be affected by social, environmental, economic and political factors.