Community Action—Challenges and Constraints—Implementing Evidence-Based Approaches Within a Context of Reorienting Services

Abstract

Community action on alcohol use-related projects face significant challenges in focusing efforts where they are most likely to be effective—on environmental strategies for optimum impact and sustainable institutional change. Reorienting and enhancing the efforts of existing services is a crucial issue for all countries with limited resources. This paper evaluates the use of a public health partnerships model to reorient resources and enhance cross sector collaboration to reduce alcohol consumption-related harm in a large New Zealand city from 2001–2004. The evaluation assessed changes in the management practices of participating health provider organisations, the reorientation of activities and the redeployment of provider resources, in light of evaluation evidence from collaborative initiatives undertaken by key stakeholder organisations. Despite the considerable challenges inherent in reorienting existing health sector resource and encouraging more evidence-based practice, this evaluation found encouraging signs of positive systemic changes, both within the health sector and with external stakeholders, in the redirection of priorities and resources. The focus on collaborative environmental strategies has also contributed to some limited, but promising structural changes to reduce harm in the licensed alcohol availability, accessibility and promotion environment.

Keywords:

• Community action
• Reorientation of services
• Evidence-based practice
• Environmental strategies
• Collaboration
• Sustainable institutional change
• Management practices
• Stakeholders
• harm

Notes

Notes

1. Dr. Holder is an internationally recognised world leader in alcohol problem prevention research and former Director of the Prevention Research Center Berkely, University of California. He directed a five-year national community trial (1994–1998) to prevent alcohol-involved injuries and deaths that has been used as a model for many community action alcohol problem prevention projects worldwide.

2. The term ‘community’ has become something of a policy buzzword which has been attached to a diverse range of ideas and initiatives. It means various things to a range of individual and systemic stakeholders. “Shared geography”, as an often-regarded simplistic, common denominator, minimizes the range of other “sharing” options which range from actual objects to beliefs, values, membership in, identification with, association with, from a micro to a globalized macro level. One can categorize in very (over)-simplistic terms- for heuristics- 3 ‘types of community intervention models’ for the reader to consider as s/he considers the “demands” and implications” of community readiness and community awareness for planned intervention. made up of agencies which are responsible for coordinating efforts around the goals set by central government. These networks, based on expert knowledge and professionally defined codes and protocols, often leave little room for involvement of those outside of the professional group. (2) Community partnership: where community members and professionals come together on a more or less equal footing, and a community partnership is formed. (3) Grass-roots community initiative: a grassroots community initiative may be created when members of a community come together over a particular issue which they consider important. The initiative unfolds as the group continues to meet and is not defined by professional interests although in time it may evolve into a community partnership. Examples of grass-roots initiatives include user / carer support groups. Source: Shiner, et al (2004) Exploring community responses to drugs Joseph Rowntree Foundation, York, UK (www.jrf.org.uk).

3. Liquor liaison groups (LLGs) are comprised of agencies with regulatory powers (police, liquor licensing inspectors and medical officers of health or their health protection colleagues that meet regularly to discuss the latest police alcohol-harm related data. All those involved in traffic, assault and disorderly incidents etc are asked where they had their last drink or purchased alcohol). The LLGs decide on follow-up monitoring and enforcement action for licensed premises that are linked to this data.