Project Co-ordinator

Dr Marisa Gilles
Director 
Gascoyne Public and Community Health Unit
Carnarvon

Title

Developing a baseline survey to measure Community Strength in Carnarvon and its relation to health

Project description

Aims of the project

To carry out a literature review looking at instruments used to measure community strength and social capital in rural areas and to determine the evidence linking these parameters to health with the aim of developing a program to monitor Community Strength in Carnarvon every 3-5 years that can also be used in other rural towns. 

Expected outcomes

· To determine the effectiveness of the Gascoyne Public and Community Health Unit (GPCHU) programs to address Diffuse needs while recognising that there are many different players and actors
· To give other actors and agencies that are contributors to Community Strength an indication of how effective everybody's contributions to improving Community Strength have been
· To develop an instrument to measure "Social Capital" or "Community Strength" that is sensitive enough for rural Australia and acknowledges the negatives aspects of community as well as its strength.
· To contribute to the body of knowledge on the impact of social determinants and rural inequity on rural health.

Significance

Despite clean air etc living in the country is hazardous, there are higher rates of suicide, injury, road vehicle accidents, asthma, diabetes, infant mortality and the 
statistics get worse as distance and remoteness increases. In a recent paper by Jane Dixon and Nicky Welch (Dixon J & Welch N. 2000) they outline a number of confounders to explain these statistics including, race and ethnicity, gender, sociocultural and psychological factors and call on more research to measure the true impact of these issues on the health of rural Australians.

Since the work of Putmen in 1995 (Putmen RD 1995) there is a growing appreciation of the value of social capital and it's importance to health. However despite much work over the last seven years trying to measure this ethereal concept, many of the existing instruments are metro-centric, dependant on large populations and not suitable for the small towns of 2-6,000 people found in rural Australia. Many of these surveys fail to tease out the negative aspects of "communities" as outlined by Bourdieu in his original description. They fail to address the fact that social capital is not always non- exclusive and that it can result in people in some social groups excluding others and being used to keep people down (Bourdieu P 1986).

This weakness was illustrated beautifully in the recent survey carried out by the Western Australian Health and wellbeing surveillance system in 2000 that found that Carnarvon had excellent social capital (over 90%) and that in general rural connectedness was greater than urban connectedness. In contrast a survey carried out in 1999 by the Regional Development Council in the Gascoyne stated that 58% of those interviewed agreed that there was "a lot of division" in the community, 33% cited a lack of modern communication was as a real problem (the lowest satisfaction for any regional area) and 29% stated they would send their children away to high school with 16 per cent planning to move with their children in search of better education (this 35 per cent compares with a regional average of only 17 per cent).

The Gascoyne Public and Community Health Unit (GPCHU) is well aware of the work of Sir Michael Marmot and recognises the importance of social determinants on health. It aims to achieve a balance and continuity between the immediate tasks of health care and the long term issues that impact on health such as social isolation, community disharmony, poverty and economic growth. Health promotion programs are developed with community involvement and ownership, and we believe that in order to make long term gains in health the unit needs to work with and have an on-going involvement in the lives of the communities it serves. The GPCHU carried out an analysis of the Health of the Gascoyne residents in 1997 and 2001 (Unwin L 2001) based on the standard datasets available to the Health Department in Perth. It is expected that the findings of this survey will be linked to the medical and other valid indices to provide a composite picture of social capital and it's impact on health in Carnarvon.

There is a growing belief that population health should be the group that measure the progress to reduction of poverty, promotion of social cohesion and elimination of discrimination. There is a huge interest internationally in getting better at measuring exactly what impact interventions that "build" social capital have and developing better instruments that tease out the negative as well as the positive aspects of "social capital.

This work seeks to address these issues, to deliver an instrument developed based on community consultations, existing instruments and previous surveys such as the "Living in Regions" survey noted above. It seeks to create a process to measure community strength, and help determine a mechanism to measure the effectiveness of programs that address diffuse needs. 

It is believed by the principle investigator that unless such a mechanism is developed diffuse programs will be threatened in times of financial hardship as, at present, there is no way to "prove" their effectiveness. In the process of developing the instrument the chief investigator spoke and corresponded with key stakeholders in this field nationally and internationally and was encouraged by all to pursue this research owing to the gap at present in any valid instrument for measuring social capital in rural Australia and the importance of contributing to the literature and developing a mechanism that can determine if change is occurring within this field. 

Research plan, methods and techniques

In March 2002 the chief investigator gained a two month fellowship from CUCRH to review the literature on measuring community strength and prepared a draft questionnaire based on internationally validated indicators. She also identified a number of other tools that would be applicable in Carnarvon. This fellowship followed work carried out by David Galloway on developing a conceptual framework for measuring social capital in response to a desire to determine the effectiveness of the GPCHU's cultural change programs. The instrument is also grounded within the themes provided after a number of consultation workshops held in Carnarvon with key stakeholders in the community by David Galloway. 

Over the two months a detailed literature review was conducted and contact made with the key researchers in this field throughout the world. There appeared to be significant interest in the outcomes of this project and no existing instrument suitable for rural Australia or work that has dealt with this difficult area before.