Community Development

Definitions and Developments

Since the 1970s, the changing fortunes of CD in health promotion have tended to vary along with the tensions between theory and practice. Since CD is a political activity based on collective experience and action, it has remained at odds with the focus on personal behaviour which has dominated mainstream policy and practice. An examination of CD for health is therefore of pivotal importance to any study of health promotion. We will consider the radical traditions of CD based on a socialist ideology of fighting injustices which impact upon the health of some more than others and ‘the current neo-liberal approach to citizenship which places obligations above rights and in which capitalism (unregulated free-market global expansion) destroys communities and social institutions’ (Jordan, 1998).

There are some important definitions to be set out before examining CD for health. In 1948, the United Nations' definition of CD linked an emerging idea of community empowerment to modern concerns with community organizing and power. The UN definition of CD was ‘a movement to promote better living for the whole community, with active participation and if possible on the initiative of the community, but if this initiative is not forthcoming, by the use of techniques for arousing it and stimulating it’ (Craig, 1989). The Standing Conference on Community Development published its own definition of CD as a charter (1995), from which two statements help to clarify CD as a process: ‘Community development is crucially concerned with the issues of powerlessness and disadvantage: as such it should involve all members of society, and offers a practice that is part of social change’; ‘Community development is about [Page 64]the active involvement of people sharing in the issues which affect their lives. It is a process based on the sharing of power, skills, knowledge and experience.’ CD is radical in intent – it aims to challenge the status quo and force changes which move power in favour of the powerless.

CD for health is inextricably linked with consciousness-raising and change, and has its contemporary origins in the political movements of the 1960s and in developing countries where colonial oppression held back human rights. Earlier forms of ‘community development’ in Victorian England adopted a paternalistic approach to improving the lot of the poor, which was replicated in British outposts, particularly in West Africa, before World War II by the Colonial Office in the form of self-help projects. During the post-war period CD programmes in ‘Third World’ countries were designed to pave the way for the transition to independence, but the approach of international agencies was ‘top down’ and ‘giving power’ with the intention that a country move towards a western, capitalist model of government. Training for CD workers was still very much for people and not with people. Other countries, such as China, Cuba and Tanzania searched for alternative solutions to conventional health development and developed socialist strategies. WHO, in its report Health by the People (1975), noted that ‘these countries had a clear advantage in starting primary health care change if they came from such a starting point politically’.

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