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S Loue, L S Lloyd, D O’Shea. (Pp 171; price no stated). Kluwer Academic/Plenum, 2003. ISBN 0-306-47390-9.
The concept of health advocacy is nowadays considered one of the main tasks of public health. Health professionals try to solve health problems with effective strategies. One of them is, specifically, community health advocacy. To act on health problems in the global context, participation and communitarian perspective is a choice. People need advocacy and empowerment to achieve health outcomes more than isolated health interventions assistance. Although the role of health services is important to promote and secure health, there are other issues that are important to guarantee people’s health. Community, organisations, and institutions must advocate for health with the necessary tools and in the context of each society.
“Community health advocacy” is a reflection on the role of different issues in relation with an empowering view of public health. To conceptualise the subject, the authors define terms as community, needs, action, grassroots, or empowerment. They try to explain the actions of all social agents that are (or can be) involved in health advocacy. They also emphasise how to integrate values and ethics in health advocacy objectives.
The different chapters provide an approach of what strategies and efforts of advocacy are required. At the end of each chapter, a specific experience of health advocacy is included related to the issue discussed. Finally, there is a section with discussion questions to investigate the subject more deeply.
In chapters 1 and 2, the authors define the relation between community and public health. They also explain community characteristics and interests from the point of view of sociology, anthropology, or psychology. They question what community needs assessments are, and what are the causes that make a particular group of persons unable to achieve a better quality of life. Assessment is a process to provide people with the possibility to identify their own needs. This is a preliminary step for health advocacy.
In chapter 3 the authors investigate ways of organising the community. They define the grassroots approach as a “bottom up” strategy, and show how people can drive health programmes themselves to achieve health goals. This focus is a tool for social change, empowering people in their own decisions about health.
Chapter 4 explains the objective of building coalitions. To improve people’s health by advocacy grassroots organisations can organise themselves into coalitions created at different levels. To secure society’s health rights it is necessary to build networks to approach the different political situations. Advocacy efforts require relationships to be built to provide people with opportunities for collective problem solving.
In chapters 5 and 6, the authors review the role of legislative advocacy as a mechanism of health advocacy. This is a formal process that makes the rules that must be accepted by the people. If the legal system is on the side of community needs, it will be one of the most important strategies to improve their health. Also, the administrative agencies have an important role in the rule making process. Organisations and individuals can act as advocates in influencing the process of legislative building, or trying to change rules that do not contribute to the health improvement of the community.
Chapter 7 explains the importance of the state court system and its capacity to be a framework for civil mobilisation.
In chapter 8, the authors explain the influence of the media as an advocate for health. An effective use of media can have an impact in society drawing attention to different health problems, the community action to solve it, or the role of politics. The information about health through media is influenced by different powers. For this reason, people must use the media as a support to advance in the solutions for health problems.
Chapters 9 and 10 are related with the evaluation of the advocacy action, and the conflicts that can result in the relation between advocacy and ethics. The authors emphasise the importance of evaluating the advocacy actions, to improve other activities in the future. People learn through their successes and failures. This is a formative perspective of monitoring and evaluation. Finally, health advocacy must act to secure health rights supporting people in building their own history. The main ethics consideration related to health advocacy is to respect people’s problems and solutions and their point of view.
In my opinion, this book is an excellent tool to be used in different areas. For example, it could be useful as a support in the planning of community projects through social and political institutions. Different bodies have in this book an opportunity to learn of other organisational experiences. Finally, this book is a great guide for teaching public health, and also in the process of research in health promotion and health advocacy.