ABSTRACT
The challenge for improving public health goes far beyond the dissemination of information about healthy lifestyles, preventative care, or even quality of care. At its roots, the challenge for public health calls for consumers to participate as full partners in the healthcare system, actively responsible for their own health maintenance and vigilant in demanding quality and cost-effectiveness (see Chapter 7, Stage 2). The principles of a community approach to any specific problem involve the participation in and ownership of agendas by all involved. This is obviously a departure from traditional methods of health assessment which use a more directive, top-down approach: experts define the problem, and then suggest solutions. The following description of the needs assessment in a disadvantaged area is based on the principle that people are experts on viewing their own environments, and this applies within the local context as much as anywhere else. Although examples of participatory research are more prevalent in developing countries (Scrimshaw and Hutardo, 1988; Thies and Grady, 1991; Ong, 1991; Shamian and Kupe, 1993; Varkevissor, 1993), this may be due to the misguided belief that poverty and ill health do not exist on the same scale in the developed countries of the Western world. Nevertheless, there would appear to be a need to apply the same techniques within locally defined areas. Moreover, it should be noted that, in spite of the rhetoric about public participation, a recent study (Poulton, 1996) found a marked unwillingness among some professionals to involve users in defining and planning services.
