Equal health: working model

The Equal Health model’s definition of health and the research- and participant-based CBPR approach create opportunities to spotlight the gaps between different concrete issues and sectors of society, thereby creating opportunities for innovation and change that result in increased health equality at both a societal and an individual level. Equal Health makes it possible to work in a structured way to overcome challenges that occur, for example, between the responsibilities of the social services and the healthcare, respectively.

The Equal Health model gives citizens an opportunity to contribute to the development of their immediate surroundings and daily living situation and improve their own health. It gives voluntary organisations an opportunity to benefit from a long-term structure and the scientific monitoring and follow-up of their efforts. The model offers academic researchers an opportunity to collaborate with societal stakeholders and citizens, and to gain access to various types of knowledge. This opens up for contexts of research interest and issues concerning health and health promotion from multidisciplinary perspectives.

In local business and industry, the Equal Health model offers opportunities to interact with prospective customers in joint knowledge development/building and other development efforts. Equal Health is based on the UN’s Sustainable Development Goals of Agenda 2030 and the WHO’s recommendation to engage in a multisectoral collaboration involving actors from various sectors of society in order to deal with complex societal challenges such as health inequalities. In collaboration, the citizens in the neighbourhood participate as equal actors in the programme’s construction and development.

Equal Health defines the concept of health as follows:

• Health is viewed as a holistic and interdisciplinary
  concept, i.e., physical, mental and social.
• ”Health is a state of complete physical, mental and
  social well-being and not merely the absence of
  disease or infirmity.” (WHO, 1946).
• Cultural aspects are an important source of health.
• Health is influenced to a high degree by crucial
  social factors such as language skills, living conditions
  and working conditions.

• The parties involved in an Equal Health programme include citizens as well as stakeholders from various sectors of society who support, follow and plan the participants’ work, based on the needs defined. Participation can be in the form of direct financial support, or through other resources such as staff or premises.
• The parties take part in an ongoing evaluation of the activities.
• The parties take part in the strategic group and the Hub’s meetings and work.
• Each party has a responsibility to communicate their expectations and requirements regarding their participation to the other partners, through representation in the strategic group and Hub.
• Partners can vary over time. New partnerships must first be discussed in the Hub. New partners are required to sign a declaration of intent concerning Equal Health’s core principles and the health promoter’s service (if the partner is the employer of a health promoter).
• Penta-helix – a collaboration between five sectors: the public sector, the voluntary sector, the private sector, academia and citizens.

The Equal Health working model is based on a CBPR approach.

CBPR is a research approach based on a partnership between academia and the citizens in a neighbourhood, municipality, etc. The method is based on participantdriven research, meaning that citizens and participating stakeholders (companies, voluntary organisations, municipality, region and/or state) jointly identify and create opportunities and challenges linked to a need for change. An example of this type of need for change are the unequal health structures in society.

Models in this research approach can be used as a tool for strategic planning based on participant-driven research. The approach can be applied locally, nationally or internationally and is especially suitable for developing user-driven processes. CBPR processes are always locally anchored to take the context and place into account.

Israel, Schulz, Parker and Becker (1998) define CBPR as a partnership strategy for research that in a fair way involves members of society, organisational representatives and academic researchers in all aspects of the research process. It enables all partners to contribute their expertise, with shared responsibility and ownership; it improves the understanding of a given phenomenon; and it integrates the knowledge gained with measures to improve health and well-being for members of society, e.g. through interventions and policy changes.

Health promotion takes place through and with people, not for or to people. This improves individuals’ ability to act and opportunities for groups, organisations and local communities to influence factors that affect health. (WHO, 1997)

• A focus on processes that promote health.
• A focus on reinforcing existing positive factors.
• A focus on the population’s self-perceived needs.
• Based on a promotive view of people, which means that all the work takes as its point of departure each individual’s situation. A promotive method reinforces things that already exist and work well at the location (Lindängen) and takes into account how the individual’s situation is affected by the surrounding societal structures.
• Based on a desire to reinforce a positive phenomenon.

Health promoters play a central role in Equal Health. They are the pivot of the activities and help build bridges between the different stakeholders and the labs. Due to their commitment and knowledge of the local context, they are recruited from the local area to lead and drive the work forwards.

• The health promoter is recruited from the local area.
• The health promoter knows the area, from social, cultural, language and other perspectives.
• The health promoter is a doer and a networker.
• The health promoter initially receives training in process management, how an association is run, etc.
• The health promoter represents different ages and genders.
• The health promoter runs the labs together with researchers and doctoral students.

Health promoters are recruited on the basis of the personal contribution they can make, rather than a pre-set list of requirements. An individual plan is drawn up for each health promoter specifying what skills they need to develop in order to grow in their role. The development initiatives are led by one of the programme partners.

The health promoters represent citizens; they ensure that the citizens’ voices are heard and that the activities remain user-driven. They also ensure that the platform’s various labs and networks are sustainable over time. The health promoters are members of all decisionmaking bodies in the innovation platform, and are also involved in developing the activities, primarily for the labs. While representing the citizens, they also understand the organisation’s structure and the structural obstacles and opportunities arising from it.

A basic concept of the Equal Health working model is that authority is gradually redistributed from the strategic group to the health promoters and citizens.

Example: Future Workshop

An pedagogical method for developing concrete ideas and visions. The method uses a clearly defined way of working that creates freedom and security while also incorporating enjoyment and creativity as driving factors. The aim of the method is for all participants to find a common platform where they can develop and realise their ideas together. A successful Future Workshop is a good starting point for future action, and often results in the formation of working groups that continue to work on solutions and new development processes.

A Future Workshop can be implemented in various ways. To implement the method, moderators are needed who are trained in the technique. The main principles of the method are participant control, democracy and structure. Everyone’s ideas and views are respectfully heard, discussed and introduced into a common context.

Example: World Café or Dialogue Café

The café method is a dialogue method that encourages people to participate in discussions on relevant issues in an informal, comfortable environment. The venue is made to be as inviting as possible, for example as a café environment with people sitting around small tables. Used to gather ideas and suggestions regarding a relevant topic or issue.

The process is led by a meeting moderator. The meeting should begin with a short review of facts regarding the topic, and the participants should also have ready access to the information material. Small discussion groups seated around tables explore a theme or specific issues, which should be open and challenging. The participants switch between tables and groups at specific times during the meeting. In principle, the process takes place in three phases: analysis, in-depth analysis, development of proposals.

The work done at the tables should be documented. Ideas and views are communicated to the otherparticipants during and after the meeting. Simple rules/principles are set out to facilitate participation and creativity among the participants.