Equal Health is a working model, developed through research at Malmö University, that can be used in developing activities to improve people’s health and empowerment in a neighbourhood or a municipality. The work structure is based around a scientific approach known as Community Based Participatory Research (CBPR), as well as a health promoter function that is an application of the international Cultural Broker concept.

Equal health in society through health promotion

To create the necessary conditions for more equal public health through health promotion. The activities are entirely needs-driven, and in all respects based on the experienced and stated needs that citizens in the neighbourhood are involved in formulating.

Improved health, empowerment and participation are the cornerstones of the initiative achieved through health-promoting activities – where the formulated needs determine what those health-promoting activities will consist of. The partnership and activities are created based on the local context. The model aims to become an integral part of the neighbourhood. 

Success factors for achieving equal health and social justice

  • A strong presence in the local context; this includes academia.
  • Always taking citizens’ needs as a starting point.
  • Trusting relationships between the partners.
  • A desire to contribute to change, based on each person’s ability.

Model design

Workshops regularly take place, where updated needs inventories and evaluations are made and subsequently decide the content of the health-promoting activities in labs (workshops) with different focus areas, led by health promoters. The ongoing dialogue in the health promotion labs is a continuous and important process that also affects the activities on the basis of the needs that are identified and defined.

The activities are characterised by openness, inclusion and integrity, and take as their starting point various meeting places in the area which are open to everyone. Everyone is welcome to participate in the activities, which are free of charge and adapted to the participants’ needs and circumstances. Documentation aiming to give an account of the activities must respect the individuals’ privacy as well as ethical rules and regulations.

The equal health model in depth

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 – for whom?

Academia

The CBPR (Community Based Participatory Research) approach based on collaboration between societal stakeholders and citizens provides opportunities for both basic and applied research to gain access to contexts and issues of research interest, and to access various types of knowledge, in order to address issues concerning health and health promotion from multidisciplinary perspectives. Doctoral students can work in pairs with local health promoters. The Equal Health model creates a strategic collaboration with external stakeholders.

The CBPR approach can be used when implementing health interventions. The CBPR interventions involve implementing solutions together and carrying out tests and measurements within the partnership to build and develop a process. The interventions are adapted to the context in which they will be implemented. Interventions are measures/actions aimed at improving or protecting the health of individuals, families, systems and/or societies.

For citizens, the Equal Health working model offers an opportunity to take part in developing their immediate surroundings and daily living situation and improving their own health. This enables them to be part of a context that contributes to greater empowerment and increased knowledge of health and health-related issues. Citizen involvement is at the core of the activities.

For the business sector, Equal Health offers opportunities to interact with prospective customer segments in joint knowledge-building and needs-driven innovation and development efforts.

Equal Health makes it possible to work in a structured way to overcome challenges caused by the structural and administrative gap between, for example, the respective responsibilities of the social services and the healthcare and social care sectors. Through an active participatory and collaborative approach, real needs are spotlighted and expressed through citizens’ experiences.

Equal Health offers an opportunity for long-term structure and scientific monitoring and follow-up of work efforts, whose results would otherwise not always be documented or verified in order for them to be presented externally. It also offers an opportunity to develop a close collaboration with business stakeholders and academia in a way that usually falls outside the working methods of these organisations.

Requirements for starting an programme

Requirements

  • Individual citizens taking initiatives and driving the work forward with academia, the public sector, the voluntary sector and the business sector, linking up with each other to develop solutions that increase people’s health and empowerment.
  • Time and presence from all parties to start and drive the work process.
  • Premises such as social meeting places where the various activities can be developed.
  • Funding for employment of health promoters and programme leaders, and the allocation of other resources from each respective participating organization.

Necessary approaches to starting, running and developing an Equal Health process

Health

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.

Partnership, the Penta-helix model

  • 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.

CBPR – Community Based Participatory Research

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-promoting approach

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.

The health promoter – a bridge builder between different sectors of society

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.

Redistribution of power and authority

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.

Workshop models with a participatory structure

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.

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