Editorial

The enabling community for child and family health

Anne M McMurray
Emeritus Professor, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD; Emeritus Professor, Faculty of Health Sciences, Murdoch University, Perth, WA

PP: 002 - 004

Article Text

An ecological view of health contends that health is created within the psychological, social, cultural, educational, physical and economic conditions that surround people's lives. Communities provide the template for many of these conditions, and are therefore integral to the development of health and wellbeing. 'Enabling' communities are those that optimise, rather than constrain opportunities for good health, and in this respect, the enabling community captures the essence of the relationship between health and place. An enabling community for child and family health is where families are central to community life, and where information, services and resources converge on the common goal of helping children reach their developmental potential. Although family cultural factors and behaviours are major determinants of children's health and development, an enabling community adds the backdrop for the health promoting networks and associations that shape social connectedness. Enabling communities can nurture connectedness through features of the physical landscape, places and opportunities for community interactions, attitudes of inclusiveness and tolerance, and policies and support services that are geared towards empowerment and capacity development.

Health and Place: From Bronfenbrenner to Contemporary Thinkers

Since it was first introduced by Bronfenbrenner in 1979 the social-ecological view of health has become widely accepted by health scholars and service planners. Bronfenbrenner's bio-ecological model contends that human development takes place through progressively complex, regular, reciprocal interaction between an active, evolving biopsychological individual, and the persons, objects, and resources within the immediate external environment (Bronfenbrenner, 1979; Bronfenbrenner & Evans, 2000). This perspective situates the community as the most powerful setting for developing health capacity. For children, the promise of health and successful personal development lies where they, and their parents, can be meaningfully engaged with one another and with other families for mutual benefit. In this type of environment the community plays a mediating role between health promoting conditions and the individual or family factors that compromise health. Some communities are enabling by virtue of their therapeutic or restorative landscapes; places where illness and/or stress can be alleviated by the healing air of the sea or the forest, or by spaces for physical activity and other leisure pursuits, or opportunities for social interaction, all of which can buffer the stresses of everyday life (Duff, 2011). Communities that provide supportive places for social interactions can be empowering, helping sustain the community's viability as well as residents' personal health (Rifkin, 2003). Such communities are often described as having high social capital.

The concept of social capital was first described by Putnam (1995) as encompassing civic engagement, trust, and norms of reciprocity among community members. In these conditions, the community tends to become dynamic and vibrant, bringing people together through networks, associations, and a sense of purpose (Wood & Giles-Corti, 2008). Information, including health information, flows in many directions, people are compelled to help others for mutual benefit, and they are more likely to participate in democratic institutions, and be accountable for their actions. When communities nurture this type of social climate people tend to share goals, bonding together to build capacity and resilience in the face of economic, social and environmental changes (Ontario Healthy Communities Coalition [OHCC], 2009).

There are many types of resources that render a community 'enabling', including social, affective and material resources (Duff, 2011). The combination of these resources define the notion of place as it shapes people's experiences. Social relations of trust and reciprocity are important elements of the enabling environment, but so are the affective resources that support intimate relationships, especially those that strengthen the family as a unit and provide the conditions for families to make supportive choices for their children's health and development. Inequity of access to knowledge, resources, support or a lack of inclusive strategies for information sharing creates disabling, rather than enabling influences on health (McMurray, 2010). Social control therefore includes a community's obligations to provide for its citizens equitably, and opportunities for people to learn from one another, develop health literacy, and articulate their lives, their values, and their expectations in their own language (McMurray & Clendon, 2011; Sen, 2000).

Identifying Community Enabling Factors

To date, there have been few examples in the professional literature of successful, enabling communities or the link between enabling environments and health outcomes. There are indications that features of the built environment such as open green spaces, are instrumental in improving people's quality of life (Cattell, Dines, Gesler, & Curtis, 2008; Maas, van Dillen, Verheij, & Groenewegen, 2009). Therapeutic landscapes in the city or country are also known to foster a sense of belonging and social integration as well as a spirit of civic participation, all of which can help counter adversity (Cattell et al., 2008). The role of 'place' in supporting the health of children and adolescents is also well established in the international research literature (Duff, 2009; Dunn, Froehlich, Ross, Curtis, & Sanmartin, 2006; Leventhal & Brooks-Gunn, 2000). Neighbourhood influences on child health and development have been found to be mediated through the quality of resources and relationships as well as collective norms of behaviour (Brooks-Gunn, cited in Andrews, 2010).

One of the greatest gaps in our literature of the enabling community for child health lies in understanding the breadth of community factors that would support parenting, such as services, transportation, play areas and job opportunities, particularly in rural and remote areas (Andrews, 2010). On a global scale, there is widespread concern that physical environments are deteriorating, and this has a significant impact on children's opportunities for outdoor activities. Health and developmental researchers have expressed concern that today's children are experiencing reduced access to neighbourhood outdoor spaces for child-driven free play, which has unique developmental benefits (Castonguay & Jutras, 2009). This is occurring in the face of empirical studies showing that access to outdoor play areas can promote children's physical, cognitive, social, and emotional health, and help them develop resiliency and friendships as well as create patterns for mutual support that can last into adult life (Castonguay & Jutras, 2009).

Implications for Nurses and Other Health Professionals

The disabling effects of shrinking spaces, deteriorating neighbourhoods and schedules that confine children to indoor activities need attention from a wider audience than community planners. Advocacy for enabling environments is the responsibility of all community citizens seeking to foster quality of life, including nurses and other health professionals. Equally important is the need for research that would keep the needs of children and parenting on the agenda of policy and planning authorities. By collecting data that integrates community factors with children's development, health professionals could add substantial knowledge to planning authorities about the local contextual strengths and constraints that impact on healthy childhoods. Community case studies could help profile access to and use of health services and health information; strategies that assist with family relocation and/or other changes; policies, structures and conditions that promote child safety, such as accreditation of child care workers, or stronger child protection schemes; initiatives to prevent ill health; health promotion and supportive programs for physical and psychosocial wellbeing such as paid parental leave schemes; the development of various cultural initiatives in the community; healthy and safe workplaces; and a range of other factors that contribute to an enabling environment. Along with this is the need for studies that would give voice to parents in identifying their family aspirations, choices and perspectives on achieving these. Most family members have insights into what they need to help them parent and how to ensure that their family adds value to community life. Their perspectives can include identifying family-friendly housing initiatives; community strategies for inclusiveness; accessible maternity care, child care and after school care; services and advice needed for breastfeeding support, parent-to-parent or grandparent-to-parent support systems. The research agenda should also include an examination of factors that would create a robust environment for early learning readiness; healthy eating resources; spaces for play and physical activity; initiatives to promote positive community attitudes and to overcome stressors such as neighbourhood violence, bullying or community incivility; as well as the macro aspects of the enabling environment: the provision of safe water, food and clean air.

Nurses and other health professionals are part of the dynamic pattern of interaction between health and place. By sharing local wisdom and continuing to map the structures, processes and outcomes of family and community life, we can forge new understandings of the enabling communities that provide a safe, healthy, equitable, accessible and inclusive pathway from birth to the end of life.

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