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Current Issues and Future Trends


1. A framework for healthy alliances

What most improves the health of our population? Developments in surgery, better diagnostic systems, better health promotion, primary care led purchasing? All or none of the above?
Robin Douglas

2. Exploration of conflict theory as it relates to healthy alliances

In the mid-1980s experience of interagency collaboration evolved through the implementation of the community care reforms. For almost all participants’ involvement in interagency work was additional to their professional tasks. In addition, as with later experiences of joint working, members found that they knew very little about methods of decision-making and the constraints on the action of other agencies (Carpenter, 1995). Differences in culture were compounded by differences in language and interpretation. By 1992 the term healthy alliances (Department of Health, 1992; Powell, 1992) was coined for the purposes of establishing arrangements for joint working, collaboration and co-operation between district health authorities and other agencies in order to work towards the achievement of The Health of the Nation targets (Speller et al., 1994). Recognition of the tremendous value that alliances can offer has already been acknowledged and promoted through The Health of the Nation progress reports. More recently, Fit for the Future (Department of Health, 1995) highlighted the significant commitment and enthusiasm for adopting the alliance approach from over 300 entries for the Health Alliance Awards Scheme for 1994.
Sally Markwell

3. Healthy alliances depend on healthy social processes

In the introductory chapter to this text Douglas has drawn attention to the importance for effective healthy alliances of working with the complexities of the real world. These complexities involve macro issues at the level of policy and organisation and micro issues at the level of interpersonal relationships of those actively participating in the alliances. This chapter proposes that those interpersonal components of healthy alliances, although often referred to in work on healthy alliances (Speller et al., 1994), must be addressed as the bedrocks on which initiatives may thrive or flounder. Social processes are a vital ingredient in the success of healthy alliances. The sociological and social psychological literature has been reviewed by Markwell in the previous chapter. The intention here is to show how some of these theoretical issues are experienced in the practical workings of a healthy alliance.
Kathryn Backet-Milburn, Lindsay MacHardy

4. The influence of government policy on health promotion alliances

It is generally recognised that there is a serious shortage of investigation into health promotion alliances, particularly in relation to the processes that obstruct or enhance joint working (Beattie, 1995). This chapter offers a contribution to overcoming this dearth of empirical research by discussing some of the results of a national study. The study was grounded in the proposition that conflicting sectoral policies are a major inhibitor and constraint to the establishment and maintenance of interagency collaborations for healthgain. Two key sectors were examined: local education authority health education advisors and health promotion specialists. What follows, therefore, is an assessment of the influence of central government policy on attempts by professionals working in these two sectors to engage in effective alliance partnerships. It is anticipated that the conclusions and recommendations emerging from the study will also be of relevance to professionals working in other sectors.
Angela Scriven

5. The ethics of getting on with others

The official advice and much of the current literature about healthy alliances emphasises the process and management of intersectoral collaboration. This sort of advice has tended to concentrate on how, and what, should be done. However, for many people working in health, social services or the voluntary sector, the high moral tone of much of this advice has often served to make them feel guilty. The experience of many professionals is that it is difficult to relate to other agencies, that conflicting traditions can easily get in the way of effective partnership relationships. This may lead to a general intolerance of views that do not coincide with one’s own. It may seem strange that people who have chosen to work on behalf of others nevertheless find it difficult to behave well with fellow workers. This chapter explores why this happens and suggests ways of overcoming the difficulties by being clearer about the ethical basis of working together.
Andrew Wall

6. Developing a strategic alliance using a soft-systems approach

The focus of this chapter is an action research project on alliance-working. The alliance in question is Recipe for Health, a project undertaken by the Health Promotion Service for North Cheshire. The chapter has four sections. The first will place the project within the context of alliance-working. The second will identify some of the assumptions and frameworks that informed the approach and issues that emerged during the implementation phase. This will lead on to a consideration of the lessons learned from the experience and their implication for future collaborative working. Finally, there will be a reflection on the evaluation process and an assessment of the future for healthy alliances.
Meg Elliott, Debbie Jackson

7. An evaluation tool for the self-assessment of healthy alliances

This chapter presents a framework for the development and evaluation of healthy alliances. This framework is the result of a two-year project funded by the Health Education Authority (HEA) and undertaken by the then Wessex Institute of Public Health Medicine. The chapter is organised into three parts: a brief description of the research project, the resulting framework and practical advice on setting up evaluation procedures for an alliance.
Rachel Funnell, Katherine Oldfield

8. The commissioning of health alliances

This chapter discusses a process carried out by the Health Commission for Wiltshire and Bath (now Wiltshire Health Authority) to audit the current pattern of alliance-working and to identify what alliances should be commissioned for the future. In its commissioning plan, A Strategy for Health and Services 1994–1999 (Health Commission for Wiltshire and Bath, 1993), the Commission stated its commitment to alliance-working. This commitment includes forming and building alliances for health with a range of agencies and agreeing joint purchasing agreements with other authorities. There is, therefore, a stated responsibility to developing health alliances with agencies as diverse as the education sector, various sections of the National Health Service (NHS), workplaces, business and employers, the media, local authorities, voluntary groups and carers’ groups.
Maggie Rae

9. Future developments of healthy alliances

The preceding chapters have considered a number of issues about alliance structures and the way in which they work. This section ends with a consideration of the future of healthy alliances. Do they have a permanent place in the provision of general health services or are they just ephemeral bureaucracies? Are they able yet to demonstrate their contributions to healthgain, and in which directions will they need to develop? Are there any threats in terms of recent policy directions that will undermine their growing influence? This chapter will consider these issues through the exploration of 10 themes relating to the organisational structure and achievements of healthy alliances.
Viv Speller

Dissemination of Practice


10. Shared responsibilities: black community groups, black HIV specialists and the statutory sector working together in HIV/AIDS prevention and care

The following chapters in this section will highlight the realities of healthy alliance practice and the different approaches and relationships involved in creating partnerships. In this opening chapter to section two of the book there is an exploration of the importance of organisational development support to black voluntary sector organisations in their role in HIV prevention, and an examination of the effects that this support has in both enabling healthy alliances to take place and sustaining the partnerships that arise from alliance work. The chapter is based on the findings of a seven-month consultancy commissioned by the National AIDS Trust in 1996 and on reflections of other related pieces of work on organisational development support involving black community groups working together in the health promotion field. All references to black are based on the premise that this also includes people of different ethnic minority backgrounds living in the UK.
Davel Patel

11. Ageing Well: healthy alliances to promote the health of older people

As with other population sectors, there needs to be a multi-agency and multifaceted approach in an alliance style of working in order effectively to promote the health of older individuals. In recent years there has been a dearth of collaborative initiatives in this area. The scope of The Health of the Nation, for example, is currently too narrow in its approach to offer a multiperspective opportunity to promote the health of older people. To address their health needs adequately, a broad approach is required that acknowledges that older people are not an homogeneous group and that they cannot be stereotyped.
Loraine Ashton

12. Glasgow: a smoke-free city by the year 2000?

This chapter provides a case study of the work of Glasgow 2000, which is a long-established alliance of public, voluntary and academic sector organisations established in 1983 with the aim of making Glasgow a smoke-free city by the year 2000. In narrative style it describes the background, formation, activities and results of the alliance, analyses influences on the alliance and discusses its future directions. The chapter draws on formal and informal evaluations of Glasgow 2000’s work and personal observations over eight years as alliance co-ordinator.
Doreen McIntyre

13. Working together to reduce suicide in the farming community in North Yorkshire

The North Yorkshire Rural Initiative was set up in May 1994 to reduce the suicide rate in the county’s farmers. The difficulties faced in achieving the alliance’s aims and objectives partly reflect the nature of suicide and the geographical setting of the heath alliance but also illustrate some of the issues and problems of collaborative working as highlighted in the first section of this book.
Anita Hatfield

14. Child accident prevention through healthy alliances

This chapter will examine the use of healthy alliances in designing and implementing a programme of work on child accident prevention in the County of Avon. This examination is based on a two-year Child Accident Prevention through Healthy Alliances project. In July 1993 the Health Education Authority (HEA) selected Avon and Shropshire to pilot a two-year study that would investigate and assess the progress made by two interagency groupings, or healthy alliances, in designing a programme of work on child accident prevention. Funding of £100,000 was awarded to each alliance over a two-year period to resource activities. An independent research team was commissioned to evaluate the development of alliance-working and the accident prevention work undertaken. The Child Accident Prevention Trust, in association with MEL Research Ltd and the Department of Child Health, University of Newcastle, undertook the research.
Maggie Sims

15. Alliance in secondary care: health promoting hospitals

The purpose of this chapter is to explore the concept of health promoting hospitals (HPHs) and to chart the development of the initiative both Europe-wide, in England and at a regional level in the South and West Region. The development of HPHs gives legitimacy to the implementation of health promotion activity and alliance partnership in the secondary care setting. A proposed model for hospital-based health promotion, along with the scope for alliance-working in this setting, will be examined. The developmental work underway in the South and West Region and the resulting organisational framework to support implementation of HPH in acute and community trusts will provide one approach to securing increased prominence of health promotion activity and alliances in secondary care.
Noreen Kickham, Annette Rushmere

16. Arts in health promotion: a comparative overview of two health arts alliances

Arts in health care is often associated with hospital arts, theatre in health education or arts therapies. Increasingly, however, a variety of other health promoting roles are being developed by artists and health workers operating in the community. This chapter identifies two health promotion initiatives that demonstrate a range of health promoting functions enabled through an alliance of arts and health and implemented using contrasting models of health promotion. One is led by a local authority arts department and the other by a specialist health promotion agency. A rationale and description for the use of the arts in health promotion is provided, and discussion focuses upon the factors that influence the development of the alliance. Comment will be made upon the extent to which outcomes have been enhanced or impeded through partnership-working. Consideration will be given to the role of specialist health promotion officers in enabling health arts alliances.
Helen Chambers

17. Communities for better health: a partnership of national and local agencies

Health Promotion Wales is a special health authority, set up in 1987 to promote good health among the three million people of Wales. To this end, the authority initiates, facilitates, supports and guides health promotion activity, including alliances, both locally and nationally.
Helen Howson, John Griffiths, Ann Davies

18. Healthy Cities: a preliminary analysis

Healthy Cities is a World Health Organization (WHO) project seeking to enhance the health of Europeans through innovative health promotion practice based on multisectoral collaboration and community participation at a local level. Eight National Health Service (NHS) South Thames management trainees, in conjunction with the WHO, researched four cities involved in this WHO project: Dublin (Ireland), Eindhoven (The Netherlands), Horsens (Denmark), and Jerusalem (Israel). This chapter will consider the process of multisectoral working and community participation by evaluating achievements of the joint working groups in each country vis à vis key indicators, and analyse both indirect and direct outputs of the projects. The process of alliance-working will be evaluated on three levels in terms of: (1) national Health for All networks (UKHFA), (2) project steering committees, and (3) individual and issue groups. The primary research was based on semistructured interviews with key informants. The chapter will be structured according to the broad themes addressed and will include an identification of key success factors of effective multisectoral working and discussion of the usefulness of national networks and the mechanisms for evaluating outputs and outcomes.
Vanessa Walker

19. Sea, sand and safer sex: an alliance for HIV/AIDS prevention

This chapter describes how a health authority took the lead role in bringing together statutory, voluntary and commercial organisations to work to prevent the potential spread of sexually transmitted diseases (STDs), including HIV and AIDS, in the form of a health alliance. This strategy recognises that each sector of the population needs a different approach, requiring close collaboration between those who have the skills and expertise, and those who identify with target audiences. This three-year project was designed to raise public awareness, by educating young people and those engaged in high-risk sexual behaviour, of the need to protect themselves and to change high-risk to risk-reduction sexual activities. The project was centred on the Torbay coastal area.
Marlene Inman

20. Working in alliances: an inside story

This chapter concludes the book by offering an account of reflections and personal views born out of observation and experience over 25 years’ work in specialist health promotion. Rigorous scientific observation and analysis of alliance-working can be found elsewhere (Powell, 1993) and in other parts of this book; this final chapter is offered to provoke thought on how the rhetoric surrounding health promotion alliances relates to real life.
Linda Ewles


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