Research

The 2030 Agenda for Sustainable Development recognized the interconnectedness of sustainable development, with peace and health emerging as highly influential. Challenges to peace and health have been linked from a systems approach by existing research; however, the potential for positive peace and positive health to be connected in a self-sustaining system has been investigated with less rigor. The present research argues that recentering a systems approach on capacities rather than challenges at the community level may present useful opportunities to both understand and pursue sustainability, which this paper explores through the lens of peace (SDG 16) and health (SDG 3).

- The COVID-19 pandemic has highlighted the interconnectedness of risks and disconnectedness of responses.

- Diverse local leadership may be well-positioned to understand and address underlying vulnerabilities.

- The Trans-local learning approach

- CBOs rapidly understood how COVID-19 would amplify vulnerabilities

- CBOs developed pandemic responses centring on equity and youth

- Examples of CBO-led COVID-19 mitigation initiatives

- Promoting community health must be approached from multiple directions

- Solutions can come from small-scale but connected-up community initiatives

GOAL, The Rand Corporation, University College London, and The Harvard Humanitarian Initiative, sponsored by Irish Aid, are hosting “From Crisis to Resilience”, a webinar series that aims to spark interest and explore the emerging lessons and best practices for building resilience in the most challenging of environments - fragile and conflict-affected contexts.

Learning and investing in resilience at various stages, and within critical socio-economic systems, is crucial to ensuring the preservation of gains in the well-being and development of people in the face of shocks, and to shift from humanitarian assistance towards long-term resilient development.

This 90 min webinar will explore innovations, evidence, and lessons learned when applying a systems approach to build resilience in fragile and conflict-affected urban contexts. Our panel of experts will draw on years of experience and lessons learned from the field in Latin America.

Panelists from GOAL, Harvard Humanitarian Initiative (HHI), World Bank Group and USAID will aim to answer the following questions:

• Are high-risk informal urban settlements to be considered as fragile and conflict-affected contexts?
• What is working or not when building resilience in informal urban settlements?
• What new ideas or approaches in systems thinking are emerging to progress resilience in informal urban settlements?This webinar is free and open to all.

Recording available here: https://www.goalglobal.org/resilience/

Background: Communities play a central role in strengthening their health, but conventional community health promotion often adopts paternalistic and top-down approaches. Conversely, agentic approaches are critiqued for tasking marginalized communities to create change without opportunities. Taking into consideration these shortcomings, we ask how communities may be most effectively and appropriately supported in their pursuit of health.

Methods: We review community health literature to articulate how community health is understood, moving from negative to positive conceptions; determined, moving from a risk-factor orientation to social determination; and promoted, moving from conventional to agentic approaches. We develop the concept of resourcefulness as a pathway to strengthen positive health, and explore how this approach may be applied in diverse communities through fieldwork in Kenya, Peru, Trinidad and Tobago, and the US.

Results: Through resourcefulness-based approaches to community health, communities cultivate agency to 1) conceptualize what constitutes their health and assets and 2) pursue and sustain health agendas driven by local priorities, needs, and learning, while they also work to 3) change power imbalances that drive inequitable patterns of resource distribution and 4) nurture ecologically sound relationships with their local environment.

Conclusions: We discuss how resourcefulness addresses tensions between resource use and sustainability, and how communities leverage partnerships for change. We make practical suggestions to apply resourcefulness as a process-based, place-based, and relational strategy, while recognizing that contexts and scale matter and limit the viability of community-based solutions.

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The 2030 Agenda for Sustainable Development recognized the interconnectedness of the social, environmental, and economic dimensions of sustainable development and the need for integrated solutions. Yet, progress toward the Sustainable Development Goals (SDGs) has been uneven and beset with tradeoffs, and the pursuit of sustainable development has been pursued through largely siloed rather than systems approaches. The present research argues that recentering a systems approach to sustainable development at the community level rather than wider spatial scales may present useful opportunities to both understand and pursue the SDGs in more integrated and locally meaningful ways, which this paper explores through the lens of peace (SDG 16) and health (SDG 3).

While the standalone peace and health SDGs are ambitious, they are measured by targets and indicators that represent narrow negative definitions of these domains aligning with common conceptualizations of peace and health as absences of conflict and disease/infirmity, respectively. Notions of positive peace and positive health expand understandings to encompass the presence of positive features that are normatively rather than objectively or universally defined and which may overlap conceptually. For example, positive peace and positive health may share local and place-based understandings and processes related to social interconnectedness, living in harmony with the natural environment, and the freedom to live in accordance with meaningful values. Moreover, positive peace and positive health may be interdependent and lend themselves to encompassing and supporting other SDGs, such as reducing inequalities (SDGs 5 and 10) and using resources in ecologically sound ways (SDGs 6, 12, 13, and 15).

The paper discusses opportunities and challenges for systems approaches to positive peace and positive health for sustainable development at the community level, including the potential for synergies and tradeoffs, collective action benefits and problems, and issues related to data collection and measurement covering qualitative and quantitative data. This paper concludes that communities may be the most appropriate and effective scale of analysis and action in cultivating sustainable development, especially when seeking a systems approach involving interconnectedness, the breaking down of silos, and combining multiple time and space scales. In this way, communities are afforded both the agency and partnership opportunities to define, measure, and pursue their own locally meaningful goals in the context of social and environmental changes and challenges.

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Communities are powerful and necessary agents for defining and pursuing their health, butoutside organizations often adopt community health promotion approaches that are patronizing and top-down. Conversely, bottom-up approaches that build on and mobilize community health assets are oftencritiqued for tasking the most vulnerable and marginalized communities to use their own limited resourceswithout real opportunities for change. Taking into consideration these community health promotionshortcomings, this article asks how communities may be most effectively and appropriately supported inpursuing their health. This article reviews how community health is understood, moving from negative topositive conceptualizations; how it is determined, moving from a risk-factor orientation to socialdetermination; and how it is promoted, moving from top-down to bottom-up approaches. Building onthese understandings, we offer the concept of ‘resourcefulness’ as an approach to strengthen positivehealth for communities, and we discuss how it engages with three interrelated tensions in communityhealth promotion: resources and sustainability, interdependence and autonomy, and community diversityand inclusion. We make practical suggestions for outside organizations to apply resourcefulness as aprocess-based, place-based, and relational approach to community health promotion, arguing thatresourcefulness can forge new pathways to sustainable and self-sustaining community positive health.

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Abstract: The 2030 Agenda for Sustainable Development recognized the interconnectedness of the social, environmental, and economic dimensions of sustainable development and the need for integrated solutions. Yet, the pursuit of the Sustainable Development Goals (SDGs) has been conducted through largely siloed rather than systems approaches. The present research argues that recentering a systems approach to sustainable development on capacities rather than challenges at the community level may present useful opportunities to both understand and pursue the SDGs in more integrated and locally meaningful ways, which this paper explores through the lens of peace (SDG 16) and health (SDG 3).

Climate change is linked to a variety of locally evident health effects. Local health systems and related services are struggling to deal with current impacts and will have to do much more in the future. Prominent topics identified by local health systems are heat-humidity stress, infectious disease, and linked food-water security. In many settings around the world, formal institutions such as governments and businesses may provide limited responses, especially for those most in need. Consequently, grassroots organisations are taking initiatives to try to translate available knowledge into action for themselves. Activities cover, for instance, environmental monitoring and participatory development to determine which climate change-related actions for mitigation and adaptation would be most suitable to support local health systems. Being non-profit, often informal, and with limited resources, these organisations face classic community collective action problems of incentivising members to create and manage systems outside formal institutions such as markets and governments.  One formal system including and connecting climate change and health is the United Nations, within which several mechanisms for the 2030 agenda sit. The 2030 agenda's relevance for local action is not always clear, especially thinking beyond 2030 when considering the development and implementation of long-term, local, sustainable solutions in less affluent locations. Two case studies are examined here, both of which are isolated with severe resource constraints: Sitka, Alaska and Toco, Trindad and Tobago. Semi-structured interviews with local environmental groups presented their concerns and opportunities regarding climate change, health, and sustainability to and beyond 2030. Lessons emerged that typical ideas from sustainability such as “participatory processes” and “resilience” might not always be as meaningful for long-term local action as might be assumed from global knowledge. Ways forward for local health systems in the context of climate change are suggested based on the groups’ experiences and advice.

The field of community health promotion encompasses a wide range of approaches, including bottom-up approaches that recognise and build on the agency and strengths of communities to define and pursue their health goals. Momentum towards agent-based approaches to community health promotion has grown in recent years, and several related but distinct conceptual and methodological bodies of work have developed largely in isolation from each other. The lack of a cohesive collection of research, practice, and policy has made it difficult to learn from the innovations, best practices, and shortcomings of these approaches, which is exacerbated by the imprecise and inconsistent use of related terms. This article provides a review of three agent-based approaches to promotion community health: asset-based approaches, capacity building, and capabilities approaches, noting the theoretical origins and fundamental concepts, applications and methodologies, and limitations and critiques of each. This article discusses their commonalities and differences in terms of how they conceptualise and approach the promotion of community health, including a critical consideration of their limitations and where they may prove to be counterproductive. This article argues that agent-based approaches to community health must be met with meaningful opportunities to disengage from the structures that constrain their health.