Guiding Participation and Inclusion

by Cormac Russell on October 7, 2013

Tagged as: Gifts / Association / Cooperation / Health

We welcome yesterday’s launch of NHS England’s Guidance for Participation and Inclusion which begins to lay a foundation for transformational change.

The central challenge for participation and inclusion more generally is how can we promote citizen-led innovation that stays local, but over time proliferates?

On Tuesday in late September in Chicago, John McKnight and I had lunch with Marion Tompson, the founder of La Leche League International. Both John and I consider this one of the finest and most enduring examples of citizen-led health-producing change there is. It also affords us a wonderful answer to the question of how to promote citizen-led innovation that stays local, but over time proliferates. It is an exemplar of what we can do to support people to share their healthfulness with each other.

When I asked Marion how they managed to grow from five women meeting — as a breastfeeding support group in a Chicago neighborhood in the 1950s — to a worldwide movement, she simply said, “We kept everything ‘mother sized,’ and did not fall into the trap of trying to go to scale. Local is everything.” Programs scale, movements spread.

It was this small group of women who, chapter by chapter, focused on the value of breastfeeding, who promoted world-wide the principles and values of breastfeeding. She emphasized, “We did not take on the ‘formula industry’; we just doggedly focused on what we were passionate about.” In other words on what is strong, not what is wrong.

They focused on what is strong, not what is wrong.

But, by doing so they did push back on the all-consuming message of that industry that argued formula was far superior to breast milk.

The question such initiatives pose for us in terms of participation is how can we help people discover that which is invisible yet abundant within and around them?

The La Leche initiative and others like it remind us that health resources are largely in our communities. Our challenge is to identify, connect and mobilize them. Participation and inclusion that only focuses on getting more people using more government-run programs misses this point. And that is what is most significant about England's new NHS guidelines. Firstly, they begin to point to the resourcefulness that’s already in our neighborhoods — albeit hidden in plain view behind labels — as the key starting point.

Secondly, by citing ABCD they open the way to a conversation that goes beyond a focus on individuals to a discussion about the "collective" nature of health.

So, this guidance signals a widespread acceptance across the healthcare systems of the importance of meaningful "participation" both of individuals and communities, and it usefully begins to share ideas, approaches and examples of how this could be achieved. We congratulate NHS England on its recognition of the need to develop more connected powerful communities and of the potential of the ABCD approach and therefore a belief that the answers lie in communities! We are looking forward to working with NHS England and others to further develop a greater understanding of the principles and value of the ABCD approach.

In a final analysis, as John McKnight would say: "You can’t know what a community needs, until you first know what a community has."


Photo of (L-R) John McKnight, Marion Tomson and Cormac Russell courtesy Nurture Development. Blog post re-posted with permission from Nurture Development. Home page image: R. Mitra.