Community psychology vs.

the public health approach 1

Social problems: community psychology vs. the public health model

Magdalena F. Kruger

Community and Health Psychology 24 April 2009

Community psychology vs. the public health approach 2

Abstract The purpose of this paper is to critically compare and contrast two approaches to social problems: community psychology and the public health approach. The similarity lies in their focus on prevention of social problems through targeting communities or populations of people instead of individuals. These two approaches find health in understanding and challenging the impact of environmental factors on healthy living. They differ much in their history, approaches and successes. This paper examines these differences and ends with possibilities where these approaches can learn from and build on each other.

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Social problems: Community psychology vs. the public health approach Social problems are common global phenomena. They range from addiction, substance abuse, violence against woman and children, unemployment, crime, poverty, homelessness and many more. For many generations the focus was only on treating disease and distress and thus only limiting its duration within an individual context. This approach was soon found to be inadequate in dealing with the issue of health. The focus shifted from the curative approach to a preventative one. This shift gave rise to the involvement of different disciplines in the fight for health. This paper compares and contrasts two approaches that focus on the prevention approach and on understanding and incorporating the role of environmental and social factors on the health of the people namely community psychology and the public health approach. Community Psychology, Public Health or both? Compared to public health, community psychology is still a fetus. Tutorial letter 102 for PSY461Q (2009) state that community psychology was formalized as a separate discipline in 1965 resulting from the need for intervention on a larger to deal with social problems and mental illness. There was a need for psychologists to move away from traditional individual centered approach and broaden their understanding of the causal factors of mental illness (Albee, 1994). Unlike traditional psychology, community psychology does not find the cause of mental illness within the individual context, but acknowledges the affects of social variables on mental health (Seedat, Cloete & Shochet, 1988). Like community psychology, the public health approach also recognizes the role played by social inequalities or injustices in mental illness and social problems. Community psychology, like the public health approach, shifted the focus from individuals to populations of people. This shift made it apparent to psychologists like Professor George Albee (1994) that if psychologists really wanted to make a difference in the long run the focus had to shift from individual treatment to prevention. Today, prevention is the core of both the public health approach and community psychology. There is a difference, however, in their approach to prevention. Let us first look at two of the community psychology models and their approaches to prevention. First, the mental health model aims to prevent mental illness through locating pathology at the interface of the interaction of both individual and environmental factors (Seedat, Cloete & Shochet, 1988). Methods include making accessable community mental health centers available to a community in a catchment

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area, identifying and treating disorders as early as possible and developing competencies and coping skills necessary for ex-patients to be successfully re-integrated into the community. Where the mental health model focus on conflicts between individuals and their social and personal environments, the second model, the social action model focus on the conflicting interests between groups and the structural inequalities of society like political powerlessness, economic exploitation and social inequalities.(Seedat, Cloete & Shochet, 1988). The social action model aims to prevent mental illness through community empowerment programs based on community participation and equality in community relations. It is asserted that the power to self-actualize ones potential results in mental health. Powerlessness renders one vulnerable to mental illness. From this discussion it is clear that community psychology base prevention methods mainly on challenging disturbed interpersonal relationships within communities, whether it is between individuals and their immediate environments or between different groups in society. The public health models understanding of social problems and approach to disease has endured great development and change. Tutorial letter 102 for PSY461Q (2009) traces this development back to the sanitary science era that emerged in 1850. The focus was mainly on keeping the environment germ free to ensure health in humans. In response to its failure to prevent disease, social medicine came into being around 1930 to 1950s. During this time the focus was on the individual who was seen as responsible for his/her own health. Although social medicine had great success in fighting disease, it did not take into consideration cultural beliefs and traditions with regards to healthy behavior. It fostered great resistance towards public health and was replaced by community health which promoted consideration and inclusion of cultural traditions and believes with regards to healthy behavior. But because it focus solely on communities as self-contained entities, it failed to analyze the affects of broader political and environmental forces on the community as a whole(Tutorial letter 301). In the mid 1980s the New Public Health came into being. Like the community psychology models, public health also focuses on the impacts of social and ecological factors on health. The public health approach focuses much of their efforts on promoting healthy living as a method of disease prevention (Gilbert, 1995). Like community psychology it also encourages community involvement for example, Trained health workers from the community act as health educators (Gilbert, 1995). But unlike community psychology it has a multidisciplinary approach that includes the services of for instance nurses, doctors, psychologists, sociologists, archeologists, etc.

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These approaches to prevention are not without weaknesses. Although the mental health approach attempts to involve the natural caregivers of the community in the service delivery and recognizes the interactions between individuals and their environments as a seat for pathology, Seedat, Cloete and Shochet (1988) criticizes that the role of the psychologist is still that of an expert rendering service to clients based on the very individualistic model community psychology attempts to move away from. In the social action model confusion might exist about the roles of the professional psychologists and the non-professional community member. Seedat, Cloete and Shochet (1988) critisisis that although the social action model uses community empowerment programs to empower people in the community and the community itself through for instance the promotion of local leadership of programs, this model does not attempt to address societal inequalities or intergroup inequalities it identifies as seats of mental illness. The public health approach on the other hand, does challenge these inequalities at national and international levels. Community psychology face challenges like defining the concepts of mental health and illness, the role of the psychologist and the causes of pathology. Definitions need to consider cultural beliefs and traditions with regards to how health problems are defined in different communities and what is considered to be a health problem and what not. Community psychology can follow the example of the public health approach and incorporate other disciplines in prevention plans with regards to teaching, research, implementation and theory development on pathology and its causes. To be more specific, the mental health model can draw from the public health models approach and train community workers to act as educators and in this way move away from the individualistic model. Community psychology can also learn from the public health approach about issues like defining mental illness and health. Another learning curve is the public healths approach to defining communities through community diagnosis which involves epidemiological and environmental surveys. A common challenge faced by both community psychology and public health is the issue of funding. Albee (1995) explained how funding towards the research on the affects of social inequalities on mental illness in the USA were stopped. This resulted from the governments realization that prevention means restructuring of social inequalities which clashed with the capitalistic attitudes of politicians. The same happened to the community based project at Pholela in Natal in the 1940s which marks the start of public health in South Africa. Research done by scientists committed to the Pholela project indicated that social

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injustices were main causes of the social problems experienced by the people of Pholela. Again, prevention programmes called for societal restructuring and the then apartheid government stopped funding as a way to protect the structures from change. Conclusions In community psychology the main challenge still remains the lack of comprehensive and relative theory on pathology and the role of professionals especially the psychologist. It is clear that although the public health model has already dealt with many of these issues they still face challenges on defining mental health. Possible solutions to common problems can result from an interactive relationship between the public health approach and community psychology. Real social restructuring can result in preventing social problems. Research has proved this to be true. What is needed is a real effort from both community psychology and public health to convince government to focus their support and funding on these preventative approaches to social problems. This seems to be the biggest challenge.

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References Guernina, Z. (1995). Community and Health Psychology in Practice: Professor George Albee interviewed by Dr Zoubida Guernina. Journal of community and Applied Social Psychology, Vol.5, 207-214. Seedat, M., Cloete, N., Shochet, I. (1988). Community Psychology: Panic or Panacea. Psychology in Society, 11, 39-54. Tutorial Letter 102, PSY461Q. (2009). Department of Psychology, University of South Africa, Pretoria.