By Professor Debra Rickwood FAPS, University of Canberra

Community and health psychology are essential to health and mental health promotion. Without the inclusion of these, the profession and discipline of psychology will lose two specialisations that prioritise a holistic approach to health and well-being through understanding whole person and whole community interactions. Instead, psychology will become increasingly narrowly focused on applications in specific settings or through preferred therapeutic orientations. Community and health psychology take as their central tenet understanding the integration and interdependence of the person within their social, community and population group roles, albeit from different perspectives. Community psychology prioritises understanding human thoughts, feelings and behaviour through the critical lens of community, while health psychology prioritises a holistic biopsyschosocial perspective for health and well-being.

Health promotion

The importance of community and health psychology is most evident through the strong focus that the World Health Organization (WHO) places on health promotion. WHO maintains that good health is a major resource for social, economic and personal development and fundamental to quality of life. This was first articulated through the Ottawa Charter for Health Promotion in 1986 (WHO, 1986) and subsequently reaffirmed through the Jakarta (WHO, 1997) and Bangkok (WHO, 2005) Declarations. These documents provide the foundation for much international health policy and particularly in Australia, which adopts a population and public health approach (COAG, 2006).

The WHO Ottawa Charter is built around five platforms for change:

  1. Building healthy public policy 
  2. Creating supportive environments 
  3. Strengthening community action 
  4. Developing personal skills 
  5. Re-orientating health care services toward prevention of illness and promotion of health.

Three basic strategies to promote health across these platforms are prescribed: to advocate, as health is a resource for development for all; to enable, as health equity must be a goal and this is reached when individuals and community groups are empowered to control the determinants that affect their health; and to mediate, in that health promotion cannot be achieved by the health sector alone but requires a whole of government and whole of community approach.

Public policy

The Ottawa Charter maintains that political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it. Health promotion action aims to make these conditions favourable and it is community and health psychology that provide the scientific knowledge and professional training for psychologists to contribute to this. For example, understanding the impact of, and contributing to, debate in public policy has been a strong focus of members of the APS Community and Health Colleges. This applies not only to health policy, but to all policies that impact on wellbeing, including submissions regarding the advertising of junk food within children's television programming, homelessness, and alcohol and other drug policy, to name but a few.

Environments

The impact of environments - social, community, economic and physical (both built and natural) - on individuals and population groups is a special focus of community psychology. Community psychology and environmental psychology have been strong partners, and are increasingly sought for their ability to research and understand the complex community relationships that affect decisions regarding the use of scarce resources such as water. It is psychologists that have the critical skills to enable translation of environmental and resource science into individual and community action at a local level. Health psychology considers the impacts of all types of environments on human health and behaviour, with a view to understanding optimal environmental conditions to promote wellbeing.

Personal skills

The personal skills platform of the Ottawa Charter encompasses a wide range of issues, but community and health psychology contribute through examining the critical impact of control and self-determination on health status. The focus in health psychology is through understanding behaviour change mechanisms and ways to improve self-management of health. Community psychology contributes through understanding ways to translate personal skills development to meet the needs of local communities and diverse population groups.

Community action

Strengthening community action is a platform of particular concern to community psychology that emphasises empowerment and self-determination as fundamental to the wellbeing of individuals, families and communities. These issues are particularly relevant for the more marginalised and disadvantaged members of society and recognition that the social determinants of health lie in social disadvantage and exclusion. Understanding the ways that community action emerges and is effective, and providing psychologists with skills to advocate and mediate to support community action, is vital to the wellbeing of society.

Reorientation of services

In terms of reorienting health services, health psychology has been a strong proponent of the need to prioritise promotion and prevention and take a holistic approach to health. Health psychology also undertakes the scientific investigation of health behaviour change, which is essential to the effective implementation of health interventions. Community psychology championed acknowledgement of the critical role of consumer and carer participation in health services, in terms of both personal health needs and participation in health service evaluation and reform.

No other specialisations focus on the competencies that are essential for psychology to take a lead role in promoting health and wellbeing into the future. The major challenges ahead of humanity - chronic disease, accelerating change, adaptation to climate change, living with increased urbanisation and globalisation, social inclusion - require a knowledge base that fully understands the interconnectivity of individuals within their communities and the holistic nature of wellbeing. Without these specialisations, psychology may become an increasingly narrow and marginalised profession, with psychologists trained to provide discrete services to individuals from special population groups consistent with a restrictive and inflexible medical model. The mission of the Australian Psychological Society is to represent, promote and advance psychology within the context of improving community wellbeing and scientific knowledge. It will be difficult to improve community wellbeing after the demise of community and health psychology, which is an inevitable outcome if they are not afforded the endorsement status that will enable them to be maintained as specific and valued sets of competencies and scientific knowledge. Psychology's capacity to contribute to understanding and adapting to our constantly changing and complex social world will be much poorer without the expertise of health and community psychology.

The author can be contacted at Debra.Rickwood@canberra.edu.au.

References

Council of Australian Governments (COAG) (2006). National Action Plan on Mental Health 2006 - 2011. Australian Government: Canberra.

World Health Organization. (1986). Ottawa Charter for Health Promotion. WHO: Geneva.

World Health Organization. (1997). Jakarta Declaration on Leading Health Promotion into the 21st Century. WHO: Geneva.

World Health Organization. (2005). Bangkok Declaration. WHO: Geneva.