Trevor Hancock: Many factors contribute to community’s health

I would like you to think back over the past six months or a year to an experience you have had — not one you have heard or read about, but seen and experienced for yourself, here or anywhere in the world — that, when you look back now, you would say: “Well, that is an example of a healthy community.”

This is a question I ask at the beginning of every healthy-community vision workshop I run, and I have run dozens of them in North America and Europe over the past 25 years, especially in the 1990s.

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It is the prelude to a guided imagery exercise, similar to the envisioning process used by athletes to improve their performance.

In the guided imagery, I take people on a trip to “see” in their mind’s eye and to experience their own community — however they define that — at some point in the future when it is healthy. They then draw what they saw, but this is drawing with a difference; it’s a group drawing on a flip chart, in groups of five or six people.

One of the interesting things about this process is that it is a great leveller. You might be the university professor with a couple of PhDs, but you probably don’t draw any better than the person living on the street, in fact, maybe not as well. In general, people have the artistic skills of a five-to-seven-year-old, all stick figures and lollipop trees.

There are some key rules about this drawing process. First, you have to live with and work with whatever others draw; there is no delete button. But you can add to or modify what they drew, and they can’t say no. Second, you can’t use words, only images, which gets interesting when people have to depict music, or love, or economic activity.

Third, you have to describe and explain what you are drawing, as at the end, someone has to explain the shared picture to the entire group. Finally, people who make a living by drawing — which includes architects, engineers and urban planners, as well as artists — can’t go first, second or third. The designers tend to impose a plan, while the professional artists just intimidate everyone.

I want to share some of what I have heard and the images I have seen, as they are revealing of our innate knowledge, as well as our deeper wishes and values. Indeed my friend and colleague Clem Bezold, one of the world’s leading futurists, has said that “vision is values projected into the future” — which is why visioning is so important.

One of the most telling things about my opening question is that people rarely mention health care. Indeed, I often have to remind them at the end that health care does contribute to the health of the community. But from their own experience, people know that what makes a community healthy does not have much to do with health care.

My favourite answer to this question was a public-health inspector (inevitably) who said: “Well, I got up this morning, flushed my toilet and it worked.” In that simple statement, he identified one of the largest single contributions to the health of the population in the past 150 years.

Another favourite was the public-health nurse who said that she had experienced communities where “we are all family to each other.” Indeed, one of the most common areas that people talk about is the experience of community togetherness, whether it be rallying round in times of trouble or having a street party or creating a community garden.

Another common topic is the physical environment, from walkable neighbourhoods and good bike systems to parks and good public transit. Clean air, clean streets and peaceful surroundings are also often mentioned.

In short, people know perfectly well what makes a community more healthy, and they know it is not primarily about health care. This is also reflected in their group drawings of their community at some point in the future when it is healthy. In next week’s column I will describe the common themes that emerge from their drawings.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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