There is a growing discussion regarding the role of ‘assets’ and ‘asset-based approaches’ in health policy in Scotland. It has been argued that assets, and the related concepts of co-production, salutogenesis, resilience and sense of coherence can make a substantial contribution to overall health in Scotland and to reducing health inequalities (Burns, 2011).
There are different understandings of ‘assets’ depending on the context. For example, ‘assets’ can refer to financial resources or physical infrastructure, or can refer to facets of social capital or individual capabilities.
Morgan and Ziglio (2010) define a ‘health asset’ as, “any factor (or resource), which enhances the ability of individuals, groups, communities, populations, social systems and/or institutions to maintain and sustain health and well-being and to help to reduce health inequities. These assets can operate at the level of the individual, group, community, and/or population as protective (or promoting) factors to buffer against life’s stresses”.
The term ‘asset-based approach’ is more problematic. It has been used with a range of meanings that have quite differing emphases. Three overlapping concepts can be identified: community development; co-production; and community ownership.
Asset-based community development
Asset-based community development can be characterised as activities which seek to build or enhance various forms of positive assets in a community. These may range from individual psychosocial assets such as ‘Sense of Coherence’, to physical assets such as local greenspace. They contrast with activities to address deficits or needs in a community. The first step is often an ‘asset-mapping’ exercise.
The Chicago based ‘Asset Based Community Development’ (ABCD) institute is an internationally recognised model of this approach, which they also describe as ‘capacity-focussed development’. The work of the institute has a strong overlap with the co-production concept as it advocates for community regeneration driven by connections between local assets, rather than by external agencies. However other initiatives remain externally and professionally-led, but as (like the ABCD institute) they focus on building community assets rather than addressing need they also claim to take an asset-based approach to community development.
There is a suggestion that a ‘deficits approach’ to health improvement and reducing health inequalities in Scotland has not worked (Burns, 2011). Community development approaches which build positive assets are perceived as ways of taking a preventative and ‘early intervention’ approach to some of these problems.
There is no single agreed definition for this term, but at a broad level it is used to refer to an alternative form of service delivery to a population. This may include closer working between service providers and service users (e.g. where a primary care professional achieves a shared agenda with a patient rather than compliance in relation to a course of treatment) or transfer of services from democratically accountable local government or the NHS to charities or not-for-profit enterprises.
‘Community ownership’ is a term which has come to refer to the ownership of (usually) physical infrastructure by a non-statutory organisation of citizens or tenants instead of either private ownership or local government ownership. In Scotland, the most common usage of the term community ownership is made by small housing associations and in relation to the buy-out of large land owners. The extent to which the increase in community ownership has democratised ownership of these physical assets is variable. The Community Empowerment and Renewal Bill was passed in 2015, in which the transfer of physical assets into community ownership plays a central role.
Critiques of assets and asset-based approaches
The focus on assets and asset-based approaches as useful in improving health and reducing health inequalities has been questioned (Friedli, 2012a; Friedli, 2012b; Macleod & Emejulu 2014). The critiques are that the approach is:
- Ill-defined and can encompass a wide variety of approaches and interventions which have little in common.
- Too individualist and underestimates the impact and influence of the socioeconomic and structural determinants of health and health inequalities and undermines the need for government to provide a context which facilitates individual and community action.
- There is an absence of evidence to suggest that either a focus on assets or asset-based approaches are an effective means to improve health or reduce health inequalities.
- There is a danger that an asset-based approach could exacerbate inequalities since assets are current inequitably distributed.
Data relating to health assets are wide and varied, with some sources more concerned with individual measures of health assets and others orientated towards the assets contained within small communities. It is also very difficult to measure the concepts discussed in the assets literature which makes any single source of data insufficient. However, the Sense of Coherence scale developed by Antonovsky is the most widely accepted single measure of individual assets.
There are no Scotland-wide surveys which currently collect data using this scale. The scale has been used in a recent representative survey of Glasgow, Liverpool and Manchester. This shows that 'Sense of Coherence' is substantially higher in Glasgow than in the comparison cities, suggesting that this is unlikely to be important in explaining the higher mortality in Glasgow.
Some aspects of 'social capital' which measure the degree to which individuals within a community are supported by those around them, and the extent to which they are linked to others with access to a wide variety of resources, experience and expertise, are also relevant to assets approaches. Data on social capital are collected routinely in the Scottish Household Survey.
Bartley M (Ed). Capability and Resilience – beating the odds. London: UCL Department of Epidemiology and Public Health, 2006.
Burns H. Health in Scotland 2010: assets for health. Edinburgh: Scottish Government, 2011.
Loeffler E, Power G, Bovaird T, Hine-Hughes F (eds.) Co-production in health and social care: what it is and how to do it? Birmingham: Governance International, 2012.
Development Trusts Association Scotland. Public Asset Transfer: Empowering Communities. Edinburgh: Development Trusts Association Scotland, 2010.
Foot J, Hopkins T. A glass half full: how an asset approach can improve community health and well-being. London: Improvement and Development Agency, 2010.
Foot J. What makes us healthy? The asset approach in practice: evidence, action, evaluation. Jane Foot, 2012.
Eriksson M LB. Antonovsky's sense of coherence scale and the relation with health: a systematic review. Journal of Epidemiology and Community Health 2006;60:376-81.
Friedli L. Always look on the bright side: the rise of assets based approaches in Scotland. Glasgow: Scottish Anti-Poverty Review, Winter 2011/12.
Friedli L. 'What we've tried, hasn't worked': the politics of assets based public health. Critical Public Health 2013; 23(2): 131-145.
Lindstrom B, Eriksson M. Salutogenesis. Journal of Epidemiology & Community Health 2005;59:440-442.
Morgan A, Davies M, Ziglio E. Health assets in a global context: Theory, methods, action: investing in assets of individuals, communities and organizations. London: Springer; 2010.
Morgan A, Ziglio E. Revitalising the evidence base for public health: an assets model. Promotion & Education 2007; 14:17-22
O'Leary T, Burkett I, Braithwaite K. Appreciating assets. Fife: Carnagie UK Trust, 2011.
Sigerson D. Asset-based approaches to health improvement. Edinburgh: NHS Health Scotland, 2011.
Solutions for Public Health. Co-production for health: a new model for a radically new world. Final Report of a National Colloquium 2011. Oxford: Solutions for Public Health, 2011.
Hashagan S, Kennedy J, Paterson A, Sharp C. Doing with, not to: community resilience and co-production: the implications for NHS Education for Scotland. Glasgow: Scottish Community Development Centre, 2011.
Glasgow Centre for Population Health. Asset based approaches and resilience.
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- This section was first published in September 2012 and was updated last in August 2016.
- The next review of the section is due to be carried out by end September 2017.