Tuesday, 21 May 2013

PRE-IMPLEMENTATION HEALTHY COMMUNITY PLAN 2013 IN SIK DISTRICT...KEDAH DARUL AMAN



Community health, a field of public health, is a discipline which concerns itself with the study and improvement of the health characteristics of biological communities. While the term community can be broadly defined, community health tends to focus on geographical areas rather than people with shared characteristics. The health characteristics of a community are often examined using geographic information system (GIS) software and public health datasets. Some projects, such as InfoShare or GEOPROJ combine GIS with existing datasets, allowing the general public to examine the characteristics of any given community in participating countries.
Because 'health III' (broadly defined as well-being) is influenced by a wide array of socio-demographic characteristics, relevant variables range from the proportion of residents of a given age group to the overall life expectancy of the neighbourhood/community. Medical interventions aimed at improving the health of a community range from improving access to medical care to public health communications campaigns. Recent research efforts have focused on how the built environment and socio-economic status affect health.
Community health may be studied within three broad categories:
The success of community health programmes relies upon the transfer of information from health professionals to the general public using one-to-one or one to many communication (Mass communication). The latest shift is towardsHealth marketing.



What defines a healthy community?

A community, like an individual, is a living organism, whose health is a result of a complex web of factors and events, some of which it consciously controls, and some of which it doesn’t. What’s your conception of a healthy community – one in which you’d like to live and raise your children, one in whose life you could happily participate, one where you’d be willing to grow old? What makes a community healthy?
Those are nice visions, but do they take in everyone in the community?  Is a community healthy, for instance, if many of its citizens are discriminated against, or have no say in its governance?  Is it healthy if many don’t have clean, safe places to live, or are threatened with daily violence?  Is it healthy if it can’t or doesn’t provide meaningful employment to a significant number of citizens, or education for their children?  If some children are neglected and abused?
If everyone doesn’t have clean air to breathe and clean water to drink?  Is it healthy if many different groups in the community – because of racial, ethnic, or class differences – simply have no positive contact with one another, and are suspicious of or downright hostile to those different from themselves?
Maybe your vision includes tree-lined streets, with neat front yards, and lots of parks and open space. Perhaps you see a place where everyone looks out for the kids, where there’s lots of vibrant street life, and where neighborhood stores are run by local people.  You might see a place where there are great services – excellent hospitals and clinics, terrific schools and colleges, great police and fire protection, reliable and accessible public transportation.
Like a truly healthy human body, a truly healthy community is one in which all systems function as they should, and work together to make the community function well.  In an individual, health is, to a large extent, a result of all the body’s billions of cells getting what they need.  For a community, health is, to a large extent, the result of all citizens getting what they need, not only to survive, but to flourish.
A healthy community is a whole that’s larger than the sum of its parts.  It’s one where people take care of one another, where people from diverse backgrounds mix comfortably and work together for the good of the community.  In short, a healthy community is one in which all citizens can be assured of a decent quality of life – economically, physically, environmentally, socially, and politically.
An argument can be, and often is, made that you can’t approach any health or community issue without addressing the community as a whole (see PRECEDE/PROCEED, the previous section of this chapter).  Just as you can promote health for individuals, there are things you can do to promote the health of your community.  In this section, we’ll examine Healthy Cities/Healthy Communities, a framework for building a healthy community.

Why use Healthy Communities?

There are a number of reasons to consider using the Healthy Communities framework in planning and implementing community action:
1.  Community perspective.  Virtually all health and community issues are affected by (or are the direct result of) economic, social, political, and/or environmental factors that operate at the community level.  If you don’t deal with those factors, the chances are slim that you’ll be able to resolve the issue you’re concerned with.
2. Participatory planning and community ownership.  Planning that includes those who will be directly affected by or benefit from any community initiative is more likely to reflect the real needs of the community than planning done only by one group.  Furthermore, the participatory nature of the Healthy Communities framework means that citizens themselves create initiatives and goals for the community.  Those initiatives and goals are theirs – not imposed by those in power or by outside “experts”.  As a result, their commitment to the process and to the goals makes them far more likely to support and work for the outcomes they’ve chosen.
3.  Range of ideas.  Citizen participation leads to the presentation and consideration of a greater range of ideas and possibilities, and is therefore more likely to hit upon effective goals and actions.
4.  Knowledge of the community.  Citizen participation taps the community’s wisdom about its own history, relationships, and conflicts, and can thus steer initiatives around potentially fatal pitfalls.
5.  Community-wide ties.  Involving all segments of the community encourages interaction across social, economic, and political lines.  Those ties strengthen the community as a whole, change people’s perspectives for the better, increase community-wide cooperation, and can positively transform how the community works. 
6.  Achievable and measurable goals.  Although Healthy Communities’ ultimate goals are wide and long-term, each goal is achievable in a manageable amount of time, and its successful achievement can be demonstrated.  Each success sets the stage for enthusiasm for the next initiative.
7.  Identification and use of community assets and resources.  A Healthy Communities initiative depends to a large extent on human, institutional, organizational, environmental, and other assets and resources already available within the community.  Through identifying and using these, communities learn that they can create their own positive change, and reshape themselves in the ways they want to.
8.  Community commitment to the long-term process.  Because of the participatory nature of the process, and because it requires recruiting more people at each new phase, it builds an ever-expanding  core of people with varied skills, talents, and experience committed to the ideal of building a healthy community and improving the quality of life for everyone.  That’s important for sustaining the work indefinitely.
9.  Community self-image.  Through the use of the Healthy Communities process, the community comes to think of itself as a healthy community, and is concerned with maintaining that image through addressing issues as they come up. Perhaps more important, it is brought to look at the larger picture as well.  Holding out an ultimate goal of a totally healthy community, whether attainable or not, keeps everyone working toward it, and means that planning goes on as a matter of course.  The healthy community ideal becomes embedded in the self-image of the community, and people understand that they can take their fate in their own hands and work to improve it.  The process itself thus becomes an important element in the definition of a healthy community – one in which citizens work together to identify and solve problems, create and consolidate assets, generate improvements, and raise the quality of life for all.

Who should participate in Healthy Communities?

The easy answer to this question is everyone in the community, and that’s in fact the ideal.  In a perfect world, everyone everywhere would participate in some way in creating a healthy community.  In the real world, while it’s important to try to involve all sectors of the community, you have to work to involve some particular people and groups if your effort is to be successful.  Crucial participants include:
1.  Elected and appointed officials.  Although a Healthy Communities initiative should not be top-down, it needs the commitment and backing of those with the power to make things happen.  Officials can use the media to publicize the effort, pass laws and regulations (and enforce those already existing) that reinforce it, and throw the weight and resources of government behind it.  Without official support, a community-wide effort is more likely to fail.
2.  Those most affected by the issue.  A sure recipe for failure is to try to impose an intervention or initiative on a population “for their own good.”  All too often, “experts” – often people who have no real knowledge of the group or its issues – formulate plans that might make perfect sense on paper, but make no sense at all in the actual situation for which they’re proposed.  The participation of those affected in identifying the issues to address, developing action plans for addressing them, and implementing and overseeing those plans is absolutely crucial to the success of a Healthy Communities initiative.  (This is equally true when the group concerned is the whole community.)
There are, unfortunately, many instances of a group resisting and short-circuiting well-meaning changes because they weren’t part of the planning.  The author experienced one as a teacher in Philadelphia, which had, at the time, an innovative and progressive school superintendent.  He tried to institute reforms that probably would have improved the lives of teachers students in the system, but he did it without conferring with them.  As a result, the teachers simply ignored directives from the central office, the reforms failed, and the superintendent was gone within three years.
3.  The people who will actually administer and carry out the initiative, or whose jobs or lives will be affected by it.  It is both unfair and unwise to expect organization staff, community employees (police, firefighters, Department of Public Works personnel, etc.), business people, and others to throw themselves into carrying out an initiative they had no part in devising.  It may have elements that ignore the realities of their jobs or their lives, or that make things harder than necessary for them, and they may be the only people who have the information to understand that.  In addition, they may regard it as just another foolish imposition to be gotten around, and do as little as possible to make it effective.
4.  All the agencies and groups that will need to cooperate and to coordinate their activities in order to implement a community-wide effort.  Both the ways in which these groups will work together, and which of them will have responsibility for what have to be part of the planning for any community-wide initiative. Without their full participation, there’s no guarantee that they’ll work together at all, let alone that the methods for their doing so will be simple and efficient.
5.  Community opinion leaders.  These are the people whose opinions others trust, and who lead the community by adopting new ideas and pulling others with them.  They are seen as level-headed, smart, and serving the best interests of the community.  Some may be current or former members of the groups already listed, and others may be clergy, credible institutional or business people (college presidents or faculty, CEO’s), or just average citizens who are known for their integrity and common sense.
If you can gain the participation of members of all these groups, it is more likely that everyone else will follow.  If you can’t get people from all these groups to buy in at the outset, an alternative is educating them about the process and persuading them to join it, while you continue to recruit other participants.  Ultimately, the combination of education and your momentum will bring in those who were initially reluctant.  That may take time and patience, but it’s worth the effort – it can easily mean the difference between a successful long-term Healthy Community movement and a dead-on-arrival, failed attempt at one.

How do you use Healthy Communities?

Because the Healthy Communities framework is just that – an intellectual framework, rather than a prescription – there is no step-by-step instruction for employing it.  It is meant to be adapted to the different needs of different communities.  There are, however, necessary components of any Healthy Communities initiative:
1. Create a compelling vision based on shared values.  As with virtually any process that involves planning – and particularly participatory planning – the first step is to create a vision that defines the effort to be made.  That vision may be broad (“A community that is truly just and equitable”) or more specific (“A community where every potential worker in the community can find employment that offers a living wage and acceptable working conditions”).  Whatever the case, the vision must be compelling – one that motivates people to work for its realization.  It must be founded in those values that they hold in common, and must be widely shared and recognized as legitimate and desirable.  (Please see Chapter 8, Section 2: Proclaiming Your Dream: Developing Vision and Mission Statements.)
In Orlando, Florida, the Healthy Community Initiative began with meetings of a few influential people.  As they learned about healthy communities, the convened a group of about 160, representing all sectors of the city’s population – citizens of all races and economic levels, organizations and institutions, city government, other groups – to hash out a vision.  That group, in turn, conducted citizen focus groups and public meetings to hear and understand citizens’ concerns.  Ultimately, they drafted a vision, based on their own discussions and the input of hundreds of others from all walks of life, that contained 14 statements about what Orlando should be.  That vision became the foundation of the initiative.
2.  Embrace a broad definition of health and well-being.  Health must be seen as not merely the physical health of individuals, but the creation and nurturing of those factors leading to health named in the Ottawa Charter (peace, shelter, education, income, food, a stable ecosystem, sustainable resources, social justice, and equity).  A truly healthy community encompasses – or works toward – all those elements and more.
3.  Address quality of life for everyone.  The key word here is “everyone.”  A Healthy Cities/Healthy Communities initiative should be aimed at improving the quality of life for all groups and individuals in the community, not just those in a particular target group or those who began the initiative.
4.  Engage diverse citizen participation and be citizen-driven.  Initiatives should be originated, planned, and implemented with the full participation of citizens from all racial, ethnic, and socio-economic groups and all walks of life.  Citizens themselves, rather than a government agency or experts of some sort, should be the force behind both the direction and the implementation of any community initiative.
5.  Seek multi-sectoral membership and widespread community ownership.  All sectors of the community – government, the business and non-profit communities, health care, education, faith communities, cultural institutions and the arts, target populations, and ordinary citizens – should be represented in an initiative, and the community should feel that it created the initiative and owns it.
In many places in this and other sections of the Community Tool Box, we refer to “ownership” of an initiative or intervention or organization.  In most cases, what we mean is that those who take part in creating and/or running such an endeavor feel that it belongs to them.  It was their idea, and they therefore see themselves as not only supportive of it, but responsible for it. 
True ownership can rarely, if ever, be attached to actions or ideas that are imposed, by others who “know better” or have more power.  It comes from within, from the feeling that you’ve made a choice based on your best judgment.  That’s why the inclusion of people from all sectors of the community is so important to a successful Healthy Cities/ Healthy Communities process.  At the end, perhaps after a lot of argument and soul-searching, participants feel that they’ve had a hand in creating something important that will result in better lives for everyone in the community.  There’s no substitute for that feeling to ensure their doing all they can to make their creation work.
6.  Acknowledge the social determinants of health and the interrelationship of health with other issues (housing, education, peace, equity, social justice). The research on the social determinants of health points to three overarching factors:
  • Socioeconomic equity.  For developed countries, the economic and social equality within the society or a given community is a greater determinant of death rates and average lifespan than the country’s position with regard to others.  The size of the income gap between the most and least affluent segments of the society or community is tremendously important, and determines to a large extent whether people get what they need.
  • Social connectedness.  Many studies indicate that “belonging” – whether to a large extended family, a network of friends, a social or volunteer organization, or a faith community – is related to longer life and better health, as well as to community participation.
  • Sense of personal efficacy.  This refers to people’s sense of control over their lives.  People with a higher sense of efficacy tend to live longer, maintain better health, and participate more vigorously in community affairs and politics.
Like the Ottawa Charter, the World Health Organization, in its publication The Solid Facts, recognizes the need to break these factors down into more manageable pieces.  It lists ten factors that affect health and life expectancy, and advocates addressing each within a coherent program that looks at all of them within a society.  These ten factors are:
  • The social gradient (equity)
  • Stress
  • Early life
  • Social exclusion (the opposite of social connectedness)
  • Work
  • Unemployment
  • Social support
  • Addiction
  • Food
  • Transport
7.  Address issues through collaborative problem-solving.  Given a diverse group, there are bound to be disagreements and conflicts.  These should be viewed as opportunities, rather than roadblocks, and people should be encouraged and helped to work together to reach creative solutions.
8.  Focus on systems change.  To be successful, a Healthy Cities/Healthy Communities initiative has to be active, rather than reactive.  It’s not enough to “fix” a problem: your goal is to eliminate the causes of that and other problems and improve the long-term quality of life in the community in the process. 
In order to address causes, you have to concentrate not on individual problems, but on improving and changing systems – the ways in which the community operates, and the attitudes, assumptions, and policies behind them.  That includes identifying, using, and strengthening the assets the community already possesses, as well as changing the systems that pose problems.
9.  Build capacity using local assets and resources.  All communities, no matter how troubled, have great real and potential strengths.  These vary from community to community, but could include:
Individuals with the talents, skills, leadership, and passion to work to change the community for the better.
Individuals, businesses, and foundations that can provide material resources – money, space, etc. – to a community effort. 
  • Institutions – libraries, schools, hospitals, houses of worship – that have the capacity to act as both resources for and agents of change.
  • Community-based and other organizations whose mission is to work for the betterment of the whole community.
    Governments and individual government officials that can add both official support and legal and regulatory power to an initiative.
  • Human resources – the skills and work ethic of the community’s work force, for example.
  • Natural and other environmental resources – open space, clean air and water, wilderness, fisheries, historic sites or buildings, housing stock.
  • Perhaps most important, the potential for all these individuals, groups, and resources to be joined in a coordinated pursuit of a common vision.
At least some of these and other assets already exist in virtually every community – usually to a far greater extent than most citizens realize until they start looking for them.  They must be identified and included in a Healthy Cities/Healthy Communities effort.
10.  Measure and benchmark progress and outcomes.  Whatever you’re doing, whether it’s a PR campaign or a complex behavioral intervention, you have to monitor and evaluate it in order to be sure that it’s effective.  That means setting objectives – benchmarks – to indicate your progress along the road to your goal, and defining clearly the outcome you’re aiming for.
Regularly monitoring what you’re doing is crucial, because it allows you to spot problems or inadequacies in goals, methods, procedures, communication, etc. and correct them before they derail your initiative entirely.  Even more important, regular monitoring allows you to change what you’re doing to respond to changes in circumstances and community needs, so that you’re always addressing current reality.  Communities are dynamic: they develop and change, sometimes in short periods.  Your initiative has to be dynamic, too, especially if you expect it to continue for the long term.
Implementing a Healthy Communities strategy
How do you actually put these components together to create a healthy community?  There’s no one way to do that – it depends on your community, the issues you want to address, and the ideas and capacities of the groups and individuals that participate in the Healthy Communities process.  There are, however, some basic procedures that, at least in outline, should be common to any Healthy Communities initiative.
1.  Assemble a diverse and inclusive group.  To begin a Healthy Communities initiative, people from all parts of the community have to come together to hammer out a vision.  That group, as we’ve been saying throughout this section, should be representative of everyone in the community, so that whatever it decides will be seen as legitimate by just about everyone, and will be owned by the community.
Someone has to start the process.  That may be a charismatic or persistent individual, an organization, a coalition, or a government office or agency.  Whoever it is should be simply a convener, and not necessarily expect to lead over the long term.  Leaders should be chosen by the group itself as it forms, and they should be collaborative (see Chapter 13, Section 11, Collaborative Leadership.)
This is not to say that a Healthy Communities effort doesn’t need leadership.  Quite the contrary – leadership and structure are necessary for any successful effort.  But leadership should be collaborative and arise from the community.  The leader may be an individual, or two, or a larger group.  Whatever the situation, the leadership should be one of an equal among equals, and decision-making should be the province of the whole group.  That’s how a participatory process works.

It is assumed that all the other steps listed here will also be carried out by an inclusive group, and that all sectors of the community – including those affected and individual citizens – will be represented and have decision-making power.  The group may change from step to step or over time, but should remain inclusive and participatory.
2.  Generate a vision.  A vision of how the community should be, based not on a single issue, but on values shared among all participants and on a high quality of life for everyone in the community, is needed to motivate and inspire participants and to guide the initiative over the long term.  Generating such a vision may take time and a great deal of discussion, but it’s absolutely necessary for a successful effort.
3.  Assess the assets and resources in the community that can help you realize your vision, and the issues that act as barriers to it.  Placing assets first is not just an accident here.  A Healthy Communities initiative is best served by looking at the community through a positive lens, and asking first what’s right with it, rather than what’s wrong with it.  The initiative then becomes an exercise in community health promotion, instead of the treatment of a diseased community.  Taking a positive perspective affects for the better the attitudes of everyone involved, the community’s self-image, and the perception of whether or not realizing your vision is possible.
By the same token, it’s important to be honest and clear-eyed about issues and problems in the community.  Once they’ve been identified, they have to be acknowledged and understood, so they can be addressed at some point in the process.
4.  Choose a first issue to focus on.  The best way to sink a long-term initiative is to try to accomplish all your goals at once.   It’s vital to choose one issue – or in some cases, perhaps, two or three – to attack, and to make it one that can be resolved, so that your first effort leads to success. 
What the issue is doesn’t matter, except in that it must be one chosen by citizens as important to them, and must be one that is specific enough to be resolvable.  Len Duhl talks about the process in a 1993 interview by Joe Flower in Healthcare Forum Journal,:
The first thing that happens when the Healthy Cities program develops in a new place is that some persons assume the responsibility of bringing together all segments of the community to deal with the issues: the business community, the government, the voluntary sector and the citizens themselves. ...
Then there are "vision workshops" in which people are asked, "What kind of city do you really want?" My personal surprise is that the clearer I am about what a Healthy City program is, the less likely a community is to develop it. The fuzzier I am in what a Healthy City is, "A Healthy City is what you want to make it," the greater the odds are that they will start.
The various participants define the program. All I say is that you have to start someplace. You have to begin to look at it in an ecological and systemic way. You have to involve people. You have to start thinking of values of equity and participation. Beyond that, you can start wherever you want.
Some cities start on the environment, on pollution, on smoking, seat belts and the quality of life index. Some have government operations, some have newspapers, big organizations, housing. Barcelona linked it to the Olympics. Glasgow linked it to developing itself as the cultural capital of Europe. It is being done every way.
5.  Develop a community-wide strategy, incorporating as many organizations, levels, and sectors as possible.  Here’s where Healthy Cities/Healthy Communities differs most from many logic models and other methods that are clear on exactly how to go about planning and carrying out an initiative.  Rather than offering a step-by-step process, HC might use any participatory planning process that incorporates a community-wide approach and that looks at all the possible areas that might affect the issue chosen.  Thus, you might use VMOSA (see Chapter 8, Developing a Strategic Plan), PRECEDE/PROCEED or some variant, or a less structured process – whatever seems appropriate and works for your community.
It is important, however, that your plan result in a community-wide, multi-pronged approach.  If your focus is on youth violence, for instance, it should involve some sort of action or supportive function by local government, parents and parent advocates, schools, law enforcement, the court system, welfare, agencies that deal with youth and families, physical and mental health services, Family Planning, the media, adult literacy (dropouts), and potentially or formerly violent youth and their victims.  All of these groups and individuals should be working together as a team, each referring youth to other appropriate services or agencies among them, and all coordinated and collaborating in their operation.  The focus should be on changing the systems that make a problem possible, or that present barriers to the ideal the community is working toward.
6.  Implement the plan.  Once again, this should involve a community-wide effort.  Any oversight of the implementation should include a broad range of individuals and groups, representing a cross-section of the community.
7.  Monitor and adjust your initiative or intervention.  Once you’ve implemented your plan, it’s crucial to evaluate the effectiveness of both your process (Are you doing what you set out to do?) and your results (Are you reaching your benchmarks?  Are you having the planned effect on the issue?)  If an evaluation gives unsatisfactory answers to any of these questions, you can revisit the issue, determine the reasons your plan isn’t working well, and change it accordingly. 
8.  Establish new systems that will maintain and build on the gains you’ve made.  Once you’ve reduced youth violence, for example, you still have to do whatever is necessary to make sure it doesn’t rise again, and that it continues to decline.  (What’s the ultimate goal here? Is there an acceptable level of youth violence?)  That may mean setting up new organizations or programs, working to change or cement changes in community attitudes and procedures, redesigning school curricula, working regularly with the media – whatever it takes to sustain progress.
9.  Celebrate benchmarks and successes.  Public celebration of achievements not only energizes those who have been working toward them, but informs the community that the drive toward a healthy community is moving forward successfully.  It helps to establish the idea of a healthy community in the public mind, and to build a foundation for the continuation of the initiative.
10.  Tackle the next issue(s).  The ultimate goal here is the development of a truly healthy community, which translates to improving the quality of life for everyone in the community.  After your first success, it’s time to use your momentum to address another (or more than one other) issue.  That may be the removal of a barrier to a healthy community, or it may be the creation of a necessary element of a healthy community.  In either case, it means sustaining citizens’ commitment to an ongoing and long-term process, the end result of which is a community controlled by its residents, where all systems work toward the public good.


In Summary

The health of a community, like that of an individual, depends on far more than freedom from pain or disease.  Health, or its lack, for a community is the result of a large number of factors, often intertwined, that span the social, economic, political, physical, and environmental spheres.  Virtually any community issue has an effect on, and is affected by, the overall health of the community as a whole, and therefore should be approached in a community context.  Healthy Cities/Healthy Communities provides a philosophical framework for an inclusive, participatory process aimed at raising the quality of life for everyone, and creating a truly healthy community.
Two basic premises underlying the Healthy Communities concept are a comprehensive view of health and community issues, covering a broad range of factors that contribute to a healthy community; and a commitment to the active promotion of a healthy community, rather than the “treatment” of problems.  By addressing the social and other determinants of health and community issues (including the Ottawa Charter’s list of peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity), and by creating appropriate policy and environments, encouraging social action, providing personal skills, and reorienting services to a more wide-ranging approach, communities can foster citizen empowerment and equity.
Reasons for adopting the Healthy Communities approach include:
  • Its community perspective, leading to a more effective approach to issues.
  • Community ownership of any effort, resulting from community participation in its development and implementation.
    The broad range of ideas gained from a participatory process.
  • Its access to citizens’ knowledge of the community, helping to avoid pitfalls caused by ignorance of community history and relationships.
  • The forging of community-wide and ties that cross economic, social, racial, and other lines.
  • Participatory planning leading to solutions that reflect the community’s real needs.
  • The adoption of achievable goals, leading to success.
  • The identification and use of community assets and resources which both take advantage of what already exists, and teach the community what it can do with its own considerable resources.
  • The fostering of community commitment to the process of building a healthy community.
  • The creation of a healthy community self-image. 
While a Healthy Cities/Healthy Communities process should involve everyone, some particularly important participants include local government and officials; those affected by the issue(s); those who will actually administer and implement the initiative, or whose lives or jobs will be affected by it; any organizations that will be expected to work together; and opinion leaders.
There are 10 important components of a Healthy Communities process:
1.  Create a compelling vision based on shared values.
2.  Embrace a broad definition of health and well-being.
3.  Address quality of life for everyone.
4.  Engage diverse citizen participation and be citizen-driven.
5.  Multi-sectoral membership and widespread community ownership.
6.  Acknowledge the social determinants of health and the interrelationship of health with other issues (housing, education, peace, equity, social justice).
7.  Address issues through collaborative problem-solving.
8.  Focus on systems change.
9.  Build capacity using local assets and resources.
10. Measure and benchmark progress and outcomes.
Although there is no one step-by-step procedure for a Healthy Communities initiative – both the content and the structure of the process depend upon your community’s needs, and, particularly on community decisions – there is, given the ten components above, a reasonable way to approach it in most cases.
1.  Assemble a diverse and inclusive group.
2.  Generate a vision.
3.  Assess the assets and resources in the community that can help you realize your vision, and the issues that act as barriers to it.
4.  Choose a first issue to focus on.
5.  Develop a community-wide strategy, incorporating as many organizations, levels, and sectors as possible.
6.  Implement the plan.
7.  Monitor and adjust your initiative or intervention.
8.  Establish new systems that will maintain and build on the gains you’ve made.
9.  Celebrate benchmarks and successes.
10. Tackle the next issue.

(The goal in choosing sites here has been to offer a few that give background or general information on Healthy Cities/Healthy Communities, and a few that are the sites of specific programs.  Nearly every Healthy Cities site seems to have its own web page, and these can easily be found by searching “healthy cities” and/or “healthy communities.”)
Essential State Level Capacities for Support of Local Healthy Communities Efforts,” by Peter Lee, Tom Wolff, Joan Twiss, Robin Wilcox, Christine Lyman, and Cathy O’Connor.
Community Partners, Inc., an organization deeply involved in the Healthy Communities movement.
“Healthy People in Healthy Communities,” a guide from the US Dept. of Health and Human Services.

Links to numerous articles on Healthy Cities/Healthy Communities from the Change Project.  Includes interviews with Len Duhl and Ilona Kickbusch by Joe Flower from the Healthcare Forum Journal.

The Healthy Communities Program in Aiken, South Carolina.  A “model” program, focused on infant mortality.  A top-down effort, it nonetheless involves the community in planning and input, and has been highly successful not only at reducing infant mortality, but at providing other needed services, many not directly related to health.
Bethel New Life, a grass roots, church-based urban development effort in the Garfield Park neighborhood of Chicago.  A bottom-up initiative that grew organically over many years, responding to the voiced needs of the community.  Most staff and board members are community residents.
[Each of these efforts benefited from the vision and strong collaborative leadership of a single individual.]
Mesa County, CO:  A case study of community transformation. A grass roots effort that involved the whole community and grew into the Civic Forum; and a more top-down community health assessment.
Greater Orlando Healthy Communities Initiative. A very top-down effort, started by current and former Junior League presidents, the newspaper editor, the mayor, and other prominent citizens.  They involved the community with the help of a consultant.
Healthy Cities information from WHO Denmark, the godfather of the Healthy Cities/Healthy Communities movement.

What happens in Sik , Kedah ..Healthy Community

Follow up of recommendations for developing an Action Plan (RKPBV) as well as special specific Action Plan for strengthening public health 2013 in Langkawi on 25 to 27 November. 2012 and aspiration of the Kedah State's health Director Master to all district health offices will be ready and succeed in developing an action plan that would be run properly and successfully.
In relation to District Health Office with the participation of all members of the Hitch unit Inspectorate is necessary in combos and in order to achieve the purpose oragnise. Among his methods are as follows according to the wishes of MOH Sik (Dr. Isaac Hj. Hussain)


  • Tuan MOH ordered to establish Healthy Community Committee (JKKS) in the community where this role become a responsibility to PPKP and PKA.
  • A JKKS there will be two (2) of the kampong
  • Each PKA will set 4 kampong will be in (two 2/2 JKKS Spaces) this means that there are 17 DHO Sik PKA is then the number of JKKS to be in the form of 34 Of JKKS which will involve 68 of kampong
  • The role of PPKP is: as Coordinator/Supervisor for zones/communities have been identified.
  • The role of implementing a PKA is: as spaces/community. (Two: kampong selected)
Next to explain what are the MOH Sik approaches that should be on the run in the area or the selected community. And criteria selection of kampong is at the discretion of all PKA and PPKP with advice from MOH and  PPKPK Sik.

There are six (6 + 1) Approaches have been identified that need to be in this community, that is;


1. Physical Activities (Exercise)

-Teach proper workout techniques
-Exercise that does not cause injury
-Exercise for fitness
-Fitness exercise with local communities


2. Environmental Hygiene
-Should be given attention by PPKP Bakas and KPAS in care and hygienic education environment.
-This includes security issues within and outside the home
-Ergonomic

3. Mental health
-How to ensure people get a good health mantel.
-Stresas Management
-Forming community advisors for problem solving

4. Personal Hygiene
-I have to prefer in terms of personal hygiene such as; a how many times a day?
-Cough Etiquette
-7 steps wash hands
-Wearing the clothes clean


5. Healthy eating
Drink 8 glasses of plain water/3 litres/day
-Eat More fruits and vegetables, eat the press needle-herb herbal practice.
-Ulam easily (the cost is very cheap)-near at home.

6.Substance abuse
-Smoking rooms (old miserable)-getting various diseases
-Alcohol (liver damage, liver inflammation)
-Drug (addiction/social problems/brain damaged): can lead to more problems such as HIV infection if drugs taken by sharing needles with an HIV positive addicts.
-drugs and Leavesof ketum in the entertainer –Majlis kenduri kampong


Six (6) main approach presented by the master of the MOH should be given education and advice to healthy community as knowledge about health.
Nevertheless, in addition to the MOH sugest the approach on the 7th, which can be used as covers the entire 6 above, namely: approach

7. Religion
-If a religion and to practise them, then all things negative is there are unavoidable within the land easily.

Ogranisai structure in healthy Community framework according to Lord Nevertheless for the formation of MOH describe an organisation JKKS in each community, there should be representatives from;
  • JKKK Kampong
  • MKK
  • IMAM
  • YOUTH
  • WHO WILL
  • WARGAMAS
  • SCHOOL
  • Etc fit which can fetch between 10 – 15 org Committee.
  • Each PPKP is assisted by 2 PKA
  • Each PKA has 4 healthy community area (4 Kampong)
  • Means that each PPKP will have eight community that need to be supervised.
CORE TEAM

The Core Team is led by:
1. family health and medical officer (kk)
2. Medical Assistant
3. Nurses Health
4. Nutrition Officer
The purpose of the Core Team are: help co-ordinator & zone area (PKA & CI) MOH inform that, may request assistance and services from Core Team above for routine program in the community.


THE CREATION OF ORGANIZATION

• District Health Officer (Dr. Isaac Hj. Hussain) get & ask PPKPK. Hamzah Ahmad to continue discussions and the formation of the organization because he has the duties and problems need immediate action at the Office.
• En. Hamzah Ahmad later explain in detail the actual objectives and this Action Plan is to reduce the cases of Denggie Fever and other health problems in the community by planning and encouraging community participation in prevention and control.
• Compliance DHO Sik district has only 18 people a PKA and 10 people PPKP this means that we need to focus on the areas of the Kutamaan 1, JKKS area

Referring to the proposed Healthy Community Committees Organization) JKKS for DHO Sik this means each PKA (public health) will be responsible to standby 4 kampong and for 20 people a PKA would amount to a total of 40 JKKS and get right by 80 of the kampong


DIVISION OF KAMPONG AND SITE JKKS ACCORDING TO PKA AND PPKP
1.      PPKP Muhammad Hasbullah Bin Hanip
a.      PKA. MOHD EZANZANY B MOHD.HASHIMI [2 LOKASI JKKS]
·   L1.-A-Kg.Charuk Senduk ,B-Kg. Melaka
·   L2 –A-Kg.Gulau B- KEDA Gulau

b.   PKA FIRDAUS B MAMAT [2 LOKASI JKKS]
·   L1.-A-Kg.Beris Jaya (A),Kg.Beris Jaya (B)
·   L2 –A-Kg. Kg.Beris Jaya (C),B -Kg.Beris Jaya (D),
2.      PPKP Zainudin B Idris
a. PKA. MOHD KHARANI B ABD RAHMAN [2 LOKASI JKKS]
·  L1-A-Kg.Chepir B-Kg.Jelutung
·  L2-A-Kg.Tanah Hitam B- Kg.Tua

b.    PKA. RAZALI BIN MAT TEK [2 LOKASI JKKS]
·  L1-A-Kg. Batu 8 , B-Kg.Charuk Kemuning
·  L2-A-Kg.Titi Semang B- Kg.Kemelung
3.      PPKP Thum Maa A/L Aproi
a.      PKA. MOHD JAZMIEY BIN MOHD JAFFAR [2 LOKASI JKKS]
·  L1-A-Kg. Begia , B-Kg.Kuala Begia
·  L2-A-Kg.Bukit Minyak B- Taman Harmoni

b.    PKA. MARIZAL AHMAD BIN ABD HAMID [2 LOKASI JKKS]
·  L1-KG.CEMARA , KG. PADANG RAGUT
·  L2-KG.BUKIT CEMARA DAN KG.LAHAR

4.      PPKP Jamalul Hayat Bin mohd Isa
a.      PKA. AHMAD TARMIZI BIN ABD.AZIZ [2 LOKASI JKKS]
·  L1-A-KG.BATU BESAR , B-KG.SRI DACHING
·  L2-A-KG.TUPAI B- KG.TELOI
b.      MOHAMMAD HAFRDZ B ZUBIR [2 LOKASI JKKS]
·   L1-A-KG.SELAMAT A  , B-KG. SELAMAT B
·   L2-A-KG.SELAMAT C  B- KG.SELAMAT D

5.    PPKP Md Zahid B. Talib
a.      PKA. MOHD AIZUDDIN BIN RAZAK[2 LOKASI JKKS]
·  L1-A-KG.CHONG  , B-KG.PAYA TERENDAM
·  L2-A-KG.SUNGAI SENAM B- KG.KEDA SG.SENAM

b.      PKA. WAN MOHD HAFZAN B ISMAIL[2 LOKASI JKKS]
·  L1-A-KG.SIK DALAM , B-KEDA PUSTIKA
·  L2-A-KG.TANJUNG B- KG.KUALA

6.      PPKP Muhamad Fahmi B. Abidin
a.      PKAK. MD AKHIR B YUSUF    [2 LOKASI JKKS]

 ·   L1-A-TELOI TIUR A , B-TELOI TIMUR B
·  L2-A-TELOI TIMUR C B- TELOI TIMUR D
7.      PPKP Mohd Asri B. Harun
a.      PKA. MAT YUSOF BIN NOORDIN  [2 LOKASI JKKS]
·   L1-A-Kg.Betong , B-Kg.Kg.Kuala Kerik
·  L2-A-Kg.Kenangan B- Kg.Pokok Jerai

b.     PKA. AL AMIN B HAWADAN SHAH [2 LOKASI JKKS]
·  L1-A-KG.BRONA KANAN  ,B-KG.BRONA KIRI
·  L2-A-KG.CHANG HAI  B- KG.MSMBONG

8.      PPKP Jamil B. Osman
a.    MD AKHIR HUSSAIN [2 LOKASI JKKS]

 ·  L1-A-TAMAN SEROJA  , B-TAMAN ORKID
·  L2-A-TAMAN KENANGA B-
b.      NOORAZRIN AZAFRI B MOHD ZAKI [2 LOKASI JKKS]
·  L1-A-KG.BELANTIK  , B-KG.BELANTIK DALAM
·  L2-A-KG.KOTA AUR  B- KG.KEDAKOTA AUR

9.      PPKP Muhamad Akmal B. Ibbarahim
a.    PKA. AHMAD SUBKY B MUHAMAD [2 LOKASI JKKS]

 ·  L1-A-KG.BANGGOL KIAT , B-KG.NAMEK TUA
·  L2-A-PONDOK HJ.SALEH   B- KG.BANGGOL DERDAP

b.      PKA. DZUHANNOR B ABD GHANI [2 LOKASI JKKS]
·  L1-A-KG.HUJUNG BANDAR , B-KG.CHARUK TOK UBAN
·  L2-A-KG.HUJUNG BECHAH  B- KG.SEPUTIH

10.  PPKP Muhammad Farid B. Abdul Razak
a.      PKA AZMI BIN ALI [2 LOKASI JKKS]

·  L1-A-KG.TERENAS , B-KG. TELAGA BATU
L2-A-KG.KEDA TELAGA BATU  B- KG.BT.50
11.   PPKP. SalehBin Hj.Md.Isa
a.      PKA.Mohd.Izuhari B. Mohd. Naffri
·  L1-Kuala Beris Melayu
·  L2-Kg.Teloi
b.      PKA. Muhammad Khairi Bin Zakaria
·  L1-A-Kg.Tanjung Belit
·  L2-B-Kg.Tupai

PLAN OF ACTION JKKS DAERAH SIK

BIL
STRATEGI
AKTIVITI
1
Memperkasakan Semua Staff Inspektorat dalam JKKS
Taklimat khas
2
Pembentukan kumpulan Petugas
Pembahagian Lokasi dan Kampong mengikut PKA
3.
Pengumpulan Data Asas & Promosi JKKS
Bancian Data Asas dan Promosi  JKKS di Lokasi
4
Kenalpasti Masaalah PRA-JKKS
Dailog dan perjumpaan dengan pemimpin tempatan di Lokaliti terpilih
5
Pendedahan JKKS kepada Bakal-bakal pemimpin JKKS
Taklimat khas berkaiatan dengan JKKS dan Plan perlaksanaan kepada pemimpin terpilih
6
Memperkasa JKKS
Mengedarkan Kit Kesihatan  spt hand sanitizer, face mask, tisu,tuala kecil, BMI calculator, risalah
7
Memperkenalkan Aktiviti Fizikal
1.Latihan Senaman
2. Senaman Berjalan kaki
3. Senaman Berbasikal
4. Sepak Raga tuju
5. Bola Jaring
8.
Kepentingan Kesihatan
1. Pengurusan Obisiti
2. Pengurusan Tekanan
3. Pengukuran paras Gula
9
Pengurusan Pemakanan
1. Taklimat khas pemakanan
2.Pemilihan Makanan Selamat
3. Audit Menu makanan di rumah Ahli JKKS
10
Penyakit Berjangkit
1.Taklimat & Bengkel
Peranan JKKS
2.Pencegahan Penyakit secara Individu
3. Nasihat & Tunjuk ajar
11
Penglibatan Remaja & Pelajar Sekolah
1.Bentuk JKK Khas bagi Remaja
2.Bengkel dan Latihan
3. Kem Remaja
4.Gotong Royong
5. Senaman dan Riadah
12
Penglibatan Wanita
1.Bentuk JKK Wanita
2.Bengkel dan Latihan
3.Kem wanita
5.Senaman & Riadah
6.Operasi khas
13
Membendung kejadian HIV/AIDS/STD
1.Pendedahan kes kepada JKKS mengikut kategori
2. Latihan khas kepada Kumpulan Remaja & wanita
3. Penglibatan NGO dan lain-lain agensi kerajaan
14
Pers0nal Care
1.Kencing manis
2.Darah Tinggi
3.Asthma
4.Kesihatan Mental
5.Stroke
11
Kebersihan Persekitaran
1. Update data asas
2.Kempen kesedaran
3.Gotong Royong
4.Pertandingan rumah sempurna
12
Kawalan Demam Dengi & Malaria 
1. Operasi cari dan musnah
2. Pemeriksaan kendiri
3.Bengkel dan latihan
4.Kem kesedaran
5.Pertandingan kebersihan
13
Pengurangan Jenayah
1.Pembentukan JKK khas
2.Kerjasama lain Agensi
3.Kempen kesedaran
4.Bengkel dan latihan
5.Pamiran
14.
Peningkatan Ilmu Pengetahuan
1.Bangkel
2.Latihan
3.Demontrasi
4.Lawatan sambil belajar
5.Kelas JKKS
15.
Sukan dan Riadah
1.Pertandingan Sukan mengikut katogeri
2.Sukanika dalam lokasi

●
16
Penilaian
1.Kaji selidik
2.Pemeriksaan kesihatan
3.Index jenayah
●

CONCLUSION 

Although there is no one step-by-step procedure for a Healthy Communities initiative – both the content and the structure of the process depend upon your community’s needs, and, particularly on community decisions – there is, given the ten components above, a reasonable way to approach it in most cases.
1.  Assemble a diverse and inclusive group.
2.  Generate a vision.
3.  Assess the assets and resources in the community that can help you realize your vision, and the issues that act as barriers to it.
4.  Choose a first issue to focus on.
5.  Develop a community-wide strategy, incorporating as many organizations, levels, and sectors as possible.
6.  Implement the plan.
7.  Monitor and adjust your initiative or intervention.
8.  Establish new systems that will maintain and build on the gains you’ve made.
9.  Celebrate benchmarks and successes.
10. Tackle the next issue.

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