Community health projects come in all shapes and sizes; some work with a particular community of interest or a specific health theme, others are more generic, delivering a range of health promotion activities often in a neighbourhood setting or based within a community centre. Such projects have been part of the landscape of health promotion in the UK since the 1970s (Tones and Tilford, 2001; Amos, 2002); nonetheless, projects are often small-scale, overly reliant on funding from short-term grants and rarely incorporated into mainstream health provision. The case study presented in this chapter provides a critical examination of volunteering within a small neighbourhood health project based on a disadvantaged housing estate. High levels of community participation were sought and volunteer activity was linked to a community committee involved in the development of health activities on the estate. The chapter looks at the practical challenges and benefits resulting from a deep level of citizen involvement and provides some insights into the dilemmas of achieving sustainability when responsibilities are handed to volunteer workers embedded within their community. The chapter starts with a brief background section summarising approaches to community-based health promotion.

Community-based health promotion

Community participation is a central feature of community health projects, which Tones and Tilford (2001) define as projects that use community development strategies in order to address health issues. Community development broadly concerns community empowerment and collective action to tackle social injustice and build healthy communities (Barr and Hashagen, 2000; Ledwith, 2005). Whitehead (2007) identifies strengthening communities by building mutual support and social inclusion as a category of actions to tackle health inequalities. There has been a long tradition of community health projects in the UK, mostly based within disadvantaged neighbourhoods, stretching back to the Peckham experiment in the 1930s. The New Labour government gave emphasis to area-based initiatives in regeneration and health that sought community involvement in planning and implementation, and many community health projects were developed through initiatives such as Health Action Zones (Bauld and Judge, 2002) and the Healthy Living Centre initiative (Hills et al, 2007). Notwithstanding these policy drivers for greater citizen involvement, Bridgen (2004) cautions that assumptions should not be made that all community-based health schemes use empowerment approaches or seek to extend community influence.