WELCOME, INTRODUCTIONS AND ICE-BREAKER (15 minutes)

1. Welcome participants to the session and to the course.
2. Ask participants to pair up with someone they do not know very well, if possible. They each introduce themselves, talk about where they are from and give one interesting fact about themselves (stress that this does not need to be of world-shattering importance or too personal). Explain to them that each person should introduce their partner to the rest of the group and tell everyone the interesting fact about their partner.
3. Come back to the full group and share.
4. As each pair is feeding back, you could write their names up on the flipchart with the interesting fact alongside them. This can then be stuck up on the wall for the rest of the session - and can act as an aide memoire for the rest of the group when trying to remember who different people are.

WHAT THE COURSE IS ABOUT (30 minutes)
Alternative versions of Exercise 2 are available here.

Spend a few minutes explaining the title of this course – “Health Issues in the Community: A Community Development Approach”. A community development approach to tackling health issues involves people, such as themselves, coming together to work out what the problems are in their community, getting organized and taking action on those health issues of concern to them. Using the course programme, explain that over the next few weeks they will be looking at:

• A social model of health
• Inequalities in health
• Equity and justice
• Participation, power and democracy.

To illustrate your point, tell participants that you will recount a story based on I.K. Zola’s writing; read through or pass out Handout A and go through with the group.

 Reference: Source: I.K. Zola (1972).  Medicine as an institution of social control. Sociological Review, No. 20, pp. 487-504.

HOPES AND CONCERNS (20 minutes)

Emphasise that there are no right or wrong answers here - the aim is simply to share how we feel.

1. Everyone (including tutor/s) jots down or thinks about two hopes and two concerns or worries they have had about coming on this course.
2.  Start with ‘concerns’, flipchart these using participants words wherever possible. Ask the group to spot similar points and note these. Have a discussion about these concerns, answer as many as you can and involve the group in offering suggestions as to how to prevent these concerns becoming reality.
3.  Move on to ‘hopes’ and repeat the exercise. Note these down next to the concerns and discuss positively.

 (These flipcharts should be kept or written up for people to look at later in the course).

INTRODUCTION TO GROUPS (30 minutes)

Explain that this course will involve participants, for the most part, in working as a group. It is important for everyone to be comfortable with this. They need to understand how groups operate and what is involved for individuals within a group setting.

1. Ask people individually to say how they are feeling and what it’s been like to get here. Make the point that groups are quite complicated because they are two things at the same time.

• They are a collection of individuals: all with their own hopes and fears. Sometimes we assume that everyone feels the same as we do and we can’t quite be bothered when we find they don’t! We can see that we all bring different ‘baggage’ with us from our own lives.
• However, a group also has its own collective identity, which is different from other groups. The group might have come together for a shared aim or because of other similarities (e.g. this group has come together to do Health Issues in the Community).

2. Why do we need groups? Use the following notes to further discussion.

•  As human beings, we usually want to feel included or to belong in a group of people, because we are fundamentally social beings. This can make us anxious about being rejected by groups of people.
• We need to feel we have things in common with others. However, we are also concerned about keeping a sense of our own individual identity and we feel uncomfortable when this is lost. This is the tension we experience in a group. How much can we be ourselves and do what we want? How much do we have to compromise and go along with others? People’s ideas about what the group is for will also differ and may sometimes be in conflict. Unless this is clear from the start and is checked out regularly then confusion and frustration can develop.

3. Ground Rules.

 For groups to be a positive experience, we need to have agreed ‘rules’ that everyone contributes to and abides by.

 Ask each person to note down a couple of ‘rules’ for the operation of this group and then flipchart these for all to see (be prepared to add in a couple of your own such as maintaining confidentiality, respecting other people’s opinions, etc.).

 These ground rules should then be posted up on the wall for the duration of the course and returned to if need be. You can add to these ground rules as the course progresses but only with the group’s knowledge and consent.

WHAT AFFECTS OUR HEALTH (60 minutes)

Materials - You will need: two packets of sticky notes in different colours, for example, yellow and blue, two sheets of flipchart paper for each group, large felt-tip pens.

1. Give each person three yellow and three blue sticky notes. Using the yellows, ask each person to write down things which they feel affect their own health. These points can be a word or a short sentence. This to be done on their own. NB one point per note.
2. Take the blue sticky notes and ask people to write down three points which they think affect the health of their community: again, one point per note. ‘Community’ can mean the area they live in or a ‘community of interest’, which includes people with whom they have something in common - their disability, their sexual preference, their culture, religion etc. Stress that these should be things that they think.  There are no ‘right or wrong’ answers and this is not a test.
3. Divide the large group into two or three smaller groups, obviously depending on numbers, and give each group a sheet of flipchart paper.  In each group, everyone needs to be able to see and have access to what is on the flipchart; so use tables, the floor or stick the paper on the wall as required.
4. Each group member sticks all the yellow sticky notes randomly and quickly on the flipchart paper, and spends a couple of minutes reading them. Now ask people to move the notes around on the page so that common ideas/similar topics are grouped together. There will be some discussion about this - people change their minds as they see the ideas emerge. Once the main groups of ideas have been decided, ask people to give each group a heading, mental health/relationships/social factors/money etc. Add more words, lines or pictures if necessary. Draw any connecting lines and so on.
5. Do the same for the blue notes, looking at things that affect the health of the community.
6. The whole group then comes together to look at the two sets. Take one page at a time, look for similarities and differences and encourage discussion about the themes each small group has identified.  Encourage people to say why they have grouped things in particular ways and why they have made certain connections

Keep the flipchart papers for Unit 1, Exercise 6.

MEDICAL AND SOCIAL EXPLANATIONS (30 minutes)

1. Put the flipcharts from Unit 1 Exercise 5 up on the wall. These are some things that the group has identified as affecting their health.

Since 1948, there has been a National Health Service (NHS) in this country. Using the flipcharts, ask the group to identify how many of the issues listed are dealt with by the NHS.

Discussion Points

• What aspects of our health does the NHS deal with?
• Who has responsibility for all the other things listed?
• What are we told causes ill-health?
• Who tells us? E.g. the Government, media, our friends, our family.

2. Give out Handout C. Read out the poem or bits of it, or ask people to take a verse each to read or read it to themselves. Encourage some discussion about this.

 Discussion Points

•  What are the health issues here?
• Who is responsible for tackling them?
• What could the NHS do about this situation?

RECAP AND SUMMARY (15 minutes)

1. Take a few minutes to go back over the key points from the session - refer to flipcharts if necessary.

• Course requirements
• Hopes and concerns
• Groups and ground rules
• Health issues identified by the group
• Who is responsible for tackling our health issues

Conclude that, in this unit, we have been exploring the idea of a social view of health - a way of thinking about health that is fundamental to a community development approach.

2. Give out the Unit 1 Learning Log. Spend a little time explaining the purpose and scope of the learning logs and, if appropriate, allow people time to fill them in before they leave if they want to.