NHS Health Scotland



A. Evidence for community engagement and assets-based approaches (Enforcement model)


Limited highly processed, review level evidence and plausible theory support the link between enhancing individual and community strengths to foster resilience of residents and develop community responsibility and connectedness, and deter crime.


In a health improvement briefing by NHS Health Scotland assets-based approaches are defined as ‘mobilising the skills and knowledge of individuals and the connections and resources within communities and organisations, rather than focusing on problems and deficits’ [1]. Thus empowering and enabling individuals and communities to gain more control over their lives and circumstances.

The mobilisation of assets to promote health and wellbeing is described as follows: ‘Under the umbrella of community development, community engagement and community planning, a range of methods have been developed which aim to identify and mobilise the assets of communities and individuals. Asset mapping – identifying and recording the strengths and contributions of the people and other resources available to a community – is often considered the key first step to enable individuals and communities to recognise what resources may be available to them. How these assets or resources can be used may then contribute to a plan aimed at addressing the problems they have identified. Other specific techniques include co-production, appreciative inquiry, time banking and social prescribing.’

The briefing cites the evidence review by NICE for Public Health Guidance on community engagement to improve health. Recommended actions include the prerequisites, infrastructure, approaches and evaluation of community engagement, while highlighting barriers to engagement and gaps in economic evidence. NHS Health Scotland’s briefing (2011) is clear that emerging evidence on assets-based approaches and improvements in health is currently only from case studies and published evidence on the impact of these approaches on health remains very limited.

The briefing cites The Commission on the Future of Public Services (2011), the Review of Equally Well (2010) and the Chief Medical Officer as supporting and advocating the principles of asset-based approaches. Tools, techniques and resources are also included [1].

As part of the Mental Health Outcomes Framework (NHS Health Scotland, 2012) limited highly processed evidence was identified from NICE public health guidance to suggest direct and indirect community engagement activities may impact on social capital. A chain of change ‘Increasing social connectedness, relationships and trust in families and communities’ is outlined in logic model 3 of the Mental Health Outcomes Framework.

The evidence summary supporting community engagement activities (link 3.3 ) is available for the following rationale:

Community engagement activities, individual and community-based arts programmes and social prescribing will contribute to individuals and communities having increased knowledge and awareness of services and promote motivation and access to services and programmes for all. This, in turn, will increase attendance, participation and engagement therefore contributing to increased trust in the community, increased social support and social networks.

A further chain of change in the Mental Health Outcomes Framework ‘Increasing social inclusion and decreasing inequality and discrimination’ is outlined in logic model 4.

The evidence summary supporting social exclusion activities (link 4.4 ) is available for the following rationale:

Having access to education, culture, leisure and the arts as well as basic needs will increase social inclusion.

Access the full Mental Health Outcomes Framework, including evidence, tools and resources.

In a Scottish Government Justice Analytical Services evidence review [2] on reducing crime, encouraging communities to exercise informal guardianship of their own public spaces was identified as a potential strategy for deterring crime. Generating ‘collective efficacy’ or ‘community cohesion’ to reduce rates of crime within neighbourhoods is based on the link concluded from seminal research conducted in the United States by Sampson and Raudenbush (1999). The theory is that communities with high collective efficacy are more effective in exercising control or guardianship on their public spaces and deter potential offenders through an increased risk of detection. The review cites Sampson & Raudenbush’s (1999) definition of collective efficacy as ‘linkages of cohesion and mutual trust with shared expectations for intervening in support of neighbourhood social control’. This empirical study concluded that collective efficacy is promoted by housing stability and undermined by concentrated disadvantage.

Scottish policy and practice note

The Report of the Ministerial Task Force on Health Inequalities (2013) [3] second review of Equally Well looked at how communities are being engaged in the decisions that affect them and also the importance that ‘place’ has on health inequalities. Two of the priority areas identified in the review were:

  • Development of social capital
  • Support for the implementation of a Place Standard

In support of the creation of health the report includes the following definition of social capital: ‘Social capital describes the pattern of networks among people and the shared values which arise from those networks. Greater interaction between people generates a greater sense of community spirit.’

The definition used by the Office for National Statistics, taken from the Office for Economic Co-operation and Development (OECD), is ‘networks with shared norms, values and understandings that facilitate cooperation within or among groups’.

The report states higher levels of social capital are associated with better health, higher educational achievement, better employment outcomes, and lower crime rates. There are a number of different aspects to social capital:

  • levels of trust (for example, whether individuals trust their neighbours)
  • membership (for example, to how many clubs, societies or social groups individuals belong)
  • networks and social contacts (for example, how often individuals see family and

Shared norms, values and understandings relate to shared attitudes towards behaviour that are accepted by most individuals and groups as a ‘good thing’.

The Task Force report highlights the growing recognition of a need to shape places which are nurturing of positive health, wellbeing and resilience. The report cites the Single Outcome Agreement (SOA) [4] guidance published in 2012 that highlighted the importance of tackling place as a key determinant of health, followed by the recent policy statement Creating Places [5] that recognised that the quality of the built environment affects everyone, and that it is the purpose of architecture and urban design not only to meet our practical needs but also to improve the quality of life for the people of Scotland. To that end, the Scottish Government has committed to developing a Place Standard.

The Place Standard will be a resource that will be used to assess the quality of places, both existing places and new developments. It will consider a range of key themes that can impact on the health and quality of life of the people who live in a place.




References :

  1. Sigerson, D. Gruer, L. (2011) Asset-based approaches to health improvement. Edinburgh: NHS Health Scotland. Available from: www.healthscotland.com/documents/5535.aspx

  2. Scottish Government (2014) What Works to Reduce Crime? A Summary of the Evidence. Edinburgh: Justice Analytical Services, Scottish Government.

  3. Scottish Government (2013) Report of the Ministerial Task Force on Health Inequalities. Edinburgh : Scottish Government. Available from (external link): www.scotland.gov.uk/Publications/2014/03/2561

  4. Scottish Government and COSLA (2012) Single Outcome Agreements: Guidance to Community Planning Partnerships. Edinburgh: Scottish Government and COSLA. Available from ( external link): www.scotland.gov.uk/Topics/Government/local- government/CP/SOA2012/SOA2012

  5. Scottish Government (2013) Creating Places – A policy statement on architecture and place for Scotland. Edinburgh: Scottish Government.