Since Australian states federated in 1901, attainment of community health and maintenance of law and order have been separate policy concerns. However, mental health problems and drug abuse are linked to crime, and young people in poorer communities are particularly at risk of being victims and perpetrators. In the 1980s, a nationally developed, regionally administered, data-driven and consultative approach to community health management began, consistent with World Health Organization policy. A coordinated approach to community stress reduction, which is also aimed at crime prevention and community-based rehabilitation, has now commenced. The national trends are described in international context and also in New South Wales, Australia's most populous state. Community management goals now require greater support through vocational education, service, and research partnerships among tertiary institutions, government, industry, and communities, undertaken in regional contexts.
J Allied Health 2005; 34:223-229.
KEY HEALTH PROFESSIONALS and Australian governments follow the World Health Organization (WHO) in defining health holistically, as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.1-4 This requires a much wider management perspective than the medical model of health, which focuses on an ailing body and its treatment. A holistic health model requires consideration of the matrix of environmental conditions that apparently produce community problems in order to prioritize, develop, and evaluate strategies designed to improve the health of all. In 1981, when Australia formally committed itself to the promotion of better population health, it followed the Alma-Ata declaration of the WHO, when participating nations established health as a fundamental human right and stated that the highest possible level of health is a most important world goal. In 1986, the WHO Ottawa Charter stated that the supports for health include peace, shelter, food, income, a sustainable economic system, sustainable resources, social justice, and equity.2
In 1992, attempts to consolidate health as the central focus of national policy and service development continued when the United Nations Rio Declaration on Environment committed signatories to sustainable development goals. The first principle of the declaration states that human beings are at the center of concern for sustainable development and are entitled to a healthy and productive life in harmony with nature. In 1994, the International Labor Organization; the United Nations Educational, Scientific, and Cultural Organization; and the WHO defined a community as a group of people with common interests who interact with each other on a regular basis and/or a geographic, social, or government administrative unit.
Community-based rehabilitation was defined as
A strategy within community development for the rehabilitation, equalization of opportunities and social integration of all people with disabilities. Community-based rehabilitation is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services.5
Such international policy agreements commit signatories to a coordinated service delivery approach to support the overarching goals of community health and sustainable development. Services are ideally managed and delivered in regional contexts and in partnerships with industries and communities to identify, prioritize, and manage environmental concerns transparently, including evaluation of comparative treatment outcomes. What this now means locally, in practice, for example, is that massive economic redevelopment of prime land in the inner city of Sydney, which major indigenous and other ethnic and low-income groups have always called home, is being supported by passage of the …