Understanding ground‐up community development from a practice perspective

Abstract

This article offers a practice perspective on Community Development from the ground up regarding health and well‐being. It advocates for a departure from traditional Community Engagement approaches, arguing that they fall short of relocating authority to communities as influential health producers. The author affirms that Asset‐Based Community Development (ABCD) approaches are preferable Community Engagement practices, as they offer more authentic pathways toward community‐centred population health and wellbeing. The article concludes that once effective ground‐up community development has been initiated supplementary efforts at reform and relief are more likely to have desired and sustained impact.

Full text

Received: 1 July 2022 Accepted: 11 August 2022
DOI: 10.1002/lim2.69
ORIGINAL ARTICLE
Understanding ground-up community development from a
practice perspective
Cormac Russell
Nurture Development Ltd., Dublin, Ireland
Correspondence
Cormac Russell, Nurture Development Ltd., 91
Bird Avenue, Clonskeagh IE, Dublin D14 E7Y8,
Ireland.
Email: cormac@nurturedevelopment.org
Funding information
I have received no funding to undertake this
work.
Abstract
This article offers a practice perspective on Community Development from the ground
up regarding health and well-being. It advocates for a departure from traditional Com-
munity Engagement approaches, arguing that they fall short of relocating authority
to communities as influential health producers. The author affirms that Asset-Based
Community Development (ABCD) approaches are preferable Community Engagement
practices, as they offer more authentic pathways toward community-centred pop-
ulation health and wellbeing. The article concludes that once effective ground-up
community development has been initiated supplementary efforts at reform and relief
are more likely to have desired and sustained impact.
KEYWORDS
public health, relationships, well-being
‘For you know only a heap of broken images’.
T. S. Elliot, ‘The Waste Land’1
1INTRODUCTION
Why do we confidently maintain that our health is primarily in the
hands of clinicians, that our safety is determined by police response
times, and that the quality of our children’s education depends on a
teacher’s qualifications? In this article, I contend that our perspec-
tive has been skewed by what is referred to as the ‘institutional
assumption’—the belief that institutions are the primary producers of
what we need to live a good life of prosperity and well-being.2,3
This notion is debunked by repositioning and re-centring regular
people and their communities and recognising them as the primary
producers and contributors of those things that lead to increased
well-being and health. This article examines how communities can col-
lectivise and mobilise local assets to extend their health-producing
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided
the original work is properly cited.
© 2022 The Authors. Lifestyle Medicine published by John Wiley & Sons Ltd.
capacities. It also brings to light a process that institutions employ
to undermine such efforts. It then illustrates how professionals, in
practice, can reduce health inequalities by encouraging and precipitat-
ing democratic citizenship among individuals and community building
among neighbourhood associations.
2CASE STUDY: STRATHCARRON HOSPICE
Located in Scotland’s central belt, Strathcarron Hospice, opened in
April 1981, has long had the objective of synthesising specialist clinical
knowledge with community-centred approaches to providing end-of-
life care. Key to this objective is the recognition that the love and
support of friends, family, and neighbours are essential and irreplace-
able. In the winter of 2021, Irene McKie, CEO of Strathcarron Hospice,
stated in an evaluation interview with me: ‘We die twice, first socially,
then clinically. We must do more about the first’.
The Hospice took increased steps toward its objective in 2013
when it made a clear distinction between Community Engagement,an
Lifestyle Med. 2022;3:e69. wileyonlinelibrary.com/journal/lim2 1of11
https://doi.org/10.1002/lim2.69

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approach they had previously borrowed from other hospices, and Com-
munity Development. The Community Engagement they had observed
and experienced was often characterised by the following traits:
∙Decision-making power rested with those who would not be
impacted by or suffer the consequences of the decided-upon actions.
∙Those outside geographic communities assumed the authority to
define problems and determine solutions unilaterally.
∙Outputs and outcomes were set by those external to the community,
not those impacted by their efforts, and tended to be transactional
and programmatic in nature.
Community Engagement can thus be understood as the ‘direct or
indirect process of involving communities in decision-making and/or
in the planning, design, governance, and delivery of services using
methods of consultation, collaboration, and/or community control’.4
In contrast to this approach, Strathcarron Hospice adopted the
following Community Development principles:5
∙Openly and routinely review power relations between community
members and outside actors to ensure that the community holds a
primary position and that members are supported in their efforts to
organise themselves in inclusive and consequential ways.
∙Start where the community is, but do not stay there. Support and
resource them in building power and power-sharing structures that
include the gifts of all residents and their associations while main-
taining a critical appraisal of power differentials and robust analysis
of social and economic inequity.
∙Have the community-impacted identify and articulate problems and
possibilities in their own language and terms.
∙Whenever possible, enable the community to agree on solutions
and responses to community problems, after which supplementary
supports from external actors may be leveraged.
∙Support the community to determine change making and desired
outcomes, which happen at the speed of trust, in ways that enhance
equity, inclusion, and social justice.
The Hospice’s transition away from Community Engagement prac-
tices and toward Community Development principles was character-
istic of the evolution of their way of knowing the communities they
served.
Strathcarron Hospice started down this path with the help of a
government-funded project called Reshaping Care for Older People,6
which aimed to increase community capacity to create culturally
sensitive community-led responses to end of life care. This broad
ambition opened a space for learning and experimentation. As the
manager of the newly formed Community Development team, Susan
High noted in review sessions with me (2021): I have to admit,
at that time I had no idea what Community Development truly
meant’! Although the project’s core principles were clear, it traversed
a steep learning curve; in its early stages, it resembled more of a
Community Engagement initiative than a Community Development
one.
Members of this team recall those early days and the lessons
learned. They saw the limits of programmatic interventions7and
the irreplaceable value of two-way relatedness at the village and
neighbourhood levels. This insight was vital to the evolution and deep-
ening of their practice. As their approach became more nuanced and
discerning, they learned to avoid the following practices:
∙Activities in which a person receives support but does not choose
the action and the means by which the support is conveyed or
offered. In other words, they stopped prescribing.
∙Convening groups in which the supported person is not missed when
they are absent.
∙One-sided relationships based on labels, in which the person labelled
‘volunteer’ or ‘professional’ provides support services to the person
labelled ‘patient’ that they passively consume.
∙Sympathy-based supports in which the ‘patient’ is understood to be
a ‘bundle of needs’ or a ‘victim’.
Their praxis8from 2013 to 2018 guided them instead in the direc-
tion of co-designing supports with local communities, beyond their
building where they go to provide supports, that
∙featured the skills and gifts of those whose capabilities are most
at risk of being hidden from or dismissed by wider circles of
participation within their diverse natural communities.
∙fostered reciprocal relationships between the person supported
and the person providing support. This focus on interdependence9
helped to bridge both wider and new support networks across differ-
ent interest groups. So that a person who may previously have solely
been a member of networks identifying themselves by medical con-
dition or age, now also were members of other associations, such as
book reading groups, neighbourhood walking groups, and so forth.
∙employed empathy-based approaches that celebrate the whole
person, valuing their gifts, knowledge, skills, passion, time, and
commitment to being present in the lives of others.3
The Community Development team witnessed firsthand how the
people they served could be healthy and safe while remaining fun-
damentally unwell and unfree. The distinction between health and
wellness and between safety and freedom was vital because the team
worked alongside people who were at the end of their lives in ways that
honoured their autonomy and citizenship.10
In 2018, the team adopted an explicit Asset-Based Community
Development (ABCD) approach.11 ABCD’s influence went beyond
the Strathcarron Community Development team to other parts of
the Hospice. It even impacted how some external partners chose
to work with their local communities. The journey away from tradi-
tional forms of Community Engagement that began in 2013 and led
to the steady proliferation of ABCD approaches has been profoundly
transformational for the Hospice and for the communities they serve.
Specifically, Hospice staff (across the organisation, not just the Com-
munity Development team) reported the emergence of the following
outcomes:

RUSSELL 3of11
∙Community ownership increased: ‘We began receiving questions
from the community and self-referrals, which we’ve never had
before’.
∙Community alternatives to Hospice service emerged: ‘We observed
raised awareness of the capacity of communities to do things for
each other that had previously been thought of as professional
functions, such as caregiving’.
∙Trust between community associations and the Hospice deepened:
‘More people are recognising the value of journeying at the speed of
trust when working with citizens and their community. There is less
pressure on us to produce interventions at an early stage’.
∙Members of the Hospice reflected deeply on power dynamics and
the dangers of displacing natural community capacities to provide
care and enhance the welfare of their neighbours at the end of life:
‘We witnessed a growing understanding of the dangers of profes-
sional overreach. Our colleagues are taking ever more seriously the
mandate, first do not harm’.
∙More emphasis was placed on community-centred and community-
first approaches: ‘We are witnessing greater understanding
between professionals in the Hospice and partner agencies regard-
ing the importance of relocating power to citizens and their
communities. It has to be more than words or good intentions’.
The above quotes are anonymous reflections from Strathcarron
Hospice staff, gathered during an evaluation I conducted in the win-
ter of 2021. In practice, the Hospice has employed four Community
Animators (as Robin is to Batman, so a Community Animator is to
residents and their associations) to work in place-based community-
centred ways with various geographical communities to support them
in exploring the following questions:
1. What are geographical communities best placed to do to support
residents in living their best lives right to the very end?
2. What are geographical communities best placed to do but with
some support from the Hospice to support their neighbours in living
their best lives right to the very end?
3. What do geographical communities need to have done for them by
the Hospice to support their neighbours in living their best lives
right to the very end?
By asking these questions in local communities over several years,
the Animators discovered significant untapped reservoirs of commu-
nity competencies essential to the well-being of individuals at the end
of life.
3MULTI-FOCAL APPROACH
It is often said that the map is not the territory. It is equally valid to say
that the lens is not the landscape. Nevertheless, human service profes-
sionals and social policymakers alike have implicit maps or preferred
lenses they use to navigate and view the social and economic land-
scapes. The Strathcarron case study charts an organisation’s journey
from Community Engagement to Community Development, offering
a compelling example of an institution learning to see communities it
serves through a fresh lens that magnifies assets, not deficits.
Two lenses through which neighbourhoods are typically viewed
when the institutional assumption eclipses community capacities loom
more significant than others within the current social and healthcare
landscape in Western liberal democracies: the relief and reform lenses.
Both are examined here and a third, the community lens, is introduced.
When socioeconomic issues are considered through all three lenses in
the optimal sequence, institutions and communities can be restored
to ‘right relationship’, by effecting a shift in perspective from what is
wrong in communities to what is strong.
3.1 The relief lens
Viewed through the relief lens, the well-being of individuals is seen
to be the result of services provided by professionals. ‘It envisions
a world where there is a professional to meet every need’.2In its
most myopic form, the relief lens portrays people as broken and
needing to be fixed. It labels them as clients, consumers, patients,
end-users, services users, troubled families, vulnerable elderly, and the
underprivileged. Rather than defining people by their primary rela-
tionships, such as brother, sister, friend, and neighbour, institutions
diagnose, characterise, and redefine them as clients within a service
system.
The message is clear: the ‘client’ has needs that can be addressed
only by service providers. Clients are needy (i.e. in need of an institu-
tional intervention), not needed for their contributions within a com-
munity. This is not to say that this lens does not have significant utility
in a just society. Neighbourhoods require and have the right to ser-
vices, from refuse collection to road maintenance and human services
such as Hospice care. Indeed, life-saving vaccinations have emerged
due to interpreting maladies through the relief lens. The Beveridge
Report in the United Kingdom and the Marshall Plan in the United
States were predicated on the urgent need for relief action following
the Great Depression and the Second World War. The importance of
this lens ought not to be minimised. But there are hazards with this
lens; chief among them are professional dominance and institutional
overreach. Other hazards include clientelism and commodification of
individual and community needs, which confuses human necessities
with institutional categories and pathologises them.12 Every lens has
its blind spot. On its own, relief action risks becoming a form of ‘poverty
soothing’; by addressing the symptoms, the root causes become fur-
ther entrenched.13 The relationship between low income and health
is a case in point. Across the life course, economic poverty is the most
reliable predictor of poor health outcomes. Yet, in many OECD coun-
tries, more than 80% of health budgets run on relief services and
programmes that draw income away from people living in poverty.14
Gustavo Gutiérrez put it thus: ‘The poverty of the poor is not a call
to generous relief action, but a demand that we go and build a differ-
ent social order’.15 This statement suggests that the root issue is one of
reform.

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3.2 The reform lens
In most liberal democracies, the reform lens is layered over the relief
lens and in tandem they portray a world coloured by the institutional
assumption. When a person seen through the relief lens does not
receive an institutional service to meet their needs, including their
need for a diagnosis of one kind or another, the reform lens automat-
ically views this denial as an infringement on their rights which sets up
the argument for a reform agenda to be pursued.
Not-for-profits are particularly attracted to this way of viewing the
social landscape. They typically advocate for institutional reform on
behalf of the most vulnerable, those excluded from services or ‘unseen’
through the relief lens. Organisations that employ the reform lens tend
to advocate on two fronts: (a) the issue itself and (b) the need to fund
their institution in order to propel the reform agenda. When this advo-
cacy is done well, the individual receives required services and the
not-for-profit receives revenue. There are hazards, however, as with
the relief lens, because the authentic voice of the community is now
mediated through an agency with the proper manners and vocabulary
to meet the relief bureaucracy on its own terms, which runs the risk
of diminishing local democracy and autonomy in the pursuit of doing
good. ‘Doing going’ becomes narrowly defined as the state distribut-
ing commonwealth funds to relief and advocacy agencies to provide or
enhance services and programmes for the ‘needy’. This is, of course, but
one of many legitimate ways a state can distribute wealth; other means
include Unconditional Basic Income16 and progressive tax reforms that
ensure that those who are disadvantaged by current tax laws receive
the same advantages as the advantaged. The reform lens can thus open
a vibrant vista of possibilities for including people at risk of not hav-
ing their gifts recognised or received. When done within appropriate
proscriptions (professional limits),17 reform can open many doors to
participation when orientated toward interdependence within natural
communities.
Strong examples of the critical importance of appraising the just-
ness of societies through the reform lens include the plight of
refugees within neoliberal countries.18 Needed human rights19 legis-
lation would not exist were it not for the heroic efforts of activists in
recent decades. The reform agenda also modifies the relief actions of
institutions because it seeks to position the voices of people receiving
services ahead of those who provide professionalised interventions.20
Although the lenses of relief and reform are both essential, they are
still insufficient to attain a fully inclusive and just society, because their
focus is too narrow. Each lens is limited to individuals and the services
they ought to receive from institutions. Human rights, fully understood,
cannot be confined to the consumer rights of individuals, nor can they
simply be contained within a transactional exchange between a given
individual and an institution. A third critical actor must be brought into
the frame—namely the community.Without this element, the relief and
reform lenses, used either separately or together, risk creating the fol-
lowing seven unintended hazards to local communities and individual
citizenship:
1. Individuals and groups are labelled and defined by their perceived
weaknesses and conditions, not by their strengths and capacities.
2. Most of the money intended for communities ultimately goes to
those providing services to them.
3. Active citizenship and grassroots activity retreat into the back-
ground, overshadowed by institutional largesse and overreach.
4. Regular people and associations see themselves as inadequate and
underqualified compared to professional helpers. Consequently,
they become disabled.
5. Residents accept that professionals and programmes imposed from
the outside are their best hope for responding to end-of-life support
needs.
6. Individuals and communities are understood and come to see them-
selves as consumers, not producers. Thus, they outsource death,
dying, and other health- and well-being-related issues to a licensed
professional or institution.
7. Institutional progressives will speak of prevention of illness while
rarely talking about community health creation, because the latter
relocates authority and resources towards community alternatives
and away from traditional institutional interventions.
3.3 The community lens
When viewed through the first two lenses, economically poor individ-
uals and low-income communities are predominantly defined by their
perceived problems, while their strengths and capacities are eclipsed
by the bias towards what is perceived to be wrong. By analogy,current
health and social care policymakers hover over urban conurbations
like passengers in an aeroplane on a night-time flight. All they can see
on the ground are the lights of public sector, third sector, and private
sector institutions, whereas neighbourhoods are in complete dark-
ness, except when an institution decides to point a spotlight in their
direction, but then only to reveal their deficiencies.
Institutions are not the sole source of power in society. They
do not have a monopoly on the means of producing the best solu-
tions to socioeconomic challenges. Another essential power source—
communities—also produces collective well-being outcomes. These
primarily overlooked well-being capacities become evident through
the community lens.
In contrast to the relief and reform lenses,21 the community lens
illuminates the neighbourhood or community as a basic unit of produc-
tion. Through this lens, people are recognised as having capacities to
produce health, safety,and prosperity. This lens reveals neighbourhood
associations as contexts in which to create and locate many sustainable
supports, especially for those at the economic and social margins who
are in need of care and support. Those who hold to this vision see the
following possibilities:
∙The untapped reservoir of community potential beyond institutional
relief efforts and reforms.

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∙A society in which citizens can be supported to be interdepen-
dent and at the centre of community life as an alternative to
institutionalisation.
∙That making state resources available to the community enhances
people’s choice, control, and civic participation.
∙The necessity of increasing shared space, as opposed to managed
space, to ensure that those who typically are on the margins can
fully participate in civic, political, social, cultural, economic, and
environmental life.
The challenge in using these lenses is to see through them in an
optimal sequence, beginning with the community lens, followed by the
reform lens, and finally the relief lens. Currently the opposite sequence
dominates, resulting in community capacities remaining dormant and
rarely discovered, connected, or mobilised, which leads to scarcity and
the overlooking of abundance.
4COMMUNITY ENGAGEMENT OR
COMMUNITY BUILDING: A QUESTION OF POWER?
Strathcarron Hospice’s move from Community Engagement to gen-
uine Community Development was achieved by relocating power and
making the communities they serve the primary authority. Staff under-
stood that these communities assumed that an appropriate response
to death was a professionalised one in which the Hospice held a license
on a subconscious level. The Hospice took an evidence-based approach
by featuring geographical communities as primary producers of health
and well-being, even in death. More than 80% of the determinants of
well-being and associated health outcomes were recognised as con-
tingent upon community connections with and within the community
and the mobilisation of community assets. In practice, individuals were
engaged not as passive or even active recipients of services but as lead
actors in the production.
Kretzmann et al. elaborate on the various power differentials
at work between human service institutions and communities (see
Figure 1), in which institutions have expropriated authority in respond-
ing to a wide variety of life’s maladies.22 They note that even
consulting and giving individuals positional influence to advise or
advocate on service design are inadequate substitutes for allowing
residents to be in collective control. Furthermore, communities are
at their least potent when relegated to a passive consumer role. In
short, professional dominance has harmful consequences, namely the
displacement of essential citizens and associational agency, which
results in the loss of both individual and community resilience and
power.
Since the introduction of Arnstein’s ladder of citizen participation,23
numerous attempts have been made to conceptualise the power
dynamics between institutions and communities of place. The diffi-
culty here is that terms like Community Engagement,co-production,
and so on can be used interchangeably to mean different things.
For example, Popay24 uses engagement and participation as the end
goal, whereas Kretzmann, in my opinion, rightly distinguishes between
Residents as Information Sources
Residents as Participants
Residents in Control
Residents as Recipients
Residents control or produce:
Goal Setting, Planning, Implementation
Residents participate in:
Goal Setting, Planning, Implementation
Residents serve on governing body
Residents serve on advisory group
Residents serve as advocates for the organisation
Residents are part of focus groups
Residents receive services; they are clients only
FIGURE 1 Residents and their associations: A power ladder. Used
with permission from original source.22
engagement and participation by residents who are in control. It is like
the difference between being invited to dance and choosing the music.
Popay’s formulation features five levels of Community Engagement,
from least to most—from informing to consultation to coproduction to
delegated power to community control. Although she usefully corre-
lates community control with better health outcomes, one is left with
the dilemma of engagement and participation being conflated with
consultation and co-production. This tendency is found in most related
literature and common practice, leading to deterioration in delegated
power and community control.
Community Engagement tends to refer to the funded professional
soliciting community stakeholders, identifying their needs, and propos-
ing an agency-driven solution that places community members in a
passive consumer role. Mapping Popay’s power gradient against Kretz-
mann’s ladder (Figure 1) shows that Popay’s conceptual model does not
free us from this epistemological error. In practice, Popay’s model gets
snagged on the third rung of Kretzmann’s ladder (Residents as Partici-
pants), falling short of what she identifies as the critical determinants
of enhanced well-being outcomes (Community Control as on Kretz-
mann’s ladder). Consequently, the community is not in control because
authority has not been relocated to them, leaving them in a passive
consumption rather than an actively producing role.
When a power shift occurs and communities take on the role of
producer, they can do the following:
∙Redistribute power to non-elite groups because communities them-
selves have the power.
∙Claim their own rights and the rights of others.
∙Participate and benefit from their participation.

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∙Cast a vision of the future and benefit from the outcomes.
∙Challenge unjust structures.
∙Work with organisations on the community’s terms in co-producing
and enhancing community well-being.25
With this power shift in mind, I propose an alternative path
toward sustainable Community Development in step with the one
taken by Strathcarron Hospice. For developing democratic power from
the ground up, I commend a Community Development/community-
building approach over a Community Engagement one. This approach
posits that enduring community change happens from the inside out
and institutions play a supplementary role in engaging the commu-
nity’s own capacities. This approach also helps us to recognise that
Kretzmann’s ladder can be viewed from both the institutional and the
community perspectives.
The institutional perspective understands the ladder as an upward
progression from citizen powerlessness to community control. From
the community perspective, the ladder can be understood as a
descending progression in which development starts with the dis-
covery, connection, and mobilisation of community-controlled local
assets, occasionally supplemented and extended by external ones. The
remainder of this article considers how to build a community following
Kretzmann’s power ladder by using 10 dynamic methods, or touch-
stone practices. These touchstones are visible in organisations like
Strathcarron Hospice and others I have worked with. They have helped
to free individuals to use what they have to secure what they want for
their individual and collective well-being.
5TEN TOUCHSTONES OF COMMUNITY
BUILDING
The following ten touchstones act together as a compass to orient com-
munities toward tried and proven community-building practices that
may be relevant in their own context. To be clear, these touchstones
are not detailed directions to where I believe communities ‘should’ go.
Also, they are not linear but, rather, iterative. Therefore, although they
are listed here in a seeming order, from one to eight, there is no right or
wrong place to start.
5.1 Discovering and connecting an initiating
group of residents
Every community has Connectors—people who value relationships
over single issues, and community-building over problem-solving or
Community Engagement. Typically, when you find one Connector, they
guide you to other Connectors, because it takes one to know one. As
the number of Connectors increases and relationships deepen, a circle
of Connectors representing the diversity of the community comes into
being. As an initiating group, Connectors actively and intentionally lis-
ten to and converse with people across the neighbourhood, identifying
gifts and noting emerging themes. Thus, the significant touchstone of
collective citizen-led action materialises.
5.2 Recruiting a community animator
The role of the Community Animator is typically a paid one. Individu-
als in this role act neither as ‘insiders’ (unpaid neighbours who speak
for the community) nor as ‘outsiders’ (people committed to Commu-
nity Engagement yet unaccountable to, unaffected by, or indifferent
to the specific local context). Instead, they act as ‘alongsiders’—people
who act like companions and are skilled in nurturing collective action
and inclusion among residents while not directing outcomes. In other
words, when it comes to community-building processes, Community
Animators are shipwrights, hired to assist in the ship’s construction.
They are not captain, who sets the ship’s direction or destination—a
role played by the Community Connector.
5.3 Hosting community conversations
When a Connector is brought into relationship with a Community
Animator, together they shift the dominant narrative through con-
versation. Residents have internalised the belief that they are on the
lowest rungs of Kretzmann et al.’s power ladder. The Connectors flip
the script through the subtle and intentional process of introducing
new questions, such as the following, that shine a light on the com-
munity’s strengths: What do you care about enough to act on? What
would you love to do on this street if you knew three or four neighbours
willing to help you to do it? Can you share a story about a time when
some of your neighbours joined together to make things better locally?
Questions like these are raised during kitchen-table conversationswith
neighbours, at fireside chats with small groups of residents, in church-
basement meetings with associations, or in one-on-one discussions
over coffee. Built into these conversations and group discovery pro-
cesses are such practices as asset mapping, a method I prefer to call
‘place-based portrait-making’. These discovery conversations evoke a
new picture or way of portraying the neighbourhood and help surface
what residents care about locally, what they desire to commit to col-
lectively, and what individual and associational contributions they are
willing to make. They are therefore about community power and local
self-determination. They animate residents to assume their place on
the highest rung of Kretzmann’s power ladder. Furthermore, they focus
on fostering a culture that values and includes all gifts (especially the
gifts of those who have been marginalised or exiled from the commu-
nity). This stands in stark contrast with more traditional change effort
that tend towards either promoting behavioural change or institutional
reform.
In sum, Connectors and Animators (1) support the broader commu-
nity in discovering and connecting local resources in order to achieve
resident-driven outcomes, (2) identify outside resources and external
actors who can support and amplify the community’s efforts, and (3)

RUSSELL 7of11
continually invite residents to look at their circumstances through a
community lens.
5.4 Animating community groups and
associations
Most, if not all, neighbourhoods are to some degree already organ-
ised in that every place has a variety of formal and informal clubs,
groups, and networks. From five people who walk their dogs together
each morning to Neighbourhood Watch committee members, people
form groups to do together what they cannot do alone. These for-
mal and informal associations participate in the community’s discovery
conversations.
By tapping into the life of these associations, Community Connec-
tors and Animators can
∙identify what people care about and what they are willing to invest
their internal and external resources in.
∙identify actionable themes that emerge from conversations.
∙invite curiosity about what one association could lend to another.
∙inspire the telling of stories that recount how things previously done
resulted in a positive outcome.
∙expand the community’s imagination about future possibilities and
initiatives.
∙encourage collaboration between associations.
∙prepare for the establishment of an association of associations.
In ABCD terms, the gifts of individuals and families are founda-
tional to civic power. However, there are things that individuals and
families cannot do without the support of the wider community. Local
associations can amplify individual and family voices and multiply their
gifts. Association also cannot work in isolation to build community for
the entire neighbourhood. They must collectivise in ways that allow
them to still do their work. Community Connectors and Animators are
essential supports in forming an association of associations because
they emphasise keeping efforts small, local, and non-hierarchical.
This approach helps a community nurture and sustain its culture by
amplifying and connecting capacities across the neighbourhood while
respecting the diversity of each small community effort; it creates unity
without uniformity. At the grassroots level, it moves the community
from individual gift-giving to collective citizenship marked by produc-
tivity, not passivity. It also gives communities the power to hold outside
actors to account when required.
5.5 Building connections and social interactions
The physical design and planning of many communities discourage
natural interactions between neighbours. Rapid demographic shifts
worldwide have significantly impacted neighbourhood connections,
reducing the number of socially and economically connected opportu-
nities. In some geographic communities, especially in many rural areas,
there are fewer school-aged children and more senior citizens, result-
ing in more occasional encounters and conversations at the school gate
and fewer connections between young and old. A dying Main Street
can mean fewer local jobs and a weakening economy, leading to dis-
placement of local people pursuing sustainable livelihoods. The result
is atomised families, longer work hours, and increased commute times.
In such a context, community life is often the first to suffer when
people allocate limited discretionary time. What can Connectors and
Animatorsdotohelp?
They can intentionally create social spaces in which residents can
interact and exchange gifts. Theydo not tell people what activities they
should engage in. They do not bring in an expert beekeeper to deliver
a talk hoping that neighbours will come and interact with one another
and do something about the declining bee population. Instead, they
converse with residents and discover one who has built a beehive in
their backyard. Then they invite that resident to share their knowl-
edge with interested neighbours. The Connectors and Animators do
what it takes to bridge the gap between the local beekeepers and their
neighbours, such as organising an ideas and skills share, at which a
wide array of skills and knowledge are shared, not just by beekeepers.
A pancake party on a Saturday morning in the local school or sports
hall, or perhaps hosted by a hospice, can be a powerful way for peo-
ple to see one another as producers and citizens. When local people
come to hear a neighbour speak about beekeeping in a hospice, which
they thought was reserved for those who are dying, space is opened for
other powerful discoveries and aliveness. Participants might say,
∙‘This hospice has multiple purposes; perhaps I could use it too’?
∙‘My neighbours are gifted people and can teach me things; perhaps I
too could share skills and knowledge with them’.
∙‘I have met people at this talk. I didn’t know they lived in the same
neighbourhood as me, and I certainly didn’t think they shared my
interest in beekeeping’.
∙‘I wonder what else we share in common? I’ll ask’.
∙‘I met hospice residents and residents of various villages, neighbour-
hoods, and estates today. Weall shared things we know and we have
skills, passions, talents, and experiences. As a result, not only do I
see my neighbour differently, I also see people using the hospice dif-
ferently; I now see them as having contributions to make, not just
needs’.
Such social moments are curated by resident Connectors but led and
hosted by residents and their associations.
5.6 Visioning and planning
In addition to facilitating the exchange of skills, knowledge, and pas-
sions, an influential community-building process seeks to hold social
and conversational spaces in which residents and associations may
come together and collectively plan and set a vision for themselves.
Such an outcome cannot be achieved simply through Community
Engagement, participation on external boards, or even co-production

8of11 RUSSELL
of services. Instead, a diverse, dynamic, broad community network
emerges by establishing an association of associations. Such a net-
work helps to evoke a community-driven vision for the future and a
plan for how to get there. Endless methodologies and frameworks are
available for moving in this direction, including traditional Community
Organising as well as more facilitative soft power processes such as
Open Space Technology, The Art of Hosting, and Appreciative Inquiry.
These approaches need to be held lightly. Typically, communities use
approaches that make the best sense to them at any given time. Most
important to shoring up the community’s efforts is finding some sense
of purpose. It is critical to ask why? Most communities come together
because they believe there is work to be done and that their we has
functions to perform.
In my experience, communities that have created and implemented
a vision have done so in response to the following three questions:
1. What can we do together as residents, with no outside support, to
fulfil our shared purpose and create a better future?
2. What else can we do to realise our vision (that we cannot do alone)
with a little outside help?
3. What do we need external actors to do for us in transparent and
accountable ways?
The answers to these questions create the basis of a robust neigh-
bourhood vision that genuinely proceeds from the ground up and is
democratic.
5.7 Implementing change
Citizens are recognised by their proximity and connection to other cit-
izens. They agree on priorities and share a commitment to acting on
what they care about. They are connected to and act with others across
the life course, from the cradle to the grave. Citizens do not always
see eye to eye on religion, politics, or the rearing of children. In other
words, at the level of opinions, there are many fractures. But the magic
happens when they join in committed and consistent action and set a
shared course for the community’s common good. By taking collective
action, their shared vision comes to fruition. They protect what they
have created because they are the primary investors and the authors
of the story, and in the telling they play the role of producers, and the
fruits of their efforts are plain to see and to be shared.
5.8 Celebrate every step of the way
This hyper-local community-building journey necessarily navigates
many ups and downs, so it is essential to have fun and celebrate the
little things, even the setbacks, because they often provide the richest
lessons. As with life in general, ‘community’ is lived between the highs
and lows. Although there is optimism about the future, doubts lie in
wait, quietly (sometimes loudly) calling into question any progress that
has been made. Regularly scheduled meals and storytelling gather-
ings are perfect antidotes to such moments. They provide excellent
opportunities to make invisible impacts visible while respecting and
therefore profoundly listening to people’s doubts and learning from
them.
Most importantly, those in our communities who are most at risk
of not having their gifts recognised must be invited in and supported
to participate fully, and their contributions must be celebrated and
included. When the skills of people pushed to the margins are shared
with and received by the wider community—not out of sympathy but
out of empathy rooted in the belief that everyone’s gift is needed in
order for an authentic community to emerge—we move ever closer
toward deep democracy. In every hospice, there are people who are
dying to share their gifts.
Finally, celebrations can also be great contexts in which to encour-
age collective learning. In the chilled-out vibe of a party, we can
talk warmly about our successes and cheer on the specific contribu-
tions that various neighbours have made. We can also talk about, and
perhaps laugh about, the things that did not go our way and what
we learned about ourselves in going through them and coming out
the other side. These reflections are essential in gathering stories of
change and remembering the irreplaceable value of citizenship and
community power.
5.9 Democratic local structures
Establish a local citizen-led Stewardship Group to support the deep-
ening of an Association of Associations and the ongoing cycling of the
touchstones described above.
5.10 Financial security for local control
Establish mechanisms to secure the future of local collective citizen-led
efforts financially.
It is important to avoid playing favourites with any of these touch-
stones; each is an optional entry point to a more connected and
powerful community. The given context will determine which touch-
stones are most relevant for each community. It is also important to
emphasise that this list of possibilities is not exhaustive in terms of
practice; please read them critically and consider whether any have
relevance in your context.
6 ADDITIONAL WAYS IN WHICH HEALTH
INSTITUTIONS CAN INVEST IN LOCAL
COMMUNITIES
For those working in a health institution that is disinclined to engage
directly in the sorts of community building that Strathcarron hos-
pice has, many other practical steps can be taken to invest in the
local community health creation. Here are some suggestions based on
what I have observed useful institutions do in the name of being good

RUSSELL 9of11
neighbours to the local communities they serve:
1. Solidarity and Advocacy. Healthcare institutions can lend their
weight to local Community Development efforts. Importantly, the
organisations that have the most impact in this regard are the ones
that exhibit solidarity and actively advocate for causes that are not
necessarily directly linked to their core mission. At first glance, this
approach may seem counterintuitive, but institutional systems that
hope to serve their communities over decades must work out how
to be a good neighbour, and that starts with supporting their neigh-
bours in achieving the things they care about. Doing so will ensure
that the downstream contributions that local health institutions
make to their communities’ interests will come back to them as trust
deepens.
2. Convening. Local healthcare institutions deal with a wide range of
leaders, Connectors, and residents across communities and organ-
isations at different points in their life course and in moments of
great sensitivity. That often, though not always, means they have
earned incredible trust, which gives them astonishing convening
power among various individuals and associations. That convening
power can be put at the service of communities that may be frag-
mented or insufficiently organised around an issue by offering to
bring different stakeholders together to advance matters of mutual
concern.
3. Sharing Economic Power: Local healthcare institutions have eco-
nomic credibility that small local community groups may not.
Hence, for example, a hospice can act as a fiscal agent for a com-
munity group trying to secure needed funds. As noted previously,
evidence is clear that economic poverty is a significant predictor of
poor health outcomes; using the local healthcare institution’s finan-
cial capacities to enhance local incomes and the local economy will
therefore effect a net improvement in the well-being of those who
are most economically marginalised. More practically, local health-
care institutions have relationships with wholesalers, which means
they have the power to purchase food, goods at scale, and services
that could be immensely useful for local communities. For example,
they can leverage their influence to broker with local supermarkets
and wholesalers to reduce the amount of unsold produce going to
landfills and instead repatriate it back into the food cycles of their
local communities. Another way of enhancing food sovereignty is by
supporting local food co-ops and pantries in bulk-buying nutritious
food options.
4. Sharing Personnel Skills: Healthcare staff have many relevant skills
beyond their clinical care expertise. Healthcare institutions are
potential skills banks for community building; they have chefs who
prepare nutritious meals for large groups; accountants, fundrais-
ers, and people with legal and employment expertise; and they have
knowledge about estate management, strategy, and negotiation.
This bank of knowledge is a veritable treasure chest for their local
communities. Actively supporting staff to share their expertise with
local communities in a spirit of reciprocity is good for staff morale
and community cohesion. This approach is a much more meaningful
version of Corporate Social Responsibility, going beyond painting a
classroom in a school or donating money to a local sports group to
having staff become an asset to communities while playing to their
own strengths. Engaging in personnel skills sharing a few hours
a month yields phenomenal goodwill and community knowledge
across the participating healthcare institution.
5. Sharing Space. Most healthcare institutions have meeting spaces in
villages and neighbourhoods in addition to the grounds on which
they provide healthcare services. Some of these spaces and lands
could be generously put at the disposal of local community groups
for no or minimal cost. The resulting goodwill and trust would make
this hospitality worth doing from an organisational point of view.
There is also a more significant reason that local healthcare insti-
tutions ought to consider hosting community groups: it enhances
the overall social cohesion of village/neighbourhood and commu-
nity life by tacitly weaving the principles of health and well-being
into the fabric of the local community. As if by osmosis, these acts
of hospitality precipitate further acts of community building that
enhance the outcomes of people using healthcare supports while
not medicalising them.
6. Relocating Authority to Community Alternatives: One of the most
potent ways a local healthcare institution can support community
building is by sparking within residents and their associations an
awareness of their own individual and collective competencies in
providing natural (non-professionalised and non-medicalised) care.
Residents may have assumed that such supports are the monopoly
of clinicians and trained practitioners within healthcare institu-
tions. The healthcare institution can cheer on and authenticate the
value of community contributions to health and well-being, creating
places of belonging close to home as well as many other mutualising
supports that are vital to a good life.
All of the supports illustrated immediately above are valuable
investments in local communities. In practical terms, they are how local
healthcare institutions can put their assets into the service of com-
munity priorities. An additional way that healthcare institutions can
precipitate community building is by encouraging other institutions to
engage in some or all of these practices.
7CONCLUSION
This article has sought to understand, from a practice perspective,
Community Development from the ground up; as it relates to health
and well-being. For the sake of conceptual clarity, it has parted ways
with Community Engagement approaches, arguing that they fall short
of relocating authority to communities as influential health produc-
ers. Instead, it has suggested that ABCD offers a more authentic path
toward community-centred ways of working.
To clear ground for such authentic approaches, three lenses through
which geographical communities are typically viewed (relief, reform,
and community) were critically appraised. I have argued for a multi-
focal approach in which external change agents—and more impor-
tantly, communities themselves—begin their efforts by first looking

10 of 11 RUSSELL
through the community lens in order to discover what capacities, latent
or otherwise, communities have for responding to any given challenge.
A subsequent step is for communities and outside practitioners to
identify practical ways of brokering supplementary reform, or addi-
tional supports, in the form of collaboration and advocacy: services and
funding.
Whether the goal is to advance end-of-life care, as in the case of
Strathcarron Hospice, or to bring about any other well-being effort,
ABCD is about placing communities at the centre, where citizens are
the primary producers of health and well-being, not simply passive
recipients of services. Outside actors endeavouring to be useful should
remember that community building is residents’ work. Their job is to
precipitate, facilitate, catalyse, and support, not direct, do to, or do for.
Communities are not wastelands awaiting institutionalised versions of
salvation. They are the sum of their past and present assets and their
alternative futures. Therefore, those engaged in ground-up Commu-
nity Development need to understand that their vocational calling is
to foreground the capacities of those they serve and background the
bureaucracy of their institutions. In so doing, they support the restora-
tion of community functions previously monopolised by professionals
and their institutions.
As the Strathcarron Hospice case study reminds us, one of the crit-
ical reasons that human beings gather in groups is because we suffer
and die and there is no cure for that, only the solace of community.
Indeed, the solace and power of community are vital across the life
course, as predeterminants of our individual and collective health and
well-being, they must be pursued intentionally,and ground-up Commu-
nity Development is one of the most purposeful and underestimated
ways to do so.
ACKNOWLEDGEMENTS
I wish to acknowledge the contributions of Irene McKie, the CEO of
Strathcarron Hospice, and Susan High and her community develop-
ment team at Strathcarron Hospice, Scotland.
CONFLICT OF INTEREST
The author declares no conflict of interest.
DATA AVAILABILITY STATEMENT
All data generated or analysed during this study are included in this
published article https://online.fliphtml5.com/kkoqn/rjfa/#p=1 (and
its supplementary information files https://www.strathcarronhospice.
net/putting-community- at-the-heart- of-the-hospice- movement).
ORCID
Cormac Russell https://orcid.org/0000-0003-3968-2275
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