Community involvement in health: from passive recipients to active participants.

J Smithies, G Webster. (331 pages, £49.50.) Arena-Ashgate Publishing Ltd, 1998. ISBN 1-85742-428-X. In the UK, the ‘new’ NHS is to be concerned about developing primary and community services across all sectors so that strategic leadership should involve the local community as well as Health Authorities and Primary Care Groups. This may be seen as part of an international trend towards developing health services that are better oriented to the needs of communities. So this book will fill an important niche, providing background information and practical advice on how to work with communities. The early chapters consider the context, particularly the history and emergence of a community health movement in recent decades. Much of the detail here is of limited importance to a wider readership, although the insights into the difficulties faced by the movement may help to facilitate future developments. A reader who is uninterested in the politics of health education and community development in the early nineties should not let that deter them from turning to Part II and moving from theory to practice. This section provides clear descriptions of key concepts and step-by-step advice on setting up practical projects, all well illustrated by case studies. For those who find it hard to define a community there is a useful reminder of the range, from a community of interests to a locality. Involvement covers the field from advocacy, which can be very individual, through community health projects and needs assessments, to a community-based approach to evaluation. There is a particular emphasis on enabling change. One case-study shows the dangers of imposition from outside. Throughout this section the need for both community and organizational development is clearly shown and this has particular value as new structures for primary care are set up, supposedly more closely linked to local communities. The development of organizational strategies is discussed further in Part III with a clear description of appropriate tools for community development and organizational change. The background, the examples and the bibliography are entirely from a British perspective, and perhaps there is too much focus on the authors' own experience. However, the principles are applicable in other social and political structures. This book is refreshingly written from a non-medical but health-oriented angle. It could help us make community-oriented health care a reality in the next century, even amongst deprived populations.