The assets-based approach: furthering a neoliberal agenda or rediscovering the old public health? A critical examination of practitioner discourses

Abstract

The ‘assets-based approach’ to health and well-being has, on the one hand, been presented as a potentially empowering means to address the social determinants of health while, on the other, been criticised for obscuring structural drivers of inequality and encouraging individualisation and marketisation; in essence, for being a tool of neoliberalism. This study looks at how this apparent contestation plays out in practice through a critical realist-inspired examination of practitioner discourses, specifically of those working within communities to address social vulnerabilities that we know impact upon health. The study finds that practitioners interact with the assets-based policy discourse in interesting ways. Rather than unwitting tools of neoliberalism, they considered their work to be about mitigating the worst effects of poverty and social vulnerability in ways that enhance collectivism and solidarity, concepts that neoliberalism arguably seeks to disrupt. Furthermore, rather than a different, innovative, way of working, they consider the assets-based approach to simply be a re-labelling of what they have been doing anyway, for as long as they can remember. So, for practitioners, rather than a ‘new’ approach to public health, the assets-based public health movement seems to be a return to recognising and appreciating the role of community within public health policy and practice; ideals that predate neoliberalism by quite some considerable time.

Theorising lifestyle drift in health promotion: explaining community and voluntary sector engagement practices in disadvantaged areas

“…The study also revealed the circumstances in which an appropriate blend of emotional involvement and detachment tended to interpretations of and practice with residents, which suggests that working conditions can be developed to foster this. This is endorsed by Roy (2016) who saw that, in the context of asset-based community development, workers in Scotland were able to exploit the neoliberal agenda and work around it by supporting communities to work together to mitigate the effects of poverty. Figurations of social relations are in a constant state of flux (Elias, 1991), highlighting the fact that practices can and do shift under changing circumstances.…”

Conceptualising the public health role of actors operating outside of formal health systems: The case of social enterprise

“…Nancy Krieger (2008, p. 223) reminds us that our “understanding of the societal distributions of health … cannot be divorced from considerations of political economy and political ecology”. Whether there is something implicit within social enterprises that enables them, or at least makes them potentially suitable, to address such structural factors, or whether their impact is constrained to dealing with (downstream) symptoms of problems alone, is a topic that deserves much closer critical examination (although see Roy (2016) and particularly Roy and Hackett (2016) for a full discussion). Glasgow also has a very specific health profile, and highly developed social enterprise sector.…”

Social enterprises and public health improvement in England: a qualitative case study

“…This is a finding that echoes debates about commissioning public services from the third sector more generally, which suggests that in practice, service provision may be more 'business as usual' than radically different. What happens in practice is a contingent outcome of local networks as much as policy drivers 16,17 , and public health practitioners working within social enterprises may not be doing anything different in practice from those in other types of organisation 18 . Despite its limited geographical scope, and reliance on reports of practice, the findings of the present study document a growing role for social enterprises in public health provision, with risks and potential benefits that need further exploration at the level of population health.…”