When you begin an initiative or intervention, you have participants in mind. They may be members of a specific group – defined by geographic or language characteristics, by social or economic factors, or by needs – or participants may include all members of the community. In either case, your initiative or intervention is unlikely to be successful if your intended participants don’t get involved in it. Show
In other words, your effort will be fruitless unless participants have access to it. That doesn’t mean only physical access – being able to reach or get into a building, for instance – but informational, social, and psychological access as well. People have to know that what you’re offering exists, to see it as important to them, and to be willing to use it. In addition, the physical, social, and psychological barriers to their using it have to be reduced or eliminated, and their opportunities to use it have to be maximized. Otherwise, many of them will be shut out, a situation both unfair and contrary to your goals. Chapter 23 is about ways to improve access – for specific groups or for everyone – to the services that enhance life in the community. Those services extend to products (medication, for instance), practices (daily exercise, voting), amenities (libraries, parks, etc.), information, and institutions (government, higher education). In this section, we’ll discuss what that means in general; the following sections will examine in detail a number of ways to reach the goal of improving access to service. The following video on the obesity epidemic beautifully illustrates the importance of modifying access, barriers, and opportunities: What do we mean by modifying access, barriers, and opportunities?Access to what? Barriers to what? Opportunities for what? What exactly are we talking about here? AccessIn general terms, this chapter is about making sure that people who need them have the ability to take advantage of the full range of community services – health services, education, human services, recreation, the arts, etc. That’s what access to community services is. It includes the need for universal access to those things that contribute to a high quality of life in a community – decent employment, a healthy and enjoyable environment, participation in public issues, and responsive and honest government, to name a few. It encompasses access to healthy practices and products. And it also implies access to the information that will make much of this possible – information about nutrition, for example, about the positions of candidates, about the environmental effects of various courses of action. BarriersThe barriers here are the conditions, policies, or attitudes that prevent or make difficult the use and enjoyment of these services, amenities, practices, products, and information, as well as those personal and social hurdles that many people have to surmount in day-to-day life. Opportunities“Opportunities” is not simply another word for “access,” but refers to something slightly different. By making access easier, and by removing barriers, you can create more opportunities for people to use community services. Remember, however, that an opportunity is only the ability to take advantage of something: it’s up to the individual to decide whether to do it or not. You can create opportunities for people to further their education, to quit smoking, to train for jobs, or to become home owners; but you can’t guarantee that people will seize those opportunities, even with your encouragement. Modifying access, barriers, and opportunitiesTo modify something is to change some aspect of it – here, we mean changing it for the better. That may mean increasing, decreasing, replacing, or removing it, depending upon what the goal is. In most of the cases here, we’ll be talking about increasing access and opportunities, and decreasing barriers, but there are large exceptions. Most communities, for instance, would want to limit access – especially for young people – to alcohol, tobacco, drugs, and handguns. A community health organization might want to find ways to decrease access to unhealthy foods and practices, in order to promote healthy lifestyles. That community health organization might try to cut down on opportunities for people to eat junk food by convincing local stores to replace some of their chip and candy displays with healthier snacks – nuts and fruit, perhaps. By the same token, a group working on the reduction and prevention of youth violence could try to decrease opportunities for violence by installing more streetlights, encouraging people to be out on the streets in the evening, and organizing neighborhood patrols. In all of these cases, barriers are being created, rather than being lifted, in order to make it more difficult for people to engage in unhealthy or dangerous practices. The ultimate goal, whether increasing or decreasing access, barriers, or opportunities, is change that leads to healthier communities and an enhanced quality of life for everyone. In this section, we’ll look at access, barriers, and opportunities, and then discuss how they can be modified to help assure that enhanced quality of life. What constitutes access to community services?There are several different ways to look at access, all of them relevant here.
What are the barriers to access to services, amenities, practices, products, and information?Barriers to access come in all shapes and sizes. The essential differences among them depend on who creates them – the society, particular institutions or organizations (including government), or those who need access themselves. Societal barriers. These are barriers that exist because of “the way things are,” and because of the assumptions that a majority of people in a community or a country make about the nature of the world. They include:
Institutional barriers.Institutions – schools and colleges, government bodies, hospitals, organizations, workplaces, businesses, etc. – often intentionally or unintentionally make it difficult for particular individuals or groups (or sometimes for anyone) to take advantage of what they have to offer. While institutions usually reflect the attitudes and practices of the society, many may react to those of their particular constituents, board members, or other internal powers. Some of the ways in which they may deny access:
Personal barriers.Some of the barriers to access are personal to those who are trying to gain it.
What do we mean by opportunities for access to services…and for access to unsafe or unhealthy behaviors or circumstances?Communities, organizations, and individuals can modify services, amenities, products, and information to provide more opportunities for access for everyone, or for specific groups. They can also, often unintentionally, encourage unhealthy or otherwise harmful behavior by providing opportunities to engage in it. And, by the same token, they can discourage unhealthy or otherwise harmful behavior by cutting down on the opportunities to engage in it. Increasing opportunities for access may involve addressing such issues as availability or affordability or effectiveness, but it may also rest on simpler changes. Providing basic information, persuading a merchant to stock new items, or posting new signs might go a long way toward your goal. It’s important to analyze the situation, and determine what’s blocking access. It could be something major, or a complex combination of factors, but it could also be a smaller matter that can be more easily addressed. Decreasing opportunities for access to unhealthy or dangerous practices and products calls for analysis. You should try to understand which practices and products can be affected by actions you can take, and also how those practices and products get to the people you want to reach. What tactics might be useful in modifying access, barriers, and opportunities?This chapter examines five tactics – action plans – for modifying access, barriers, and opportunities:
Each of these tactics will be treated in detail in its own section in this chapter. We’ll introduce them briefly here, and discuss how each can be part of a larger strategy for long-term change. 1. Reducing access to unhealthy products and practicesLimiting the opportunities for behavior unhealthy or harmful to either the individual or the society as a whole is a way to increase opportunities to engage in healthy behavior, just as eliminating barriers increases the opportunities to gain access to services. Some examples of limiting access to unhealthy or dangerous behavior or products:
A campaign to change behavior – to promote healthy nutrition and exercise, for instance – might use a combination of this and other tactics in an overall strategy to increase the use of healthy products, and cut down on the use of less desirable ones. 2. Enhancing access to services, amenities, healthy practices and products, and information.This usually means addressing one or more of the issues described earlier as elements of access, and may also involve limiting access to some activities or products. Some ways to increase access:
These types of actions are perhaps among the most commonly used in a strategy to enhance access. They can stand alone, or be used in combination with others to fill out a larger strategic plan. 3. Extending opportunities for the poor.Many of the specific actions here might be the same as those for enhancing access, but there are some that aim more closely at this target. Some examples:
These tactics, coupled with those aimed at enhancing access in general, can be particularly useful in an anti-poverty initiative. 4. Increasing access for people with physical disabilities.It may seem that this kind of access is merely a matter of making some specific changes in physical facilities. The Americans with Disabilities Act (ADA) provides guidelines for those physical changes. In fact, there’s more to it than that. The physical changes are really all-encompassing, if they’re to be done right, and there are other changes involved as well. Some of those changes include:
The Americans with Disabilities Act requires any facility or organization that receives public money to either make itself physically and otherwise accessible, or to make “reasonable accommodations.” This phrase is open to interpretation, but generally means that such facilities and organizations have to make a good-faith effort, within the limits of financial reality, to ensure that people with disabilities receive the same level of service or the same opportunities as those without disabilities. ADA can be used to bring suit in cases where negotiation fails.
5. Using outreach to increase accessThe term “outreach” covers a lot of ground. It can mean anything from putting information where you hope people will see it to delivering services directly to them in their homes or on the street. The key here is that, in order to use a service, people have to first know it exists, be willing to use it, and be able to use it (i.e., have access to it). Outreach can be used to address any or all of these necessities. An outreach plan is therefore crucial to the use of the other tactics discussed here.
In SummaryFor an intervention or initiative to have an impact, people have to participate in it. The same is true for community amenities – libraries, cultural facilities, hiking trails, etc. – information, and institutions. Healthy products and practices have to be used if they’re to have a positive impact on the lives of individuals or the community. In all these instances, the important issue is access: the ease with which people can gain it, the barriers that keep them from it, and the opportunities provided for them to take advantage of it. By addressing each of these – and understanding also the factors that lead people toward unhealthy or negative products, practices, and situations – you can enhance access and increase the likelihood of positive social change in your community. |