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11 January 2006

Health hazards

Community participation is a good thing. Correct? Not when it burns out the participants, says Carolyn Kagan

Is community activism bad for your health? Everyone agrees regeneration projects benefit when local people get involved; not many have stopped to ask how such involvement affects the participants.

In an ideal world, people who take an active part in their communities gain confidence and pride from what they do. Everyone wins as the neighbourhood improves and the activists increase their sense of satisfaction from a job well done.

But research published today by RENEW Northwest suggests that far from being a source of wellbeing, participation can actually increase stress. It tells of community activists working under unrelenting pressure: isolated, without supervision, coping with local conflict, without time off - and without pay.

By definition, these activists are themselves already under considerable stress from the constant grind of life in an area of deprivation. Their community involvement then often results in them giving hours of emotional support to other group members, who may have been struggling all their lives with poor facilities and living conditions, and sometimes addictions, abuse and even violence.

On the one hand, local people may see the activists as the problem solvers of the community; on the other, their links with the authorities can provoke suspicion or even hostility. One woman interviewed for this research was working with the police to tackle drunk and disorderly behaviour. She had her windows broken. Another had ‘grass’ daubed on the side of her house (see panel).

The constant hassles and stress can produce burnout similar to that which is well recognised among highly paid executives.

This research suggests two ways to counter such a threat. To start with, it is vital that everyone who gets involved has the information and support they need to make the experience enjoyable and not exhausting, fulfilling and not frustrating. Too often, activists fail to get the access to power and resources they need.

Second, it is crucial to recognise that there are different approaches to and degrees of participation. Formal participation, such as consulting residents about a regeneration project, is a top-down system that can often result in local needs being defined by the professionals, with little ‘ownership’ by residents.

Informal participation - a local campaign to save a hospital or parents setting up an after-school club, for example - works from the bottom up. It emerges from the people and is not initiated by a professional or an authority.

General participation, such as getting to know the neighbours or attending a local cultural event, is a third type, more low key than the other two but still likely to improve social cohesion and wellbeing.

In any project it is vital for everyone - organisers and participants - to be clear about what kind of participation they are looking for; and to ensure that adequate support and resources are in place for the members of the community actively involved.

Participation and wellbeing

Participation by local people is the cornerstone of social regeneration policies and practices. Government policies view community engagement as critical to the success of social inclusion, urban renaissance and improving service delivery.

But participation is not necessarily good for the people who take part. Plenty of research has been done on the physical, environmental and economic benefits of regeneration; little attention has been paid to the psychological aspects.

The term ‘wellbeing’ refers to health in its broadest sense: physical, emotional and psychological. It also includes the development of identity, attainment of personal goals, pursuit of spiritual meaning, prevention of maladaptive behaviours, development of skills, and social support. Wellbeing is closely linked to quality of life and to having control over events in one’s life.

There is plenty of evidence that people who live in poverty experience poorer health and are likely to die earlier than other people. Similarly, there is widespread recognition that wellbeing is affected by many factors, even if individual behaviour is nearly always blamed more than anything else for poor health.

But wellbeing is not simply related to absolute poverty. Income distribution is the most important factor. The greater the gap between rich and poor, the worse the health of those at the bottom of the social hierarchy.

Such stress can have physical effects, such as a weak immune system, slow physical growth and low height. It also has important psychological consequences that then contribute to poor health behaviours.

This is very similar to what is known as burnout. People living in areas of deprivation with little in the way of community activity live at constant risk of exhaustion from the daily grind, hopelessness and despair. They are prone to ill health, accidents and relationship breakdown.

Participation and positive wellbeing

At the very least, participation in community life helps prevent social isolation. Participation in collective action may even lead to increased social support, which in turn acts as a buffer against the damaging effects of stress.

This looks like a straightforward link between participation and increased wellbeing. However, we need to look at different forms of participation.

In his book Participation: the new tyranny, Bill Cooke argues that there is a difference between ‘participation as a means’ and ‘participation as an end’ in social development. Referring to formal participation, such as consultation processes in regeneration, he argues that participation as a means builds a sense of commitment and improves service delivery.

Participation as an end, however, increases local people’s control over development activities that had previously excluded them.

There are two other main types of participation in the UK. As well as formal participation by invitation from above, there is informal, bottom-up participation. Residents’ groups that emerge to deal with specific local problems - such as campaigns to preserve local health services - are an example.

There is also general participation in community life. According to the latest census, many more people in the UK are involved in a low key way, on a one to one basis with others, than are in organised community groups.

Top down participation is only ever likely to involve relatively few people, although those who are involved may well gain better knowledge, understanding and possibly control over decision-making. The prolonged involvement of a few may also lead to different kinds of involvement by many more.

Participation may also lead to increased confidence and skills. These gains are particularly important for young people, and there is some evidence that involving young people in regeneration projects also helps divert them from antisocial behaviour (see case study).

However, some of the studies that are emerging into the effects of regeneration on mental health and wellbeing are not encouraging.

It seems that participation-consultation and involvement that is based on external requirements to involve local people will often proceed too rapidly, missing the preliminary stages of listening to local people, or failing to build in ways for people to discuss and develop their own awareness and ideas.1

The result is that local needs are defined by the professionals and regeneration workers, who often live outside the area and have labelled a particular neighbourhood as lacking in some way. Local people - who know about invisible strengths, networks and economic activity - may well take a different view.

Other studies that have looked at changes in mental health and wellbeing more generally are also discouraging. General participation, such as contact with neighbours or going to a local event, tends to reduce stress, largely because of the social contacts and physical activity involved. It may also improve social cohesion and general wellbeing, but it is unlikely to have a direct impact on people’s living conditions.

Bottom-up participation and collective action are likely to have the greatest impact on wellbeing and the highest potential for changing the material circumstances of life. This type of participation does several things.

First, the group’s critical awareness is developed. Second, members of the group renegotiate their collective social identity and views of the world, sharing information and understanding in a way that increases the likelihood of adopting more healthy behaviours.

Finally, people’s confidence and ability to take control of their lives is reinforced, particularly in relation to their health. People are empowered to make changes to their lives.

Participation as a threat to wellbeing

In practice, however, bottom-up, active participation and collective action is exhausting. It takes time, energy and perseverance. Not everyone who opts to take part is strong and resilient. They may have been struggling with hardship all their lives.

Community leaders and other activists are under relentless pressure. They have no supervision, despite working in complex human systems, often with people with extensive personal difficulties. They have no colleagues to share the load when the going gets tough, no working hours, time off or holidays, no development activities built into the role. And they do not get paid.

People who take an active part often get satisfaction, a feeling of wellbeing and pride in what they do. Their community involvement ‘fills their lives’ and they cannot imagine any other way of living. However, they often struggle to get the information and resources to support their work.

When they liaise with professionals, they may be treated with suspicion, and sometimes with what they consider intimidation. Other community members sometimes view their involvement with distrust, sometimes with hostility, but at other times with gratitude and praise. Community activists are seen simultaneously as the problem solvers of the community, and as part of the authorities.

There is extensive media coverage of how some people’s lives are destroyed by antisocial behaviour, crime and vandalism. Community activists are affected by these things too; their wellbeing also suffers. Yet many of the battles they have are with professionals and agencies.

Imagine how the pressure on activists increases when authorities encourage the formation of residents’ groups and then ask those same groups to identify problems, collect ‘evidence’ against their neighbours - and take action too (see panel).

Friendships have been fractured amid misunderstanding about who says what to whom, and some people have found little time for their families because they are so busy.

We know about the effects of emotional labour (being ‘nice’, pleasant and supportive all the time), stress and burnout on highly paid executives. Far less is known about the emotional labour, stress and burnout in community participation.

To reduce the danger of burnout, and to improve wellbeing, top down and bottom up participation in regeneration must be supported through information and hard resources. Professional attitudes must change: there must be more openness and social support. Every effort must be made not to overload particular community activists and to ensure people’s energies and enthusiasms are renewed.

Supporting participation

As we consider how to encourage participation for wellbeing, we need to take a closer look at the participative process. This will help us clarify what effect on wellbeing we would expect from it, and reflect carefully to see if this has been achieved.

In our work, we have found it useful to think of participatory work along two dimensions of participation (proactive and passive) and commitment (high to low).

We can then map different activities and degrees of involvement along these dimensions, as in Fig 1. Here we can position the types of participation required by policy as well as participation roles in practice.

Community activists, who identify their own needs and set their own agendas and often find their own strategies for achieving change, are in the proactive participation, high commitment quadrant. Community members and representatives who work in partnership with agencies on policy agendas can also be placed in this quadrant.

Self-appointed community representatives who get co-opted into processes with agendas set by professionals could be situated in the proactive participation, low commitment quadrant. Professionals who are committed to working on community issues but who work weekdays only and go home at night can also be placed in this quadrant.

This mapping of participation and commitment can be useful for exploring movement over time, and for identifying those most at risk of stress, disaffection or burnout.

We might need to rethink how we encourage and identify formal and informal participation. We may need to target resources on more intangible social outcomes.

We need to put the emphasis back on people, not traffic; on the use of public and open spaces, not just buildings; on social contact, not just consumption; on celebration, not just despair; on the generation of art and entertainment, not just the passive receipt of the mass media.

Perhaps we should make wellbeing the top priority for public services and private enterprises. It affects us all.


Participation can improve quality of life and wellbeing for people who live in areas of deprivation. But we must not lose sight of a number of lessons.

In any project it is vital for everyone - organisers and participants - to be clear about what kind of participation they are looking for; and to ensure adequate support and resources are in place for members of the community who are actively involved.

It is one thing to understand participation and its effect on wellbeing in theory. It may be another to understand the reality. Only when professionals undergo the procedures they create for others will they understand how it feels to be a participant.

Everyone who expects others to participate should themselves participate in their own home and work communities.

1 Diamond, J. (2004). Local regeneration initiatives and capacity building: Whose ‘capacity’ and ‘building’ for what? Community Development Journal, 39(2), 177-189

Carolyn Kagan is professor of community social psychology and director of the Research Institute for Health and Social Change at Manchester Metropolitan University:

A full summary of her research on participation and wellbeing is published today by RENEW Northwest, the regeneration centre of excellence for northwest England, and has been distributed with copies of New Start in the region. For further information see

Case study: Youth Works, Colne, Lancashire

Youth Works is a national partnership that helps ‘at risk’ young people between the ages of eight and 25 play a creative role in regeneration in their communities and in creating safer environments.

A partnership between Lancashire County Council and Groundwork East Lancashire worked with young people to plan a range of activities and facilities on a local estate. It had considerable success in reducing youth crime and antisocial behaviour, and many of the young people involved have also managed to find jobs or training places.

The key to the success of the project was the participation of young people in all the activities.


Participants under pressure

Two activists who are working closely with the police to resolve problems of drunk and disorderly youths pass people in the street who hiss at them ‘grass’. One then has her windows broken and two months later the other has ‘grass’ daubed on the side of her house.

Another community activist has worked hard to involve a group of local people, including children, in campaigning for a clean environment. One day she shows an environmental officer round the area and points out all the problems.

He keeps asking her to report them to the one stop shop - which he manages. ‘Do you think I have nothing to do but sit on the telephone all day doing your job for you?’ she retorts. ‘You have seen the problems - why don’t you report it?’

Another community activist was asked to report incidents perpetrated by a ‘neighbour from hell’ to the housing agency. She ran up a considerable debt on her phone and got no help with paying the bill. What made it worse was that the housing agency did nothing with all the information she supplied.

Source: Kagan, C., Castile, S., & Stewart, A. (2005). Participation: Are some more equal than others? Clinical Psychology, No.153, 30-34.

Beating burnout: key points

  • Participation can overburden some people, causing stress and burnout, and the very skills, knowledge and energies essential for meaningful regeneration might be lost

  • Participation - both as a form of consultation and as a grassroots movement - needs to be supported if the pressure on some community members is to be relieved

  • Cultural enrichment that offers short term and varied opportunities for participation can contribute to wellbeing, but the converse is also true, where unrealistic expectations or unsympathetic behaviour by professionals or organisations creates problems

  • There is a need for more research and, based on the evidence we already have, a much wider dialogue about the positive and negative effects of participation on wellbeing if we are to ensure positive, effective and sustainable regeneration practice in the future.

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