Community involvement at what cost? - local appraisal of a pan-European nutrition promotion programme in low-income neighbourhoods

In the UK, government has committed itself to improving health and reducing inequalities in health. For the first time, issues such as food poverty wi ll be addressed by tackling the causes of poverty and wider determinants of ill health. The time has never been better, therefore, for health and loca l authorities to work collaboratively to promote and improve health. Commun ity involvement is also paramount to sustainable programmes. However, such a dramatic shift in policy and greater emphasis on public health requires h ealth professionals themselves to adopt a different approach. The World Hea lth Organization (WHO) recommends a health promotion approach as a framewor k for action. But despite the existence of this framework there is little e vidence that a wider understanding of health promotion and the necessary pr actical experience has been achieved. This hasweakened the potential impact of health promotion and has possibly encouraged inappropriate use of healt h promotion principles in practice. The European Food and Shopping Research Project (SUPER project) was established render the WHO European network of Healthy Cities to help local projects implement the principles of health p romotion (WHO, 1986). This paper describes the SUPER project and its implem entation in Liverpool (1989-1997), where levels of unemployment, deprivatio n and ill health are amongst the highest in the UK. Participation in SUPER is appraised to identify the various benefits and obstacles involved and to identify links with progress at the local level. This appraisal is discuss ed and the use, and potential misuse, of participatory appraisal techniques to elicit information and mobilize communities is examined.