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This chapter discusses the lessons that can be learned from the Sustainable Health Action Research Programme (SHARP) in Wales about the character of communities and strategies for engaging with communities. It considers community engagement as a continuing process, and one in which initial engagement and re-engagement offer particular challenges to both communities and to the SHARP partnerships. The chapter evaluates the extent to which communities engaged with the various SHARP projects and suggests that the experience of all the projects within SHARP is at odds with unitary conceptions of community and community leadership.

This chapter examines one particular way in which projects sought to engage communities in the action research process and discusses the role and experiences of community-based action researchers (CBARs). The analysis reveals that the Sustainable Health Action Research Programme (SHARP) projects which used the CBAR model found that it worked. The CBARs gave projects an entrée into communities and brought a very different perspective from that which would have been provided by traditional researchers. However, there are social risks and ethical issues in the CBAR model that need to be considered and properly addressed.

This chapter considers the nature of public policy and the ways in which health policy is made in Great Britain. It examines attempts to improve policy making and its effectiveness, particularly against a challenging agenda of revitalisation of welfare and public service. The chapter also evaluates how the Sustainable Health Action Research Programme (SHARP) could be established as both an action and a research programme against the emergence of health and health inequalities as public policy concerns. It contends that policy requires legitimacy other than governmental authority if it is to be carried through.

This chapter describes the evolution of the Sustainable Health Action Research Programme (SHARP) initiative for tackling health inequalities in Wales. It highlights the ways in which this differs from previous policy initiatives and explores the origins and rationale for SHARP as a contribution to policy implementation and development. The chapter discusses the seven projects that emerged from the selection process to be funded under SHARP.

This chapter examines the issues of social policy, sustainable communities, and social theory in relation to the 1998 White Paper Better Health – Better Wales. This White Paper addressed the issues that most directly affect the health of people in the Sustainable Health Action Research Programme (SHARP) areas and recognised the social causes of ill health. However, the paper only made indirect reference to social capital, and while it listed eight points directed towards supporting or changing the behaviour of individuals, only two were directed towards building resources in the community.

This chapter sums up the key findings of this study on the role of action research in addressing health inequalities in Wales. It explains that much of the evidence on social determinants of health indicates that the most important determinants are nothing to do with the institutional domain of health at all. The chapter commends the accomplishments of the Sustainable Health Action Research Programme (SHARP), which has systematically sought to add to the understanding of both the character of health inequalities and of the possibilities for taking intelligent local action to address them.