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Who Decides What Health Means ? (Part Two)

15 Feb 2018 - 10:08 by claire.tomkinson

So as usual, I’ve found myself frantically involved in a Twitter debate and am struggling to coordinate a response within the strict character limit, so this is the result…

Just to be clear, this is an updated version of a blog that I wrote a couple of years ago (hence the “Part Two”) but the thoughts are still relevant, and I have some stuff to add.

A couple of years ago I was running an activity at a large event in South Manchester to celebrate the launch of the hospital trusts Community Service Directorate. There was a huge variety of stalls ranging from health advice to support from local housing providers, and myself and a colleague were asking local people a very simple question. What makes us healthy and what keeps us well?

The answers overwhelmingly included the following: having a role to play, having a purpose, not feeling useless, having days out, seeing friends and family, being connected to local people, volunteering, gardening in the front garden so I can talk to neighbours and stroke their dogs, going to different groups and activities, and spending time with the grandkids.
The table was covered with Post-Its, but when we covered the responses and asked clinicians how they thought people had responded. Their answers included: losing weight, smoking less, reducing alcohol intake, eating more fruit and veg, and getting more exercise.

I’ve picked up on similar things while having conversations around the different views of recovery. People using services feel that medical professionals define recovery by them needing less medication and less hospital appointments, while they talk about their desire to walk to the hairdressers and back on their own “without getting out of puff” and aiming to be well enough to go on holiday later in the year.

My concern here is that communities and clinicians have two completely different views on what being healthy and keeping well means and these tend to conflict with each other rather than complement each other. How do we merge our thoughts about what creates good health, instead of just constantly trying to change behaviour that results in “bad health” and blaming people for their choices?

We know that 30 per cent of health is determined by clinical factors while 70 per cent is affected by social determinants. Yet how much time is spent making lists of all the problems, responding to health needs and fixing people’s medical conditions without thinking about the importance of being an active, valued and connected member of the community. We know that problems exist, but defining people by their skills, strengths and capabilities and building upon what already works well in communities will have a massive impact on people’s ability to support themselves and each other locally.

The social determinants of health really matter, but are our systems set up and willing to think about this as equally important as clinical and medical health interventions?

I talk a lot about the role of the voluntary, community and social enterprise sector, people using services and the wider community in the transformation of health and care. I’m pretty passionate about it, and I feel that we undervalue and miss the stuff that really makes a big difference here. I know that partnerships with primary care and building relationships across sectors is vital (this is such a big part of my job), but I don’t think that GP’s and the NHS have the answer to this alone (despite the number of jobs that are being created in the NHS with the aim of connecting with the VCSE sector- but that’s another blog coming soon)

If people associate good health with having a role to play, having a purpose, having a friend, being part of something, meeting new people and getting out of the house, we have to understand that the solution to this lies within the local community. Not just through social prescribing, by creating another new care pathway or by mapping community assets, but by community building and by connecting communities and recognising that good health isn’t just about having a service.

Prescribing anti-depressants and sleeping pills won’t solve anything if people still feel isolated and like they don’t have a purpose. If I’ve had a bad day I drink too much wine and eat too much chocolate, so how do we focus on what makes a good day?

Lovely NHS friends- you can’t do this on your own, and it’s OK to not have all the answers. Let’s do it together! Not as service providers and service receivers, but as equal partners with an equal contribution to make.

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