Knocking on the door to the future of health

I have written previously about the importance of focusing on what matters to individuals rather than institutions. Drawing on public insight work funded by the Charity, we know that people living in Lambeth and Southwark see health as more than just avoiding illness. They have a broad view of health which includes a desire to live a fulfilling life, one that is financially secure with nourishing relationships.

Following that work, we are now exploring whether enabling individuals and communities to improve their wellbeing could have a radical impact on people’s health. We want to know what has worked well as well as what are the pitfalls to avoid, so we’ve asked Pritpal S Tamber to lead a review of available evidence. Pritpal is the founder of the Creating Health Collaborative and so, as part of the review, he suggested that the Charity host a meeting under the banner of the Collaborative.

Facing the challenges

In half a day we could only scratch the surface of how to support true community-defined health. It was clear that everyone* saw a huge opportunity to improve lives, but important challenges began to emerge.

One was the issue of language. This is an area of work that is fraught with confusion over terminology – some people talk about “health”, others “wellbeing” or “life satisfaction”. This inhibits discussion on what the real value of community-defined approaches is. There was a sense in the room that everyone instinctively understands that this work has value, but that there is often a struggle to make it resonate with statutory and other funders. Indeed, CCGs and other commissioners often have metrics and targets which seem at odds with those things that are most important to communities.

This links to a second challenge, evaluation. It is difficult to evaluate a concept that is not well articulated. Often we try to apply methods that have been developed for medicine and which assume causal, linear relationships that can be teased out. However, health beyond the framework of medicine is complex and such clear causal relationships do not exist. We need to look for the patterns and correlations that can guide us in understanding what works and how that can be replicated and scaled, but there was no consensus that the right tools yet exist to do this well.

Another big challenge identified was the bottom up revolution versus top down evolution. We had a heartfelt debate on whether it was appropriate to include existing statutory organisations in creating health at a community level. Many felt that including such organisations meant that any community voice, and so prospect of real change, was crowded out; others argued that without introducing them, at the appropriate time, any change would be unsustainable as no ongoing funding would be forthcoming.

Keeping grounded

Among the challenges there was one area of clear agreement: the importance of going to the community to understand their priorities. This shouldn’t be about expecting people to attend a "consultation” event. Organisations need to get out of their buildings (“There is no substitute for door knocking!” ). An important reminder of how community-defined efforts to improve health must stay grounded or they will miss the point, and the opportunity.

The rich discussion will feed into our commissioned report on the evidence for the impact of enabling communities and individuals to improving health, and will inform the Charity’s thinking on what role we might play in this important agenda. I look forward to sharing more in early 2016.

* The first UK-based meeting involved individuals from Big Local, Bristol Health Partners, Citizens UK, The Company of Community organisers, Connecting Communities, Guy’s and St Thomas’ Charity, The Health Equalities Group, Lankelly Chase, The Living Well Network, NHS England, Pembroke House, The RSA, Well Communities, Well North, Timebanking UK, University of Exeter, and Wandsworth Community Empowerment Network.