Barbara Reichwein, Programme Director, Guy's and St Thomas' Charity
Feb 25, 2020
In November 2008 Professor Sir Michael Marmot led a review exposing the stark health inequalities in England at the time. Published in 2010, the Fair Society Healthy Lives report demonstrated that health was strongly correlated with social and economic status, and the lower this status was, the poorer a person’s health was likely to be.
Marking the anniversary of the report, Health Equity in England: The Marmot Review 10 Years On shows how little we have progressed at a national scale on reducing inequality. It also gives an even stronger impetus to persist with work that demonstrates how the upstream drivers of health inequality can be tackled.
At the Charity, we are identifying ways to do this, taking a long-term view on particularly complex urban health issues.
In our place, people develop their first long-term condition in their early thirties, followed by their second in their mid-forties. When the cards are stacked against you in multiple ways, for example, if you live on a low income and in a poor neighbourhood, chances are you will spend more years in ill-health.
The first thing to do in learning how to address this is to listen to people. Our joint ethnographic report with the national Taskforce on Multiple Conditions, “Just one thing after another”: Living with multiple conditions demonstrates that ways to protect the health of people with long-term conditions are often hidden in plain sight – and can be found in people’s homes, money, work and neighbourhoods.
As part of our multiple long-term conditions programme, people from our place in south London are currently teaching us about the relationship between their money and health and the key moments that impact their journey into, and out of, ill-health.
We have the privilege and freedom of working with partner organisations as diverse as the people within our boroughs. We have learnt that the list of organisations that work to tackle wider determinants of health is too narrow today, and we are actively broadening that circle. We support community organisations, GPs and CEOs to contribute to healthy environments. To improve health, there isn’t a sector we don’t engage with, and we hope more partners will join us to think outside the box.
For example, we are convening employers in inner-city London to reflect on their role in promoting the health of their employees, and how responsible supply chains and meaningful local jobs that are flexible to the needs of people with long-term conditions can directly improve health.
We are setting up Neighbourhood Schemes as a key element of our multiple long-term conditions programme, working at a small geographic scale with places of 10,000 to 30,000 residents to gain a deeper understanding of how we can support good health. Our Neighbourhood Schemes focus on driving change by testing whole-system solutions to health challenges facing the local communities.
One of the first projects to emerge from the Walworth Neighbourhood Scheme has been a new physical place to test a blended model of ‘meaningful connections’ supporting people at risk of rapid progression to multiple long-term conditions and the wider population through clinical and non-clinical approaches. When the doors of the new Walworth Living Room opened, our partners at Pembroke House, a Southwark-based settlement and social action organisation, began organising a space around people and health, hosting colleagues from integrated health and social care provision and strengthening the local community’s networks. Together, we are now inviting other partners into the same neighbourhood to combine forces.
Similarly, we are testing a model of social prescribing that is preventative, targeted at working-age adults at risk of progression to multiple long-term conditions and specifically addressing inequalities. We also see potential in the novel way to support self-management through Wakey, a new breakfast show delivered on mobile phones to entertain and offer evidence-based mental health support. Ultimately, we see a kaleidoscope of ways emerging to tweak a place to be healthier for us.
In sum, we take courage from Marmot, because health inequalities are not inevitable. The quest to shrink the unknowns in social determinants is a worthy one and we are only just getting started. We will share what we learn along the way. People, partners and places will be our compass in reducing inequalities in one of the most vibrant, diverse and urban places in the world. We hope you will learn with us and are confident you’ll discover many parallels to other places. To keep up to date with our work on addressing the social determinants of health, sign up for our newsletter.
Programme Director: Barbara Reichwein
23 April, 2020
As a funder, our priority is to support our partners and the communities most affected by COVID-19. Our Portfolio Director, Louise Mousseau, sets out the actions we've taken to date and how we're adapting our work in response to a changing environment.