Presentation on theme: "Community-led Health and Wellbeing Improvement: rhetoric overload – I feel the need for a Babel fish!"— Presentation transcript:
Community-led Health and Wellbeing Improvement: rhetoric overload – I feel the need for a Babel fish!
Iceland and Greece The IMF fiscal multiplier had a value of about 0.5 for all countries, meaning that government spending would shrink the economy. Hence cutting budgets would boost growth. The IMF admitted in 2012 that it had underestimated the harms that austerity could cause especially to public health.
Rhetoric? ABCD Put empowerment of individuals and communities and reducing social isolation at the heart of action on health inequalities Pay attention to the importance of stress and mental health in shaping physical health and life chances Pay attention to the importance of personal and community resilience, people’s ability to control their lives and levels of social support Concentrate on the ‘causes of causes’ – that is invest more in the material, social and psychosocial determinants of health Need for public bodies to be built around people and communities, and work together to achieve better outcomes for those that use services There is substantial evidence that despite the intent of policy, practice frequently has lagged behind participatory rhetoric
Language used is critical Care services should map around the individual and community assets Informal, community capacity building and asset based approaches An outcomes based joint performance framework Mutually supportive four sector engagement Proportionate universalism
Policies and Decision making Government task forces on health inequalities (2008, 2013, 2015) reviews and annual reports Better partnership working is needed to reduce health inequalities. To date there is limited evidence that strategies and interventions aimed at reducing health inequalities have made a significant impact”. Audit Scotland, 2012 The most disadvantaged people with the most complex problems and the fewest resources, also face significant barriers in accessing services. Health and Sport Committee, 2015 Reducing health inequalities should be at the heart of the Scottish Government’s drive for social justice ….and….. “Comfortable myths” about poverty
Complacency?: The epidemics Mental health Obesity Loneliness/lack of company Substance misuse Hidden!
What about the ‘How?’ Project models and social capital models Social models and medical models Deficit approach and asset approach Social cohesion and social capital “Little evidence that £500m funds to tackle inequality worked” (Government Committee Jan 2015) “Equally Well” …learning from test sites has, so far achieved a limited amount” (Audit Scotland June 2013)
Medical and Social Models of Health – the imbalance While the NHS functions broadly as a “fix-me” service for delivering one –off medical remedies for defined conditions, it has far more difficulty dealing with the more diffuse, often only partly medical ‘help-me’’ problems that the troublesome cases were either partially or exclusively presenting with….Meeting ‘help-me’ demand requires skills and aptitudes that don’t necessarily coincide with traditional professional boundaries. While technical and clinical competence remained important in meeting ‘fix-me’ demands, it was paying attention to the social needs that made the biggest impact on better outcomes for both the individuals and the system as a whole. That puts a premium on interpersonal, organisational and problem-solving skills as the key attributes needed for understanding and helping people to rebalance their lives. (‘Locality’ report 2014)
Community-led Health Improvement Governance Implementing a community led approach to improving health and wellbeing involves enabling disadvantaged communities to become involved as key stakeholders in the process of changing their own situation and supporting external agencies to work with communities and respond to a community-led agenda Processes involved: – Engaging communities – Supporting the capacity of communities to respond to their own issues/priorities – Supporting the capacity of agencies to collaborate with each other and communities in order to respond to community need
Healthy n Happy Community Development Trust Community led An ‘anchor’ organisation- why it works! Flexible and responsive Finance and sustainability Social enterprise Research and development
Community-led Approaches to Improving Health and Wellbeing “The challenge we face, in its simplest form is how we make developing and supporting community-led solutions a part of mainstream business rather than an occasional project, add- on or experimental programme. This will present challenges including for example shifting resources, challenging the pattern of service delivery and potentially reassessing professional roles and responsibilities.” (‘Building a Sustainable Future’, Scottish Government, 2011)
Worth a Read (A good investment of time) “Understanding a Community led Approach to Health Improvement” SCDC, 2008 “A glass half full: how an asset approach can improve community health and wellbeing” Improvement and Development Agency, 2010 “The lies we tell ourselves : ending comfortable myths about poverty” Report by 4 Churches, 2013 “Saving money by doing the right thing” Locality and Vanguard, 2014 “The Body Economic”, David Stuckler and Sanjay Basu, Penguin 2013