The Kings Fund and National Voices have recently launched an excellent helpful paper ‘People in Control of their own Health’ designed to provide a practical framework to help turn policy rhetoric into a reality.
At the launch event the following question was asked:
What one thing do you think needs to change to support people to take control of their own health?
My simple response to this question is:
To change the lens through which we view and try to improve health from ‘I’ to ‘We’
This response is based on my personal experience of living with type 1 diabetes, supported by experience of working in community development and research around citizenship, peer support and well-being.
A good starting place might be this powerful definition of health I discovered a few months ago through social media in a post written by an Australian GP and writer called Tim Senior
‘Health is not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole community in which an individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their community. It is a whole of life view and includes the cyclical concept of life-death-life.’
It is the Aboriginal definition of Health.
This is about having the opportunity to reach our full health potential no matter what health conditions or disease we may live with. It is also about recognising that our health depends not simply on clinical and medical care but on wider social determinants of health in particular our relationships and our community connections.
To bring this to life in our context, I have had a number of conversations with health care professionals in the last few months often in the context of diabetes around supporting self-management.
We have talked about some of the enabling resources from a more clinical perspective including training and support, equipment and digital technology, but we have also shared a belief that our relationships and networks including the very important human interaction between health care professionals and patients and our wider support network, the social capital in our lives are very important factors in our ability to take control of our health.
We know there is evidence of the impact of isolation and loneliness on our health generally. There is evidence to show that loneliness is worse for our health than smoking 15 cigarettes a day and has an impact on our immune system.
There is increasing evidence that support for self-management needs to be set in the context of social networks. A study published in June 2014 ‘Contribution of social networks to the health and self-management of patients with long term conditions’ showed that greater social involvement was significantly related to better self-management ability, better physical health or ability to cope with health conditions and greater emotional well-being.
So the idea of building a sense of community into supporting people to control their own health not only makes common sense but also has a growing evidence based behind it.
Important dimensions of ‘We’ not ‘I’ are the relationships between the health care professional and the individual, and the health system and citizens. As we are all aware this is delicate, tricky and complex because we are human beings. The place to start must be with shared purpose and responsibility, not paternalism and a lopsided power base but the co-production of solutions which are meaningful to us all. If we genuinely wish to support people to feel empowered and in control of their health, we must recognise that the person in the room is a whole person not a condition/set of conditions, e.g. ‘a diabetic’.
So here are some descriptions of people:
- A person who lives with Diabetes and Asthma and is a Patient Foundation Trust Governor
- A person who is a wife and mother of 2 primary school age children and a volunteer reading buddy at school.
- A person who has an MBA and is a CE of a social enterprise
This is not three people but one! When this person walks into the consulting room or surgery they bring all these different facets with them. Each patient or person comes with an individual set of circumstances and resources/assets and so does the health care professional, all of which may be useful but it can take time, trust and listening with intent to understand to effectively utilise all that we bring into the room.
The ‘We’ of community and peer support networks and the ‘We’ of the clinical/patient relationship are important factors of helping us to take control of our health.
Here are a few examples of existing and emerging related approaches and activities which help to build the ‘We’ into Wellbeing:
- Asset based community development and other strength based community development work – great work happening across the UK including the Nurture Development learning sites, Forever Manchester and Move More Sheffield.
- Emerging digital peer support and community network developments Neighbours Can Help, Casserole Club, We Love Life Diabetes
- Relationships Alliance and One Plus One emerging work on relational capability including the Mindful Working Tool
To complete this post a quote which sums it all up in one sentence…..
John Walsh recently wrote a very thought provoking post on his excellent ‘yes to life blog’ which articulates the value of each of us taking responsibility for building collaborative and connected communities.