Assets-based public health

Responding to the Policy and Practice challenges

Michael Shepherd

http://www.msresearch.co.uk/resources/Assets%20report.pdf

“A review of the evidence on health inequities and community cohesion with recommendations for strengthening the health assets approach.”

Dr Michael Shepherd, April 2012

health - a ‘resource for everyday life’ ~(Nutbeam) and nested within complex systems…the individual, the social or interpersonal, the environmental and policy

A social-ecological model of health

Complex systems – how health is linked to society and environment

Environment

Society

Economy

Composed of many component parts; Difficult to define – to find boundaries; Relationships between elements are not linear

and are often unpredictable; Elements and systems learn and change; Dynamic, constantly adapting; Systems may be nested and/or inter-related; The impact of change in one system can have

unpredictable and unexpected change in related systems;

What are complex systems like?

Relative contributions of determinants of health

Tarlov, A.R., Public Policy Frameworks for Improving Population Health. Annals of the New York Academy of Sciences, 1999. 896 (SOCIOECONOMIC STATUS AND HEALTH IN INDUSTRIAL NATIONS: SOCIAL, PSYCHOLOGICAL, AND BIOLOGICAL PATHWAYS): p. 281-293.

Building healthy public policy Creating supportive environments for health Strengthening community action for health Developing personal skills, and Re-orienting health services

Ottawa Charter – priorities for action

Wealth and Wellbeing

“The Gross National Product counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage. It counts special locks for our doors and the jails for the people who break them… It counts the destruction of the redwood and the loss of our natural wonder in chaotic sprawl… Yet the gross national productdoes not allow for the health of our children, the quality of their education, or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials… it measures everything, in short, except that which makes life worthwhile.”

Bobby Kennedy 1968

Five ways ToWellbeingSource: new economics foundation

…increasing inequalities have complex causes including increased social and economic inequality, deindustrialisation and a breakdown of community structures resulting from (neoliberal) UK Government policies in the 1980s (McCartney et al 2011, Elliott et al, 2011)

“the closure of the pits and steelworks represented not only a decline in the local economy, but a cultural crisis… social networks were grounded in the workplace and trade unions… there remains a deep sense of loss in communities that had relied on these industries for their existence” (Shepherd, 2010)

“what we have tried to date (although well meaning) has not worked”

Harry Burns , Chief Medical Officer, Scotland

Health inequalities

A wicked issue is one imperfectly understood, to which solutions are not clear or simple. It signifies an intractable problem (eg. climate change, drug misuse, inequalities).

Addressing wicked issues needs concerted action across organisations and authorities, and at many levels.

‘Wicked issues…’

Holistic (not partial or linear) thinking; A capacity to think and work across organizational boundaries; Ways of involving the public in developing solutions; A willingness to think and work in completely new ways. Willingness to entertain the unconventional and pursue the

radical.

This implies: A new style of governing for a learning society.

Clarke & Stewart (1997) Handling the wicked issues. A challenge for government. Birmingham: INLOGOV

How can we work together to tackle ‘wicked issues’ like inequalities in health?

Health is not an end in itself, but a resource for everyday life;

Health and wellbeing are the result of multiple factors and the interaction of complex systems mostly outside of health service policy;

Improving health needs collaboration between citizens and with organizations from the statutory, voluntary and private sectors;

It needs to involve different levels of government; We get the best results when people (and organisations)

work together well.

Routes to health improvement and equality in health

Strengthening individuals; Strengthening communities; Improving working and living conditions; Macro-economic change.

Whitehead, M., 2007. A typology of actions to tackle social inequalities in health. J Epidemiol Community Health 61, 473–478.

How do you address inequalities?

Deficit and Assets-based approaches

Source: International futures forum/Glasgow Centre for Population Health

Salutogenic umbrella

“with the salutogenic model, the concern is with full and active adaptation to environments that are plagued by stress. To adapt, people look for those inputs from the social… and physical environments… as well as from their own personal reserves…”

D. Korotkov, 1998 The sense of coherence: Making Sense of Chaos, in: Wong, P. Fry, P. (eds) The Human Quest for Meaning: a Handbook of Psychological Research and Clinical Applications, Personality and Clinical Psychology Series. Routledge, pp. 51–70.

“If we had a garden, the kids wouldn’t always be under my feet, they wouldn’t get smacked so much and then I wouldn’t feel guilty and get depressed like I do”

Bristol & Weston HA Public Health Report 1990

“Twenty-five years ago, there was nothing to do… twenty-five years on and there’s still nothing to do…”

Bristol & Weston HA Public Health Report 1990

“I gets a bit frustrated… they just seem to discuss the same things over and over again… this last time, I got really fed up and let them have it – they just never get on with it and do things.”

MS - PhD (2005)

We live there… we should know!

Words into ActionCheck these out…

http://www.youtube.com/watch?feature=player_embedded&v=7BFSK-kMzfE

Ashton Allotment ActionIt hasn’t been for nothing… if they kick us off of here, they will have to kick us off Of somewhere else… Inspired by ‘the Diggers’, AAA has taken possession of disused land to plant vegetables… You tube report from ‘The One Show’

People Powered Health (NESTA)Based on the notion of co-production which begins from the question “how do you want to live your life?” rather than “what services do you need?” The underlying principle of co–production is that wellbeing is greater when people are involved in equal and reciprocal relationships with professionals and others, working together to get things done. So by recognising that people have existing capabilities, not just needs; incorporates ideas of mutuality and reciprocity in public services, including peer support networks; and blurs distinctions between professionals and users with professionals cast as facilitators of care.http://www.nesta.org.uk/library/documents/PPHsystempaper.pdf

Knowle West Health Park – ‘process, partnership and power’A new Health Centre and Healthy Living Centre designed in collaboration with local people drawing on local knowledge and strengths. Community involvement facilitated through community workers and direct contact with planners and architects. ‘Taking off the suit’… ‘No big office downtown’ … ‘spreading out the plans on my living room floor’.http://onlinelibrary.wiley.com/doi/10.1111/j.1369-7625.2006.00364.x/abstract;jsessionid=752C6D5D7B05484C61DD88A9B915B206.d01t01

Words into ActionCheck these out

Re-spoke Cycles/Gorbals Recycles Recycles, repairs and maintains bikes for adults and children. It is a social enterprise staffed by volunteers who are trained in cycle repair and maintenance. Almost 500 bikes recycled in 2010. Gorbals Recycles also runs other social enterprises in the area. ‘More than just a job’… ‘gives me a real boost’.http://www.gorbalsrecycles.co.uk/about.html

One approach to Public Health

Another approach to public health

health - a ‘resource for everyday life’ ~(Nutbeam) and nested within complex systems…the individual, the social or interpersonal, the environmental and policy

A social-ecological model of health

Focus on the inner levels in conventional public health – especially individual behaviour

Focus on system change in salutogenesis and assets inspired strategies