Building Healthy Towns and Regions

The other week, I was phoned by a BBC producer to ask if I would take part in a discussion on the Victoria Derbyshire show about how we can build healthy towns. It’s partly due to the work we’re doing here in Morecambe Bay with our communities around being more healthy and well, especially working with schools. Unfortunately, I was away on holiday and missed the call and so didn’t get on the show! But it did get me old grey cells thinking about this whole idea. Here at Lancaster University, we have the Health Innovation Campus, which is helping to design a new ‘healthy town’ in Lancashire. The “Imagination Team” are also hosting a conference this week called “Does Design Care?” But what do we mean by a healthy town and what ingredients might we need to see in our cities in order to say that they are, or are becoming “healthy”?

 

We must get beyond thinking that a healthy town is simply one where there is clean air to breathe and everyone is out jogging, smiling at each other and eating quinoa salads for lunch – it’s all a bit middle class! I would like to make some fairly radical suggestions of what it might mean for a town to be truly healthy, especially having been so inspired by the amazing ‘Doughnut Economics’ by Kate Raworth. I think if we don’t have a vision for what we want our future towns, cities and regions to be like in 50 years, we will not build them! I am often told that you cannot eat an elephant in one go, and we must focus on the small things we can do – eating it one bit at a time – true enough, but we need to hold both things in tension. We need a vision big enough to inspire us to change and then we need to pick up the knives and forks and begin the process of eating it!

 

So, what might healthy towns of the future be like?

In healthy towns:

There are no homeless, not because of social cleansing, but because everyone has a home in which to live.

Design cares enough to ensure that spaces are built which encourage communities to spend time with each other, connecting and collaborating, breaking down isolation and loneliness and facilitating new political space.

There is a creative commons, with plenty of space that belongs to all.

The economy of the town/region is designed to ensure that resources (including land) are redistributed, breaking cycles of poverty and enabling all to flourish. This increases the happiness and health of all and allows a society in which the wellbeing of all matters to all.

The economy of the town/region is designed to ensure regeneration, thus taking care of the environment for future generations. Towns like this will not only be carbon neutral, they will in fact, as Kate Raworth says, become generous in their approach to humanity, other towns and the planet itself.

Children will be nurtured, as part of communities, not as fodder for the economic machine, educated as socially adaptable human beings, understanding their place within the ecosystem of which they are a part.

There will be a culture of positive peace, made possible through non-violence, in which architecture is used to enable communities to live well in the midst of and celebrate difference. Facilitation and mediation will be normative practices when relationships become strained or difficult and the lust for competition and war will be quelled.

There will be a culture of love, in which all are welcome and accepted for who they are. This does not encourage selfishness, nor does it mean that there is no challenge. In fact, love, at its best, is self-giving and others-empowering (Thomas Jay Oord).

There will be a culture of kindness, displayed through humility and respect.

There will be a culture of joy in which people know that they belong and are trusted.

Justice will be restorative, rather than retributive, something which does not negate the need for discipline, but hopes for a better future through grace.

Refugees are welcomed, cared for and also allowed to flourish.

Equality and diversity is celebrated as a norm.

Farming practices are kind to the land.

Business is changing it’s goal, becoming agnostic about growth, but obsessed with how it plays it’s part in improving the wellbeing of all through regeneration, redistribution, repair, reuse, refurbishment, recycling and restoration.

People are valued in their work place and the workplace is a healthy place to be in.

Physical activity and healthy eating are a normal part of every day life. (Thought I’d better add that one in!).

Wherever possible, people die well, surrounded by community who love them.

 

Wouldn’t you love to live in a happy, healthy, wholesome town?! It’s not beyond our grasp. We simply need to adapt the ones we have and build the ones we want! Building together a future that is good for all. Which bit shall we eat first?!

 

 

 

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We Have a Power Problem!

NHS – we have a problem! This blog forms a hiatus in the middle of a 4 blog mini-series about what I call the four rings of leadership (in the context of healthcare). I have been musing on some statements made at the IHI conference in London, Quality 2017, and before I go any further, I want to take a pause to reflect on the notion of power. Helen Bevan says that the number one issue facing our health care system is the issue of power. I would suggest that unless we seriously reflect on power and how it manifests itself in our systems and in us as individuals, then we will never be able to co-create health and well-being in our society.

 

In my last blog, I mentioned an excellent talk that I heard Derek Feeley of IHI and Jason Leitch, the CMO of Scotland, give together about our need to “cede” power, if we are to build safe, high quality, economically sustainable health systems. They contend that we need to move from keeping power, to sharing power and then ceding power. To cede power, means to transfer/surrender/concede/allow or yield power to others. I do believe this is correct. I believe that true leadership is absolutely about being able to ’empty out’ positions or seats of power, so that all are empowered to effect positive change and build a society of positive peace. However, my contention is this: ceding power is not helpful unless we first deal with the very nature of power. Once we have dealt with its very substance can we truly cede it through our organisations and systems to bring increased well-being for all.

 

I have talked many times over the dinner table with my great friends Roger and Sue Mitchell about the nature of sovereignty and power. Sovereignty is a dominant theme within our political discourse at the moment, at a national and international level. It is worth reflecting that sovereignty (the right to self-govern) is utterly intertwined with our understanding of power, and we need to pull the two apart if we are ever to cede the kind of power that can transform the future. If we do not recognise (have a full awareness/deeply know) this, we will continue to inadvertently create hierarchical dominance and systems that become the antithesis of what they are created to be.

 

 

We see the issue of sovereign power at work every day in the NHS. We see it in terms of power edicts from on high, without understanding the local context or issues worked through in a relational way. We see it in the way these edicts are then outworked through leadership and management styles, which are very top-down and hierarchical in nature, eating up people like bread in the process – what Foucault calls “Biopower”. We see it in the way wards are managed and in the way GP surgeries are run. Sovereign power says “I’m in charge around here” and “we’re going to do things my way”. We see it in individuals who choose to practice autonomously without thinking about the wider implications on the system, prescribing however they would like to, without thinking about the cost implications. We see it in the attitude of some patients, when it becomes about “my rights” with an unbearable or unaffordable pressure put onto the system. If we multiply sovereign power, we simply end up with lots of  kings and queens who defend their own castle, creating more barriers, walls and division in the process. Sovereign power is defunct and dangerous and it is this which is currently destroying our ecosystems and wider society. The “I did it my way” approach is rooted in self preservation and ambition and does nothing to help us build health and well-being in society. Sovereign power stands in the way the very social movements we need to see, because Sovereign power is based on fear.

 

Sovereign power has its roots in certain streams of theology and philosophy which have in turn laid the foundation for a way of doing politics and economics based on the supremacy of the state and within that the individual. However, the damaging effects of this are seen on our environment and on community, with utterly staggering levels of inequality, injustice and damage to the world in which we live.

 

If we are to truly cede a power that is effectual in changing the world, then it is not enough to simply reconfigure (rearrange) it, or reconstitute it ( i.e. give it a new structure/share it). First of all, we must revoke it! In other words, we must look ‘Sovereign power’ straight in the eyes and reject it, cancelling it’s toxic effects on our own selves and on that of others. We must change our minds about it and embrace instead a wholly different kind of power. Sovereign power has not changed the world for the better so far, and I hold no hope of it doing so in the future. No, we don’t need Sovereign power and we certainly don’t want to cede it. Instead, we need kenotic power. Kenotic power is based in self-giving, others empowering love (Thomas Jay Oord). It empowers others, not to live like mini-dictators, but to also dance to a very different beat.

 

I used to play the card game bridge, with my Grandpa (he was an amazing man, who invented Fairy Liquid!). In bridge, to revoke something is to fail to follow suit, despite being able to do so. Kenotic power refuses to play the game of Sovereign power. It embraces an entirely different approach. And as many through the ages have found, this kind of power is truly costly, and can even cost you your career or life; but it is the only kind of power that truly changes the world for good. Jesus, Rosa Parks, Emmeline Pankhurst, Gandhi, MLK, Malala Yousafzai, Nelson Mandela, Florence Nightingale and Mother Theresa are just some, who have embraced this ‘self-giving, others empowering love-based power.’ This is the kind of power we need now. We need it in healthcare and in every other part of our society.

 

Kenotic power is vulnerable but it is not about being a door mat. It is like a beautiful martial art, in which we can say “I won’t fight you and you can’t knock me down, unless I let you” In other words, we lay down our rights and power freely, they are not taken from us by force. So, even when energetic attacks are launched against us, this kind of power allows us to move out of the way, allow the attack to pass through and then to come along side the person and help them see another point of view. Switching to this kind of power is far more creative, less combative and far more fruitful in creating a way ahead full of possibilities without the need for making enemies in the process. We must challenge the deep structural belief that our political and economic systems must be built on and can only be held together by Sovereign power. What if we developed systems based on love, trust, joy and kindness, aiming for the peace and wellbeing of all (including the environment?) – what might such a health system be like? It will take a social movement for us to get this shift, and as I wrote in my previous blog: You might call this a re-humanisation of our systems based on love, trust and the hope of a positive peace for all. But this social movement is not aiming for some kind of hippy experience in which we are all sat round camp fires, singing kum-ba-yah! This social movement is looking to cause our communities to flourish with a sense of health and wellbeing, to have a health and social care movement that is safe, sustainable, socially just and truly excellent, serving the needs of the wider community to grow stronger with individuals learning, growing and developing in their capacity to live well.

 

 

I agree wholeheartedly that the most important role of leaders is to cede their power, so that all can truly flourish, where there is a far greater sense of cooperative and collaborative agency within our (health) systems. But if we do not examine the nature of this power, we will only perpetuate our problems.

 
Martin Luther-King said these famous words – they are seriously worthy of our reflection:

 

Power without love is reckless and abusive and love without power is sentimental and anaemic. Power at its best is love implementing justice, and justice at its best is power correcting everything that stands against love.”

 

 

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Time to Face the Music

Tweet We have yet to really face up to the crisis we are in. We keep on pretending that by making a few alterations here and some adjustments there to how we deliver health and social care, we might be able to save the NHS. But this simply isn’t true. Last weekend saw a crisis [Continue Reading …]