Who is Responsible for Your Health?

Who should take responsibility for you health? Sounds like a straightforward question, doesn’t it? But I get so frustrated when complex issues get squashed into simplified, silo-thinking, ready for twitter or media sound bites, or the under-girding of political ideologies.

So….just as the economy is not just made up of the interplay between business and the household, but is in fact far more rich and complex, so too the interplay of responsibility for our own health.

Kate Raworth, really helpfully uses the following diagram to help us rethink the components of the economy. I would like to suggest that we use it to think about health, also.

So…who is responsible for your health and wellbeing?

  1. Your Family/Household
  2. Society/The Commons
  3. The Market
  4. The State
  5. You

In some ways, I feel like all of these are obvious, in their own way, but I will just unpack each one a little bit more.

 

Your Family/Household

We all have needs. We need to know we are provided for (water, food, clothes etc), safe, loved, welcome, encouraged, disciplined and given place to dream and live those dream out. It is the role of our families or the household to which we belong to ensure those things happen as we grow. So much of our ill-health, our brokenness and our long term physical and psychological pain is because these basic needs were never met and left us without a sense of wholeness. The lack of met need, has a huge impact on the development of our personality and character. When we speak of ‘personality disorders’, each type has it’s roots in early life when needs were unmet and therefore parts of the personality remained undeveloped. Let’s face it – no family is perfect! And so, I would argue, that all of us have ‘disordered personalities’, and until we confront the shadow parts of ourselves that are trying to overcome this sense of loss or inadequacy, we continue to project an ego version of ourselves to those around us. We do so to cover over this pain, but facing it head on and allowing ourselves to fess up to our deepest needs, would actually lead to us being a great deal more healthy.

When I work with head teachers and ask them what the biggest need they have in their school, the answer is almost always ‘parenting classes’. However, there are very few providers of this available (due to cuts at a county council level) and the classes available are often very ‘middle class’ in their approach. We need to completely rethink parenting classes in the context of the poverty-truth commission and think about less twee ways to really engage with communities about how we raise happy and healthy kids. The truth that Adverse Childhood Experiences are our greatest public health crisis is not going away. Grasping this nettle is going to be painful but really necessary if we are to breathe health and wellbeing into our society.

 

Society/The Commons

Just as we get our needs met by those in our immediate household, the same is true of society. The way we treat children, the things we expose them to, the way we love them and educate them has a massive impact on their current future health and wellbeing. It’s becoming clear that social media is causing significant harm to our mental health as a nation, particularly our young people, and yet we don’t know how to curb our enthusiasm for all our technology…let alone the rise of the robots…

The commons is fast disappearing, too easily privatized and made available to those who can afford it. How do we safeguard the commons and use it for the benefit of all? What would the Diggers say to us now? The breakdown of our communities, with increasing isolation and loneliness is having a detrimental effect on our wellbeing. What can we do to recover the spaces that belong to us all and help us rediscover the joy of connecting and being together?

The commons is also about our corporate voice. It is only really vast people movements, speaking with one voice that can really cause governments to sit up, listen and take heed of the needs of the people. It is only together, that we will make enough noise to change the health and wellbeing of all of us for the better. How might we speak and act together in a way that will take corporate responsibility for all our health and wellbeing?

 

The Market

Oh the benevolent hand of the market! If only…. But the Market plays an absolutely key (though currently over played) part in our economy and our health and wellbeing. We know for a fact that advertising is deliberately trying to misinform us so that we make irrational decisions. A key component is to make people feel worse about themselves so that they buy things they simply do not need. Supermarkets are being challenged for the ways they deliberately place products and arrange their stores to cause people to buy more unhealthy things and food chains are constantly trying to ‘up-sell’ their unhealthy products and downgrade our health in the process. They evangelize the masses with the idea that we are all free to make our own choices, but if this were so, they would not spend the billions of pounds involved in socially engineering our choices, so that we ‘freely’ choose that which harms us! Oh for a market that might redefine it’s moral code! The market could do SO much good, but unharnessed and left without true accountability or consequences, it serves to damage our health – something it is truly responsible for.

 

The State

The state has a vital role and responsibility in caring for all of our health and when it washes it’s hands of that responsibility or tries to pass it over, we see a massive rise in health inequalities and overall worse-health for all. The NHS in the UK is one of the great triumphs of the state. Providing brilliant healthcare for those who need it whenever they are unwell is truly amazing. Imagine not being able to afford this because it depended on keeping up with insurance bills. It is not uncommon for us to see people in General Practice, who literally cannot afford to feed their families any more and are having to make some incredibly difficult choices (made far worse by long school holidays). Easy to point the finger and start creating a narrative about how it’s “all their fault”, but far harder to hear the truth of what it is really like to be a lived-expert in poverty and the trap it creates and harder still to look to alternative solutions, rather than believe the austerity narrative. There is clear evidence that the more unequal a society becomes, the worse the health outcomes – both physical and mental. When the market is allowed to behave exactly as it wants, we also see the health of people suffer. It is only through the right kind of government that the market can be tamed. It is only with the right kind of legislation that the economy can be skewed towards redistribution and regeneration of the resources needed – this would need to include a radically feminist approach that works on behalf of women, in particular, for equal opportunity, pay and recognition of just how much the ‘household economy’ contributes to the overall wellbeing of the nation. It is only the right kind of leadership that will tackle the inequalities we see and refuse to be wined and dined into maintaining the status quo. It is only brave leadership that will take the ecological issues, like plastic in the oceans, massive over antibiotic use in animals, and ongoing air and river pollution that will give us a healthy planet and human population in the future.

 

You

And where possible, and for some given various health issues, this is more possible for some than others – we do not all have an equal starting place or a level playing field – where we can  – we do have a responsibility to ourselves and to the wider society to care for our own health and wellbeing, so that when the health and social services are needed, they are available for all. It also means using the health and social care services in a way that creates sustainability, being grateful for them and ensuring they and the people who work in them are not abused.

 

It’s complex, but it’s vital that too much emphasis is not put on any one area. We must not play the blame game, especially not towards individuals when we haven’t taken the time to hear their story, nor understood the wider context of the role of the other vital players on the field. Each aspect of the economy plays a massive role in the health and wellbeing of the nation, and it is high time that each plays it’s relevant part to its fullest ability.

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Changing Health and Wellbeing Through ‘Self-Care’

imgresBetter Care Together is the way in which health services are now being redesigned and reorganised around Morecambe Bay, so that we can provide the best care we can for the people who live here in a way that is safe, sustainable and accessible. It is an on-going process and involves the breaking down of barriers between General Practices, the Hospital Trust (UHMBT), Community Nursing and Therapies, Mental Health Services, Social Care, Allied Services – like the Police and Fire Service – and the Voluntary Sector.

Here in Carnforth, we are piloting some work around ‘self-care’ and exploring what it means to be a healthy town. This is now beginning to spread like wild fire around this area, which is exciting to watch! Part of this work is rooted in the fact that currently 1 in every 5 pounds spent in the NHS is due to our lifestyle choices. If we’re going to have a NHS in the future, then we need to try and choose to live more healthily together. We must also recognise that being healthy and well is far more than just physical health. It includes mental health, social heath and systemic (or environmental) health. A few months ago we hosted a number of conversations in Carnforth about what it might be like if Carnforth was the healthiest town in Lancashire. Some really interesting ideas emerged from the community about singing together more regularly, having less dog poo on the streets, creating safe places for the children to play, getting more exercise into our schools, encouraging healthy eating, a mental health café, help for carers and many other brilliant suggestions.

From these conversations, a ‘Self Care Tree’ has grown with four roots and three clear branches that we believe will help us grow together into a healthy and well town. The roots are straight forward –tn_TreeRoots_resized_b-300x300[1] 1) Really learning to engage with our local community instead of assuming that we know what they need and learning to do things with them instead of to them, 2) being part of an Integrated Care Community – see below, 3) Being part of Better Care Together, 4) Understanding Wellbeing – shifting our mindsets from an ‘illness model’ of health to a ‘wellness model’.

The three main branches we have developed in Carnforth are as follows: The first is that we have some ‘culture change’ to undergo, both in our medical and nursing teams and also as a wider community. Over the coming months we will see the emergence of what we are calling an Integrated Care Community – first modelled for this area in Garstang. As part of Better Care Together, we have appointed a fantastic new Care Co-ordinator, Sarah Baines, who was part of our District Nursing team. Sarah will work alongside Dr David Wrigley at Ash Trees Surgery to help co-ordinate care more effectively in the community for people with more complex health problems and provide more stream-lined care, preventing unnecessary hospital admissions and enabling faster and smoother discharges back home from hospital. Secondly, we are learning to take more of a ‘coaching’ approach to how we consult with patients, to encourage more partnership working with people, rather than telling people what to do (which isn’t actually very effective). Staff are training in ‘coaching practice’, ‘motivational interviewing’ and ‘shared decision making’. We are trying to be more proactive with information. If you look on our practice website, www.ashtrees.co.uk, you will find a tab entitled ‘self-care’. Here you will find videos (many more to come and some of which we are re-doing!) that talk about various common conditions you can treat yourself without having to go through the often difficult task of finding an appointment with one of our team. Our local pharmacists are a hugely valuable resource, who can offer excellent health advice and treatments over the counter, saving local people time and inconvenience.  Also, not too far away, we hope to have a brilliant new facility called ‘e-consult’, which will allow our patients to manage their own care more efficiently ‘on-line’.

Stack-of-British-one-pound-coins-1516897[1]The pressure on General Practice is huge. The government only allocates £136 per person per year to General Practice. this money accounts for all GP consultations, appointments with nurses, blood tests, investigations and referrals and indeed the payment of staff. If you want to know what this compares to, then for £136, you can buy 11 months worth of pet insurance for a rabbit or 3 months worth of coffee every day on your way to work!! No wonder the system is under strain! If we want to have a NHS that is free for everybody and still standing in the years ahead for future generations, then we do need to be careful that we don’t abuse the system and take care of ourselves better and think about whether we really need an appointment before booking one!

 

The second branch we have seen is the emergence of ‘community leaders’, who have seen a community need and have stood up to do something about it. We know there are already loads of il_340x270.575369125_lhd6[1]community leaders out there doing great stuff, like sports clubs as just one example. So, we have seen the start of a mental health café, called “Serenity” every Wednesday afternoon at Hunter Street in Carnforth, 2-4pm. A carer’s café has started on the 3rd Saturday of every month 2-4pm, again at Hunter Street. Carnforth Community Choir meets at 7pm every Friday evening at the Civic Hall – singing is well known to improve our health and wellbeing! We have volunteer dog poo wardens, trying to help our streets be cleaner (it’s amazing what dog poo says about a town), and people cleaning up our parks to give the children in our community safe places to play outdoors. We have trained 22 “health champions” who will be starting with various initiatives soon, and many others have volunteered to help in lots of exciting new ways. All of this serves to break down social isolation and encourage us to take care of ourselves and one another.

 

The third branch is ‘clinical leadership’. Right now, Morecambe Bay has some of the worst health outcomes in the country. We have terrible heart disease rates and people die here far too youngimage[1] of preventable illnesses.  It would be wrong of us, as clinical leaders in the community, to stand by and let these statistics continue as they are. Morecambe Bay deserves better. So, we are working with schools to encourage more exercise in the children and young people in our community. Two local schools (‘Our Lady of Lourdes, Carnforth’ and ‘Arch Bishop Hutton, Warton’, with ‘St John’s C of E, Silverdale’ soon to follow)  have started running a mile a day – all children and staff! This is an amazing achievement and there are some wonderful stories emerging already of the great impact this is having on pupils and staff alike. We’re seeing huge improvements in sleep cycles, behaviour, concentration and general health. Under the banner of ‘Let’s Get Moving’ we hope that all the primary schools in the district will soon be participating in other similar initiatives. We have also started a couple of programmes of work with Carnforth High School, in line with needs they have highlighted to us. We are also going to trial a new NHS shopping list and menu to try and encourage us as a community to eat more healthily and avoid some of the unhealthy ‘bargains’ that the advertising giants try and tempt us with, cutting down on meat, alcohol, sugar and too much fat. If we don’t learn to manage our appetites and our spending habits better, we will never overcome the alarming rise in diabetes rates and heart disease. We are responsible together and really can make a change! So, not long from now, people in this area won’t even need to stress about what to cook for the week ahead, because they will be able to turn up to their local supermarket and get some really healthy and tasty ideas, all costed out and easily affordable (with huge thanks to our amazing chefs, Andy Bickle and Lee Till, from our hospital trust, working with us)! By eating more healthily and taking more exercise, we can genuinely change the health and wellbeing in this area for the next 50 years! On a different tack, our district nursing team is also beginning a leg-ulcer café for those who have been housebound. Such cafés have been proven elsewhere to break social isolation and improve healing rates for patients. All of this work is being undergirded by amazing research projects with the University of Lancaster.

As part of our on-going conversation with this community, we are hosting a further 781-T[2]evening, alongside our Mayor, Malcolm Watkins. It will be on Wednesday 6th April, 7pm at Carnforth Civic Hall. There will be other conversations in the next couple of months in Warton (for those living in Warton and Silverdale) and in Bolton-Le-Sands, for those in BLS, Halton and the Kellets. On Saturday 25th June 2016, we will also co-host a huge Health Mela at Carnforth High School. If you live in the area, please do come along to either of these events and talk with us about what is already going on and how we can all work together to make this town and district a truly healthy place.

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