Wisdom From My Nanna

Last week, I was on the closing plenary panel at The Kings Fund, as we reflected on what we had learned together about ‘PopulationHealth’ across the UK. There were some really excellent contributions throughout the day.

 

Councillor Matthew Brown, leader of Preston City Council, talked powerfully about the new economic models they are using there and the incredible regeneration they are seeing. Councillor Becky Charlwood, spoke about the great work being done across the city of Leeds and how strong relationships enable them to flex around complex legislation. Mayor Andy Burnham spoke with humility and realism about the power of devolution and the challenges they face as a city in Manchester in giving kids a great start in life and ending homelessness. Liz Gaulton, Director of Public Health in Coventry, spoke about how the Marmot principles are radically shaping the future plans of the city in thinking about inequalities and how they face them together. Prof Kate Ardern, from Wigan, talked about how we need to change our relationship with power and work radically differently with our communities. Prof Dominic Harrison from Blackburn brought his wisdom on how we face up to multiple unhealthy risk factors. Perhaps the most important contributions from my perspective were from Carina Crawford-Khan, lead organiser of Citizens UK and Dr Charlotte Augst, CEO of National Voices who asked us to reflect on how “Powerlessness leads to ill health” – that’s a statement worthy of pause and much reflection. Power is the ability to act. Anger without power leads to rage. So, if we don’t radically change our relationship with power, we can never see true population health – rather we have disempowered people who feel angry and unable to be part of the change we need to see.

 

The reality is that all of the things we long to see in society will not happen unless we ourselves are willing to change. In all the uncertainties we face and admidst the brokenness of our political and economic models, how do we stand firm and find a new way through to a way of being together that is socially just for humanity and sustainable for the future? In reflecting on all of this in the final panel, I drew on the wisdom of my Nanna.

 

My Nanna, Joyce, who is 97 years old this year and who still wakes every morning to play Mozart and Chopin on her beloved piano, has always been one of the most important people in my life. In our family, we call her “Yoda”, because she is strong in the force and exceedingly wise! This 5ft tall lady, who taught me to bake, spent hours helping me with my music and can still whip my butt at scrabble and rummikub, is a truly remarkable woman.

 

When I was a boy, we used to talk to each other whilst making ginger biscuits. My Nanna is a deeply spiritual woman and she used to tell me about her favourite bible verses, one of which is from the book of the Prophet Micah, Chapter 6 and verse 8. That verse says – “God has shown you the best way to live – act justly, love mercy and walk humbly with your God”. I think those three statements hold profound and ancient wisdom that we need to draw on in the complexities of what we face together now. What does that actually mean for us in practice, as we try and transform culture, relationships and behaviours? I suppose I think it’s pretty simple.

 

Firstly, as leaders and as people who want to see change, we must act with justice. We must care deeply about issues of injustice in our society and be willing to challenge it whenever we see it. But we must not just care, we must act. We have to be willing to put justice into practice in what we build. We’re beginning to see this, and it’s exciting!

 

Secondly, we must love mercy. I think that means we have to love the principle of mercy and therefore we have to love people with mercy, or as I put it at The Kings Fund, with real kindness. I love what Prof Micheal West says, when he talks about looking at people with kind and fascinated eyes. We did a lot of thinking about the need for a different kind of power. I think we need to unashamedly talk much more about love and the transformative power it holds. MLK said that love on it’s own is anaemic – it certainly can be. Power alone is destructive. But power and love together is a force to be reckoned with! We need this kind of love in the power that we hold to keep mercy at the fore and kindness as our way of being.

 

Thirdly, we need to walk in humility WITH our communities. I replace the word God here, with communities, not because I don’t believe in God (I do), but then Nanna and I used to talk, she would tell me that walking humbly with God means walking humbly with other people – with your community. It is worked out in the practice of every day life and being willing to interact with and be changed by the person you most look down on or despise. Nanna isn’t a fan of people getting too big for their boots. She sticks her tongue out at arrogance and blows raspberries at pride. She’s not into titles or pretensions. As a true elder, she knows humility and walks in it. I have learned so much from her and it has shaped so much of who I am and how I choose to spend my time. We must learn to sit with, be with, learn with and create the future with our communities. We don’t have the right to dream up plans and do them to people. Together with, is the kind of humble, mercy-loving, justice-acting way that we so badly need. Without those under-girding, foundational truths, we will never see true population health. Our guiding principles and undergirding culture will shape what we become together.

 

In a time of so much uncertainty and complexity, we do well to stop and draw on the wisdom of the elders. And so I offer that of my lovely Nanna – in all you do, make sure you act with justice, love with kindness and walk in humility with your community. 

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Knife Attacks – Whose Crime Is It?

I find myself staring at the screen, unable to comprehend how utterly devastating it must be as a parent, to have a police officer knock on your door in the early hours of the morning, to be told that your darling child has been stabbed to death. My heart weeps for the senseless loss of life, young lives stolen away in this rising tide of violence. I know what it is like to break truly awful news to people and their families and my heart goes out to the police officers on the beat or the clinicians in the Emergency Department, who have to break the terrible news to the parents and the siblings, that so suddenly, a bright shining light in their lives, has been extinguished.

 

Knife attacks are a crime, there is no denying that, but the burden of guilt is not so easily apportioned. We are seeing an exponential rise of it in our streets, with a 93% increase in recent years across England, whilst in Scotland, they have seen a 64% decrease over a similar timeframe. We need to examine what has gone on in that time and ask some very uncomfortable questions. We also need to call people to account for decisions which have been made, despite knowing the evidence, and  we desperately need a ‘whole systems’ approach to tackling this epidemic.

 

The Primeminister has stated that “knife crime” is not linked to a decrease in policing numbers. The police chiefs disagree. The truth is, that it’s not only the police who have disappeared off our streets (and these are community police officers, who knew their communities well and were respected and trusted – it takes years to build up those kind of relationships) – we’ve had a perfect cocktail of cuts right across the board which is directly attributable to the mess we are now in. Ongoing austerity, which is a political choice, has also led to the closure of youth centres, more young people than ever excluded from school, (who then have a 200 times higher chance of being groomed into violent gangs) and massive cuts to public health and local government, meaning many preventative schemes have disappeared. When policy fails, it has to be called out and challenged. Everyone with a brain knows that prevention is better than cure. And for those who have lost loved ones, there is now no comfort – this could have been prevented, but has been allowed to escalate at such an alarming rate because we do not have a form of politics or leadership that listens to what is really going on in our communities, but continues to drive through ideological changes without thinking through the consequences. This is unacceptable.

 

When Heidi Allen MP came to Morecambe, she heard the testimony of my friend, Daniel, who grew up in some really tough circumstances, forced into a gang culture in order to help put food on the table and prevent harm coming to his family. Tears streamed down her face as she heard his powerful account of what it meant for him as a young person, to have his youth centre closed, his local high school closed and being told he was not a priority when he was street homeless. She told us that she had not realised the layers to the poverty that many are experiencing across England. And this is how the (perhaps) unintended consequences of remote policy decisions affect ordinary people in droves across the UK. When school budgets are cut and mental health teams are cut and social care provision is cut and youth centres are cut, children and young people from home environments which are already struggling to make ends meet, already processing significant trauma and adversity, fall prey to gangs and criminal networks who use them and abuse them for their gains across county lines.

 

And yet in Scotland, we are seeing an altogether different picture emerging, because they saw this problem 10 years ago and decided to make a difference by dealing with complex living systems, rather than tinkering clumsily with mechanistic thinking. So it is high time that England ate some humble pie and learnt from our Celtic friends.

 

Scotland, unlike the English, are not delaying on taking a serious approach to Adverse Childhood Experiences, hoping to become the first fully trauma informed nation in the world. They have taken a public health, holistic approach to the knife crime problems in Glasgow and then spread the learning across the nation, rather than making devastating cuts to their PH budgets. What they have done isn’t rocket science – it’s plain, public health common sense. They have chosen not to criminalise, label and stigmatise young people (something the hostile environment rhetoric seems to do). They have refused to see it as a race problem – because it isn’t (but some in our press in particular, and some members of the government have stirred up this nonsense anyway) and they have invested in early and effective youth intervention programmes, amongst other things.

 

One of things my work has taught me to do, is suspend my judgements of those who we would automatically and ordinarily point the finger at, the supposed perpetrators of a crime, and really listen to the truth. The truth here is complex and I’m not saying that people who commit violent acts do not need to face the consequences of their actions. They do. But what I am saying is that we need restorative justice in our communities that breaks this horrendous cycle. We also need to recognise that there has been terrible violence done to our most vulnerable children and young people across England by a series of political decisions. The government has failed those it should have protected. In my line of work, those kind of errors would lead to massive learning events and the dismissal of those who had failed in their leadership. Perhaps people have such little faith in the political system we have because there is seemingly such little accountability. Now is not the time for silly political defence of failure. Now is the time for humility, repentance and a genuine turning of the hearts of the fathers and mothers in the nation to the rising generation, far too many of whom are no longer with us.

 

 

 

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A Vision for Population Health and Wellbeing – All Together We Can

Tweet If you haven’t yet had the chance to read the Kings Fund’s vision for population health (and it’s the kind of thing that interests you) then I would heartily recommend that you do so. (https://www.kingsfund.org.uk/publications/vision-population-health). It is a real ‘Tour de Force’ and deserves some significant consideration. I like it because it doesn’t hold [Continue Reading …]

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Health Spending in The North vs The South

Tweet A few months ago, I wrote a couple of blogs exploring the social justice issue that is the vast difference between the health spend in the North, compared to the South.   This week a graph was produced by HM Treasury to show how overall spending has changed across England since 2012. Here is [Continue Reading …]

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Building Healthy Towns and Regions

Tweet 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 [Continue Reading …]

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Think About This

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Love – It’s a Two Way Street

Tweet There is a lie that has been told, to clinicians in particular, that it is wrong to get too close to patients. One is told to keep a healthy separation, perhaps to make the tragedy we often deal with somewhat more bearable. We have shaped medical ethics around the four core principles of beneficence (do good), [Continue Reading …]

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UK, You’ve Had a Heart Attack – How Are You Now?

Tweet You might want a cup of tea whilst you read this! I often see patients a week or two after they have been discharged from hospital with a Myocardial Infarction (what we often refer to as a heart attack). In this part of my home county, once someone is diagnosed with having a MI, [Continue Reading …]

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