Agenda – John Cassidy: We need imaginative leadership to tackle health and wellbeing issues
If you ever had any doubts about this read the excellent, "The Body Economic" by David Stuckler and Sanjay Basu Staff and volunteers in community organisations know this. NHS staff know this. Social services staff know this. It’s getting worse and not gradually! It is interesting that the International Monetary Fund in 2012 apologised for underestimating the impact of its austerity packages on the health and wellbeing of the poorest people in bail out countries!
At a conservative estimate, in Scotland we currently have 6 major health epidemics on the go. These are having an increasingly devastating impact on individuals, families and our poorest communities … and the economy.
The recent paper from Locality, a leading nationwide network of community enterprises, development trusts and social action centres, entitled "Saving money by doing the right thing" illustrates how unprepared we are to deal with these epidemics. The hit and miss approaches of our attempts may even makes matters worse and cost lots.
Using the helpful language of the Locality paper our 6 health epidemics – poor mental health, obesity, substance misuse, self harming, prescription drug addiction and loneliness – which are often interlinked in people’s lives can be characterised as "help me" epidemics.
We’re frequently not that great at responding to "help me" and when we do try we frequently become engaged in what the authors of the Locality report call ‘failure demand’. Failure demand and costs stack up when our first attempts to respond to a ‘help me’ situation are based on an inappropriate medical approach.
Or they may be based on a response from social services which cannot for a variety of structural, regulatory or cultural reasons take account of the whole context in which the situation has arisen. So things escalate, more and more agencies become involved and in the end all this activity may not address the critical determinants of the condition. This is well illustrated in the detailed case studies in the Locality report.
However we are much, much better, even world class at dealing with "fix me" types of health complaints. I have recent first hand experience of this with two hip replacements. It is time to look at how we can get seriously as good at responding effectively to the "help me" situations. We need to reduce failure demand. We can’t afford not to if we are to tackle health inequalities with determination, resolve and lower costs. We also need to make best use of increasingly critical health resources and assets we have in Scotland. This is especially true of the national health improvement budget, and our many amazing community led health and wellbeing improvement organisations.
We do need to "do the right thing" which a bit different from what we are currently doing. We need to look at how we resource health and wellbeing improvement. We should examine the current imbalance between the resourcing of the medical (fix me) and social (help me) models of health improvement. But that is not all we need to do by a long chalk. We do need to look at the restrictive nature of the regulation of public services. We do need to understand and value local energy, knowledge and resilience in tackling health and wellbeing problems. An offer has been made to the Scottish Government from Scottish Communities for Health and Wellbeing (www.schw.org.uk) to establish in Scotland a world leading community led approach to help deliver our national strategy on health and wellbeing improvement and reduce health inequalities. We need to help empower people to help themselves. We need to focus on purpose not outcomes and we need to manage value, not cost. We need bold, imaginative well-informed leadership at all levels. We urgently need to move on, in a serious way, from the overwhelming and at times encouraging but ultimately disappointing ‘official’ rhetoric on health and wellbeing improvement of the past few years.
John Cassidy is a volunteer director of both Healthy n Happy Community Development Trust and Scottish Communities for Health and Wellbeing