Influencing sustainability of local health and social care services

Is now the time for health & wellbeing in the Transition Movement (part 3/4)

I have a feeling out there in Transitionland, and in communities generally, that people feel that healthcare is too big a nut to crack. Particularly in England (and UK) where the NHS is seen either as a political football or as a huge behemoth of an organisation, people can feel impotent to ‘make a difference’. But this is just the same as climate change. However there are few things that are really on our side (compared to the Energy sector for example); a) health and social care is still delivered by people (not machines), b) the NHS is on our side (on paper at least), c) there are huge supply chains that run through our whole economy (and therefore through many communities).

a)      Healthcare and social care is people-based (and will be for the foreseeable future). NHS is the largest employer in England (although dwindling with privatisation). This means that every community contains a large proportion of health and social care workers. Inevitably some can be found within Transition Initiatives, or can be encouraged to join! Staff can be an important link of communication between the community and the surgery, clinic or hospital.

b)      Again I feel that many people see the NHS as a huge impenetrable institution. However NHS Trusts and GP practices are increasingly keen to listen to patients and the community. Try to avoid cynicism and send your views in, or as above, talk to staff. The SustainableDevelopment Unit for health and social care does have an influence on NHS organisations, but the board of the hospital is more likely to take action if they also feel pressure from the community, eg to recycle more. The new Sustainable Development Unit emphasises the importance of community and resilience, giving a common language for Transition Initiatives to address these issues.

c)       Procurement for the NHS is a huge opportunity. Recent guidelines recommend ‘sustainable’ procurement, and encourage hospitals to choose local suppliers to reduce transport. Again, food is an obvious example, but procurement covers all sectors and therefore must draw upon businesses in almost every community (I guess). If carbon footprint of a product is lower than the competition, it should give an advantage in the tendering process, and hence encourage sustainability in many local businesses. Could Transition Initiatives support their local business to win NHS tenders – possibly through REconomy type projects?

 

Healthy communities and prevention

Is now the time for health & wellbeing in the Transition Movement (part 2/4)

Another approach to health that is very well aligned with Transition is Healthy Cities. In fact the Healthy Cities Network UK recently had a joint meeting with Transition Network to discuss shared agenda (Oct 2013 see event details).The settings approach to health encourages any community to actively seek to optimise the benefits to health at every opportunity. For a town or suburb, this may include tackling aspects which are detrimental to health, including fast food outlets and betting shops. 

Another good example is walkability of the neighbourhood. If parents can walk with their children to school, this is an indicator that the whole community can benefit. If streets are designed for walking it may lead to fewer cars and hence less pollution. Of course pollution is harmful to health; as highlighted in the smogs in England earlier this year as well as impacting on the climate. Walkable streets are often green streets, with trees and grass verges. The greenery can reduce noise pollution and absorb air pollution (so best not to grow food on the verges!) Again calmer, greener streets can better for people with disabilities, who may need to use a car, or for people with learning disabilities or dementia. Lastly traffic-calmed streets and green streets have been shown to increase sociability of neighbourhoods, and English ‘Homezones’ have partially helped here.

I’m particularly keen on enabling healthy lifestyles because this can prevent ill-health. Prevention has got to be better than cure, especially considering the carbon footprint of cure (healthcare)– from pharmaceuticals to hospitals. A great example linking prevention with climate change and our corporate-driven culture is obesity. Commodification and global trade of food have played a big role in causing both climate change and the increasing rates of obesity, I would suggest. The corporate, profit-driven, pressure to aggressively market high calorie food cannot be matched simply by public health campaigns and diet fads. This is a good example of the corporate determinants of health. Our corporate influenced food environment and car-dependency will increase the likelihood of obesity, which will in turn cause further health problems down the line, including diabetes, heart disease and stroke. The carbon footprint of treating these diseases should clearly be avoided, let alone the suffering and disability. 

Potentially community based initiatives are the best place to start to counter the negative impacts of food marketing and car-dependency, because they may change social norms rather than focusing on individual behaviour. If Healthy Cities or Transition Towns can start to address these issues and improve health, disease can be prevented, along with a huge carbon footprint of hospitals and drugs.

Is now the time for health & wellbeing in the Transition Movement (part 1 of 4)

Just noticed this tweet and it reminded me to write a blog on health and transition. 

Professionals in healthcare (NHS) and public health (independent Directors of Public Health and Departments of Public Health in Local Government) are getting political; for example denouncing the aspiration that food and drink corporates can regulate themselves with ‘responsibility deals’. Whilst it is now well established that the social aspects of our lives affects our health and length of life (social determinants of health), a new concept has emerged; the corporate determinants of health. This concept is more outspoken indicating that large corporates, including multinationals, almost inevitably, are blind to the detriments to health that their activity causes. It’s another argument to reinforce the view that the global capitalist, neoliberal, model is not benefitting the majority of people, in health terms, as well as other living standards. I see Transition Movement as a 'viable alternative', if you like, to corrosive capitalism.

I was really pleased that Transition Network have chosen to focus on Health and Wellbeing as it’s theme of May 2014. Here’s my thoughts on how transition initiatives could consider how they currently benefit health of their locality, and how health benefits could be maximised.

Let’s start with what’s currently happening out there in Transitionland...

I’ve been involved on and off with several Transition Initiatives in England over the last 6 years. My feeling is that many of the projects may already have benefits for health and wellbeing which may not be explicitly recognised and valued. I’ll just run through 2 of the most common examples; food and home insulation. 

Growing food primarily may have nutritional benefits, but there may be further benefits from the whole project; the physical activity of horticulture, vitamin D from being out in the sunshine (but wear a hat and sunscreen in intense sunshine!) Then there are social and mental wellbeing benefits of interacting with fellow gardeners, a feeling of productivity and self-sufficiency, and a tendency to direct attention to nature for a while, rather than the self-absorption that consumerism encourages. Most tenuously, perhaps, using a permaculture type approach may reduce rainwater run-off and hence protect from flooding and the negative impacts of health that this causes. 

How many transition food projects value and shout about the many health and wellbeing benefits that they bring? (Five Ways to Wellbeing can be a useful way of capturing these benefits). I should add that gardening is not only for those who are fit and able, as the paragraph above might imply, but should aim to be inclusive. Gardening programmes have enabled people with disability or dementia, for example, to benefit.

Home insulation can improve housing conditions. Poor housing is a key factor for ill health, recognised as one of the social determinants of health. Damp can lead to mould spores and irritation of breathing difficulties. Excess heat or cold can worsen health conditions and lead to premature death for vulnerable people. Poor energy efficiency leads to money wasted on energy that could otherwise be spent on improving nutrition or necessary medicine. No surprises that poor housing leads to poor mental wellbeing. So do your housing projects capture benefits for health and wellbeing? As mentioned the social determinants of health may be the best approach for estimating these benefits.

In next blogs I'll go on to discuss:

Healthy communities and prevention

Influencing sustainability of local health and social care services

Adaptation to protect health

Wider political aspects and Language