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Health and wellbeing
seen from the ground
Elizabeth Bayliss
Social Action for Health March 2013
On the ground in east London
• People are fearful of the changes to benefits
• People are fearful that the NHS is going to be lost
• People are fearful that they will never work again
• People are fearful of a government that does not care
NHS seen from the ground
• GPs are now in charge; they are so busy they do not listen; they never do an examination;
• GPs only ever give me paracetomol; • My GP will not refer me to a specialist so I wait til I go
home (abroad) and pay for examination there; • Why not go to A&E when I need medical help quickly?• Out of hours doctors do not have my records so what is
the point? • Where are the interpreters now? How can I describe my
condition when the doctor does not understand me/• Why are there no ESOL classes anymore?
It takes two to tango!
• NHS behaves as though it can sort out health inequalities and rising demand on its own or somehow through the mystical intervention of the market
• The relationship between the NHS and local communities is squeezed through the narrow conduit of ‘community engagement’ which is a reductionist process that leads to an impoverished relationship
The relationship matters
• There are no shortcuts
• Relationships between human beings are always transactional - what is the nature of the transaction;
• There has to be a balance of expectations
• Professionalism can get in the way, leading to a manufacturing of dependency
SAfH values
• We start with the people • People have the right to take control of
their own lives • People’s health can be improved by
tackling isolation, poverty, racism and unemployment
• Healthy communities are good for the whole society
SAfH Spiral of Participation
• SAfH spiral of participation
SAfH’s role
SAfH sits in the community, encouraging local people to take more responsibility, to reduce their dependency, increasing their ability to be self determining;
We find that people to want to take responsibility - to be of use in their community – no place for paternalism;
We work within social mores , respecting leaders;We listen to what people say, preferably in mother tongue, drawing out
meaning from their experiences;We give local people accurate information about complex issues like
morbidity and mortality rates so that people can see themselves in relation to the wider world;
We teach people how to engage with professionals so that the communication both ways is richer and more useful;
We tell people with power and authority what we have heard in words the powerful understand.
What this means on the ground
Focus on the people:√ reach out (on the streets, in community centres, in public
places);
√ start conversations (We use the promotion of cancer screening to start conversations about self care).
√ bring people together – cross culturally
√ teach people new skills – go step by step
√ encourage these to be shared - Build up mutuality
√ promote health intelligence – ability to make sensible
decisions about own health and wellbeing
Who does the work?• Local people, who are lay, trained, paid, supervised
and supported, with multiple languages • We have 100 people at any one time whom we have trained as
Health Guides, Mental Health Guides, Self Management and Good Move tutors, Ambassadors, Community Health Champions, Mentors, Representatives.
• We have a staff team of around 25 people who support, record, report, manage, coordinate, teach these local people; manage networks of community groups providing information and advice; evaluate work and aim to influence policy and practice.
Is the work useful?
• Screening take – up increased• Demand on GPs from people who have been through a
self management course reduced• Benefit entitlements secured and appeals won • People empowered personally, with evidenced
improvement in health and wellbeing;• People more confident in communicating with their GP; • Voices heard by decision makers through platforms eg.
Open events; • Health Action groups formed• Community groups forming networks.
Scale and impact
SAfH works with 11,000 people a year directly but this feels like small fry;
Work needs to be rolled out big time;
Funding needed to evaluate work eg. Impact on A&E; eg. impact on communities
Tips on policy direction!
• Funding for evaluation on community development approach
• Hospitals and primary care to be encouraged to collaborate on such evaluations
• Funding for community work at a local level necessary
• Meta narrative – honour the public arena