Seems to be a lot of suppressed anger around since lockdown and I guess I’m no exception! As far back as 1968, as a teenage student nurse, health inequalities (HI) awoke a deep anger in me at the sheer unfairness of it all and drove a lifetime’s work alongside very low income communities as a Health Visitor seeking, and finding partial answers.
For this reason in 2000 I was invited to join a Modernisation Action Team for Health Inequalities alongside other great pioneers including the late Sir Sandy Macara, Sir Nick Young, Sir Michael Marmot and Lord Andrew Mawson. Wise people full of integrity who shaped my thinking for years to come. It was chaired by another hero CMO Sir Liam Donaldson, to develop the NHS 2000 ‘ plan for reform’.
Fizz that fizzled out
Exciting times working alongside ministers, and we were all full of hope that health inequalities would cease to be the ‘poor relation’, that policies would be implemented reflecting all our recommendations and that there would be proper investment in preventive works-streams treating the ‘causes of the causes’ of poor health. There followed a year’s secondment with Dept Health, challenging and a huge learning curve coupled with inclusion on a Health Inequalities Taskforce set up to maintain this new momentum –except it didn’t and fizzled out!
But for me the answers always lay at the frontline, at the practical rather than the policy level. So it was back to the drawing board and almost 2 decades of a learning journey with a great team of academics at University of Exeter to refine and apply ‘community health creation’ wherever we were invited, in challenged communities across the UK with C2 Connecting Communities with varying but for the most part, robust and measurable impact on HI.
And of course we’re not the only ones. We know a lot of excellent work tackling HI including strengthening and working with community assets, has been happening at scale in the last decade so we do know what has impact. We have the evidence to prove it. We have a flourishing and growing social prescribing network. All work in progress, not enough and not joined up, but enough for a new offensive surely?
Where the answers lie
We know the answers continue to lie in the wider determinants of income, housing, employment, education, transport etc and that hasn’t changed in decades. It’s almost 40 years to the day since the largely ignored Black report spelled this out and evidence from the Marmot team has backed this up for the last 2 decades too. We know this challenges policy makers, that the answers are ‘multi-faceted requiring multi-faceted solutions’ but heck! nobody said it would be easy – and not a reason to file it away in the ’too difficult’ drawer. We have some answers now.
So forgive me, half a century on for still being angry (absolutely hopping mad actually!!) that not only has nothing changed but the health gap has widened and we’ve had to helplessly watch our amazing NHS cope with vast swathes of our population dying because of largely preventable ‘underlying health conditions’. Surely beyond unfair now! What a dreadful price to pay for our inability to impact on inequalities. We know it’s doable. Our track record is poor and we lag far behind many other EU countries to date.
So what will it take to finally get a grip? I’m sure I’m not the only one fed up with the sound of my own voice when I’m asked to speak about HI saying the same things I was saying 20 years ago!
So could this crisis be a watershed?
The stark reality is that, post pandemic, health inequalities can only worsen for those many thousands living in very low-income communities. For us in C2, after many years ‘learning by doing’ we believe that the answers always lie within these communities, many thousands of whom have shown us since lockdown began just what an incredible health resource they are when given the free rein from bureaucracy that a crisis needing immediate action brings.
Health is made at home
And of course we’re not alone in our thinking. Lord Nigel Crisp who was CEO of the NHS 2000-2006 launches his new book ‘Health is made at home: hospital is for repairs’ on 29th June featuring health creation in the workplace, schools & communities. The New NHS Alliance is championing health creation and gaining traction at a policy level.
So if you’re also a Mr or Mrs Angry like me about health inequity, join our growing cross-sector social movement, alongside the voices of ‘real’ people on the community frontline at www.nhsalliance.org and let’s make some noise and finally get, in not a grip, at least a toe hold on the ‘wicked’ problem of ongoing Health Inequalities.
Hazel Stuteley O.B.E. – C2 Founder and Programme Director
- The C2 journey began with the Beacon Project. Read the FAQs and get in touch to start a conversation.