A Healthy Change?

June 26, 2014 by
Filed under: Social Economy 

Last week I outlined the beginnings a toolkit to help make relational state and community-based approaches a reality: 5 community rules, 4 principles of engagement, 3 approaches that work.

Using health and social care as a key example, I will finish off with two (and a half!) caveats and One Ask (coming Friday).

Two and a half Caveats: 

  1. Change can be painful.
  2. Never forget the fun vs. need continuum.

       2½. Have an offer and be patient with it.

 

  1. Change is hard, and that means you too.

Basically:

“If you’re not in the arena with the rest of us, fighting and getting your ass kicked on occasion, I’m not interested.

Brené Brown, Daring Greatly

If we are to move from a state provision model to a relational state model, a lot of things will have to change. That includes the ground you are currently standing on. Working relationally – where value is linked to the interactions and exchanges between actors – is a whole other ball-game compared to working with and within institutions, where value is linked to status and hierarchy.

As my colleague Dave Yates has highlighted elsewhere, true resilience is not the ability to weather the storm and emerge from changes unscathed and unbeaten; true resilience is the ability to change in the face of changes in your environment. A resilient society is one that has accepted that the rules of the game have changed, and that is therefore changing its own rules, its norms and its incentives structures.

 

Changing Health?

Let’s look at health. Psychosocial factors (e.g. work-related stress), life-style related conditions (e.g. obesity linked to poor diet and inactivity) and demographic changes (e.g. older person isolation linked to changing community structures) account for a massive proportion of the local burden of ill-health. Not wishing to conflate issues too much: i) the World Health Organization estimates that by 2030 depression will be the leading global disease, with the UK Home Office assessing its economic and social cost as greater than that of crime; ii) lifestyle-related diseases represent one of the world’s key challenge as they account for almost 60% of all deaths worldwide; iii) loneliness is as deadly as smoking, with effects ranging from depression to cardiovascular disease.

As ill-health is massively affected by psychosocial factors, life-style related conditions and demographic changes, it should be obvious that giving pills and acting the expert is not going to be enough. Conditions that have routes and consequences in people’s social context, community and  employment status, need to have responses that also sit there. If a medical practitioner, a public health system and statutory bodies are to start co-producing relational approaches to these problems, then it is not just their toolkit that needs to change: their roles and their relationships with the people they are working with will also need to change.

This is really hard: it will require new training, new incentives and new norms. I would suggest that, as with co-production approaches, the test must be linked to the one-off crisis to long-term axis, and the infrastructure to social structures axis. The closer you are to crisis and infrastructures, the more you need the professional to be the person in charge – I am happy for my cardiovascular surgeon to be as in charge as s/he likes.  The closer you get to long-term and social structures/norms, the more there needs to be  a facilitative, co-productive approach: maybe being referred to a heath trainer who will work with me over six sessions (capacity building) to develop a plan around how I will engage with my local community’s exercise and healthy eating facilities more (network weaving).

 

2. Fun vs. Need

Nobody is sitting there, waiting for your change to come; the world is not waiting for you to innovate it out of its “wicked problems”. We tend to do things because they are the done thing, because we think we should, because we think we need to, or because they are fun.

Some projects work because they are enjoyable. Talk to Me London - disclaimer: of whom I am (almost!) a trustee – managed to whip up a week’s worth of fun, community-minded, pro-social activity through arts-based interventions in the New Cross area. Someone sleeping on top of your bus-stop is bound to get you talking! They will now be hosting London’s first ever Talk To Me day on the 30st August, and this Saturday you can check out their Talk Bar at the Southbank centre.

Generally however, we are very busy.  Fun is not always enough. Most often projects will work because they obviously respond to a local need in ways that do not stigmatise people. With the Social Mirror project  where an automated app ‘prescribed’ local activities based on people’s answers to a short survey  we found that the activities that were most taken up by people were the ones that were obviously useful: walking groups, lip-reading, basic computer skills groups and children’s activities. Sure archery (fun!) got a buzz, but we do not have any evidence of people having actually gone to it.

Need to be active? Try this free walking group. Losing you hearing? Try lip-reading. Grand-kids have got you a tablet computer but you can’t make neither heads nor tails of it? Try the computer class; Have young kids? Try the toddler groups.

As a participant told us:

“Social Mirror itself has made a massive impact on my life, especially purely because when I moved up I had nobody and nothing, so when I went to the GP surgery and I was approached by Social Mirror, they asked me questions about me and what I would like to do, what sort of thing I wouldn’t like to do and they put me into contact with things within the area and with that, I then received all the information I needed, groups and things like that for us to do. So, from there, I went along to these groups and once I went, that started the ball rolling if you like. I was going to groups for my children, for myself, and from there I have made friends, I know the area better, and my life is a lot more happier and I don’t feel so lonely.”

 

2½. Have an offer and be patient with it

This is less of a caveat and more just obvious. Talk is cheap. Actually put out something in the real world that people can see and touch, and people may just come. This could be:

-          planting (and re-planting and re-planting and re-planting) the first propaganda seed garden that eventually helped spark Incredible Edible.

-          opening a small-grants community seed fund in an area where you are failing to get local buy-in and traction: £5000 goes an incredibly long way on the right hands.

-          building the tool first, and accepting that for a project ‘to be locally owned’ it needs to exist first.

Be patient with it, change can take time:  half a year is nothing in the arc of someone’s life, but it is a very long time to be overdue on a project plan, or late on reporting your evaluation figures.

Interviewer: So, how long do you think it took between doing Social Mirror and doing activities?

Participant: I don’t think it was that long to be honest. Couple of months at most.

Interviewer: And between starting the children’s activities and doing [activities] for yourself, how long do you think that might have taken?

Participant: A couple of months again, sort of thing. By the time you go and get to know people. Those people then suggest things because they have got to know you. Stuff like that, so it was a couple of months between each stage. 

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Gaia Marcus is a Senior Researcher on the RSA Connected Communities project.

She is an Edgeryder and an UnMonk advisor, founded the RSA Social Mirror project and is ¼ of the ThoughtMenu.

This Summer she will be cycling 1000km in memory of our RSA colleague Dr Emma Lindley and in aid of Mind

You can find her on twitter: @la_gaia

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