What is Health?

by Steve Chalke, Founder of Oasis Global

The National Health Service 70 years old. Only 70 years old. And in those short decades it has revolutionised health care; from hip replacements and heart transplants to IVF and gene therapy.

But this ground-breaking world first has also become a victim of its own extraordinary success. More and more people living a lot longer and so creating an ever increasing strain on limited resources alongside the constantly growing challenges that come with every new medical breakthrough. So, how do we equip the NHS and wider society with it for the next 70 years of the journey to bring increased health and wellbeing to all?

We must, I believe, begin at the beginning; with the fundamental question; ‘What is health?’ That’s why new Public Health England research figures around the key contributors to health in the UK, make for thought-provoking reading.

‘Clinical Care’ (both our access to it and the quality of it) accounts for 20%. But our ‘Socio-Economic’ situation (our education, employment, income, family support and community safety) contributes a massive 40% of our overall score. Then our ‘Health Behaviours’ (smoking, diet, exercise, alcohol consumption and sexual health) account for another 30%. Whilst finally, the built environment around us (its design and quality) contributes the last 10%.

These figures are a wake-up call. Rather than the services of the NHS, the vast majority of the factors that define our health are down to the work of everyone from local councils to charities, schools to churches and other faith groups and businesses to individual residents.

Our problem is that we have medicalised health care, focusing our thinking, energy and funding too narrowly. What we call the National Health Service would be better labelled a National Sickness Service. It’s time to think differently and invest in the other pillars on which real health and wellbeing are built. Health is 3D – it is about body, mind and spirit. The NHS cannot solve the health problems of the UK alone. It is time to think more radically.

As I chat with local GPs in the communities Oasis works in around England – they regularly explain that more than half of the patients they see don’t have any biomedical problem: instead their issues are to do with housing, education, employment, debt, relationships, lack of self-worth and loneliness.

As we all know, however, it’s one thing to say that we need to think radically; to broaden the focus from beds, hospitals and GP surgeries to community based prevention and intervention, but quite another to achieve it, and to do so sustainability.

Oasis has worked in community development since the 1980s to pioneer models of sustainable integrated and holistic health and wellbeing. We currently work in 38 local neighbourhoods around England and another 26 in other countries around the world – where our goal is always the same; to build strong neighbourhoods where every person can flourish and achieve their God given potential.

Here in the UK, we currently provide schooling for some 30,000 children and young people, in 51 schools, as well as substantial amounts of supported housing and healthcare for vulnerable people, whilst our wider community work includes local churches, children’s centres, sports clubs, gyms, farms, libraries, adult learning initiatives, foodbanks, debt advice, credit unions, shops and cafes, choirs and much more, all supporting tens of thousands of parents, carers and other community members every day of the year.

Over these 30 plus years our work has grown to be focussed around a small number of core principles:

We’ve learned that, although in theory what is true in theory is also true in practice, in practice what is true in theory often isn’t.

We’ve learned that in order to understand anything about community development in general you must first experience it, in micro detail, in at least one real community. You can only really lead from the ground – and you will be all the better in the boardroom as a result of it. And, it’s on the ground that we discover what matters to people rather than simply what is the matter with people.

We’ve learned that real transformation is fuelled by truly empowering individuals and whole communities to become change makers themselves. Disadvantage and inequality will not be addressed until our society moves away from traditional models of project delivery, where experts do things ‘to’ or ‘for’ people, towards one of grass roots empowerment where everyone works together. Health care can’t be left to the professionals; it is far too important for that. The volunteer – or use their other name ‘amateur’ – which as all French speakers know comes from the word meaning ‘lover of’ – has a key role to play in any effective integrated health service of the future.

We’ve learned that relationship building as well as relational equity are critical in ensuring individual and community transformation. Transformed individuals and communities will not emerge unless society recognises the prime importance of placing relational dynamics at the heart of community development.

We’ve learned that although our mission is always the same, the work we do in local communities is always different. It must always be a locally tailored offer, where community members are actively engaged in designing, leading and delivering the work.

We’ve learned the importance of personal transformation. And we learned that external transformation (improvement in skills, economic wellbeing etc.) is only sustainable when we place equal emphasis on supporting people to explore how to change their attitude to life and themselves. Disadvantage and poverty will not be addressed in a deep and long-lasting manner unless society recognises that external change must be accompanied by people having the opportunity to deal with the implications of trauma and distress from earlier life experiences.

We’ve learned that integrated services are essential. Anything less misunderstands the nature of human need. Poverty and disadvantage cannot be addressed in silos; people’s needs are interconnected – they are social, moral, spiritual, physical, emotional, academic, vocational, economic and environmental. Initiatives that are not integrated and holistic are not effective, as they dismember an individual’s interdependent needs. In order to genuinely tackle poverty and disadvantage, society must recognise that interventions need to be integrated and holistic.

And lastly, we’ve learned that partnership is key. None of us have the whole answer. In order to get the job done we have to partner together; only this can create and sustain the high quality, integrated approach to health, mental health, personal and community care and development which we believe must be the vital ingredients of a National Health system fit for the next 70 years.

That’s why on July 5th, the day of the 70th birthday of the NHS, Oasis signed an agreement to work in partnership over the coming years with the Frimley Leadership and Improvement Academy, which is part of the Frimley Park Hospital NHS Trust in Surrey, as it works to deliver an Integrated Care System for its community.

That’s why, year in year out, Oasis is so committed to working alongside Lambeth Council, for instance in partnership around the provision of the Waterloo Library and our two Waterloo schools. It’s why we celebrate our partnerships with local Lambeth businesses and churches to deliver the Waterloo Foodbank and Debt advice service.

And, it’s why we are proud to work with Guys and St. Thomas’ Hospitals, not only in delivering care and support to young people in St. Thomas’ A&E who have been victims of violent crime, but also working with those who are diabetic, developing the Oasis Waterloo Farm, and most recently in partnering with them to tackle childhood and youth obesity over the coming years.

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