Increasing inequality

Austerity

A crisis in democratic accountability

Threat to community life

Shrinking the state +

Communities, power and health

Brian Fisher MBE

Chair of the Socialist health Association

RESILIENCE UNDER PRESSURE

• Hollowed out communities

• Threat to mental health

• Attenuation of social networks

• Weakening of associational life

• Deterioration in health

PARTICIPATORY

DEMOCRATIC

ACCOUNTABILITY

ASSET-BASED WORKING

ASSET-BASED COMMUNITY DEVELOPMENT

• Statutory services become more responsive• Promotes health protection and community

resilience • Helps tackle health inequalities• Has an impact on behaviour change• Saves money

CDStronger and deeper SocialNetworks

RESILIENCE

Health protectionResilience to economic adversityBetter mental health

ENHANCED CONTROL

Can negotiate with servicesMore strength for self-careHealth inequalities reduce

6-Month Survival after Heart Attack, by Level of Emotional Support

0

10

20

30

40

50

60

70

Men Women

Per

cent

die

d 0

1

2 or more

Sources of support

OUTCOMES – HEALTH

SOCIAL NETWORKS REDUCE MORTALITY RISK

• 50 % increased likelihood of survival for people with stronger social relationships

• Comparable with risks such as smoking, alcohol, BMI and physical activity.

• Consistent across age, sex, cause of death.

• 2010 meta-analysis of data [1] across 308,849 individuals, followed for an average of 7.5 years 1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley Layton.Plos Medicine July 2010, Vol 7, Issue 7. www.plosmedicine.org doi:10.1371/journal.pmed.1000316

A RESIDENT-LED PARTNERSHIP

LED BY RESIDENTSTHEIR EXPERIENCE DRIVES CHANGEFORMAL STRUCTURES MAY BE NEEDEDA CORE REACHES OUT

OUTCOMES - RESPONSIVE SERVICES

• Services begin to change within 6 months

• Affects many sectors simultaneously (health, police, education)

• Communities gain confidence and leaders emerge

• Staff enjoy their jobs more

RESPONSIVE SERVICES

• A new dental service established• Funding of £95k to transform a derelict area into a

playpark awarded • A new GP surgery planned• Well attended social events and football sessions• Relations with the housing department improved and

tenants more satisfied.• Summer holiday activities for all ages • A cooperative plan for social renewal agreed between

the community and public agencies

Operation Goodnight

• “This downward trend is more than likely due to the introduction of a permanent PCSO for Townstal and a more regular link with the Dartmouth Community College and the school.”

• “The community involvement of the Townstal Community Partnership giving the residents ownership and a ‘say’ in what they want for Townstal has brought the community together and must be considered as a factor in this reduction of crime.”

• Townstal Beat Police sergeant  

CRIME – A CASE STUDY

SOCIAL RETURN ON INVESTMENT

• With modest gains on the eight indicators, the model posits a saving of £559,000 over three years in a neighbourhood of 5,000 people, for an investment of £145,000: a return of 1:3.8

• For £233,655 invested across four authorities the social return was £3.5 million.

• For every £1 a local authority invests, £15 of value is created.

NOT BIG SOCIETY

• No intention to substitute statutory services with private or voluntary.

• Does not cut across work on:– Income inequality– A just tax system– A living wage

• This is about responsiveness and effectiveness

AN OPPORTUNITY

• A new approach to improving population health

• Wraps around primary care• Links LAs and primary care• Challenges the balance of power• A number of models to choose from

– HELP– Altogether Better– Turning Point

It has transformed the way we practice medicine. It has stopped us seeing our patients as if we were just service providers to people who are ‘needy’.

We now recognise that they can contribute, and when you see people light up when you ask them to do so, it changes your relationship with them.

The culture has changed. The relationships are different, deeper and more therapeutic than they are in the usual doctor’s office.

Dr Abby Letcher

www.healthempowerment.co.uk