phillip blond: the big society
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Annual Health Strategy SummitAnnual Health Strategy Summit
Phillip BlondDirectorResPublica
Twitter: #NTSummitTwitter: #NTSummit
The “Big Society”: Si k d i In Sickness and in
H lthHealth
Phillip BlondDirector ResPublica
Lack of participationLack of participation
• Decrease in civic engagement: In 2009/10, only 34% of people in England engaged in some form of England engaged in some form of civic participation – in 2001, this figure was 38%
• Decrease in volunteering: In 2009/10, 25% of people in / p pEngland volunteered formally at least once a month, compared to 29% in 2005Source: ONS Citizenship Survey 2009/10
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69
Who is at fault for obesity? Who is responsible for addressing it?
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40
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31
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Parents Food & drink manufacturers
The individual The state
• Decrease in responsibility: 76% believe that parents are at fault for their child’s obesity, but 69% agree that the state is gresponsible for addressing itSource: The Henley Centre, 2007
• Low awareness and lack of concern: Many parents of overweight children
th t th i hild i b are unaware that their child is obese – and are unconcerned about the consequent health risksS C f d l “P l b hildh d b i d hSource: Crawford et al., “Parental concerns about childhood obesity and the
strategies employed to prevent unhealthy weight gain in children” (2006)
Lack of social cohesion• Fragmentation of the community:
Lack of social cohesion• Fragmentation of the community: 97% of communities in the UK have become more socially fragmented over the past three decades over the past three decades (based on the number of nonmarried adults, oneperson households and people moving in the last year)Source: Changing UK (Dec 2008), BBC Report
• Loneliness: The number of loneperson The number of lone person households has risen from 3 million to 6 million over the last 35 years and is expected to rise by another 3 million in the next 15 (by 2021)Source: JRF Report, Social Exclusion (Sept 2006)
• Socially isolated men were at increased risk of cardiovascular increased risk of cardiovascular disease mortality and deaths from accidents and suicidesSource: Kawachi et al., “A prospective study of social networks in
relation to total mortality and cardiovascular disease in men in the USA” (1996)
• Socially isolated women with Socially isolated women with breast cancer had a 66% increased risk of mortality Source: C. Kroenke, “Social Networks, Social Support, and Survival
• Those with higher blood
After Breast Cancer Diagnosis”, JCO (2006)
pressures were revealed to be the most lonely (in a study based on 299 men and women aged 50 to 68)Source: John Cacioppo & Louise Hawkley, “Loneliness is a unique
predictor of age‐related differences in systolic blood pressure”, Psychology & Ageing (2007)
Concentration of assets• The wealthiest half of households
Concentration of assetsThe wealthiest half of households hold 91% of the UK’s total wealth, whilst the other half has the remaining 9%gSource: ONS, Wealth in Great Britain – Main Results from the Wealth and Assets Survey 2006/08 (2009)
• In 2008/09, 13m people were in poverty (in low income households before household costs)
• Of these 5 8m (44% of the total) • Of these, 5.8m (44% of the total) were in ‘deep poverty’ (household income at least one third below the poverty line) the highest poverty line) the highest proportion on recordSource: JRF Report, Monitoring Poverty and Social Exclusion 2010
• Males in the professional class had a life expectancy at birth of had a life expectancy at birth of 80.0, compared with 72.7 years for those in the manual unskilled class – for females, this is 85.1 class for females, this is 85.1 and 78.1 respectively (in the period 20022005)Source: ONS, “Variations persist in life expectancy by social p p y y
class” (2002‐2005).
• Infant mortality for the lower social group is 5.9 infants per 1000 live births, which is 20% higher than the average 4.9 per 1000Source: DH, Review of Health Inequalities Infant Mortality PSA
T t F b2007Target, Feb2007
Concentration of powerConcentration of power
• Low levels of influence: In 2009/10, only 37% of people felt they could influence felt they could influence decisions in their local area –this figure was 44% in 2001Source: ONS Citizenship Survey 2009/10Source: ONS Citizenship Survey 2009/10
• Nearly three out of four Britons d i h h h agreed with the statement that
“the state intervenes too much” – a higher level than almost any other EU nationSource, David Halpern, “The Wealth of Nations” (2007)
The Big Society: Health by g y yAssociation
• Both Welfarism and Market Both Welfarism and Market based approaches have lead to further inequalities…
• The lower your social and economic status, the poorer your health is likely to beyour health is likely to beSource: The Marmot Review, 2010.
• The ‘Big Society’ can reduce h i li ithese inequalities
Civil Society and AssociationCivil Society and Association
Building social capital and strengthening communal
ibiliresponsibility...‐ support environments that offer the ‘space’ for social pbonding, bridging and linking to take place
‐ encourage participation and ‐ encourage participation and education in health related programmes
• The quality of neighbourhoods q y gand the social environment in terms of social capital are closely linked to a wide variety of health yindicatorsSource: Kawachi & Berkman (2003)
• Poortinga found that “positive g pperceptions of the social environment (i.e. social support and social capital) were associated and social capital) were associated with higher levels of physical activity and lower levels of poor health and obesity”health and obesitySource: Poortinga, “Perceptions of the Environment, Physical Activity, and
Obesity, Social Science and Medicine” (2006)
Encourage social enterprises and community groups…
• There are 238,000 social entrepreneurs in the UKSource: Global Enterprise Monitor
• Only 1% of them will get the advice and money they need to growSource: UnLtd
• A support infrastructure is needed
• Bureaucracy reductiony
Open up tendering? Any willing provider not private sector capture but private sector capture but public partnerships
…promote peer to peer communication…
DECIPHerASSISTSmoking prevention intervention that aims to intervention that aims to reduce adolescent smoking through peertopeer communicationpeer communication
• Weekly smoking was 19.8% lower amongst the students who lower amongst the students who participated in DECIPHerASSIST
• 95% of those recruited agreed to b become peer supportersSource: DECIPHer‐IMPACT
…promote education and a greater sense of personal and shared responsibility
Mind, Exercise, Nutrition… Do it! (MEND, UK)
Social enterprise that
p y
Social enterprise that provides healthy lifestyle programmes that teach children and their families children and their families how to improve their health, fitness and the way they feel about their bodiesthey feel about their bodies
• Those who participated saw a mean reduction in waist of 4.1cm more than the control (6 months after intervention began)
• 86% attendance maintainedSource: Sacher et al., “Randomized Controlled Trial of the MEND Program: A Family‐Based Community Intervention for Childhood Obesity”, 2010
…an associational direction for care: friends and relatives a genuine win win
Patient Hotels
a genuine win win
• Hotels for patients undergoing treatment for cancer or other chronic conditionschronic conditions
• Friends and relatives provide social and medical supportA hi b li i l • Achieve better clinical outcomes at a lower cost
• Score highly in patient satisfaction• E.g. Paul O’Gorman Patient Hotel for children with Leukaemia
KeyRing• Community supported living
h ll d dthat allows dependents to become independent
• Builds support network: each pplocal network is made up of 10 homes: 9 are in need of support (the members) and 1 is the ( )volunteer
• Paid carers can be called if further support is needed
KeyRingWrexham’s Community Allotment
further support is needed• Lets members know what is going on in the local community
f th t k
• Members of KeyRing were awarded a Small Sparks grant to purchase their
– encourages further networksown allotment• Encourages exercise and engagement with the g glocal environment & other dependents
Welfarism into genuine transformation
Distributing assets and promoting ownershippromoting ownership...
‐ support employee and community ownership of health services and projects
‐ encourage the pooling of personalised budgets to p gprovide a costefficient and a (truly) publically owned health service
Ownership encourages i iassociation…
Central Surrey Health• Social enterprise• Owned by its 780 staff• Surplus capital is reinvested into services that the cointo services that the coowners deem in need of improvementW t t b Employee and community
ownership…• Motivates staff
• Wants to become more involved in the community in the future
Motivates staff• Localises decisions• Reduces the gap between
d idusers and providers• Increases trust
Local Care Direct (Bradford)Local Care Direct (Bradford)• Community owned health service provider
l k d• Assets locked• Involves the community in making decisions in how to improve care –pmeetings occur in each centre at least once a year
• Members elect the advisory boardMembers elect the advisory board• Any member can call a meeting• Changes employees’ ways of thinking
…and association encourages ownershipencourages ownership…
Participatory BudgetsParticipatory Budgets• Directly involves local people in making decisions on the
di f bli b d tspending of public budgets• Increases transparency, accountability, understanding and social inclusion in local government affairs
• Shifts ownership and Shifts ownership and responsibility back to communities
Your Community, Your Health, Your Voice (Thornhill, Southampton)• Participatory budget set up in an area that is both in an area that is both socially and economically deprived
• Empowers local groups to
Pooling personalised budgets…?
• Empowers local groups to bid for money and manage healthrelated projectsg
• Increases resident participation in decision making
• Personalised budgets can be transformed into
Source: PB Unit Pilot Schemepurchasing power• Pooling budgets can allow patients to group purchase and shape their own healthcare
Social impact b d
• Innovative way of attracting
bonds…
y gnew investment to improve social outcomes and benefit communitiescommunities
• Financial returns to investors are based on improved social outcomes
Source: Social Financeimproved social outcomes
• Community based
Reoffending rates in Peterborough• Ministry of Justice will reward investors if reoffending investors if re offending among prison leavers falls by 7.5% against standard
…channelling investment into community j t ith bl tprojects with measurable outcomes
• Achieving more for less• Achieving more for less…• Reduction in pressure on health servicesB t t i t tl • But most importantly, encouraging local and associative initiatives that work
Possible ways forward: • Prevention of and reduction in obesity (e.g. MEND), alcoholism…
• Reduction in hospital admittance for the elderly and those with chronic illnesses (e.g. patient hospitals, KeyRing)
We need a ‘Big Society’ approach to health
• The Big Society is a vital i di b h h l h ingredient to both health provision and maintenance
• By opening up associative economic models, health
l b linequalities can be greatly reduced