Our vision for a healthier society: from hospital beds to hospitable neighbourhoods

After genetic determinants, our well-being is decisively more determined by our community assets than any other health and well-being determinants. Tragically community building hardly features as a priority in the current ‘sickness model’. And so, for example, older people are dying of loneliness in a sea of neighbourliness that does not know how to express itself.

While it is true to say we are creeping towards a change in focus in this regard, it is also fair to say we stand economically and morally at a pivotal point in time. There is a critical need to accelerate this portion of the public health agenda by elevating the status and function of ‘connected communities’ as agents of health production in their own right.

Fortunately in our view this has become all at once both more critical and more possible than at any other time in human history. Everyone’s health and well-being depends on a fundamental shift from viewing health as a product to be consumed to a condition that we all have a part in producing.

A society where most are choosing to co-create a shared health seeking future will not come easily. But here are three drivers which we believe would accelerate us towards that ambitious (stretched) objective:

1. Invest in asset based community building that fortifies community assets and supports social networks to grow deeper and to become more inclusive. This will yield profoundly better returns than the current social service or medical models can do unilaterally. In practice this means having an asset based community builder in ever neighbourhood.

2. Bridge the gap between community housing, social care, environmental and economic sustainability, public safety and health. This will lead to a life course approach that goes with the grain of people’s lives not against it. Organising services the way people organise their lives, requires that wherever possible services are delivered at neighbourhood level where people are most likely to easily connect with community assets. Putting unnecessary distance between people and their community assets is harmful and creates false efficiencies.

Working at community level also calls on agencies to get serious about population health and recognise if we invest in the health of an entire neighbourhood – not just a small part of an individual’s body – then we will reduce dependency on services and at the same time substantially increase well-being across the population. Thereby decisively advancing the preventative agenda.

3. Move from a focus on what’s wrong to what’s strong. Joint Strategic Needs Assessments (JSNA) are not a helpful starting point. Neither are Joint Strategic Needs and Asset Assessments. In my view the only thing that needs analysis is needs analysis. Assuming that an asset based approach is simply about getting a better balance between assets and needs is misguided and equally problematic. Such an assumption fundamentally misses the core challenge underpinning ABCD. Which is, by starting with an inventory of assets that has been developed by citizens at neighbourhood level through community building, they themselves can say what they can do for themselves and each other, what they can do with help (Citizen-led Co-production) and what they need institutions to get on and do under their own steam. Asset mapping is not about gathering data about community health assets, it’s about building strong healthy communities from inside out, where citizens are in the driving seat.

This means agencies/funders cannot insist that people work to their institutional outcomes, or even that what they do must be health related. Instead agencies need to support intentional asset based community building for its own sake; citizen-led well-being outcomes will follow as sure as day follows night. This is nothing short of asking Agencies to lead by stepping back while still caring. It’s a fundamental shift from top heavy service provision to light touch community building with service in reserve when required. I am pleased to say the evidence base for this way of working grows by the day.

[youtube=http://www.youtube.com/watch?v=fbSgTqp4CxM&w=420&h=315] In April 2012, I gave this presentation in which I asserted ‘we can’t know what a community needs, until that community first knows what it has’ (a quote from Professor John McKnight). I would add that discovering those assets takes time and is not something you can do over a couple of workshops. This is about process not product or outcome, and it requires the skill of a dedicated community builder and the willingness of citizens to work towards more connected competent communities. It also calls on professionals to do their part in growing systems that know how to let go and trust the people they serve.

When it comes to staying well and recovering quickly when unwell, we don’t need more hospitable beds, we need more hospitable communities.

Cormac Russell

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