Health and Wider Determinants: Mixed Emotions

I am simultaneously very pleased and very concerned about the intention of health to have a bigger focus on prevention, early intervention and the wider determinants.

“But isn’t working with communities part of your mantra?”, I hear a cry from those of you who know me.

Yes, it is. Of course. However, if done in the wrong way, it could actually destroy value – relationships, social networks, information flows and person support in the shape of charities or local groups.

Why and how? Third sector organisations holistically help people to have better lives – especially those with the most challenges in their lives. The third sector has been doing this for hundreds of years. Or to put this into NHS language, third sector organisations help reduce inequalities/address the wider determinants of health/help people to have better health outcomes (or whatever other current buzzwords are in vogue). The NHS is a newcomer to much of this space and there is a real risk of destruction of community value here if it moves into this space without understanding what is already there.

When the public sector comes in and starts doing activities previously done by the third sector, some third sector services may be redundant, indeed some organisations may be redundant or no longer financially viable and they will pack up and go home. As well as the loss of the organisation, much more is lost when an organisation shrinks or shuts up shop – much ‘social capital’ is held in third sector organisations, especially small, local ones, bringing a wealth of benefits to the local community beyond the obvious – practical and emotional support, information sharing, sense of self-worth, hope, personal solutions and much, much more. Furthermore, residents typically find being part of community led and driven organisations, where people can both give and receive, a much more satisfying way to get the help that they need than a traditional professional/patient model.

As everyone knows, public sector cuts are a frequent and sad reality, so when the public sector comes in and then cut back their services a year or two later, the original groups no longer exist.

So, the starting point for all work needs to be an investigation into the charities, social networks and groups that are already there meeting people’s needs. This should include informal and formal groups – particularly around peer support type activities. And what is the perspective of these local organisations? What unmet needs are they seeing? What routes do they see for meeting those needs? Growing existing initiatives should always be the preferred course of action for mobilisation of resources rather than starting new ones.

If you are working in Surrey and would like help to explore what is out there, please do get in touch with us.

– Cate Newnes-Smith

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