Twelve-hundred years of insight in 90 minutes!

After having worked for over twenty years in health care, this year I have been given the fantastically exciting responsibility for scoping the Foundation’s strategy for improving health. We will be extending our work to look more broadly at the determinants of health, the factors that shape where we live, learn, work and play. And over the next 18 months I will be working with colleagues within and beyond the Foundation to identify where we can make the greatest impact.

This week is the starting whistle for this exercise. In partnership with the Robert Wood Johnson Foundation in the US, we are hosting a Salzburg Global Seminar entitled: Hooked on Health Care? Designing Strategies for Better Health.

Bringing together around 60 participants from 17 countries, the five-day seminar will explore why it is that, despite the widely accepted understanding that health is the product of our social, commercial, political and environmental context, politicians and the public are generally more concerned with the quality and access to health care than the wider determinants of health.

With inputs from people with backgrounds as diverse as community organising, education, workplace health, urban planning, philosophy and social justice, coupled with a depth of knowledge and expertise in population health, I am confident that the discussions that ensue will provide the opportunity for us to identify forward thinking solutions to a long standing problem.

The starting session alone was invaluable. Everyone in the room was asked to set out what they could offer the group and what they were seeking from the group. So in about 90 minutes we were able to pinpoint where it is that people with years of experience in this field are getting stuck. Five themes emerged:

The need for better thinking

A number of people touched on the need for us to be better able to articulate the problem rather than the challenge. The challenge (childhood obesity, air quality etc) is often more visible and tangible. But the challenge is also often too big to tackle (you can’t eat an elephant whole…). We need better processes for building our understanding of the problems that results in these challenges if we are to design effective solutions.

The need for a different public discourse

We all value our access to high quality healthcare however the broader understanding and recognition of the factors that ultimately impact most on our health and wellbeing is not so widely articulated to the public. How can we make more explicit the health consequences of decisions taken on wider social determinants?  What is the role of the media and marketing, and where are the opportunities for inter-generational learning?

The need to value the future

Whether at an individual level or a political level, we have a tendency to prioritise what is in front of us and prefer to reap benefits oday rather than tomorrow. No wonder that our Secretaries of State for Health are preoccupied by health care rather than the wider determinants of health. Their political future rests on whether or not the NHS delivers what is needed today. The health consequences of decisions around taxation, welfare and wider public spending will not generally lead to direct consequences during their political lifespan. What can be done to shift individual and collective attitudes toward the future?

The need to engage employers and business in this agenda

There was recognition of the important contribution the private sector can play in influencing health - for the better or worse. On the positive side, being in employment is an important determinant of health and employers do have an interest in having a workforce supply that is healthy and productive. So how can business leaders be encouraged to own the health agenda and use their influence to effect change? 

On the downside, poor working conditions can be detrimental to health. We may not in the UK face the industrial type illness and injury that still beset many of the lower and middle income countries, but the impact of shift working, sedentary workplaces and stress are factors that need attention. And perhaps the most challenging issue to tackle in this space is the significant commercial interests that potentially run counter to population health.

The need for scalable models of community empowerment

Many in the room advocated the role of communities in mobilising assets to create health. However, they also acknowledged the paradox of ‘scaling localism’ and the need to find a solution to this challenge.

A number of other issues for which people were seeking help were raised: addressing the health issues that arise from growing urbanisation; the need for greater alignment of incentives, payment systems and funding streams; the need for workers beyond the traditional health care system to understand their contribution towards health.

So, I feel hugely privileged to have been able to learn from the collective wisdom of people with over a 1000 years worth of experience in this field and hope that the Foundation can make a significant contribution to this agenda.

Jo is Director of Strategy at the Health Foundation, www.twitter.com/JoBibbyTHF