Dr Margaret Hannah, Director of Health Programmes, International Futures Forum. 

editorial@internationalfuturesforum.com

This blog relates to a discussion at the COIN meeting of October 2023 - https://www.youtube.com/watch?v=YyK24LD6i6I 

Patterns of disease change over time.  At the time of the NHS forming in 1948, the commonest causes of hospital admission were for accidents (often work or traffic-related) and infections. Today, it is more commonly the exacerbation of an underlying chronic condition. It is taking a long time for the healthcare system to adapt and respond effectively to this new challenge.  Whereas attention on individual pathology within different body parts has led to major discoveries and treatments for specific forms of trauma and diseases, there is a limit to the effectiveness of this reductive approach when dealing with chronic ill health. 

The onset of chronic health problems is often decades earlier in people who live with the daily stress of poverty and injustice compared to those living in more affluent and privileged environments.  This provides a hint for how we might respond more effectively.  

What follows are some ideas shared at a recent COIN meeting which emphasise the role of collective approaches in improving health and reducing the burden of disease.  These ideas add to previous discussions about local collaboration, integration and generalism for whole society health.   At their heart is a restoration of meaning and agency in people’s lives.   

Promoting human health is more than providing technical, medical care.  To thrive, people need to be in caring relationships, able to access good food, be employed in meaningful work, have somewhere safe and warm to live and be able to play their part in creating a healthy planet.  Everyone has a part to play in making life worthwhile but are often constrained by the way we are able to interact with others to make our contribution.  

This means healthcare systems which show the greatest promise for the future are those which understand that providing treatment and care for individuals cannot be effective without paying attention to their relationships. As Carl Rogers described in Becoming a Person, we are not individuals alone, we are persons – living in a web of interacting relationships which can nurture and sustain us or be troublesome and drain us.  Our relationships also include with our past, our view of ourselves and the wider world.  Whilst the NHS is well-designed to respond to a presenting crisis, longer-term recovery takes care – which is intrinsically relational.    

In some parts of the UK, this culture shift is taking off.  It is slow, deep work, driven by a commitment from those leading the work to shape relationships such that people feel they are active participants rather than passive recipients of care.  They are beginning to see what were previously blind spots.  For example, in Lambeth, they now include a code for chronic pain to record people coming to primary care who have a long history of this condition.  They are working with community groups to co-design programmes of support for people such that they learn self-help and develop links with others in their community and not just receive one-to-one expertise from clinicians.  International Futures Forum (IFF) nurtures links with people working in these kind of ways, such as in the West Country, Scotland, Sussex and London.   By fostering relationships of reciprocity and mutuality, they are restoring a sense of agency in communities.  

If you wish to be part of this network of hope in health and care, please contact Dr Margaret Hannah via editorial@internationalfuturesforum.com