Margaret Hannah
At the May 2024 COIN meeting - https://www.youtube.com/watch?v=EQS2dUNkxms - I presented my ideas about how the changing pattern of health and disease requires us to re-orient healthcare practice towards the community (starts at 17.42 minutes into the video). Here is a summary. A fuller version is available in a paper published by the Journal of Holistic Health and Integrative Medicine - https://bhma.org/product/crisis-co-creation-community/.
Patterns of health and dis-ease has changed profoundly since the NHS was founded and demands on carers are growing.
For example, women today are starting families much later, meaning their parents are older and more likely to need care at the same time as they are raising young children.
Greater geographic spread means that caring for elderly relations becomes more difficult; family arrangements have become more complicated.
Big changes in the world of work - less manual labour and industry. Health & safety is better but we have a toxic legacy, often blighting land and water especially in areas of deprivation.
A lot more work behind desks and behind wheels, leads to poor work-life balance and poor attention to our bodies.
The 'gig economy' leads to people having temporary positions in companies that fail to care for them. This causes constant stress that Arlene Geronimus calls 'weathering' – afflicting every aspect of mind and body all the way down to the cellular level.
The effects of weathering and social inequalities became even more apparent during COVID when those in low-pay work, often providing essential services were more at risk of the infection and more likely to develop serious complications compared to those who were able to work from home.
Changes in the financial sector is putting huge pressure on people, for example making houses unaffordable for most people, putting further strain on people's health.
Austerity in public spending has squeezed public services, aggravating the picture.
Improvements in healthcare and digital technologies have enabled more to be done and learning to be disseminated more quickly. But there is a limit to the effectiveness of new technology which reinforces a provision of healthcare based on individual conditions when the pattern of illness today is of multiple and complex dis-eases, both medically and socially.
The changing pattern of illness requires more holistic approaches, with better understanding of the importance of relationship-building, collaboration and acknowledgment of early psychological trauma.
We need healthcare systems that revolve around people and build trusted relationships, rather than diseases, the Alaskan Nuka model aims to do this.
Health practitioners and people ('patients') need to feel equal members of a partnership in care based on conversations about what “better” looks like for them. Families too need opportunities to 'all get round the table'.
UK examples of practices that are moving forward collaborative ways to work include Frome in the Somerset, Fleetwood in the North-West, Lambeth in South London. They are recognising the limitations of the dominant mindset and instead understand the need to nurture community connections recognising most care and recovery from illness takes place at home.