3. Lack of participation
Lack of participation
• Decrease in civic engagement:
In 2009/10, only 34% of people in
England engaged in some form of
civic participation – in 2001, this
figure was 38%
• Decrease in volunteering:
/ p p
In 2009/10, 25% of people in
England volunteered formally at
least once a month, compared to
29% in 2005
Source: ONS Citizenship Survey 2009/10
4. Who is at fault for obesity? Who is responsible for addressing it?
76
69
48
40
31 30
22
12
Parents Food & drink The individual The state
manufacturers
• Decrease in responsibility:
76% believe that parents are at
fault for their child’s obesity, but
69% agree that the state is
g
responsible for addressing it
Source: The Henley Centre, 2007
5. • Low awareness and lack of concern:
Many parents of overweight children
are unaware that their child is obese
th t th i hild i b
– and are unconcerned about the
consequent health risks
Source: Crawford et al., “Parental concerns about childhood obesity and the
S C f d l “P l b hildh d b i d h
strategies employed to prevent unhealthy weight gain in children”
(2006)
6. Lack of social cohesion
Lack of social cohesion
• Fragmentation of the community:
Fragmentation of the community:
97% of communities in the UK have
become more socially fragmented
over the past three decades
(based on the number of nonmarried adults, one
person households and people moving in the last
year)
Source: Changing UK (Dec 2008), BBC Report
• Loneliness:
The number of lone person
The number of loneperson
households has risen from 3 million
to 6 million over the last 35 years
and is expected to rise by another 3
million in the next 15 (by 2021)
Source: JRF Report, Social Exclusion (Sept 2006)
7. • Socially isolated men were at
increased risk of cardiovascular
disease mortality and deaths
from accidents and suicides
Source: Kawachi et al., “A prospective study of social networks in
relation to total mortality and cardiovascular disease in men
in the USA” (1996)
• Socially isolated women with
breast cancer had a 66%
increased risk of mortality
Source: C. Kroenke, “Social Networks, Social Support, and Survival
After Breast Cancer Diagnosis”, JCO (2006)
• Those with higher blood
pressures were revealed to be
the most lonely (in a study based on
299 men and women aged 50 to 68)
Source: John Cacioppo & Louise Hawkley, “Loneliness is a unique
predictor of age‐related differences in systolic blood
pressure”, Psychology & Ageing (2007)
8. Concentration of assets
Concentration of assets
• The wealthiest half of households
hold 91% of the UK’s total wealth,
whilst the other half has the
remaining 9%
g
Source: ONS, Wealth in Great Britain – Main Results from the Wealth and
Assets Survey 2006/08 (2009)
• In 2008/09, 13m people were in
poverty (in low income households
before household costs)
• Of these 5 8m (44% of the total)
Of these, 5.8m (44% of the total)
were in ‘deep poverty’ (household
income at least one third below the
poverty line)
poverty line) the highest
proportion on record
Source: JRF Report, Monitoring Poverty and Social Exclusion 2010
9. • Males in the professional class
had a life expectancy at birth of
80.0, compared with 72.7 years
for those in the manual unskilled
class
class – for females, this is 85.1
and 78.1 respectively (in the
period 20022005)
Source: ONS, “Variations persist in life expectancy by social
p p y y
class” (2002‐2005).
• Infant mortality for the lower
social group is 5.9 infants per
1000 live births, which is 20%
higher than the average 4.9 per
1000
Source: DH, Review of Health Inequalities Infant Mortality PSA
Target, Feb2007
T t F b2007
10. Concentration of power
Concentration of power
• Low levels of influence:
In 2009/10, only 37% of people
felt they could influence
decisions in their local area –
this figure was 44% in 2001
Source: ONS Citizenship Survey 2009/10
Source: ONS Citizenship Survey 2009/10
• Nearly three out of four Britons
agreed with the statement that
d i h h h
“the state intervenes too much”
– a higher level than almost any
other EU nation
Source, David Halpern, “The Wealth of Nations” (2007)
11. The Big Society: Health by
g y y
Association
• Both Welfarism and Market
based approaches have lead
to further inequalities…
• The lower your social and
economic status, the poorer
your health is likely to be
Source: The Marmot Review, 2010.
• The ‘Big Society’ can reduce
these inequalities
h i li i
12. Civil Society and Association
Civil Society and Association
Building social capital and
strengthening communal
responsibility...
ibili
‐ support environments that
offer the ‘space’ for social
p
bonding, bridging and linking
to take place
‐ encourage participation and
education in health related
programmes
13. • The quality of neighbourhoods
q y g
and the social environment in
terms of social capital are closely
linked to a wide variety of health
y
indicators
Source: Kawachi & Berkman (2003)
• Poortinga found that “positive
g p
perceptions of the social
environment (i.e. social support
and social capital) were associated
with higher levels of physical
activity and lower levels of poor
health and obesity
health and obesity”
Source: Poortinga, “Perceptions of the Environment, Physical Activity, and
Obesity, Social Science and Medicine” (2006)
14. Encourage social enterprises and community groups…
• There are 238,000 social
entrepreneurs in the UK
Source: Global Enterprise Monitor
• Only 1% of them will get the
advice and money they need
to grow
Source: UnLtd
• A support infrastructure is
needed
y
• Bureaucracy reduction
Open up tendering? Any
willing provider not
private sector capture but
public partnerships
15. …promote peer to peer communication…
DECIPHerASSIST
Smoking prevention
intervention that aims to
reduce adolescent
smoking through peerto
peer communication
• Weekly smoking was 19.8%
lower amongst the students who
participated in DECIPHerASSIST
• 95% of those recruited agreed to
become peer supporters
b
Source: DECIPHer‐IMPACT
16. …promote education and a greater sense of personal and
shared responsibility
p y
Mind, Exercise, Nutrition…
Do it! (MEND, UK)
Social enterprise that
provides healthy lifestyle
programmes that teach
children and their families
how to improve their
health, fitness and the way
they feel about their bodies
• Those who participated saw a
mean reduction in waist of
4.1cm more than the control
(6 months after intervention began)
• 86% attendance maintained
Source: Sacher et al., “Randomized Controlled Trial of the MEND
Program: A Family‐Based Community Intervention for Childhood
Obesity”, 2010
17. …an associational direction for care: friends and relatives
a genuine win win
a genuine win win
Patient Hotels
• Hotels for patients undergoing
treatment for cancer or other
chronic conditions
• Friends and relatives provide
social and medical support
• A hi
Achieve better clinical outcomes
b li i l
at a lower cost
• Score highly in patient satisfaction
• E.g. Paul O’Gorman Patient Hotel
for children with Leukaemia
18. KeyRing
• Community supported living
that allows dependents to
h ll d d
become independent
pp
• Builds support network: each
local network is made up of 10
homes: 9 are in need of support
(
(the members) and 1 is the
)
KeyRing Wrexham’s volunteer
Community Allotment • Paid carers can be called if
• Members of KeyRing were further support is needed
awarded a Small Sparks • Lets members know what is
grant to purchase their going on in the local community
own allotment – encourages further networks
f th t k
• Encourages exercise and
g g
engagement with the
local environment &
other dependents
19. Welfarism into genuine
transformation
Distributing assets and
promoting ownership...
promoting ownership
‐ support employee and
community ownership of
health services and projects
‐ encourage the pooling of
p
personalised budgets to
g
provide a costefficient and a
(truly) publically owned
health service
20. Ownership encourages
association…
i i
Central Surrey Health
• Social enterprise
• Owned by its 780 staff
• Surplus capital is reinvested
into services that the co
owners deem in need of
improvement
Employee and community • W t t b
Wants to become more
ownership… involved in the community in
the future
• Motivates staff
• Localises decisions
• Reduces the gap between
users and providers
d id
• Increases trust
21. Local Care Direct (Bradford)
Local Care Direct (Bradford)
• Community owned health service
provider
• Assets locked
l k d
• Involves the community in making
decisions in how to improve care –
p
meetings occur in each centre at
least once a year
• Members elect the advisory board
• Any member can call a meeting
• Changes employees’ ways of
thinking
23. Your Community, Your Health,
Your Voice (Thornhill,
Southampton)
• Participatory budget set up
in an area that is both
socially and economically
deprived
• Empowers local groups to
Pooling personalised bid for money and manage
healthrelated projects
budgets…?
g
• Increases resident
• Personalised budgets can participation in decision
be transformed into making
purchasing power Source: PB Unit Pilot Scheme
• Pooling budgets can allow
patients to group purchase
and shape their own
healthcare
24. Social impact
bonds…
b d
• Innovative way of attracting
y g
new investment to improve
social outcomes and benefit
communities
• Financial returns to
investors are based on Source: Social Finance
improved social outcomes
• Community based
Reoffending rates in Peterborough
• Ministry of Justice will reward
investors if re offending
investors if reoffending
among prison leavers falls by
7.5% against standard
25. …channelling investment into community
projects with measurable outcomes
j t ith bl t
• Achieving more for less
Achieving more for less…
• Reduction in pressure on health
services
• B t
But most importantly,
t i t tl
encouraging local and associative
initiatives that work
Possible ways forward:
• Prevention of and reduction in
obesity (e.g. MEND), alcoholism…
• Reduction in hospital admittance
for the elderly and those with
chronic illnesses (e.g. patient
hospitals, KeyRing)
26. We need a ‘Big Society’ approach
to health
• The Big Society is a vital
ingredient to both health
i di b h h l h
provision and maintenance
• By opening up associative
economic models, health
inequalities can be greatly
l b l
reduced
