By Dr Ollie Hart (GP in Sheffield), November 2022
It has been a pleasure to take part in the recent events of The Health Creation Alliance’s ‘Health Creation: Coming of Age´ series. The big question at the end, ‘Is Health Creation coming of age?’ For those many hundreds of enthusiasts involved in the week it certainly is. Lords, Clinicians, Businesses, Community Groups, Experts, Learners and People with Lived Experience, there was a huge range of roles and experiences involved. But is Health Creation coming of age in society at large?
Maybe you are wondering what Health Creation is? I feel I have been part of a huge collective ‘penny-drop’ as many of us have collectively explored what it is and how it could and should be a core part of how we support good health and wellbeing.
My understanding is Health Creation is like the other side of a coin from illness treatment. It’s a focus on what makes you well and helps you thrive. The Health Creation Alliance defines Health Creation as a process through which individuals or communities gain a sense of purpose, hope, mastery and control over their own lives and immediate environment. When this happens their health and wellbeing is enhanced. It’s worth exploring the THCAs website for a deeper definition and how to do it, but they highlight particularly the 3 Cs of Health Creation, supporting people to increase meaningful contact within their community, build self-confidence and take control.
For me as a GP trained in diagnosing and treating illness, discovering Health Creation feels like a huge light shining on a gaping hole I’d not fully noticed before. I’m professionally very interested in having a positive impact on people’s health and wellbeing, but if feels like we in the NHS have been completely focused on treating illness and totally neglected the equally valuable business of pursuing what keeps people well. This is not even ‘Prevention’ work, that is still concerned with illness. This is much more positive; it’s about proactively understanding and enabling the conditions for the best possible health.
Interestingly when you listen to how people do this, it’s not really about traditional health care. It is far more about communities and interpersonal relationships. Part of the week was an awards ceremony to celebrate some of the most imaginative ways people are practicing Health Creation. This includes the Intergenerational Music Project. They discovered that one of the best ways to energise elderly people in care homes, is to connect them with primary school children through music. It also turns out that singing with older people, who might need a little help along the way, is a great way of improving the attention and focus of energetic children. The shared time making or listening to music together is a great win win for all involved, and this project sets about pairing up care homes and primary schools across the country.
On a similarly imaginative but slightly different take (there is no one size fits all in Health Creation), a team from Northern Ireland were also recognised for their work in frail elderly adults. Amongst many ideas they hosted funeral fairs to get people talking and connecting, and break down the stigma and fear of death. Their Mars Bar and Apple sandwiches are a great talking point, helping to transcend traditional cultural barriers too.
Lord Crisp, a previous Chief Executive of the NHS was hosting one of the sessions. He talked of how Health Creation creates conditions for people to flourish. It reminded me of the book called ‘Flourish’ by Martin Seligman. This book really caught my attention. The author’s name was familiar. He was the researcher who had developed the theory of ‘Learned Helplessness’ which informed much of our medical school teaching of the causes of depression. This research had recognised that people consistently traumatised with conditions of no hope, after a time, stop pursuing an optimistic and positive outlook, and develop depression. But whilst Professor Seligman was hugely respected for his influence on medical practice, his work was taking a toll on him personally. He was so immersed in the causes of mental illness it started to cause him to become depressed himself. So mid-career he switched to research the causes of great health, culminating in his book Flourish. His personal experience of researching the positive emotions, life meaning, and good relationships he outlines in his book, helped reverse his own health outcomes.
With this memory jogged by talk of flourishing, I started to notice another overwhelming common feature of the people and organisations involved in the sessions. Everyone loves their jobs. Universally people spoke with passion about how meaningful and energising their work was, even some in the face of funding cuts. You should have seen the sparkle in the eyes of Alana and Lyndsey describing the music project.
Lord Crisp, commented at one point that he wished he had known more about Health Creation when he was boss of the NHS. He now makes it his business to promote the value he sees in Health Creation. It feel’s even more relevant now amid the crisis of burnt-out and demoralised NHS staff. Perhaps just like Prof Seligman they could do with switching focus a little from illness treatment to Health Creation.
Although Health Creation might recharge our flagging staff, is it the right thing for the NHS to focus on? Haven’t we enough on our hands with illness treatment? We know from the work of Nobel prize winning psychologist Daniel Kahneman that we are biased towards valuing protection from harm and loss, prioritising this over pursuit of ‘better’. Maybe it’s enough for the NHS to protect us from our worst fears of illness and disease? Matthew Taylor CEO of NHS Confederation is convinced otherwise. He told the conference that Health Creation is essential to the sustainability and success of the NHS. It seems from evidence and experience that a more balanced approach of both illness treatment and Health Creation achieves much better longer-term outcomes for people, better quality of life and years living in good health.
I know as a GP that the current NHS is not set up to deliver Health Creation. Our training, targets and incentives are all based around illness treatment and prevention. One of the delegates shared data that currently the NHS spends 97% of its resource on illness, and 3 % on Health Creation. Perhaps the evolving collaborations in communities, primary care networks, social prescribing and the like are a good start towards the NHS embracing Health Creation. Indeed, this is reflected in a key message from the weeklong series of events: systems transformation needs to be driven by the right relationships within, and with communities, and that it is relevant for all the programmes being ‘rolled out’ by NHSE. I think it will involve new skills, new roles and a new mindset to fully transition. But like me, once you have realised the gap, that other side of the coin, you can’t un-see it. I think for any of us interested in how people can enjoy their best possible health, and pursue the life they most value, you have to be interested in how we enact Health Creation as robustly as we pursue illness treatment. Whether it’s the NHS expanding its remit or a new ‘National Flourishing Service’ partnering it, we have so much to gain in health creation ‘coming of age’.
Conflicts of interest:
Dr Ollie Hart is a Clinical director of Heeley Plus, one of the NHS’s Primary Care Networks, and a director of Peak Health Coaching, a company that delivers training in health coaching and person-centred care in the NHS.