A response to the IPPR Commission on Health and Economic Prosperity from The Health Creation Alliance, 15 October 2024
Health is created in and by communities and at the intersection between communities and frontline services. The role of everyone else – across all sectors and at all levels of communities, organisations, systems and policy-making – is to create the conditions for communities to create health and to remove the barriers, of which there are many.
Delivering the bold vision of the IPPR Commission on Health and Economic Prosperity will require nothing less than a revolution in our understanding of how change actually happens; this is the leadership challenge. The Health Creation Alliance’s community-lens experiential approach offers important insights that can help make the change happen everywhere. The real work begins now.
A blog by Chief Executive, Merron Simpson and Ambassadors for The Health Creation Alliance: Chris Carlin, Loreen Chikwira, George Fielding, Lisa Holden, Dr Sandra Husbands.
Of all the publications that have emerged on the future of health and social care over the last few weeks, there is one that stands out for The Health Creation Alliance.
Our Greatest Asset, the final report of the IPPR Commission on Health and Economic Prosperity argues that ‘better health will only be possible if we move from a sickness model of health policy to a health creation one. It is achieving this shift that should define the implementation of the new government’s health mission’.
While IPPR is not the first think tank to talk openly about health creation, it is the most influential one – particularly with the current Labour administration. Brilliant then, that they have made such a clear case for change. Health Creation: for now and future generations is, after all, what The Health Creation Alliance has been calling for, for the last eight years. The fact that such an important precept, that health can and must be created as well as poor health treated and prevented, is catching on at the most senior levels is a huge step forward.
Many of our passionate members have been creating the conditions for communities to create health for a long time and supporting new ways of working that enable these conditions. Others are newer to this, while others still are just setting out exploring how to do it. What binds our members is a desire to see a different way of working become business as usual and embedded in systems alongside the treatment of illness and prevention of ill health.
With the publication of this report, we feel a big step closer to realising that ambition.
Here are some of its key messages.
First, there is a clear focus on workplaces, schools, homes, communities, families and friends. This is good, because we all know that Health is made at home; hospitals are for repairs.
Second, to ‘hard-wire health creation across Government’ and support a new whole society approach to making healthier lives a cross-society, cross-economy mission it scopes out (in text-book think tank fashion);
- five foundational pillars or ‘shifts’ from illness-inducing to health creating work, markets, families, places and services
- a large number of detailed policy recommendations – such as a Fair Work Charter, taxes on unhealthy food, a Sure-start restart.
- a means of measuring progress through the ‘Health Index’ that sits alongside GDP.
Third, the report proposes a programme to spread ‘what works’ to the places that stand to benefit most, enter Health and Prosperity Improvement (HAPI) Zones designated by local people and signed off by national government; these should be the focus for investment to rebuild community assets and pilot ‘strength creation’, billed as a bolder version of an asset-based approach.
And fourth, it sees this ‘health creation model’ incorporating a more sustainable NHS that can both contribute locally to prevention and do its core job of treating sickness, brilliantly. To this end, it backs the Hewitt Review’s recommendation to significantly reduce centrally mandated targets giving systems more scope to define their priorities, goals and partnerships based on their populations’ health needs.
So what should we make of it?
While the report says many of the right things it does so by looking through the policy-lens. The focus is on policy ideas and it is under-cooked on its analysis of how health is actually created. This is the gap that always creates the challenge to implementation and long-term change. It is this gap that The Health Creation Alliance fills by looking at both the problems and solutions through the community-lens and building the paradigm from there. This approach is articulated in our May 2024 Manifesto for whole system change.
Many of the elements in the IPPR report’s ‘strengths creation’ section are things we called for in the our Manifesto – they are important for communities to create health. But there is plenty missing. Where is the request for truth-telling and transparency that communities crave? Communities give and ask for ‘reciprocity’ but are frequently denied it when power-holders see systems falter and over-estimate their role in putting things right. And where is the listening and responding in fashioning the policy recommendations? Did the Commission heed the Poverty Truth Network’s and Commissions’ request that ‘nothing about me without me is for me’?
The report offers a very welcome vision for how a mission-driven approach to public policy should ideally work. It also represents a huge undertaking – to create and fund a whole new infrastructure with all its elements oriented to creating health. As No. 10 embarks on this, the big question as to how to build it to assure best chance of success over several parliamentary terms.
Getting Health Creation right:
- demands an acknowledgement that the standard approach to making change happen – pulling levers in Whitehall that deliver rules and regulations – have, at best, been partially successful (the Grenfell Inquiry has shown just how limited this approach is).
- requires humility, imagination and a willingness to entertain the idea that there may be a different way to enable change that works for people and communities by working as equal partners with them, offering opportunities for health creation within the process.
- means being intentional about having deliberative conversations with people who don’t get heard, giving them the space to create something of value to them and allowing them to own, publicise and deliver it – responding to their requests for assets and support.
Concluding thoughts
The Commission has come up with an excellent vision. We all need this change to happen. We all need to be a part of it. We all need to see our role in it. It’s about having some form of change that everyone can own.
Health is created in and by communities and at the intersection between communities and frontline services. The role of everyone else – across all sectors and at all levels of communities, organisations, systems and policy-making – is to create the conditions for communities to create health and remove the barriers, of which there are many.
Delivering the bold vision of the IPPR Commission on Health and Economic Prosperity will require nothing less than a revolution in our understanding of how change actually happens; this is the leadership challenge. The Health Creation Alliance’s community-lens experiential approach offers important insights that can help make the change happen everywhere. The real work begins now.
