The Creating Health Collaborative now has an Executive, a subgroup of its members who have agreed to help me think through what we need to do, and to help me do it. While it’s great to ‘share the burden’, as one of them described it, recruiting the Executive required me to be clear on what we’re trying to do. This is what I came up with:
The Creating Health Collaborative is a community of entrepreneurs and intrapreneurs working individually to understand and create health beyond the lens of health care
I want to explain three parts of that description but let me start by listing – and thanking – the members of the Collaborative who have agreed to be on its Executive:
- Bridget Kelly, Former Interim Director, Board on Children, Youth, and Families, National Academies of Sciences, Engineering, and Medicine, USA
- Jamie Harvie, Executive Director, Institute for a Sustainable Future, USA
- Jeff Cohen, Director, FSG, USA
- Lauren A Taylor, Co-Author, The American Health Care Paradox, USA
- Leigh Carroll, Master in City Planning Candidate, Massachusetts Institute of Technology, USA
- Mark L Wieland, Assistant Professor of Medicine, Primary Care Internal Medicine, The Mayo Clinic, USA
- Ollie Smith, Director of Strategy & Innovation, Guy’s and St Thomas’ Charity, UK
- Scott Liebman, FDA Regulatory & Compliance Partner, Loeb & Loeb LLP, USA
Health Beyond Health Care
Going back to the description of what we’re trying to do, then, the ‘health beyond the lens of health care’ part reflects our desire to understand how people and communities think about their health. As we say on our webpage, what makes people feel healthy are things like safety, physical functioning, financial security, emotional security, nourishing relationships, a sense of control over one’s life, and a sense of meaning. These are not things that the current health care system can help with so what is ‘the system’ that can? We want to be clear that we’re not saying that we do not believe in health care. We do, and many of us work within it. But we also understand that people and communities talk about their ‘health’ in ways that are beyond the reach of health care.
The ‘understand’ part reflects our desire to learn. How do we elicit people’s understanding of their health? How do we create it? And how will we know if what we’ve tried ‘works’? Indeed, who gets to define the parameters of success? These are all issues that we need to discuss.
One of the things that’s emerging as an impediment to learning is the re-branding of ‘prevention’ as ‘health creation’. To our mind, these are two separate things. Prevention is about mitigating known risks to bio-medical health. Creating health, by contrast, is about starting from how people and communities think about their health, as described above. That’s why we’ve always communicated treatment, prevention, and health creation as three separate spaces (see diagram).
The ‘preneur’ part reflects my personal bias. I believe the future has to be created by doing not just talking. Health care is brimming with talkers, so much so that it’s almost paralysed by the cacophony of opinions out there. It takes a brave person to just get on with it and I believe these are the people that we need to not only learn from but support.
What We’re Not
We’re not a political movement.
I say that because some people think we are and have engaged with us on that basis. Their framing is one of ‘health equity’, the idea of eradicating avoidable or remediable differences in health outcomes. While it’s certainly the case that some of the members of the Collaborative have chosen to work with communities enduring health inequity that doesn’t necessarily mean it’s our focus.
Underpinning the desire for health equity is the desire to address structural inequalities in society, such as the lack of equal access to opportunities, multi-generational racism, and worsening income inequality. Again, some of the members of the Collaborative have chosen to work with communities enduring these issues but that doesn’t necessarily mean it’s our focus (even if I commented on the topic at Exponential Medicine 2015).
I’m keen to make this distinction because I think trying to address structural inequality to improve health is just too big. Someone needs to do it but I don’t think it’s us. Our focus is to start from how people and communities think about their health and build from there. It may, of course, be the case that the communities we work with want to address such issues, and that working to create health outside health care can contribute to progress on health equity, but that’d a consequence of our focus (perhaps even an intentional consequence), not our focus per se.
Over the next few months you’ll see the fruits of our shared labour, specifically:
- A report from our July 2015 meeting in which we have refined the principles for creating health (sorry that it’s so overdue)
- A meeting in July 2016 at which entrepreneurs and intrapreneurs will share their work to continue to contribute to our collective thinking and perhaps further refine the principles
- An event tentatively planned for October or November 2016 at which we’ll seek to share our work to date, continue to explore the space of creating health, and encourage learning among a wider community
- Finding ways to make ourselves available to the small but growing number of people who have asked for our help to think about health beyond health care and public health
- And some snazzy new branding
I want to reiterate the ‘understand’ part of the work. Fruits one and two above are specifically designed to advance our learning, and we’ll also learn from the people that participate in three or those we connect with through four. Indeed, even though this post is about what I think we’re trying to do there’s little point in recruiting an Executive – all of whom are ‘preneurs’ in some form or another – if we don’t collectively question and iterate it.
That’s the ‘burden’ they’ve agreed to share.