I’m finding it hard to start this post because I have to start with an admission. It’s an admission of laziness, of presumed superiority. In many ways I have slipped into the very behaviour I have wanted to question by creating Wellthcare.
We’ve always been open about the fact that this is an exploration, a process to find new ways to create and value health. A few months ago, I was struck by the often stated fact that health care contributes only 10-20% of what we call health, the rest coming from our genes, behaviours, social factors and the environment. It made me realise that “the 80%” was largely an untapped space.
If we can create value in “the 80%” we’re effectively creating health, I was thinking. And how we see that value might be partly based on reduced demand for health care and partly based on wider social benefits made possible through better health. As a result, more and more of my time has been focussed on understanding the latter. Does better health mean better school grades for kids, for instance? And if so, what does that mean for their job prospects, their earning potential and their wider contributions to society?
Yesterday, I spoke with two Wellthcare Explorers and it made me realise how lazy and inappropriately superior my thinking had become.
The first was Scott Liebman who was reviewing a proposal I am writing for what we might do next with Guy’s and St Thomas’ Charity, my current funder. I’m thinking about building a coalition of organisations that “get” the need to create health and are willing to explore what that actually means and how we might go about it. My proposal was full of stuff about the wider benefits of health; school grades, job prospects, that kind of thing. Scott looked at me puzzled and said: “There’s no mention of community in this; isn’t the point that we’re a ground-up thing?”
The enormity of what he said didn’t really become apparent to me until I got an email from his fellow Explorer, Leigh Carroll. We were reflecting on how so many organisations are increasingly saying they want to focus on health not health care. Perhaps, I have been wondering, Wellthcare isn’t needed because other, bigger organisations are beginning to make the switch. But Leigh asked whether these organisations were really geared towards enabling health to grow from communities, based on what people in the communities actually want.
Leigh's email made me reflect on Scott's puzzlement and this morning I realised that my thinking has drifted away from our Manifesto. Creating health is not an end in itself it’s a means to something else. It’s not for us to decide what that something else is. People and communities will decide that – and their choices will be as unique and context-specific as they are. As we say in the Manifesto:
“Health is a means to an end, a vital tool to get to where we want to go, to achieve. Creating health, including the contribution of health care, has to serve our ends, our wants.”
Measuring our success in terms of school grades and job prospects is a presumption, the kind of thinking that policy wonks have to resort to in order to make sense of the big picture they trade in. I’m not saying that people don’t want all of those things but all of them embody some kind of socio-political bias. I went to school with lots of kids who were rubbish at exams but talented all the same. And I know people who see great value in taking care of their family rather than going out and getting a job. If we think of evaluating health creation through school grades and job prospects what are we, as a society, saying about such people?
If we’re going to create health we have to start with a genuine understanding of what people want. Sure, they probably want to be healthy, but what most people want is enough health to do what they want to do. As Arthur Kleinman, the medical anthropologist, said when I met him last month, longevity combined with earlier diagnosis means more and more of us – if not the majority – will have some form of ill-health to contend with. It’s inevitable. Against that backdrop, targeting health may well be unrealistic. We have to start with a deeper understanding of what people want. Enduring some level of ill health may well be par for the course from now on.
For me, there are three lessons in all this. First, it’s incredibly hard to think anew, even when you’ve specifically challenged yourself to do so as I am doing through Wellthcare. As my friend, Ronna, said over email, “It is a slog, always, when one is trying something new. No one wants to be bothered having to think about something new…it is just the human condition.” Second, it’s incredibly important to have friends and advisors to keep you focussed. Scott, Leigh, and Ronna were being incredible in ways that I doubt they truly understood. And third, although I worried that it might be “self-inflating and vulgar” to have a Manifesto it’s proven an important tool to re-align my thinking – and rediscover my mojo.
If we’re really going to move from health care to creating health we have to value it based on what people want. Anything else is either lazy or a presumed superiority. I apologise for falling into that trap.