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Phillip Blond: The big society
This document discusses Phillip Blond's perspective on using civil society and association to address health inequalities in the UK. It notes decreases in civic engagement, volunteering, and social cohesion. Strengthening social capital by supporting community groups and encouraging participation in health programs could help reduce inequalities. Peer-to-peer communication and promoting personal responsibility are highlighted as strategies.
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Phillip Blond: The big society
- 1. Annual Health StrategySummit Phillip Blond Director ResPublica Twitter: #NTSummit
- 2. The “Big Society”: In Sickness and in Sik d i Health H lth Phillip Blond Director ResPublica
- 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 genuinewin 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
- 22. …and association encourages ownership… encourages ownership Participatory Budgets Participatory Budgets •Directly involves local people in making decisions on the spending of public budgets di f bli b d t • Increases transparency, accountability, understanding and social inclusion in local government affairs • Shifts ownership and responsibility back to communities
- 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… bd • 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