This is probably the last post I will do on the Wellthcare site. It’s been four months since the last one. This is not because our work faded; quite the opposite. Things really took off and that’s partly why I have decided to change how I work and write.

There have been three major achievements in the last four months.

Firstly, the nine organisations that I announced in my last post all met in New York on July 22nd. We spent the day discussing how we’re struggling to think of health beyond the bio-medical model, while at the same time sharing some of our attempts to create health. It was clear that we’re only at the beginning of an entire new discipline of ‘health creation’, and that we have more questions than answers - but we all saw that as a good thing. 

Nine organisations have joined Wellthcare to debate and plan how to make creating health the norm. Last week was the first meeting. For the time-being the group is being called the ‘Creating Health Incubation Group’. 

The organisations are:

1. Columbia University’s Earth Institute
   
2. FSG
   
3. Guy’s and St Thomas’ Charity
   
4. HICCup
   
5. The Institute for a Sustainable Future
   
6. The Institute of Medicine’s Collaborative on Global Chronic Disease
   
7. The Mayo Clinic’s Center for Innovation
   
8. The University of Strathclyde, 
   
9. The University of Toronto’s Women’s College Hospital
   

The meeting was the key deliverable of the grant that we received in January 2014, and marks not only the end of this phase of our journey, but the start of the next. 

The cost of health care is contributing to the social unrest we’re seeing all around the world and doctors are utterly failing to respond. Those were the two things I learnt last week at the biennial gathering of people working in the health insurance industry, a meeting that I was lucky enough to speak at.

Industrialised nations have a record burden of debt, so much so that if they taxed their citizens 100% of their earnings they’d remain in debt for a decade. So said Pippa Malmgren, an economist and former Special Assistant to the President of the United States for Economic Policy. Given the size of the debt, many countries are deciding to do less through the state (austerity) and print more money (quantitative easing). With more money about, prices are going up but salaries are not following suit and the state is providing less of a safety net. All in all, workers have less economic power and are feeling the squeeze; between 40-70% of their incomes are going on food and energy, leaving little for rainy days and old age. 

In over a year of exploring what it takes to create health through communities few articles have better summarised the challenge and the possibilities better than Jamie Harvie’s Foreword to the Democracy Collaborative’s report Hospitals Building Healthier Communities by David Zuckerman published March 2013. 

It’s with great pleasure that I am sharing it with you today.

For us, the fundamental challenge is to stop seeing health solely through the bio-medical model. This model sees people only as pathology and does not take into account the role of social factors or individual subjectivity. Jamie describes this perfectly but also provides some hope by weaving together “collective signals”, as he calls them, that keep reminding us that we need to include community as an equal partner. His text focusses on the US. 

Jamie is the Executive Director of the Institute for a Sustainable Future, a founding organisation of the Commons Health Network, an organisation that looks to support systems that promote individual, community, and ecological health while recognising that ultimately, health is local.

We hope you enjoy Jamie's article as much as we did – and do. 

This week I've despaired at how the needs of the few always seem to trump those of the many, especially when it comes to health. It made me feel nervous — if not plain over-awed — about the challenge ahead of us. Luckily, two courageous leaders have restored my hope.

My despair arose in the National Museum of Singapore where I learnt about Dr Lim Boon Keng. In 1896 Dr Keng criticised the squalid conditions that many migrant workers lived in, seeing it as the source of their many ills. One of the four conditions that he specifically listed was the prolific consumption of — and addiction to — opium. The problem with addressing the issue, however, was the government at the time derived about 50% of its revenues from the trade of opium; banning it was impossible.

Money and power are intertwined. The government at the time (the few) clearly needed opium irrespective of the health consequences to the people (the many). The needs of the few out-trumped those of the many, the consequence being ill-health.

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? 

In California, it’s a tale almost worthy of Hollywood.

In 2008, Alex Briscoe, the Director of Alameda County’s Health Care Services Agency, stood watching a demonstration against the police after the shooting of a young black man, Oscar Grant III, by a white police officer.  He was there with the Medical Director of the Emergency Medical Services (EMS) Division that he oversees, and together they watched the angry, largely black, crowd of demonstrators stop yelling at the police when a fire truck went by. Instead of yelling, they waved.

To most, this would have been an idle observation but for Briscoe it sparked an idea. He had spent almost 15 years trying to get primary and preventative health care to low-income, largely black, communities. Given that 85% of fire fighters are trained as Emergency Medical Technicians (EMTs) and that every fire department in the county was contracted to provide EMS, the fire fighters’ unique alliance and standing in the community made them the perfect health care delivery mechanism. 

In this post, I am reproducing a chapter from The Alpine Review by Charles Leadbeater. He argues that creating the health systems of tomorrow will mean learning from the developing world, so-called reverse-innovation. He also argues that we need to see health in a completely different way – as something we create and manage in relationships, communities and networks.

How do you take England's £120bn healthcare system that was designed for one set of challenges: infectious diseases, their diagnosis, treatment and orderly cure–and redesign it for an era in which you face, not only huge fiscal challenges, but more importantly, a change in the kind of health problems you face?

Indeed, the biggest challenges now are no longer about infectious diseases but rather ageing, long-term conditions and lifestyle. This means that having highly capital-intensive, large institutions in fixed places with very expensive doctors pushing more and more technology at people is probably just going to drive up costs rather than create better solutions at lower cost. If that isn’t the solution to this new set of problems, what is? And where do we find it?

At the end of February we published the Wellthcare Manifesto. Having a Manifesto is probably grandiose, if not self-inflating and vulgar, but we wanted to bring our thinking together into a brief, easy-to-read, and hopefully powerful, statement. 

At first we thought about publishing a ‘framework’ – the things you need to do to create Wellth – health-related value that sits latent in our networks, communities and contexts. However, we soon realised that we don’t yet know what you need to do. Indeed, just trying to answer that question made us realise that Wellthcare is not about knowing but about exploring – discovering what courageous people are doing on the frontlines, giving them a voice and then trying to find common themes that will embolden others to try.

The last few weeks have been exceedingly busy as we finalised the Wellthcare Manifesto, interviewed more Wellth Creators, and started work on what a meeting on ‘health creation’ might look like. One question has surfaced a few times and I wanted to reflect on it here: “How is Wellthcare different to public health?”

Public health, according to Wikipedia, is:  

It sounds awesome but my experience of it – as a citizen and an observer of health and health care – is that when it comes to lifestyle diseases it’s heavy on the ‘what needs doing’ and very light on the ‘how’. Without knowing the ‘how’ the ‘what’ becomes almost pointless or – when it’s constantly reiterated – runs the risk of being a form of pernicious moralising.