Three healthcare workers walking down a corridor in an English hospital

Health Creation: Coming of age and addressing health inequalities

In December 2017, National Health Executive interviewed Duncan Selbie, the then chief executive of Public Health England, on what truly matters to making and keeping England healthy. This interview was prior to his keynote speech at The Health Creation Alliance´s annual summit, where he reiterated his interpretation of the event’s core message: the value of Health Creation to resilient happy communities.

Fast forward to 2022 and Health Creation has truly entered the mainstream. It is now recognised by many people across many sectors as more than an approach to building resilient happy communities; it is an essential component of a new, integrated approach to health and care and, importantly, to addressing health inequalities.

The pivot-point was of course, COVID-19, which exposed stark inequalities at the same time as making visible some of the more hidden aspects of how communities work, become resilient and thrive. It concentrated minds on how inequality leads to poor health outcomes but also drew attention to the fact that health inequalities can only be sustainably addressed when we have strong, connected, self-organised communities. Services can create the conditions for communities to strengthen and self-organise and work with them on their terms, as equal partners.  

“The Community response to COVID-19 completely changed the dynamic between providers and the community. The ability of our community to provide for itself and to work in partnership with services to get the vaccination done shouldn’t have come as a surprise, but it did. We stepped in where services couldn´t: We only allow people into our community to work with us on our terms now.” Dawn Shepherd, Informal Community Connector, Townstal, Devon.

About Health Creation

Health Creation describes a process through which individuals and communities gain a sense of purpose, hope, mastery and control over their own lives and immediate environment. When this happens their health and wellbeing is enhanced.

Creating health with people and communities is happening all around us and it is called many things, however, adoption of ´Health Creation´ provides a common currency that offers a real opportunity to bring together community strengthening, community-led development, health inequalities and place-based working with multiple partners to drive approaches to health and wellbeing that are proven to work.

Professionals can help create the conditions for Health Creation by working as equal partners with local people and focusing on what matters to them and their communities.

This goes well beyond ‘coproduction’. It requires much more than listening to and co-creating solutions with communities that services then deliver; Health Creation also necessitates allowing and supporting people and communities lead on the delivery of  solutions they know will work, funding and sharing power to support their efforts.

Commenting on the importance of sharing power, Andy Knox, Associate Medical Director for Lancashire and South Cumbria ICB, said: “ There is enormous power within communities and we must really listen to communities to find out what their innate capabilities are, what they are really saying to us and what is important to them. When we begin to listen and go and support where the power lies, we can work smarter and more cost effectively, while better addressing health inequalities.”

Health Creation is supported by a framework comprising six features of health creating practices, features identified by individuals and communities as being important to them. The features are Listening and responding, Truth-telling, Strengths-focus, Self-organising, Power-shifting/sharing and Reciprocity.

Integrated Care Systems and Health Creation

The newly empowered Integrated Care Systems are beginning to recognise the importance of Health Creation in addressing health inequalities. What is now required is a shift in style from organisation to systems-leadership, and a commitment to ground up transformation – a very different style to traditional NHS leadership. It will require new leaders to emerge and establish a very different approach. It goes without saying that progress on the ground is patchy.

Never before has this been more critical. COVID-19 is just one of many destructive forces in our world today; the cost-of-living crisis, climate change, ongoing racial and class discrimination and economic restructuring all present huge challenges to our ability to address health inequalities. We absolutely need a whole raft of policy changes to address the structural issues underpinning inequality and the current political ambivalence is breath-taking. But the one powerful agent that is consistent (and underrated) through all of this is ‘community’. Strong, connected communities are resilient, imaginative, caring. They offer a range of ‘protective factors’ and a wealth of insight into what will make them and their communities well. How best to create the conditions to strengthen communites to play their part and transform the way systems work should be a key consideration for all policy makers, providers and the community itself. Health Creation is a route to this.

We are living through challenging times and challenges are what bring communities together. Whether the issue is COVID-19, the response to severe flooding, or finding ways to survive the cost-of-living increases, communities can make a real, impactful and lasting difference on people´s lives. The system needs to get behind them, fund them directly, listen to them, work as equal partners with them and enable them to do what they do best.

Support for delivery of national initiatives

Embedding Health Creation, and two or more of its features into daily practice will support health and care systems deliver on a range of national initiatives including:

  • Core20PLUS5 – an NHS approach to healthcare inequalities, focusing action on those areas and groups that experience the poorest outcomes and on some of the common health issues faced by the communities that live there
  • Fuller Stocktake Review particularly action 13: Work alongside local people and communities… in the planning and implementation process of the actions set out above… ensuring that these plans are appropriately tailored to local needs and preferences… taking into account demographic and cultural factors
  • Population Health Management – recognising the power of community insight to understand the really issues impacting communities, and the power of communities to transform lives as equally important to quantitative data, and a commitment to community strengthening through Infrastructure, Intelligence, Interventions, Incentives – the 4 I’s of Population Health Management. 
  • NHSEI´s 10 principles for ICBs to use when developing their arrangements for working with people and communities
  • DES Contract – Tackling Neighbourhood Inequalities specification.

Health Creation: Coming of Age

There is no doubt that understanding of the importance of creating health with communities to address health inequalities has increased hugely over the last five years, and arguably Health Creation has finally come of age. This is the theme of a week-long series of events that will explore and demonstrate how and why Health Creation is essential to the success of a range of national programmes; while recognising and celebrating progress being made across the UK.

Health Creation: Coming of Age is being delivered by The Health Creation Alliance, a national cross sector organisation addressing health inequalities through Health Creation. For more information on the events, or to book your place on one or more of the sessions, please visit Eventbrite.


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