Who decides what health means?

Claire Tomkinson, Trustee at Timebanking UK and Wellbeing Development Lead at Macc writes for C4CC about her reflections on the differing views on what makes us healthy and keeps us well.

I was recently running an activity at a large event in South Manchester to celebrate the launch of the hospital trusts Community Service Directorate. There was a huge variety of stalls ranging from health advice to support from local housing providers and myself and a colleague were asking local people a very simple question. What makes us healthy and what keeps us well?

The answers overwhelmingly included the following: having a role to play, having a purpose, not feeling useless, having days out, seeing friends and family, being connected to local people, volunteering, gardening in the front garden so I can talk to neighbours and stroke their dogs, going to different groups and activities and spending time with the grandkids.

We then covered the responses and asked clinicians how they thought people had responded. Their answers included: losing weight, smoking less, reducing alcohol intake, eating more fruit and veg and getting more exercise.

My concern is that in communities we have two completely different views on what being healthy and keeping well means and these tend to conflict with each other rather than complement each other- but how often do we ask people that we work with what is important to them, what matters to them and how this impacts upon their health and wellbeing?

We know that 30 per cent of health is determined by clinical factors while 70 per cent is affected by social determinants yet in health we spend the majority of time responding to health needs and fixing people’s lists of medical conditions without thinking about the protective nature of being an active, valued and connected member of the community. Defining people by their skills, strengths and capabilities and building upon what already exists in communities will have a massive impact on peoples resilience and ability to cope whilst preventing needs arising and enabling people to support themselves and each other within their community. A great starting point is to ask- what can you do for yourselves and each other to have an impact on health and wellbeing in your community, what can you do with support from the voluntary, community and social enterprise sector and what is left for public health to do?

Chapter Two of the Five Year Forward View talks about new ways of working with people and communities and Nesta are doing great work as part of Realising the Value, but something that I’m asked over and over again is “how do we do it?” How do we adopt a community asset based approach and how do we see people as more than a list of medical conditions to be fixed? One highly effective approach is Timebanking. It is simple and it works.

Timebanking only defines people by their strengths, capabilities, aspirations and what they can do for others. It’s based on mutual support, trust, respect and reciprocity. Everyone’s time and skills and valued equally and is a great equaliser as we all have the same amount of time each day. A common misconception about Timebanking is that it is all about volunteering, incentivising volunteering or rewarding volunteers. It isn’t. Timebanking isn’t about connecting volunteers to services and claiming something in return. Timebanking is about connecting people to people and making the most of things that happen in communities everyday yet go unseen and undervalued.

It’s about an older lady depressed that she’s struggling to maintain her garden but used to work in a dress shop and can make curtains and repair clothes as an equal exchange of time. She meets people, uses her skills, feels valued and doesn’t go to her GP as much.

It’s about a lady that had to give up her job as a nurse because of ill health and struggles to get to her many hospital appointments having a lift from local person in exchange for baking cakes for community events and knitting cardigans for babies.

It’s about a man who recently lost his wife, can’t cook a meal and was incredibly isolated attending a cookery class delivered by another Timebank member in exchange for doing small jobs and DIY for someone else.
As a result we see a huge impact upon the issues raised again and again by our health colleagues- people were less isolated, less lonely, more confident, more motivated and better able to cope just by self-organising around their assets and what they had.

It’s time that we started seeing people in communities as part of the solution instead of constantly being defined as the problem. It’s time to be a good listener instead of a good teller. It’s time to stop deciding what people’s needs are without ever asking what their strengths are and it’s time to celebrate and recognise what already exists within communities and see what happens when you connect people around their assets.

Claire Tomkinson is Wellbeing Development Lead at Macc, the voluntary, community and social enterprise sector support organisation for Manchester and is Vice-Chair of the Board of Trustees at Timebanking UK.

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