There are key building blocks for a healthy society, including stable work, good pay, quality housing and education
Opinion: Care. It's such a little word for the connective tissue of our lives. The care we give to those we love and befriend during our lives sustains and nourishes us. While the care we receive from those we do not know ensures we don't just survive but we thrive as a society.
All care work, both informal and formal, needs the right support, recognition and respect to be done well. And many of the people who are providing care in a professional and personal capacity across our health and social systems right now are not getting what they need to provide the best care. The systems they work within are simply not designed to ensure they can give high quality care that works given the volume and complexity of health and mental health needs in our society. Covid-19 has sped up the slower moving health crisis we were already feeling the sharp edges of. What can be done? It has to start with interventions to keep people well where we know how to – the building blocks of a healthy society.
The focus needs to be on ensuring people don’t die or get unwell earlier than they should
Following the evidence that shows how we can stop people dying or getting unwell earlier than they should will make a big difference to lift the pressure off people working across our health system. We know there are some key building blocks for a healthy society – ones that create a framework for good health and help people cope with shocks. When in place these building blocks work to reduce the need for as much or as intensive care. These building blocks include stable work, good pay, quality housing and education. They also include harder to see things such as clean air and water, a transport system that protects people, easy access to healthy, nourishing food, being free from the influence of people pushing substances on us that shorten our life such as tobacco and alcohol.
There are too many gaps in these building blocks right now, Covid-19 has exposed them acutely. To prevent people from dying and getting unwell earlier than they should, we need to fix the gaps. We need more people in politics and policy making to focus with more urgency on them. We also need to make the sorts of repairs that have immediate benefits – as people in our health system are experiencing burnout right now. The good news is there are some that can be done that will make a big difference very quickly.
There are quick things we can do to ensure people don’t die or get unwell earlier than they should
Last week, Dr Caroline Shaw and Dr Cristina Cleghorn started a new blog series to showcase exactly how quickly we could do repairs to these building blocks. Writing in the public health blog series, Shaw and Cleghorn tell us that:
“There are a range of public health interventions we can put in place that will reduce demand on the health system. These interventions would improve overall health and wellbeing, and many would have benefits to other sectors … many public health interventions act very quickly to start improving health”
The series will cover in detail various interventions. Good news. People in government (and all of us really) need access to quality and easily digestible evidence from experts about what works to build a healthy society. So what sorts of things will give these quick benefits in extended life spans and fewer people in hospital? Many of the building blocks of a healthy society sit outside of health's purview, and the authors start with interventions in the transport system.
Caroline Shaw, Alistair Woodward and Alex Macmillan explain in their first blog how repairs to our transport system could have a huge impact on people’s health and for people providing care in our hospital system. They cover changes that need to be made to local streets to open them up to children and adults walking and riding bikes, the use of pop-up protected lanes for all the non-car-wheeled things, and calming speeds everywhere.
Lowering the speed people travel as a case study for a quick and impactful repair to the building blocks of a healthy society
The transport system, as Shaw and her colleagues note, is one of the major causes of early death in this country. We know especially that children across the country, and especially those living in the lowest income neighbourhoods, are dying as they go about their day to day lives. They die because they are hit by people driving cars and trucks in their streets at speeds that are incompatible with protecting people. Speeds that were set randomly decades before because someone decided they sounded good. We also know that these high speeds and large vehicles on our streets lead to many walking, cycling, scootering journeys not being taken by kids and parents, people who are less mobile, disabled people, because they are harmed when walking and riding in their own streets. By lowering the speed at which cars, vans and trucks travel in our communities people in government would make it easier to stop before hitting a child. Reducing speeds also means less trauma if people are hit. We know it would also protect people to the extent that more people would feel confident to walk, ride, or use small wheels as their main mode of transport. As Shaw and colleagues note:
“A system-wide reduction in speed limits in town centres and on residential streets to 30kph and on the open roads to 80kph would immediately lighten the trauma load on health care”, and that “once they are put in place, most people support them”.
Lowering speed limits is simply a critical next step, a very pragmatic and common sense thing we need people in government and local councils to take to make sure everyone can live a long and healthy life.
People in Governments can and do act – we can push for more from them
There is already good work going on in terms of these building blocks for a healthy society, from fluoride, folic acid, and tobacco smoking to abortion law reform. Ayesha Verrall is pushing forward a decisive body of health building legislation for instance. Three waters is ultimately a policy seeking to repair some very damaged health building blocks.
We have seen during Covid that people in Government can act quickly and decisively; policy that seemed impossible can rapidly become normal. Tobacco cigarettes will be impossible for my children to buy, thanks to years of focused policy making from people working together across the political spectrum.
However, while people in government can and do act decisively, the politicisation of such work needs to be acknowledged and addressed. The politicisation (and polarisation) of health and wellbeing policies based on good evidence is exactly the outcome that people who use false information have sought for some decades. When the public are exposed to false information and false narratives about health building policies – such as the rhetoric used in recent weeks by National MP Simeon Brown about transport system changes – they become confused, exhausted and see it all as “Politics” and they want no part of it. That lack of public understanding and a withdrawal from engagement is enough to maintain a broken framework especially when it occurs in combination with action from noisy opponents.
There are ways to take the politicisation out of these changes and repairs, and give people in government the confidence to move with more urgency. It helps to build a deeper public understanding of the evidence and the issues. Blogs such as the public health series are one place to start, but not where you stop. Facts are simply a character in the stories and broader narratives we need to use to connect science with people in the public. Finding ways to communicate the changes needed to the public in ways they can quickly process and understand is critical. Underpinning all of this is developing a good understanding of the people (and rhetoric and narratives they use) who work against the repairs to these building blocks so we can navigate around the barriers they put up. It's about understanding and navigating around the politics of it all, instead of hoping the facts will rise about it.
I started by talking about care, the care we give and the care we receive and how fundamental it is to our daily life. For many people who work in research, advocacy, the health system, and in our government, care for others is central to their motivations. It's helpful to know there are straightforward and quick ways we can repair some of the building blocks of a healthy society and enable people to be better cared for across our society, including those working in our hospital and health systems.
