The individualisation of public health and health policy.

This is a major and ongoing concern. It’s often termed “lifestyle drift”.

I’ll be clear here – lifestyles are a major risk factor for illness, and we shouldn’t mustn’t ignore “lifestyles” the question is what approach you take to be more equitable, effective and efficient. We should NOT ignore lifestyles in our rush to address the social determinants (see next blog).

Concern about individualisation is also much broader than “lifestyles”. It goes into every area of social policy

 

All political theories are visions of well being and set out ideas on how that visions is best actualised. there are different lenses on health and well being:-

  • Individualistic – fits well with market thinking
  • Medical – focused largely on physical and mental health
  • Social or ecological notion – broadens to take into account relationship between person and society (governance)

All three matter – but where you start and broaden out from has fundamental implications

 

Giving back control

There is lots of narrative around at the moment on the topic of giving individuals back control, empowering individuals and similar.

This is great.

The flip side of this is transferring risk from society or corporation to individuals. This may have perverse effects re equity and loss of efficiency in net social terms.

 

Here are three examples that articulate the drift towards individualistic approaches

 

Food banks

The growth of food banks has been controversial. A recent McKee lecture cites cabinet members quoted as saying the growth of banks is attributable to people who are unable to manage their money, or spending the money on booze and fags. This is obviously incredulous and not defendable, if true.

Others argue that food banks are a necessary response to austerity and food insecurity.

Arguably a Necessary but insufficient, arguably the wrong response. 

The right response is a policy response that addresses the determinants of food poverty. 

Obviously that is easier said than done, hence the fall back to what is more easily and readily done….setting up and running food banks.

 

 

SRE is now statutory. 

This is obviously welcome. But note the requirements around focused on resilience of individuals. 

What about the system & context in which those individuals live. 

It’s less efficient to increase the resilience of individuals than it is to alter the environment. Ideally both are needed.

 
 

Workplace well being 

Workplace health is more than a banana in the canteen, a bike shed, stress balls and a massage. It should easily – more – focus on toxic environments in which people work.

See the recent RAND study evaluating the Workplace Wellness Charter. There seemed a strong tendency of Focused interventions on where there is a tendency for individal paradigm approach – most obviously employee wellness checks.

Easier to measure. More visible, emblematic, (less meaningful)?

 

Message

It’s a straight message from my health promotion training of the 1990s from Keith Tones and Sylvia Tilford

  1. Individual behaviour matters. It matters a lot. But understand it, understand the context and don’t victim blame individuals if the social context is wrong.
  2. Secondly – addressing the social, economic, political and environmental context is considerably more equitable and efficient than focusing on individuals who may have limited power or motivation to change.
  3. We obsess with pathologising everything, this is at the expense of a broader econoligc approach.

 

 

Reading 
RSA – A happy society needs more than mindfulness https://www.thersa.org/discover/publications-and-articles/rsa-blogs/2017/03/a-happy-society-needs-more-than-mindfulness

RAND http://www.rand.org/pubs/research_reports/RR1661.html

McKee lecture – https://www.phc.ox.ac.uk/blog/jam-tomorrow-prospects-for-the-just-about-managing-in-britain

 

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