Comment

The three Cs of health inequality

Tips to encourage patients to take an active role in their wellbeing
Three Cs

With the gap in life expectancy between the haves and have nots increasing for the first time since 1870 (Mayhew and Smith 2016), community nurses need to take a long hard look at what we can do to address health inequality.

I have just taken over the chairmanship of New NHS Alliance, a group of thought leaders born 18 years ago from a gathering of forward-thinking GPs, but now a multidisciplinary organisation influencing policy in community and primary care. We are thinking seriously about other evidence-based ways to tackle inequality. I set out what this might mean for nurses.

The NHS Alliance Is Changing

The predominant approaches to addressing health inequality from a clinical perspective can roughly be described as the three Ps: health promotion, prevention of ill health and health protection. Clearly these approaches, successful as they are, are not enough.

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With the gap in life expectancy between the haves and have nots increasing for the first time since 1870 (Mayhew and Smith 2016), community nurses need to take a long hard look at what we can do to address health inequality.

I have just taken over the chairmanship of New NHS Alliance, a group of thought leaders born 18 years ago from a gathering of forward-thinking GPs, but now a multidisciplinary organisation influencing policy in community and primary care. We are thinking seriously about other evidence-based ways to tackle inequality. I set out what this might mean for nurses.


The NHS Alliance Is Changing


The predominant approaches to addressing health inequality from a clinical perspective can roughly be described as the three Ps: health promotion, prevention of ill health and health protection. Clearly these approaches, successful as they are, are not enough.

When we look at these three Ps, we are looking through the lens of preventing or addressing ill health. But what if we turned it on its head, and instead of thinking about what causes illness (which we can then prevent or ameliorate), we thought about what causes wellness?

We call this health creation and it is characterised by the three Cs, which are complementary to the three Ps. These are (based on Hothi et al (2008)):

  • Control over the circumstances of your life.
  • Contact with other people that is meaningful and constructive and addresses social isolation.
  • Confidence to see ourselves as an asset, to be in a position to take actions and responsibility and to have a positive impact on those around us.

It is also about having a reason to get up in the morning; to live a life with meaning and purpose (Frankl 2008). This is my experience of working with fathers facing severe and multiple disadvantage:

Many were separated from their children or faced privations such as homelessness, worklessness or poverty. This caused most to lapse into mental health problems and/or substance misuse. I brought six of these fathers together as strangers in a café to ask them if they would help me run a children’s competition: ‘Men Behaving Dadly’ where children told us why their father was the best in town.

After lunch and a chat about the competition, one father, recovering from alcohol misuse, and prevented from seeing his children, lent forward and said ‘Can I ask you guys something? Have you ever felt like killing yourself?’

The conversation that ensued was one of the most startling moments of my life. They bonded in an instant as fathers and they transformed into purposeful people who helped a whole community of fathers and children in Salford – Salford Dadz – (Robertson et al 2015) come together and help each other. They found purpose in my simple request for help, they gained confidence to take action with my support and they stopped feeling alone with their problems. Slowly they stopped feeling so out of control, lessening the chronic stress that leads to cardiovascular disease.

So what actions can you take? Here are a few tips to get you started:

Find fun ways to bring people in the same position together, with purpose

Bromley Heathcare ‘Leg Club’ – where volunteers bring people with leg ulcers together socially so they can make friends and take ownership of their condition

See your patients/communities as assets – don’t offer help – ask for it

Altogether Better, a not-for-profit, helped GP surgeries to recruit local people to act as practice champions who found new ways for local people to access social support. 86% of champions and 94% of participants reported increased wellbeing.

It is time we shared the responsibility for tackling health inequality with our communities. Nurses are only part of the solution – citizens are the other half.


References

Frankl VE (2008) Man's Search For Meaning: The classic tribute to hope from the Holocaust. Rider.

Hothi M, Bacon N, Brophy M et al and The Young Foundation (2008) Neighbourliness + Empowerment = Wellbeing: Is there a formula for happy communities? London School of Economics, The Young Foundation and The Improvement Development Agency.

Mayhew L, Smith D (2016) An investigation into inequalities in adult lifespan. Cass Business School, City University, London.

Robertson S, Woodall J, Hanna E et al (2015) Salford Dadz: Year 2 External Evaluation. Leeds Beckett University/University of Salford, Manchester.

About the author

Heather Henry is an independent public health nurse, Queen’s Nurse and co-chair of New NHS Alliance


Further information

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