The Hot Futures Think Tank was held last Monday night on the topic of creating a healthy community working within a tightly defined local region such as The Grove.
The discussion was very rich and rewarding. This is clearly a topic with great potential for on-going examination.
Discussion Starter notes:
Hot Futures: Creating & maintaining a healthy community in a tightly-defined small region with local resources
Pointers
Once you start looking there is a huge amount of information and research on methods that could be used with a local population that do not rely on pharmaceuticals surgery or high-tech equipment so the shortage of potential ideas is not the issue
Health districts are typically very large and can be quite poorly defined. There may be multiple non-overlapping health districts for different health concerns
There is potential to analyse a tightly-defined community very precisely in terms of its health profile and chronic health conditions right down to identifying target individuals or families.
By a ‘tightly-defined community’ I am meaning a population in a precisely defined region with an algorithm for identifying any individual as either included in that community or not. Busselton in WA is a good example. The community should have a self-awareness of itself as a community and the boundaries should make sense to it.
Small regions have the potential to own communications and programs in a personal way with everyone getting involved and following progress.
It is possible to identify some large primary drivers of health that have the potential to make a massive difference. An example would be smoking.
Some of the major drivers of health fall outside the healthcare system but well within the capacity of a local community to statistically document and precisely address.
There are a lot of small local businesses that can loosely be defined as ‘healthcare’ that can be drawn on to provide local services in a community-wide project (fitness instructors weight-loss instructors alternative healthcare providers mainstream healthcare providers (doctors physiotherapists podiatrists optometristsnurses…))
There is a lot of potential for health literacy programs at the local level closely targeting statistically identified common local chronic conditions.
There is a lot of potential for health support and learning circles at the local level sharing emotional support encouragement caring mutual helping with transport sharing of information about the condition and treatments.
There is real potential for modelling successfully healthy communities and generating competition between communities (comparable to a football ladder).
Drivers of health locally need to be identified. If an area has a statistical blip on say leukaemia statistics this needs to be identified and the reason identified and targeted for fixing.
Health initiatives that are operating successfully at a local level need to be identified. (Ex. Occupational Health and Safety Regulations teaching kids to wash hands in school garbage disposal management of blackwater and greywater)
A local plan in case of a pandemic could be prepared.
Topics:
A. Sir Michael Marmot has just been appointed as the new President of the British Medical Association. He is a strong spokesman for social determinants of health and made six recommendations in his “Inequalities Review”:
Give every child the best start in life
Ensure the population are educated and literate
Ensure that employment conditions are safe and healthy for workers
Ensure that everyone has enough income for healthy living
Support sustainable communities
Focus on prevention.
He says: “It’s not all about money. It’s very much about social conditions. The real determinants of health lie outside the healthcare system.” He recommends things as simple as reading to children daily.
Another recommendation that might be added relates to law and order and anti-bullying measures given statements such as: “Murder and suicide cause more years of lost life than cancer and heart disease together.”
B. 70% of the Australian population are obese or overweight. Obesity is implicated in a wide range of chronic ill health conditions.
Do we understand enough of the drivers of obesity to mount an effective program to support a whole community losing weight?
What local resources might we draw on to mount an effective program to inspire a whole local community to get involved in a weight-loss program?
What sorts of targets and measures might be used? How could the community success be communicated back to it? Could the program have wider applicability?
Are there identifiable groups in the community particularly at risk?
C.When you start looking there is a plethora of ideas and information on how to treat particular conditions yourself in ways that enable individuals to take more control directly over their own health. Some of these are what might be called alternative some are ‘mainstream’. Some have been tested through research some not. A sizeable proportion are free and involve minimal risk. They either work or they don’t but the worst that could happen if they don’t work is you’d have to go to the doctor and get medicine anyway. A primary obstacle to giving such methods a go is the high level of control over our health and medical regimes with strong restrictions on sharing information about ‘folk remedies’.
Some of the folk remedies may include locally-growable herbs nutritionous local foods or products that can be produced locally. These could be identified. Examples might be using locally grown turmeric ginger garlic and chillis in recipes.
How could individuals and communities be encouraged to:
Take more responsibility for their own health
Learn about their condition and simple practices that can assist them to keep well
Build up a store of shared local knowledge about helpful health practices?
D.How can we use the Internet Facebook and websites such as Transition The Grove’s Health Forums to enable a community to become much more health literate and to manage their own health for effectively before they descend into serios chronic illness?
E. How could health emergencies be managed effectively locally? What information would local residents need to have? What obstacles are there?
F. We have a well-developed network of local childcare facilities and support services for new mums. What would it look like if we had a parallel local network of caring/hospice/respite facilities? At present local carers and people with a severe disability are relatively isolated in their own homes. Working parents with a sick child are stretched to find a way to care for the child and many send infectious kids to schools or daycare. People can be sent well outside their familiar communties when they are terminally ill. Locals who could potentially volunteers to help in a local respite centre or carers who might like mutual support and company lack the opportunity without the local facility. It is not difficult to quantify the need. What would we have to do to get local facilities? How could we keep them local (instead of having small centres used as hubs for big areas?)
G. How can we develop strong working definitions of tightly-defined local communities? How can we limit the size of these communities sufficiently to allow locals to identify and to have recognisable local knowledge and social groups? Transition The Grove is using a definition that covers a population of about 31000 people in 5 suburbs defined by a bioregion (a valley). It is a relatively stable homogeneous community. The diameter of the region is about 6 kilometres. A local radio station potentially reaches everyone in the community. There is a local newspaper (with a somewhat broader coverage). The boundaries do not match either council state federal or QLD Health boundaries. What does it offer as a model? What limitations?