1. Shrinking
the state + Austerity
Threat to
Increasing
community
inequality
life
A crisis in democratic accountability

2. Communities, power
and health
Brian Fisher MBE
Chair of the Socialist health
Association

3. RESILIENCE UNDER PRESSURE
• Hollowed out
communities
• Threat to mental
health
• Attenuation of social
networks
• Weakening of
associational life
• Deterioration in health

4. PARTICIPATORY
ACCOUNTABILITY
DEMOCRATIC

6. ASSET-BASED WORKING

7. ASSET-BASED
COMMUNITY DEVELOPMENT
• Statutory services become more responsive
• Promotes health protection and community
resilience
• Helps tackle health inequalities
• Has an impact on behaviour change
• Saves money

8. Stronger and
CD deeper Social
Networks
RESILIENCE ENHANCED CONTROL
Health protection Can negotiate with services
Resilience to economic More strength for self-care
adversity Health inequalities reduce
Better mental health

9. OUTCOMES – HEALTH
6-Month Survival after Heart Attack,
by Level of Emotional Support
70 Sources of support
60
50
0
Percent died
40
1
30
2 or more
20
10
0
Men Women

10. SOCIAL NETWORKS
REDUCE MORTALITY RISK
• 50 % increased likelihood of survival for people with
stronger social relationships
• Comparable with risks such as smoking, alcohol, BMI
and physical activity.
• Consistent across age,
sex, cause of death.
• 2010 meta-analysis of data [1] across 308,849 individuals,
followed for an average of 7.5 years
1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley
Layton.Plos Medicine July 2010, Vol 7, Issue 7. www.plosmedicine.org
doi:10.1371/journal.pmed.1000316

12. A RESIDENT-LED
PARTNERSHIP
LED BY RESIDENTS
THEIR EXPERIENCE DRIVES CHANGE
FORMAL STRUCTURES MAY BE NEEDED
A CORE REACHES OUT

13. OUTCOMES - RESPONSIVE
SERVICES
• Services begin to change within 6
months
• Affects many sectors simultaneously
(health, police, education)
• Communities gain confidence and
leaders emerge
• Staff enjoy their jobs more

14. RESPONSIVE SERVICES
• A new dental service established
• Funding of £95k to transform a derelict area into a
playpark awarded
• A new GP surgery planned
• Well attended social events and football sessions
• Relations with the housing department improved and
tenants more satisfied.
• Summer holiday activities for all ages
• A cooperative plan for social renewal agreed between
the community and public agencies

15. Operation Goodnight

18. CRIME – A CASE STUDY
• “This downward trend is more than likely due to the
introduction of a permanent PCSO for Townstal and
a more regular link with the Dartmouth Community
College and the school.”
• “The community involvement of the Townstal
Community Partnership giving the residents
ownership and a ‘say’ in what they want for Townstal
has brought the community together and must be
considered as a factor in this reduction of crime.”
• Townstal Beat Police sergeant

19. SOCIAL RETURN ON
INVESTMENT
• With modest gains on the eight indicators, the model
posits a saving of £559,000 over three years in a
neighbourhood of 5,000 people, for an investment of
£145,000: a return of 1:3.8
• For £233,655 invested across four authorities the social
return was £3.5 million.
• For every £1 a local authority invests, £15 of value is
created.

20. NOT BIG SOCIETY
• No intention to substitute statutory services with
private or voluntary.
• Does not cut across work on:
– Income inequality
– A just tax system
– A living wage
• This is about
responsiveness and
effectiveness

21. AN OPPORTUNITY
• A new approach to improving population
health
• Wraps around primary care
• Links LAs and primary care
• Challenges the balance of power
• A number of models to choose from
– HELP
– Altogether Better
– Turning Point

22. It has transformed the way we practice medicine. It has
stopped us seeing our patients as if we were just service
providers to people who are ‘needy’.
We now recognise that they can contribute, and when you
see people light up when you ask them to do so, it changes
your relationship with them.
The culture has changed. The relationships are different,
deeper and more therapeutic than they are in the usual
doctor’s office.
Dr Abby Letcher

23. www.healthempowerment.co.uk