The saying “Health is made at home, hospitals are for repairs” captures the need for a more inclusive and broader approach to future public health systems. Creating health is a collective responsibility and cannot simply be outsourced to direct healthcare providers.

In this session of Ask our Experts features Lord Nigel Crisp, an independent crossbench member of the House of Lords where he co-chairs the All-Party Parliamentary Group on Global Health. He co-chairs Nursing Now, the global campaign on nursing. Chief Executive of the NHS in England from 2000-2006 he now works and writes extensively on global health with a focus on Africa.

Nigel is with us on the eve of the publication of his latest book ‘Health Is Made at Home, Hospitals Are for Repairs’.

KEY TAKE-AWAYS
  • Although the Covid-19 crisis is far from over, it is possible to determine which countries, so far, have fared better than others in dealing with the pandemic and its economic and social repercussions, and therefore which political and health strategies have been or are most effective. Having a clear, well-communicated strategy, a strong operational grip, and setting up an optimal form of coordination amongst different levels of authority are the three elements that emerge as having contributed to the successful handling of the crisis.
  • It can be said that the UK failed on all three aforementioned fronts. Its delayed reaction combined with confusing communication and weak operational handling of the situation has revealed deep flaws within the country’s different institutions, notably a serious lack of coordination. The UK’s inability to respond aptly to the crisis is also a consequence of shifting policy priorities in the run-up to Brexit – which only further fragilized a sector that is already comparatively (20% lower than France and Germany) underfunded.
  • When the coronavirus virus first struck, there was an inclination to believe we were all in this together. It fast became clear that the reality was quite the opposite. The fact that the pandemic only exacerbates existing inequalities along racial and socioeconomic lines is now a well-established fact, but one that governments and societies as a whole have yet to properly reckon with. In the UK, 75% of the NHS staff who died because of Covid-19 were from Black, Asian, and Minority Ethnic communities. This shocking statistic highlights the need for public health systems of the post-pandemic era to prioritize fighting the inequalities it reflects.
  • Already observable before Covid-19, the pandemic has made it clearer than ever that there is a need to rethink our approach to health. There is a tendency to view the prevention and cure of the disease as the sole route to good health, whereas the path is actually threefold: creating health, preventing disease, and providing adequate services when needed. A healthy society made up of healthy individuals is one that strikes a balance between these three components. In our contemporary Western societies, there is not enough focus on the first. As a result, our national health systems are ill-equipped to address some of today’s most prevalent public health issues namely obesity, loneliness, and depression.
  • The saying “Health is made at home, hospitals are for repairs” captures the need for a more inclusive and broader approach to future public health systems. Creating health is a collective responsibility and cannot simply be outsourced to direct healthcare providers. It needs to be prioritized within communities, schools, and businesses. Educating ourselves and each other about the holistic nature of health, and how it is impacted by socioeconomic and racial factors should be central to any public health policy and systems. Local initiatives, whether in the realm of urban planning, guerilla gardening, or inclusive policies, are all important contributors to an overall healthier society, both physically and mentally.
  • Governments have a crucial role to play in enabling or accelerating such changes. The nature and scope of this intervention will vary vastly depending on their political and economic model. A possible scenario for countries with more authoritarian regimes is one where creating health will become mandatory and monitored. In more democratic regimes, governments will look to reviving a social contract founded on trust and greater social cohesion to then encourage the diffusion of responsibility for creating health for educators, architects, employers, and individuals not just medical personnel. Such measures would not only make the latter’s work less onerous and but also more effective.