By Elizabeth Bayliss

1. Health and wellbeing
seen from the ground
Elizabeth Bayliss
Social Action for Health
March 2013

2. On the ground in east London
• People are fearful of the changes to
benefits
• People are fearful that the NHS is going to
be lost
• People are fearful that they will never work
again
• People are fearful of a government that
does not care

3. NHS seen from the ground
• GPs are now in charge; they are so busy they do not
listen; they never do an examination;
• GPs only ever give me paracetomol;
• My GP will not refer me to a specialist so I wait til I go
home (abroad) and pay for examination there;
• Why not go to A&E when I need medical help quickly?
• Out of hours doctors do not have my records so what is
the point?
• Where are the interpreters now? How can I describe my
condition when the doctor does not understand me/
• Why are there no ESOL classes anymore?

4. It takes two to tango!
• NHS behaves as though it can sort out
health inequalities and rising demand on
its own or somehow through the mystical
intervention of the market
• The relationship between the NHS and
local communities is squeezed through
the narrow conduit of ‘community
engagement’ which is a reductionist
process that leads to an impoverished
relationship

5. The relationship matters
• There are no shortcuts
• Relationships between human beings are
always transactional - what is the nature
of the transaction;
• There has to be a balance of expectations
• Professionalism can get in the way,
leading to a manufacturing of dependency

6. SAfH values
• We start with the people
• People have the right to take control of
their own lives
• People’s health can be improved by
tackling isolation, poverty, racism and
unemployment
• Healthy communities are good for the
whole society

7. SAfH Spiral of Participation
• SAfH spiral of participation

8. SAfH’s role
SAfH sits in the community, encouraging local people to take more
responsibility, to reduce their dependency, increasing their ability to
be self determining;
We find that people to want to take responsibility - to be of use in their
community – no place for paternalism;
We work within social mores , respecting leaders;
We listen to what people say, preferably in mother tongue, drawing out
meaning from their experiences;
We give local people accurate information about complex issues like
morbidity and mortality rates so that people can see themselves in
relation to the wider world;
We teach people how to engage with professionals so that the
communication both ways is richer and more useful;
We tell people with power and authority what we have heard in words
the powerful understand.

9. What this means on the
ground
Focus on the people:
√ reach out (on the streets, in community centres, in public
places);
√ start conversations (We use the promotion of cancer
screening to start conversations about self care).
√ bring people together – cross culturally
√ teach people new skills – go step by step
√ encourage these to be shared - Build up mutuality
√ promote health intelligence – ability to make sensible
decisions about own health and wellbeing

10. Who does the work?
• Local people, who are lay, trained, paid, supervised
and supported, with multiple languages
• We have 100 people at any one time whom we have trained as
Health Guides, Mental Health Guides, Self Management and Good
Move tutors, Ambassadors, Community Health Champions,
Mentors, Representatives.
• We have a staff team of around 25 people who support, record,
report, manage, coordinate, teach these local people; manage
networks of community groups providing information and advice;
evaluate work and aim to influence policy and practice.

11. Is the work useful?
• Screening take – up increased
• Demand on GPs from people who have been through a
self management course reduced
• Benefit entitlements secured and appeals won
• People empowered personally, with evidenced
improvement in health and wellbeing;
• People more confident in communicating with their GP;
• Voices heard by decision makers through platforms eg.
Open events;
• Health Action groups formed
• Community groups forming networks.

12. Scale and impact
SAfH works with 11,000 people a year
directly but this feels like small fry;
Work needs to be rolled out big time;
Funding needed to evaluate work eg. Impact
on A&E; eg. impact on communities

13. Tips on policy direction!
• Funding for evaluation on community
development approach
• Hospitals and primary care to be
encouraged to collaborate on such
evaluations
• Funding for community work at a local
level necessary
• Meta narrative – honour the public arena