'Health is made at home, hospitals are for repairs'

By Lord Nigel Crisp | 05 May 2021

There are many groups, organisations and individuals who are creating health in their own homes, workplaces, schools and communities all over the country. I visited and met with some of them in the months before the pandemic struck in an effort to understand what they were doing and what it might mean for the future of health and social care.

I met leading bankers and lawyers in the City of London who were changing working practices and culture to reduce stress and create a health-enhancing work environment; a policeman in Cornwall who was fed up with chasing teenagers for minor misdemeanours and helped them set up a dance club that has now been running for 14 years with demonstrable improvements in health; and the housing association in Bolton that was creating healthy communities and bringing isolated people together.

A number of patterns emerged as my meetings continued. Perhaps most importantly, these were all people who had decided to do something for their own reasons – and brought their own passion and determination to it. They were not responding to health or other authorities seeking to engage them or tell them what to do. They were taking control for themselves. They also all started by building relationships with like-minded people rather than beginning with a detailed plan. They experimented, were entrepreneurial and learned by doing.

I went on to meet other health creators including the woman who set up the Sewing Rooms in Skelmersdale as a community business which provided local employment and a meeting place for lonely older women; the Salford Dadz, a group of unemployed fathers who were improving their community; the women running Free Range Kids, a forest school in north London; and many other enterprising people and groups.

Other themes emerged. All these groups were addressing mental as well as physical health and were seeing health as being about physical, mental and social wellbeing in line with the World Health Organization definition of health. There was also a very wide spectrum of organisations involved: businesses, public institutions and voluntary groups.

The health creators were thinking about health differently. They reminded me of Professor Francis Omaswa, former head of the Uganda health service, telling me that ‘health is made at home, hospitals are for repairs’. All these groups were aiming to create health not just prevent disease – important as prevention is. Very importantly, they were concerned with the causes of health and not the causes of disease.

Creating health is about creating the conditions for people to be healthy and helping them to be so. It is what parents do, good teachers and good schools do, and what communities and employers can do as well. All of them helping to develop resilient, capable, confident, and healthy individuals.

There are people like these health creators in every community and every part of society, but they are not always the obvious people. As Lord Andrew Mawson – chair of Well North Enterprise and a great social entrepreneur – told me, the trick is to find the forward-thinking movers and shakers in any community, bring them together and then things happen. It might be the head of the FE college, the police superintendent and the manager of the local supermarket and it might not be the leader of the council or the officer whose job title it may be.

New Local has called for government to recognise the community paradigm as a way of improving public services. Coalitions of local interest have a vital role to play in improving lives for us all. Whatever the future arrangements will be for managing health and social care, local authorities will always have a crucial role in these coalitions – as leaders and as participants. They are the guardians of the places we live in and our health as individuals is intimately linked to the health of our communities, of society as a whole, and ultimately to the health of the planet.

I would also call for local authorities to explore their role in creating health alongside their vital roles in preventing disease and protecting the health of the population. They have enormous potential to foster and create the conditions in which people can be healthy and to help them to be so. Aristotle discussed eudaimonia, normally translated as human flourishing, as being the goal of the well-lived life. Local authorities could well adopt human flourishing as their over-arching goal, combining as it does health, well-being and prosperity.

Lord Nigel Crisp was chief executive of the English NHS and permanent secretary of the UK Department of Health from 2000 to 2006. He has since worked extensively in global health, mainly in Africa.


Health is Made at Home, Hospitals are for Repairs is available from www.healthismadeathome.uk for £9.99 postage free in the UK

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