What does it mean to be healthy?

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Part of A vision for population health in England

Alongside our new vision for population health report, guest author Carina Crawford-Khan – who works as a Supervising Organiser with Citizens UK – explores what it means to be healthy.

How do you define ‘health’?

My first job was as a youth worker in south London 15 years ago. It was this that really impacted on me and how I view people’s health. I saw on a daily basis young people affected by mental health issues, gangs and domestic violence, or in families where parents were not around as they were working three jobs to make ends meet. People who lived in overcrowded housing, looked after children and faced unresolved immigration issues; and young people coming in with weapons, suffering from drug abuse, or self-harming – sometimes there in front of me. As a youth worker, I felt like I was putting a plaster on a huge wound. It was so clear to me that people’s health is affected by all of these issues – where they live, the family circumstances they are born into. These are the things people are actually dealing with, things that are impacting significantly on their lives. I was reminded of it again when my husband was going through the immigration system and the uncertainty of his visa, and when my mum was suffering from poor mental health because of growing debt.

How possible is it improve people’s health?

We need to make a real difference to the root problems and drive systemic change. That’s the amazing thing about my work at the moment – helping people to take more control of their own lives and to address these wider issues. It’s what drives me to keep doing what I do. Just today I got a wonderful text from a boy in South London who I worked with for three years. He was nearly excluded from school but through working with him, he realised that he was angry about the way his community in Abbey Wood was changing because of the increase in house prices in the area. He ended up standing on a stage in our Mayoral Assembly in 2016 in front of Sadiq Khan and Zac Goldsmith, with 6,000 people, talking about the impact of poor housing on people’s health and improvements that were needed. And it made a big difference – once elected, Mayor Sadiq Khan introduced a minimum of 35 per cent affordable homes on all new developments. His message today was to say he’s now got an apprenticeship in a GP Surgery. He’s following his dream to be a physiotherapist in the community his gran, mum and now he can contribute to.

What achievements are you most proud of in your career?

Over the past 10 years, I worked to end the detention of children for immigration purposes, which has now resulted in a change in legislation to prevent children being locked up in prison-like conditions. That felt like a major achievement. I’ve also helped to build the foundations of the newest chapter of Citizens UK – Tyne and Wear Citizens – and pioneered the work with the health sector. I have been pushing the boundaries of relational conversation, citizen role and building power across the health and care system.

What is the best approach to improving population health?

For me, being healthy means having power to control your own life. It means feeling like you belong, like you can participate, and are recognised for your talents and role you are playing as a person no matter what it is or who you are. It means being given the tools to be able to do things for myself when I can. I believe powerlessness leads to ill health. Relationships are key to staying healthy. Personally, I feel most healthy when I have clear vision for where I want to get to and that I have the ability to achieve my goals. I think it’s important to apply the same principle to population health. Really allowing people to feel in control. My role is about enabling this.

I think there needs to be much more focus on the places people live in. It is just so essential to be able to live in affordable uncrowded housing, to feel safe in your neighbourhood, to look out of the windows and see trees and nature, to have conversations with neighbours, to be able to participate in community organisations and to feel able to influence the decisions that are being made about the neighbourhood. I’ve seen the devastating effects of people not having these to know just how important it is.

I see health care services as a last resort. Most people I come across try to keep themselves healthy or seek support from family and community to keep them healthy. So, to really focus on population health it’s essential to focus on the individual, family and community as the main priority.