Developing community public health/community wellbeing.

Wellness relationship to illness

Williams and Innes Pearse developed a new approach to primary care in the 1930s which attained its apotheosis with the development of the Peckham Pioneer Health Centre. This relegated traditional healthcare to a subsidiary function in relation to what today we would call the wellbeing functions such as various physical activities, leisure pursuits, education and social interaction. Patient nutrition was seen as a key component of promoting health.

Paradoxically the project was undermined by the introduction of the NHS with its emphasis on the delivery of medical technology by general practitioners and hospital consultants.

The time has come to reinvent Peckham and to develop it further by transforming primary healthcare from a mainly reactive entity to a determinedly proactive one and by broadening its purview from the individual and the family to the local community.

Without affirmative action to identify the healthcare deprived in order to provide appropriate high quality healthcare NHS primary care will continue to increase health inequalities because the health advantaged currently get more out of it than the health disadvantaged. At individual GP level it should be possible to identify healthcare deprived patients from the Practice Register and then contact them to ensure that they take advantage of the services they need. This is outreach at the individual patient/family level

Generally speaking public health has been delivered from on high, from central, regional or district level and has signally failed to engage with real people in real communities.

There is a growing realisation that local communities must play their part in promoting the health and wellbeing agenda; and that a key vehicle for this is community development.

Two convenient platforms for delivering community health and wellbeing are general practice and the local secondary school acting as a community school or college.

A model the author envisaged some years ago based in part on his experience as a Councillor for a deprived ward in a large provincial City involved General Practice premises/Health Centres providing in addition to the traditional primary healthcare a range of wellbeing services such as Benefits Advice and social services; and fulfilling a signpost function in respect of other wellbeing services such as housing advice and environmental health.

The other limb of this community health and wellbeing axis would be the local secondary school acting as a community school or college supplying education and lifelong learning opportunities as well as sports facilities and opportunities for social activities of various sorts.

Public health leadership would be provided either by a suitably trained General Practitioner, or more likely, by a health visitor or health promoter working within the primary care team and relating to the local community and and its key institutions.

The nearest approach to this model that I am aware of is the Bromley by Bow Health Centre in East London.

Knowing what we now do about the determinants of disease and the promotion of wellbeiing and if we are serious about reducing inequalities in health moving from the traditional reactive primary healthcare model to a new proactive community health and wellbeing framework is the way forward.

Paul Walker. December 2016

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