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Posts tagged ‘health/wellbeing’

Please note: if you are studying TU811 the contents of this blog should not be favoured above a detailed reading of the module material and assessment information and advice from your tutor.

 The OU module TU811 Thinking strategically: systems tools for managing change introduces the concepts ‘area of practice’ and ‘situation of interest’.  I studied this module in 2010 and I now have the privilege of being an associate lecturer on that same module.  The other evening I told my group of students that – with hindsight – I didn’t really ‘get’ the concept of ‘area of practice’ when I did the module and tried to explain why.

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When we use systems to help us understand the busy, messy world of human activity, we are in effect drawing a boundary.  We identify some things that are ‘in’ our ‘system of interest’ and that means other things are outside it i.e. not a focal part of our interest.  We do this whether we realise it or not – the problem is, if we are not being explicit about our choice of boundaries then we blur them for ourselves and other people.  Then we get confused and conflicted.

Take for example, the NHS planning guidance published in December 2015.  The word system is used in it a lot – it is all about ‘the system’ but here are some insights into my thoughts as I read it…

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As  someone who likes to read into language and discourse, I’ve been thinking recently about the different ways in which the relationship between wellbeing and health on the one hand and work on the other is framed.  Sadly I don’t have time to do a ‘proper’ study to see whether others are saying this or to reference back to all the sources that are leading me to these understandings, but this is where my day to day observations and reflections are leading me.

I see three different types of ‘framing’ going on…for convenience I have named them….

  • wellbeing and health in order to work
  • wellbeing and health at work
  • wellbeing and health through work

So here are my explanations…

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Not got much time but I don’t want to lose this one…

The Journal of Public Health Policy have just published a ‘Special Section’ on “What is health?” with the editors intro entitled “What do we mean when we use the word health?

The special section centres on an open access article by Bircher and Kuruvilla (2014) introducing the Meikirch Model of Health.  The model offers up a particular definition of health:

Health is a state of wellbeing emergent from conducive interactions between individuals’ potentials, life’s demands, and social and environmental determinants

This definition:

  • resonates with me – ’emergent from conducive interactions’ reminds me of my own post from ages ago now on A systems perspective on health and wellbeing which talks about interactions and emergence.
  • throws up intrigue – ‘is a state of wellbeing’ connects me to my recent post on Conceptions of wellbeing – if health is ‘a’ state of wellbeing what other states of wellbeing are there? or is health the only state of wellbeing? It strikes me that you could swap the words ‘health’ and ‘wellbeing’ over ‘Wellbeing is a state of health…’ and still get people nodding their heads wisely.
  • and questions – the abstract also mentions lifecourse approach – so is it a ‘state’ or ‘dynamic’?

Overall I quite like it.

Unfortunately the commentary offered by other authors in the Special Issue aren’t open access and Lancs Library isn’t a subscriber.  Trying to source.

I feel the need to start this post with an acknowledgement of the gap since my last post.  Whilst I don’t pretend to think there are people out there missing my blogs – I’m more worried about the number of streams of thoughts I have had which have come and gone and are unrecorded.  It’s all because  I’ve been busy keeping up with the reading and discussion forum for my PhD modules – and the assignments.  I’ve also worked with two others to plan, design and facilitate the first ever Open University Systems Thinking in Practice alumni and friends get together – which was great.  The formal taught work for my PhD finished today, I’ve got one more assignment to do – and then hopefully can use the summer to consolidate some of the material I have covered through blogs.  It’s been a great journey, just haven’t had time to stop and take stock of it on the way.

Anyway, back to the real reason that I started blogging today.  It was prompted by a seminar I participated in last Monday.  Newcastle University, Sheffield University and NEF have got some funding to run a series of seminars on the ‘Politics of wellbeing‘.  It is essentially people from the discipline of political science coming together to consider what the discipline offers to the ‘shift’ towards wellbeing in policy and politics – both in a critical and a constructive way.  This seminar was the second in the series and I was asked to speak.

Preparing the talk led me to articulate and make explicit something that had been going on in the back of my mind for a long time. Read more »

Just recently, the concept of ‘evidence-based public health’ or ‘evidence-based policy’ (and therefore, evidence-based public health policy) has started to worry me.  It’s so part of our discourse that you don’t often stop to think what does it really mean? and is it ‘really’ happening? and is it really possible?  But then when you do, you kind of realise that even the notion of ‘evidence’ is contested – what does it really mean to the people who advocate for ‘evidence-based xxxx’?

After christmas, the module on my PhD is called ‘Knowledge, evidence and theory’ so I suspect/hope I’ll have the opportunity to think of this more then, but in the meantime I’m pondering what does it mean to say that a public health initiative (policy, programme, project, service) is or isn’t underpinned by a sound evidence base?  I’ve jumped around a few books and internet searches in order to gain some initial impressions which I hope will form a basis for further inquiry into this area.

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As part of the introductions for my current PhD module, we were all asked to introduce our job roles through the lens of the ‘three domains of public health’.  We all did so – but it was only when I was chatting to another student, that I dared to say that I didn’t really like them and was pleased when she agreed.  But before rejecting something outright on the basis of an emotional reaction – it is perhaps best to look where they originally came from and what they were originally for…and explore the thoughts behind my emotional reaction.

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WHO Publication I’ve just familiarised myself with WHO’s publication “Equity, social determinants and public health programmes“.  It was written in 2010 with a view to drawing lessons from the WHO Global Commission on Social Determinants in order to think further upstream than the traditional public health programmes.

I have to say I struggled to start with.  I always groan a little when I see documents about ‘public health’ where the chapter headings are the ‘usual’ suspects – diseases such as cardiovascular disease; diabetes; mental disorders and ‘lifestyle behaviours’ such as alcohol; tobacco; diet.  My worry is always that this silos people into thinking of the determinants of each of these ‘usual’ suspects without considering the crossovers between them – what you then get is practitioners fighting for the attention of different stakeholders on a disease by disease or risk by risk basis.  Just recently I was at a WHO European Healthy Cities Network conference where there were calls to move away from that perspective to think more holistically about what creates health.

But I thought I’d persevere, after all – equity and social determinants were in the title.  And I’m glad I did.  In essence the introductory chapter introduces a common analytical framework to consider inequities in major public health priorities i.e. usual suspects (more later).  Then this framework is applied in each of 11 chapters to all those ‘usual’ suspects.  Then in the final chapter – yeah – they synthesise the findings across the whole lot and highlight those social determinants that should be addressed in order to have an effect across a substantial number of all those ‘usual’ suspects.  In other words, they recommend working upstream in an integrated, holistic way – rather than a disease by disease or risk by risk way.

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You only have to search Google images with the key words “dilbert open plan” to find some Dilbert strips that make you giggle – I found the strips of May 31, 2011, November 2, 2012, May 14, 2003 and October 17, 1998 particularly funny.  But look down at some of the comments and it all gets a little more serious – on the most part, people don’t like working open plan.

All the Dilbert gags aside, I’ve just spent a few weeks carrying out a literature review into the health harms/benefits of different sorts of office.  It led me to conclude that this isn’t a laughing matter…

The short story is – depending in part on your personality and the particular nature of your work – but on the whole…

If your office is shared, larger and/or has a density that makes it feel crowded – your health is at risk.  Your health is more at risk if your own workspace in that office is further from a window, nearer to circulation areas and/or the distractions of shared facilities.  If you are by the window – especially if you have a green view – you seem to be protected a little.  If you have some control – over your own light, your own temperature, your own ventilation – then it helps again.  It gets worse if control is removed, for example you have no input into the decor of your office or you are told no personal items on your desk. Read more »

Not sure what it is but I keep seeing the phrase ‘health system’ at the moment.  It always seems to be in the context that it should be obvious to the reader what the ‘health system’ of interest is – as if it isn’t open to different understandings.

So let’s pick this apart a little…

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