Are we really well?
From a TedX talk by Dr Andy Knox
In 19th Century France, there was a philosophical ‘battle royale’ between two great giants of the scientific world, which has shaped western medicine for the last 150 years. On one side, Louis Pasteur, declared: “we must prevent disease and kill disease in order to create health”. Antoine Bechamp disagreed, saying: “No, it is poor environments that lead to poor health and therefore we must create wellness. If we do that, illness will be far from us.”
Louis Pasteur won the debate and that has shaped our way of working in healthcare and the impact of massive health inequalities across the UK.
Dr Andy Knox, a General Practitioner, is based in North West England. His particular area of interest is ‘Health and Wellbeing’. As a qualified facilitator he loves to host and facilitate conversations about re-imagining cities and regions as healthy places and generally re-imagining the future. He spoke at a TedX event in January 2020 about the culture that’s needed to develop in order to create real wellness within our communities:
The Pasteur approach has achieved some amazing things; mass immunization, the advent of antibiotics and the development of chemotherapy to name just three. But are we really well?
Where I live in Morecambe Bay, you can walk six miles from the one side to the other and find that life expectancy decreases by 15 years. We have rising childhood poverty, increasing use of food banks and we are facing an epidemic of type 2 diabetes. So Bechamp might rightly ask us, "Have we created environments that help us to be well?"
About seven years ago, working as a GP in my practice, I ended up crying on my desk one night feeling completely at the end of myself. We felt so overwhelmed with the pressures of everything coming through our doors. I realized that I couldn't really fix the problems that my community were facing and so I needed to find a fresh approach to my work.
We reduce the conversation about health and well-being to being far too much about self care and personal responsibility. Of course those things are important but I believe that we have to get into the much deeper issues of poverty, housing, adverse childhood experiences, pollution, social isolation, etc., with our communities and we need to learn to challenge unfair and unkind national policy and societal structures that keep us unwell.
I've become really fascinated about how we might create the kind of culture together to build this sense of wellness where we are and what I've discovered through my work is that there are four key foundations on which we need to build wellness:
There is so much in our context that might lead us to feeling hopeless but hope is not built by focusing on everything that is wrong and entering into a cycle of despair. Hope rather is built by focusing on what is possible despite our difficulties and our pain.
We have been hosting some conversations around Morecombe Bay and the city of Lancaster. When I asked the people gathered from many different communities, 'What gives this place its heart and soul and what are your dreams and your visions for the future?', they were not short of answers. They began to create the most beautiful picture imaginable of what their city is like now and also what it could become over the next 5, 10, 20 years.
People are not afraid to dream together, creating a sense of vision and hope and then even voting on what their priorities are. Hope gives us an amazing foundation on which to build a different kind of future. It allows us to believe that things really could be different - where every person can find well-being and purpose.
It has been so humbling for me to realize how often we make decisions on behalf of communities, especially those who are most deprived without ever involving them in the process. Nothing about us without us is for us.
inclusivity is about a different kind of power. It puts relationship into the heart of everything we do and every decision that we make. How complex it is to try and navigate your way through the health, mental health, social care and welfare system when you are on the ropes. The very time that we actually need our systems to work the best for people can sometimes be the times when they are most humiliating, degrading and dehumanizing.
I believe that we have to take the lanyards off our neck and embrace a whole load more humility to step outside the walls of what we think we know, into our communities and learn to sit with them to listen to them. To be with them to experience the pain that they often sit in and with and allow it
to change us. I cannot be well unless you are well.
The Institute for Health Innovation have shown that a culture of joy is the single most important determining factor in building a safe, sustainable and excellent health and care system. Joy is not built by telling people to be resilient and just keep calm and carry on. Stiff upper lips don't help joy.
Joy is built very deliberately and it takes more than anything, a sense of camaraderie, a sense of belonging - that we are all in this together. Joy is built when we let our barriers down. When we choose to be a bit vulnerable. When we show something of ourselves. When we choose to connect as human beings. We become friends rather than just colleagues.
We're seeing loads of fantastic new initiatives spring up in our communities, like community choirs, mental health cafes and comedy festivals.
I believe that we need to take the judgments and the assumptions that we make about other people, often fueled by reality TV and social media, and put them aside. Instead, we need to embrace a whole load more kindness and compassion in how we choose to look at people because we do not live their story, we do not understand their journey and we do not have to go back into their reality.
What I'm finding is that there is kindness at work in our communities all the time. We just need to cultivate it more.
Louis Pasteur has inspired us to create one of the best health care systems in the world and yet when we look across our communities we would need to conclude that we are not well. So I'm asking us together, whoever we are, wherever we're from, whatever our role is, that we would take a step outside the walls of what we know and learn to be with our communities and our teams differently. That we would build wellness on the steadfast foundations of hope, inclusivity, joy and kindness.
Watch Andy's 17 min talk here:
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