Meet the man bringing Transition to the NHS David Pencheon is a public health doctor and Director of the NHS Sustainable Development Unit. His interest is, as he puts it, in “promoting health in the best sense of that phrase, rather than just as a large illness treating machine”. He is one of the people behind the NHS Sustainable Development Strategy, and one of the key people trying to embed Transition ideas into the public health setting. We were delighted that he agreed to speak to us to close our months theme on Transition and health. Jamaica Plain New Economy Transition in Boston have started a process of asking “what would a cancer free Jamaica Plain look like by 2030?”. Most of the things that you would do to make it a cancer free are actually the same that you would do to make it a low carbon and more resilient place. How do you see that coming together of the two things? It’s a very strong message. It’s one lens through which the health service can really add value in that to make this transition to a low carbon, sustainable world. The health system doesn’t actually need to do anything differently. It just needs to do what it’s already doing much better and in a transformationally better way because exactly as you say, so many of the things that we would do to make health better, even if climate change were not happening, give us so many short term health benefits that there are very few trade-offs. In public health terms, there are two very obvious examples of this: the first is in travelling. Never before have we moved our bodies around the world so much without moving our bodies. It is absolutely extraordinary. If you think about low carbon transport systems, they both serve our needs in terms of climate change and low carbon transition but also serve our immediate health very well in that we would raise our physical activity rates much, much more leading to a reduction in diabetes and heart disease and so on. The other area is clearly around food. We know that a low carbon food system, which is essential for the future, is actually very beneficial for our health now. So the decision co-benefits: what’s good for the future is also good now. It’s a very important message and an important framing of the significant overlap between public health and the transition into a low carbon society. In the editorial for this theme I speculated that hospitals could be reimagined as market gardens, power stations, co-operatives and so on. Through the Clinical Commissioning Groups that NHS Trusts have, in theory those they now have the potential to make such radical shifts if they chose to. Do you think the obstacle to really embedding a Transition take on public health in the NHS in a very practical way that’s rooted in local community is prevented from happening from a lack of vision or a lack of agency? I think it’s much more a lack of agency. The phrase I use is that lack of “aligned incentives”. All the things you described about what hospitals could be as health enhancing civic structures and civic systems, i.e. supplying energy through district community heating systems, biomass, combined heat and power. Could they provide allotments, could they provide green spaces, could they provide places where people could actually see what it looks like to live healthy lives? Could they have good food shops in the concourses, could they have fair trade coffee in the concourses? All of those things sound quite visionary. But actually every single one of those things is happening now, but sporadically in isolated examples. We know all those things are possible. There’s nothing to stop any of those things from happening. As we often say, the future has already arrived, it’s just a little unevenly distributed. So that is perfectly possible, but we do not see it at a system-wide level. What we see is stars in the night sky, not the dawn, to be blunt about it. Why does it not happen? Part of it is cultural. We are a rescue system, we wait until people get ill, and we know hospitals for instance are quite unhealthy places to be both for patients and staff. It’s quite a brutal environment to be in. People sometimes say if you’re not ill when you go into hospital you certainly are when you come out. People put up with it because they feel like some good is being done. We tend to pay hospitals and we tend to pay professionals in hospitals for activity not outcomes. The more you do, the more you get paid. The more operations that are done, the more the hospital gets paid. That means that all these visionaries who are working in hospitals promoting care closer to home, they are losing the Trust or the hospital money. That’s not a good idea, because the hospital can see that although there’s an obvious merit to keeping preventable illnesses away from hospitals, promoting health, promoting resilience, adding social value in the community, they tend to look at their financial bott... buff.ly/1l0fG…
Posted on: Mon, 02 Jun 2014 17:51:17 +0000
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