Shifting power in favour of those experiencing health inequalities
The topic for this meeting of our Sharing and Building Power Cell on 30th May 2023 was to consider: “What can be done to shift power in favour of those experiencing health inequalities?”
The meeting heard from the cell’s thought leader (Arvinda Gohil) who shared insights into a number of community-based programmes related to health including people with HIV, older people in the Asian community and in poor and disadvantaged communities. The reflection from Arvinda was that these project-based interventions have made an impact on the targeted communities because bridges have been created between statutory services and communities struggling to access those services because they are not always presented in a way that is reflective of who they are and what they need.
Our provocateur (Samira Ben Omar) asked us to think about how we scale up what works in a way that presents a real change and shift in equalities and she asked us to reflect on the following:
We have the data but the inequalities still exist - there are examples of programmes and projects that are transformational but it is in silos and is not making the change that is required.
The system is set up to do exactly what it is doing so it is not broken - we need a paradigm shift and so need to think about what that might look like.
The system does not want to give up power.
Is there a real and genuine commitment across the system to addressing inequalities?
Finally Samira told us that communities are not waiting for permission - they are mobilising and demanding and bringing about change - so what can the system learn from this?
The meeting than considered the experiences shared by Arvinda and the provocations offered by Samira and considered what can be done to shift power. Here are some of the points that emerged from the discussion:
We need to use the power that we have wherever we are in the system.
For power to be shared then people need to give up power – when they don’t, the system stays the same.
There is a need for a stronger partnership between the NHS and the community in order to encourage people to access services.
The voluntary sector often acts as a conduit to communities, but does not have an equal voice at the table within the health system.
There is a need for space for the community to be engaged in the discussions but the system already has systems - these are top-down and what we need is bottom-up. We are too often mirroring the system rather than disrupting it.
Co-production is being misappropriated and is becoming a tick box exercise.
The data about health inequalities is there. Endless demands for more data should be resisted - and we do not need to collect more, we just need to take action.
There are two types of systems change - tweaks and fundamental. A Better Way recognises is that it is important to change oneself as opposed to first-off demanding change from others.
Efforts to shift power in favour of those experiencing health inequalities must recognise the central importance of relationships and trust.
It takes a long time to build trust and the funding system needs to understand this, and move away from funding short term projects.
We must remember that change is possible – we have seen that we have been able to share power when there is a crisis, not least during Covid.