Transition Culture

8 Jun 2014

Peter MacFadyen on Independents for Frome

Something remarkable is happening in Frome, a story that offers many useful insights for increasing the impact of Transition and reimagining how it relates to local politics.  Peter MacFadyen is author of Flatpack Democracy and very recently became the Mayor of Frome.  Previously he worked for Comic Relief as a development consultant, and is also the director of an undertaking firm.  In 2011 he was one of a group of ‘Independents for Frome’ who ran for, and were elected onto, the local Town Council.  I asked him to tell me the ‘Frome story’. 

“The Frome story starts four years ago really. In January before a local election, I was the Sustainable Frome representative who was meant to have a relationship with the town council. Sustainable Frome is the Transition Town equivalent and a member of the Transition Network. When I went to the town council, their sustainability policy consisted of “we’ve got a park, what more do you want?” Essentially I found that rather unsatisfactory, and I met a number of other people who were also finding all sorts of other bits of the town council’s work unsatisfactory really, because they were missing opportunities rather than that they were particularly evil in any way. It was just that they didn’t do anything.

That then led, as so often happens through probably too much beer, to “ok, let’s try and whip this up a bit, make it more interesting, raise some issues and see if more people will vote”. Like many places, we have a lot of wards that have not been contested for years. That led to an election in May 2011 where a group of people stood as ‘the Independents of Frome’ and won 10 out of 17 seats.  [Here’s a piece from local TV just after their election]

We have an outright majority and have continued over the last three years with a very ambitious programme which has at its core a lot of green things because a lot of the people who got involved were green in everything but politics, because we’re independent.

So why Independents?

It’s partly anti-party politics because part of the history of Frome was party politicians bickering around party issues and spending their time doing party things. For instance, a number of the party politicians last night couldn’t come to the meeting because they were all off campaigning for the Euro elections. Things like that, we just felt, at this level, they should have Frome at the core of their interest and they shouldn’t be driven by ideologies that are actually irrelevant and often corrosive at a local level.

The thing that’s slightly different about us is that we work as a group of independents, which is not the same as a party. But we do have a way of working, we set out some rules of behaviour really which are essentially common sense: accept that if you lose a vote, you move on from it, things like that. Ours and many other councils and councillors get terribly involved in stabbing each other in the back, revenge for previous votes and that kind of thing. That’s probably one of the best examples of where we’ve said we’ll work as individual people with individual ideas but we’ll work with a common purpose which is around the betterment of Frome.

As part of this month’s theme I interviewed Natalie Bennett from the Green Party and I asked her what her thought was about the role or otherwise of party politics at the very local level, and she said it’s really useful because it means you have all the support of a party, advice and policy and all of that immediate profile. Do you see anything to be said for that or really do you feel that party politics just has no place at the local level, it does more harm than good?

I think it does more harm than good. I think you can pick and choose. I’ve had some really interesting discussions in the last few weeks with the prospective parliamentary candidate for the Tories, the guy who’s going to stand for the Tories in the next election. If I was a Labour politician I probably wouldn’t feel I could do that or he wouldn’t want to see me. I think it’s really important to be able to pick and choose and the vast majority of what Natalie was talking about just wouldn’t be relevant at a parish town level.

What are the things that you’ve been able to do? One of the things that’s really interesting in the book I think is how you set out that there are powers that town councils have that they may not know about, which you’ve taken full advantage of.

We have. Some of that comes from localism. We were very happy at the beginning of Independents of Frome to have some of the really key people who were involved in the new localism Act as it was created, and to be able to tip us off on what might be useful. There are powers through which local communities can try and buy land, can try and do things in a way which they didn’t used to be able to. 

Essentially, what you had to do before was what’s on a list, and the list was dog shit, bus shelters, and at our level very limited. What we’ve now done is to break out from that and we can now do anything that isn’t illegal other than, apparently, “form an army”. Other than create an army, anything that’s legal, we can do it. This means we’ve been able to, for instance, borrow significant sums of money in order to do up buildings or create opportunities which we wouldn’t have been able to do and wouldn’t have had the ambition to do…

I have to say I’m very relieved to hear that you aren’t able to form an army in Frome, that’s a great relief.  You’ve done some work around allotments and you’ve been looking at bringing assets into community ownership I think? Tell us more about some of the things?

We’re just about to bring a significant asset into community ownership. We agreed last night to pursue the purchase of what will become a major community hub. This is an ex-Somerset County Council building that we’re going to buy with yet another loan. These loans, incidentally will add up to about 10% of our budget. So it is significant, but it’s not a problem, just not something that was done before.

The allotments was an interesting combination of the council combining with a local donor who wanted to support Frome, so we used his money to buy some land and then added council money to that, to get rid of a 10 year waiting list overnight.

A lot of what we’ve done actually is to up the buzz of Frome though. There’s now a very large market in the town which closes the whole middle of town, brings thousands of people in once a month in very much a European-style market. Again, that’s happened because the town council’s combined with local entrepreneurs, with the district council to do all the road closing and so on.

We’ve done that partly by the nature of the people who we’ve attracted to the council. In many ways, it’s not very tangible, but one of the main things we’ve done is to massively the structure. There were five layers of council management, there are now three. There were a plethora of meeting, there are now two main ones and two committees. With that cleanness, we seem to have been able to attract staff who would definitely not have worked for local councils before.

We’ve got some really, really good people who come with a different outlook. I don’t mean that negatively about the people who were there before really, but they’ve brought in ideas to up the whole game, in that kind of way.

You mentioned localism, and the Localism Bill gives communities some very interesting powers it didn’t have before. What do you see as being the opportunities that localism presents and also perhaps some of the down sides of it?

I think the ethos is really exciting. The idea that communities really can do things, essentially a Community Right to Build, the Right to Challenge, the Right to Bid. They basically say that if the community comes together and has a referendum around something like a building which was going to be sold – which might be a pub or something, it doesn’t have to be a public building – then that community can really have a say in what’s going to happen.

There was also meant to be money that came down to support a lot of that. The challenge is that certainly for us, the interpretation of what local is, and much of that has been ‘district’ so it has stopped at the level above us. We have a very highly politicised district who are very short of money. They all are, we do understand their problem, but they’ve creamed off the money and basically held the decisions at that level.

We’ve done the consultation, said what the people want or found what the people want, we’ve set everything up and then it doesn’t happen. At the moment it’s got stuck, and not surprisingly in many ways, the government’s moved on to things like the recession and fracking and whatnot and have kind of lost interest, I think. So it doesn’t have the weight from the top down to make this happen.

One of the things in UKIP’s EU elections mainfesto which is interesting is how it takes the idea of localism a stage too far, I think, saying that local communities should have the power of referendum on everything, basically. On wind farms, solar farms, any housing development, any development at all. If you can get 5% of people to say they want to have a referendum, then there should be a referendum. Which makes me think actually that the piece that’s missing is if you give people loads and loads of rights but you don’t give them the responsibilities that go with them in terms of national targets for cutting carbon, then it just doesn’t make any sense at all. So actually if you were to say, yes you can have a referendum on planning but in total over 5 years those have to add up to a 10% cut in carbon emissions over a period of time, then you’ve got something quite different.  I wondered what your thoughts were on the extent to which giving people power over local decisions is wise or not?

That’s a very interesting point. Obviously I must go out and read the document before I rush out and vote, which I haven’t done yet. This whole thing of giving people power is also without information. So people will vote with their instincts. There’s a real dilemma there. I went to a meeting about fly tipping the other night as there’s a particularly big issue on fly tipping in one area of Frome, and for some people the answer was to close the road. But that’ll just mean they’ll move somewhere else, the answer being that we don’t care. So we’ve got things like that to deal with, NIMBYism at its most astute, which I suppose is what you get with wind farms and solar farms and so on.

But also a lot of these issues are complicated aren’t they?  They are difficult things to get our heads around. Quite a lot of people elect people like me as a councillor and then say – look, I trust you, I’ve elected you in order to make all the decisions for me, so I don’t have to read all these papers and get involved. And it’s really difficult to find that point where you engage people enough so they actually understand the issues and can make the decisions and could take part in a referendum sensibly. At the other extreme you have a dysfunctional democracy like we have at the moment. So I don’t see an easy answer, but giving that level of power to what would inevitably, at least initially, be a very few people who turn up, would be deeply dangerous I would say.

At the moment I imagine Frome has a town council, a district council and a county council.  Do we need all those tiers, and if not, which ones should go?

We don’t and the district should go. In my view, it’s now irrelevant. Not least because it has so few resources. Much of what it does they have sold off anyway, so it’s been privatised. All the street cleaning, for instance, is on a 10 year contract. A lot of the other services which they used to provide they’ve sold off, so they’re not really doing anything. Probably technically they’re managing them, but they’re effectively gone. It seems to me they just cost money and are completely unhelpful now. Certainly for us they’re just another layer which serves no useful function at all as far as I can see.

We talked about how the powers of localism have helped what you’ve done in Frome, and given you new powers that you can do a lot with. And how you see the work that you’re doing there as an extension of the Transition work that was happening before. What would more government help and better legislation, what would need to change in order to help you deepen that work and help you move further forward? How much further could government go to enable that?

There’s a lot of training that people need, a lot of confidence that they need to get that actually if they were to have the skills and if they were to participate and engage, that participation and engagement would lead to change. Then they would do it. I think what’s happened at the moment is everything’s got sucked to the top. I’m not at all surprised that Russell Brand can say what he said and 11 million people can watch him and most of them will agree, that actually “voting only encourages them”.

Actually, our system is collapsing from the top down, and what government could do is to give real powers to local people and the resources, partly to have an army if you like, of facilitators and well-trained people to help people to help the community to make those decisions and to engage. We’ve lost those skills, I think, and we need to regain those skills. The government could really help in training people, working with people to get them back again. Then, crucially, make sure that decisions that are made at a local level actually lead to real change. That people will get pissed off really quickly if that doesn’t happen.

What would your advice be to people who are thinking “I wonder if we should do that and get a few people together like they’ve done in Frome?” What would your advice be to them?

My cocky advice would be read my book, Flatpack Democracy, but there is a real moment actually. What the book set out to do is to try and help people to see actually how easy it could be to take power at a local level and then really put in place some change very quickly. We are at a unique moment.

Although unemployment may be falling, there are vast numbers of young people who are either unemployed or under-employed. If they continue to be totally disenfranchised as they effectively are now, (well not totally, but really have a deep cynicism from the system), we’ve set up something which is potentially really explosive. There’s a real need but there’s also a real opportunity particularly to bring young people into the system and to running things like councils.

The mayor who I replaced was 21 when he took over, and he’s done a fantastic job. There’s no reason why young people shouldn’t be much more engaged than they are. There is a moment, particularly with social media where cheaply, quickly and easily, new bunches of people can come in at the bottom level and make things change.

It strikes me that what you’ve done in Frome is really imaginative and bold and creative, and town councils aren’t renowned for being bold and passionate and creative. Is there a way that they can have an injection of that? How can we get these ideas into councils?

Hopefully Frome and other places, because we’re not alone, can be examples and things do spread quite quickly. I think it’s a social media thing. Something like Incredible Edible which I know wasn’t a council idea, spread quickly. Transition Towns, blimey, world domination in only a few years!  Good models can spread quickly. The effect of somewhere that is functioning being put out there is that it puts pressure on those that aren’t functioning. Other councils and other groups of people hopefully will think, why not us?

That’s definitely happening in the conversations that I have. I have a significant number of conversations now with people asking for advice or support and will you come and talk to us and so on, who want to do similar things. We’ll come to things talking a bit more later about the Transition Town movement because I think that’s the same thing really. A lot of what the Transition movement are doing is parallel democracy really. That puts a huge pressure on town councils to up their game.

The advantage of a town council is you have access to money, which a Transition group doesn’t have in the regular way that a parish or town council does. There’s real potential in there for the two working together to lead to a really significant evolution or revolution. 

[Here is the podcast of our interview in full]

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7 Jun 2014

Is Transition political?

Criticising Transition for being explicitly apolitical, and for not engaging in the political system in the conventional way feels, to me, like criticising a spoon for not being very good at cutting bread.  Transition is a tool designed for a specific purpose.  But with the rise of UKIP, the National Front, the Golden Dawn, and others in Europe and elsewhere, is the Transition approach still tenable?   Should we all actually be standing for election?  This feels like a good time to explore how Transition relates to politics, and whether its approach is still appropriate.  Welcome to our month on Transition and politics. 

Over this month we’ll be exploring 4 key questions:

• Is Transition political? 
• What does it look like if you and some similarly-minded friends get together and run for your local council? 
• How do those within the political system who question its fundamental assumptions find a voice?
• What do the main political parties make of Transition? 

We’d love to hear your thoughts and contributions too.  We’ll start today with this piece as the response to the first question, “Is Transition political?”, and our interview with Peter Macfadyen for the second. First thing to say is that what follows are my thoughts, not any kind of official Transition Network position on politics.  For me, I imagine Transition as being like an app.  It is designed to do a particular thing, to bring people together to support and enable them to build resilience at the community level, but always in the context that, if done in a sufficient number of places, it will start to change politics on the larger scale and help to bring about a more healthy human culture. 

But it’s one of a number of apps you might have for different purposes.  It is different from the campaigning and protesting apps, it’s different from the political lobbying apps, and you’ll use different ones at different times.  As Jeremy Caradonna puts it in his forthcoming book Sustainability: a history, “the challenge is to have a politically active movement without coming politicised“.  

But the question that arises is if Transition is but one part of the wider process of driving the shift towards a more resilient, just, low carbon and abundant society, what should its relationship be to the other pieces of the puzzle? How should it relate to the other ‘apps’ (i.e. other movements/campaigns/ideas for change), and to local and national government?

Esther Aloun and Samuel Alexander of the Simplicity Institute recently published a refreshingly well-researched and thoughtful paper called The Transition movement: questions of diversity, power and affluence. In it, they ask “can a social movement, such as the Transition movement, achieve fundamental change without engaging in ‘top down’ political action?”  

I would respond that that is the only way that Transition will work, by creating a space for innovation and experimentation at the local scale in such a way as to inspire change in other communities as well as higher up.  We are starting to see evidence of this working.  Aloun and Alexander’s suggestion that Transition would be more effective by being better connected with more radical change movements feels to me to entirely miss the point.  It is effective precisely because isn’t connected to radical change movements, in my opinion.  Let me unpack that a bit more. 

If I decided to run for election as a Transition Town candidate, alongside my great Transition-related policies, I would need to have policies on abortion, healthcare, education, defence, international trade, etc etc.  Every time I state a policy on one of those issues, I increasingly place myself somewhere on the left/right, pro/anti-growth, pro/anti-capitalism spectrum.  As soon as I do that, I lose all the people who don’t also inhabit that place.  What works at the national political level becomes profoundly unskilful at the local level.

Working through a Transition initiative, that lack of an explicit political positioning is one of our key strengths.  It enables you to build the kind of diverse, cross-political groups that building more resilient communities requires.  It enables the creation of projects on a meaningful scale, but unfettered by party politics and wider issues.  It’s the ‘power to convene’ that Transition is so good at, which is virtually impossible to do in a truly inclusive way if you are seen as being politically aligned.

I was intrigued recently to get a copy of a novel called The Second Life of Sally Mottram, just published by David Nobbs, author of The Fall and Rise of Reginald Perrin, among other things.  It tells the story, in the kind of novel many people will be taking to the beach this summer, of Sally who, according to the back cover “embarks on her ambition to bring her town back to life” by trying to start a Transition initiative.  It’s “a hilarious, heartwarming tale about what keeps our community spirits alive”.  How does he sum up Transition?  Here Sally is on the train reading, for the first time, about Transition:

“The books are full of small details of little things that have been done to change and improve many places, mostly quite small places, but their underlying subject matter is not small.  It is, simply, the saving of our planet.  Implicit in it and the actions is that big things come out of little things, that out of a thousand tiny acts, if they can be joined up, one mighty act may emerge.  

The idea that bottom up citizen-led approaches actually represent just the kind of political action that we need to see, is gaining momentum, galvanised in particular by the recent successes of the Right in the European elections.  The left wing think tank Compass recently wrote, in their reflections on the European election results:

A new economy is waiting to be fashioned via companies serious about climate change, through peer to peer lending schemes to really challenge the big banks, through crowd sourced investment like Kick-starter and sharing platforms in which we borrow and lend big ticket items we don’t often use. A myriad collaborative projects made possible by new technology, democratic initiatives like Abundance and big ideas like B Corps that change the very social nature of companies.

The same trends towards collaboration, self-organisation and social networks will infuse our politics. From 38 Degrees to Frome’s Flatpack democracy, from the great success of Hope Not Hate in defeating the BNP to Transition Towns, we need a citizen led politics of everyday democracy not just a vote once every five years.

When we started Transition, people said “you’ll never be able to influence policy-makers through community projects.  It’s not going to happen”.  Yet we can now start to get a sense of what that progression might look like.  Let’s take Transition Town Brixton in London as an example:

• A group of people come together and raise awareness locally, Open Space events, engage as many people as they can, and formally kick themselves off as a Transition initiative
• This creates a supported space in which people have permission to start projects, enterprises, initiatives, but within a wider context of other people doing the same
• One of those, Brixton Energy, emerges from the Energy Group, and soon becomes a successful community energy company, running three share offers
• Secretary of State for Energy and Climate Change, Ed Davey, chooses it as the place to launch his call for ‘a community renewables revolution’ (see right). 
• When the government drafts its ‘Community Energy Strategy‘, Brixton Energy are part of the drafting team (along with people from other Transition energy initiatives) and are mentioned as a case study.  

That feels to me to be as radical as any of the groups Aloun and Alexander feel Transition should be teaming up with, but couldn’t have happened if they had.  The question that arises of course is whether engaging with something like the Community Energy Strategy was a good use of time, whether it looks likely to bring about the kind of truly transformational change we really need. 

The answer, thus far at least, is that it’s not enough, but it’s probably the best one could have hoped for under the current government.  And it has enabled the funding to enable things like the Community Energy Peer Mentoring Fund which has enabled the peer-to-peer work OVESCO is now doing, supporting 10 neighbouring communities to set up their own community energy companies, as well as other financial support.

There is always, of course, the danger of co-option, a danger raised by Aloun and Alexander:

“As with most reformist, non-confrontational approaches, by the time the movement creates enough change to become noticeable, the existing system may already have had time to adapt and simply adjust to that change”.

That’s a risk.  One could argue that, in the UK context, the Big Society was an attempt to try to bottle some of what Transition does so well.  As indeed were some elements of the Localism Bill.  But although getting support from local authorities and other bodies could be seen as co-option, it can actually be one of the best ways to protect against it.  For example, the degree of institutional support for the Bristol Pound from Bristol City Council is such that if the government or the Bank of England wants to close the scheme down for any reason, it’s not just the Bristol Pound they need to pursue.  

Ultimately, you can get more done at the local level, you can make more change happen. Seeing that change happen rebuilds your belief that change is possible and that it’s worth making an effort, something far harder to sustain when trying to bring about change at the national level. I tend to go along with John Boik who recently wrote in the Guardian: 

“The national level is not the place to introduce bold change. Doing so would be too risky, too abrupt and too chaotic for a nation. Besides, it would be politically infeasible; the push-back from vested interests would be intense.

A far more practical strategy is to introduce new monetary, financial and corporate systems at the local level, on a volunteer basis and as a complement to current systems. Such an approach is already legal in the US and many other countries; no new laws would need to be passed. This strategy offers the greatest chance of success with the least amount of friction.

At the local scale you can create a new story, show it in practice, living and breathing, functioning pieces of the larger forthcoming resilient economy in practice.  And that matters.  As John Ehrenfeld put it in Sustainability by Design: 

“Sustainability can emerge only when modern humans adopt a new story that will change their behaviour such that flourishing rather than unsustainability shows up in action”.  

What fascinates me is how this idea of being more effective by not being explicitly political is gaining momentum.  It’s written through the story of Independents for Frome that we’ll hear about next week.  It’s in the invitation I had to speak in Salisbury a couple of weeks back from a mixture of councillors from across the spectrum and some local people wanting to get Transition started but realising that the Council couldn’t do it. It’s in the Totnes Economic Blueprint, created with a coalition of local stakeholders.  

So, to answer the question that kicks us off this month, “is Transition political?”  The answer is yes.  Deeply.  It has the power to transform communities, economies, shift power back to the local level, encourage communities to own their own assets and be more in control of their economic destiny.  To create new food systems, economic systems, education models, and so on and so on.  You know this stuff.  It’s deeply, profoundly political.  But it isn’t explicitly so. It comes in under the radar, and that really matters. 

But the question then arises as to whether, when the Queen’s Speech gives, among other things, fracking companies the powers to frack under your home without your permission, your best option is to get your neighbours together to reduce your energy use and start a community energy company (as recently happened in Balcome), or to lobby and protest?  And which, ultimately, is more ‘political’?  Enjoy the month. 

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3 Jun 2014

Transition as Social Medicine?: health leaders discuss

One of the following quotes comes from the Transition movement.  The other 3 come from public health professionals.  Can you tell which is which? 

A: “A sustainable system protects and improves health within environmental and social resources now and for future generations. This means reducing carbon emissions, minimising waste and pollution, building resilience to climate change and nurturing community strengths”.

B: “We need a new vision of cooperative and democratic action at all levels of society and a new principle of planetism and wellbeing for every person on this Earth – a principle that asserts that we must conserve, sustain, and make resilient the planetary and human systems on which health depends by giving priority to the wellbeing of all”.

C: “Changing light bulbs, sharing cars and flying a little less is not going to get us to these targets.They are all necessary actions to take now, necessary but NOT sufficient. We need a radically low carbon society (and a health service to match – which will mean that health care will need to be delivered in radically different ways)”

D: “Our wellbeing is determined to a greater extent by our community assets than any other health and well being determinants. However, community building rarely features as a priority in the current sickness model. But that’s all about to change because more and more health care radicals are shifting their focus from what’s wrong to what’s strong”

Actually it’s a trick question: none of them come from Transition writings.  In order, they come from the NHS Sustainable Development Strategy, The Lancet, British Medical Journal and Cormac Russell of Nurture Development.  Hard to tell though, huh?  This month we have been exploring the overlap between Transition and public health, and arguing that in many ways they could be seen as being one and the same thing.  

Let’s get a quick snapshot of some of the things that Transition groups do from our latest monthly roundup: creating new community markets to bring local food into communities, mobilising people to come out and recreate their bus stops as ‘Edible Bus Stops’ where people can graze while they wait for the bus, running energy festivals where people can learn how to save energy and more about renewables, putting up polytunnels in schools, trying to support their local traders to become plastic bag-free, setting up community energy companies and projects, enabling skillshares, planting community orchards, organising river bank clean-ups, fixing local bikes, planning developments of affordable homes built with local materials, running repair cafes and so on.  I would argue that there’s a strong case for seeing all of those as being public health. 

A new vision for public health

The term ‘social medicine’ was the term used before it was replaced by ‘public health’.  I rather prefer ‘social medicine’.  For me it better captures that sense of skillful health interventions in the right place, remedies suited to people and place, as well as the fact that it’s as much about people and communities and people as it is about community farms and renewable energy.  

While Transition and public health have, until now, largely run in parallel, there is a strong case for moving the two closer together.  It’s certainly a link that Prof Janet Richardson, Professor of Health Services Research at Plymouth University in the School of Health and Human Sciences, and the first person to do a Health Impact Assessment for a Transition initiative, sees: 

“Public health has a huge remit for health promotion and primary prevention and a lot of the work around Transition is capitalising on staying well”. 

For a growing number of people in public health, the need for such an approach is clear.  Martin McKee, Professor of Public Health at the London School of Hygiene and Tropical Medicine and one of the authors of The Lancet’s remarkable ‘Manifesto for Planetary Health’, told me: 

“Those people who want to promote a healthier, safer, higher-quality environment as well as the health of the population have much in common. We should be working together in some coalition of the willing to try and make the world a better place”.  

What would it look like if the two agendas were to merge more successfully?  Mark Dooris, Professor in Health and Sustainability and Director of the Healthy Settings Unit at the University of Central Lancaster, shares his vision: 

“We’d have something a lot more seamless.  We’d have health seen as a core value and function within delivery organisations. We’d have that being seen as intricately related to and interconnected with other agendas rather than separate from them. We’d have a really balanced focus on acknowledging that there are very real needs and problems out there but there are also huge assets, capabilities and potentials.  

We’d be moving away from that kind of negative needs-based culture to something which is actually celebrating and harnessing the assets and potentials of communities. We’d also have a real balance and mutual learning, where we acknowledge the importance of government and other policy and delivery instruments, but also bring that together with the grassroots creativity, innovation and energy that I think characterises the Transition movement”. 

For David Pencheon, Director of the NHS Sustainable Development Unit, this coming together is already happening, just not yet at the scale required: 

“Hospitals could be health-enhancing civic structures … could they supply 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 … it 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.  

So how might we help move towards this?  Firstly, what are the opportunities?  Janet Richardson again: 

“If we can look at the win-wins and sell the healthcare benefits of living in a way that is good for the planet, i.e. not eating too much meat, growing our own vegetables because that gets us outdoors, we’re exercising, we’re growing healthy food, cycling, all of those things. Those behaviours that are good for the planet are also good for health and wellbeing”. 

For Angela Raffle, public health worker and co-founder of Transition Bristol, having been immersed in both worlds for some time, the overlaps are obvious: 

“I see health as wider than the NHS. Health is an outcome really, and everything that the Transition movement is doing is good for health because it’s about clean water, clean air, good food, safety, security, connection with nature and towns that are liveable”.

Martin McKee believes such an approach already enjoys a lot more support than one might imagine: 

“The public health community should be seen as a group of people who have a particular set of skills who may work in many different settings, but they’re united in the belief that we do need to look at the broader determinants of health in the population”. 

If it is clear that both perspectives would be strengthened by a more explicit overlap, where to begin?  Firstly by acknowledging the great work that is already underway, such as the NHS Sustainable Development Strategy, and secondly by looking at the obstacles we need to overcome if we want to see a move in this direction.  For example, it is useful to understand the possible reservations people working within public health might have about a more explicit connection to Transition.  Mark Dooris identifies two key ones: 

“The first is the extent to which Transition has successfully embraced a commitment to equity, social justice and diversity, and I think that’s something which has had more and more discussion in the last few years in a really positive way. 

The second thing is around the way in which health tends to be articulated. There tends to be quite a strong emphasis on what I suppose for some people would be called spiritual wellbeing, so the inner transition focus. Whilst I think it’s important to engage with that, I think the perception of that from outside can be seen as offputting and can seem to be focusing so much on the micro inner that it fails to be dealing with the population and real determinants-level stuff that impacts on the health and wellbeing of people at large”.  

For David Pencheon, trying to shift the NHS in the same direction as Transition faces the same cultural inertia as in any sector of society: 

“Part of the challenge is that we’re so addicted to what we currently know, that we don’t have the vision to see that it could be much better. It could be so much better for the present and for the future.  Sometimes we do lack vision and we do lack courage.  Things do not have to be this way and to live sustainable lives we don’t have to resort to living in caves”. 

Angela Raffle identifies the difficulty of enabling a concerted push in one direction due to the huge pressures the NHS finds itself under: 

“At the moment it’s a very difficult environment to work in because it’s going through enormous structural changes and the 2011 Health and Social Care Act which led to the 2012 Health and Social Care Bill has really fragmented the NHS a lot. It’s become a really heartbreaking field to work in, to try and get unified change”.

For Mark Dooris, “the way in which the delivery organisations are still set up now in local authorities still doesn’t help that”.  He also sees cultural inertia as a problem, adding “some of that is to do with very pressurised workloads, but some of it is to do with silo thinking”. Yet it is clear that there is huge potential, if the right interventions can be made in the right place.  

What needs to change?

Mark Dooris argues that one of the places this needs to start is some joined up thinking at government level, rather than the current rather schizophrenic approach:

“What we tend to see is still this fragmentation, so we will have discussions about fuel poverty, we’ll have discussions about transport planning and about the obesity epidemic. Elsewhere we might have something about the need for preparedness for climate change in terms of the risks related to flooding etc, which are perhaps the most obvious public health risks that have confronted people in this country. But actually what we don’t have very often is an articulation of how it all comes together and why there are things you can really be focusing on that are going to be hitting a number of different priority policy buttons”. 

For David Pencheon, at the moment, our current health system incentivises the wrong things:

“Very rarely would you get a Secretary of State for Health standing up in the House of Commons and saying “I’m proud to announce we’ve done fewer operations this year because we have needed to do fewer, because we have prevented this whole range of preventable illnesses”. Normally politicians will congratulate themselves on the NHS undertaking more activity, which is not necessarily the vision we want.  Also, we prescribe pharmaceuticals like there’s no tomorrow and if we do that there will be no tomorrow because of the resource use, because of the post-use environmental effects, because of the huge financial cost”. 

Mark Dooris sees openings that are already underway, foundations on which such a shift could be built.  

“There is interest in what’s termed ‘social prescribing’, where rather than looking at prescribing medication a good example that links up with Transition agendas is the ‘Green Gym’, where people are doing environmental conservation, horticultural work and that’s actually seen and evidenced to have positive impacts both in terms of physical activity and mental health and wellbeing. My team is leading work across North West prisons where that Green Gym approach has developed. We’ve got strong horticultural work where car parks are being turned into gardens with polytunnels.

As David Pencheon puts it: “There’s nothing to stop any of these things from happening”.  So where might the best leverage points within the public health system be?  For Transition initiatives seeking to engage their local public health professionals, where best to start?  One potentially interesting foundation is Health and Wellbeing Boards. According to Mark Dooris:

“They have a role in developing overarching health and wellbeing strategies for the local authority areas. What we need to be doing is identifying areas where there really is that interest and engagement to join things up and to have a brave vision so that they can almost be seen as pilot areas to develop new ways of thinking and articulating how we could move forward”. 

Another possible inroad is Clinical Commissioning Groups who are now responsible for each NHS Trust’s procurement.  But as Angela Raffle told us: 

“They are very stretched, short of skills, criticised daily by politicians, and under threat of judicial review for any decision from people who quite understandably want to throw a spanner in the works with the current reorganisation which they see as simply selling the NHS to the private sector”. 

But at the same time new opportunities are emerging.  She adds:

“It’s familiar territory to the Transition movement because in a way what the Transition movement is doing is setting up new prototypes that work at a local level irrespective of what’s going on in the big multinational corporations. In a way health will start doing that. We’ll start seeing community-owned companies saying “this is really fragmented, we’re going to set up to take over community care for old folk” or whatever”.

As Transition initiatives on the ground, where’s the best place to start?  Who are the best people to make first contact with to suggest finding imaginative new ways to collaborate? David Pencheon suggest starting with your local GP’s practice:

“Logically the first people to engage are one’s GPs, one’s primary healthcare centre. There are an enormous number of GPs – in fact the Royal College of General Practitioners is one of the royal colleges that’s actually devoted a lot of time to thinking what would a sustainable health system look like. They know very well that much of it would be outside hospitals. In fact much of it would be outside primary healthcare”. 

 Final thoughts

It’s been a fascinating month.  We’ve explored the idea that the agendas of public health and Transition would be best served by working more closely together.  For Transition this could be a great way to accelerate impact and influence, while bringing additional support and relevance to what it is already doing.  For the public health sector, engaging with Transition could offer a different approach, a more skillful way of achieving a range of their goals.  For now we leave it hanging as a question, as a proposal, one we will return to.  Perhaps the best way forward would be to run one of our occasional ‘Thinky Days’ to explore it in more detail?  For now, we leave the last word to David Pencheon:  

“Living truly fulfilling, meaningful, connected lives depends on four key things: 

• “Do you have a house, do you have somewhere to live?
• Do you have a job, are you in education or do you have a fulfilling role in your community?
• Are you connected socially, do you have friends, do you have a community you’re part of?
• Do you have access to services which are the icing on the cake for health which deliver things which none of the first three can do?

If you take that as your concept of public health or community health or holistic health or health in the broader sense, then it’s absolutely clear that public health is by far the best investment we could make in local, meaningful, resilient, sustainable communities where it is just a much better place to live”. 

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2 Jun 2014

How public health + grassroots creativity = innovation

Mark Dooris is Professor of Health and Sustainability at the University of Central Lancashire. A lot of his work is about managing the delivery of programmes related to public health, wellbeing and sustainability.  We started by asking him “would it be fair to describe you as somebody who is trying to bring Transition thinking into the public health arena?”

“Yes indeed it would. I think my own journey with that has been I suppose over many years now. I started off working with NHS and local government really around health promotion and public health from very much a community development level and moved to combine that with working at a policy and strategic level, but very much trying to bridge environment, health and sustainability and this is going back more than 20 years before the Rio Earth Summit.

That was my grounding that led to a passion for bringing agendas together. More recently I’ve done a lot of conceptual work as well as trying to get some thinking going in the public health world, working particularly with Blake Poland from the University of Toronto.

Speaking of Blake Poland, there was a paper that you wrote with him where you wrote “as the converging crises of Peak Oil, climate change and environmental degradation intensify and inter-connect, much more radical action will be required.” What do you see as being the key challenges in the public health field to responding adequately to the scale of those challenges?

There’s several points to make. I think if we actually look at where the convergence and connections between climate change, sustainability and health have begun to be made, a lot of that has been made within what a lot of people see as the health system, so working to green the NHS, to look at the footprint of the NHS etc.

That’s really valid work and really important work, because clearly the NHS is one of the world’s largest organisations so its leverage and clout is potentially very big. But I think we need to go beyond that and really embrace the understanding I think that’s come out through specially commissioned research in The Lancet, in The American Journal of Public Health, The British Medical Journal and other prestigious research publications, showing that actually climate change and, I think it’s been recognised, resource depletion and environmental degradation generally are actually themselves public health threats. They’re not just something that we need to engage with and talk about but are potentially the biggest challenges that we’re facing.

How would you rate the level of awareness of those issues though in the health field? There are more and more organisations like the World Health Organisation who are really starting to flag that up, but where does it feel like it’s got to?

We’re seeing more and more of that awareness coming out in publications from the World Health Organisation down to the UK Faculty of Public Health through to individual professional associations. But there’s a real challenge in that filtering down to and informing the day to day work of people in broadly public health.

Some of that is to do with very pressurised workloads, but some of it is to do with silo thinking. People have been trained in particular ways where if they do embrace the issues around climate change, resource depletion, environmental degradation then it’s quite peripheral to their training. There’s a lot that’s going on within nursing education, increasingly medical education and certainly where I’m working looking more generally at health promotion and public health training to try to bring these issues in. But I think it is a real challenge and the way in which the delivery organisations are still set up now in local authorities still doesn’t help that.

Having said that, we’ve seen public health in England at least move from the NHS into local authorities in the last year. That offers real potential for public health to be bridging across a whole range of different agendas and different professional areas and interests so that we can be bringing into the mainstream the way in which agendas not only overlap but have what’s increasingly being talked about as co-benefits so for instance when you’re looking at urban planning how do you plan in ways which maximise walking and cycling thereby hitting the policy agendas both for carbon reduction and for increased physical activity and working on obesogenic environments.

That’s just one example and we could say the same for local food growing and healthy and sustainable food policies. There’s lots of really good stuff happening but I think there’s still a long way to go before we’ve got that real joined up approach happening in delivery organisations.

You’ve written that sustainability and work on health operate largely in parallel. What would their converging look like?

To take an example, I head up the Healthy Settings Unit at the University of Central Lancashire. Broadly, a settings approach is trying to take a whole system approach within organisational and geographical settings so there’s a healthy cities programme, healthy schools, healthy universities. If you look at schools, and I’m not as up to date with that now as I was a few years ago, but certainly going back a few years you had a healthy schools programme run by a government department, you had an Eco Schools programme, you had the emergence of a sustainable schools programme.

Actually I think you get to that point where there’s initiative overload. If you could somehow bring those together so that we’re actually talking about schools or other settings which were promoting an  understanding of a good future, really, and what’s needed, in that sense you’re not having this duplicated effort but actually finding those nodes of convergence where you can work around issues that are meaningful to people like food.

You begin to talk about what would good food look like – now actually that has benefits for health, for wellbeing, for sustainability I think, if it’s organised appropriately also in terms of equity and social justice. That’s for me that kind of thinking that requires people to have an ecological framework where they actually understand and acknowledge that things are connected and interdependent.

On paper at least, Clinical Commissioning Groups have the potential to make a more Transition approach to public health happen. When I spoke to Angela Raffle, her sense was that that looks unlikely to happen. Is your sense that it could and if so, how?

In this whole brave new world that we have of a new public health system that’s emerged as part of the reforms that have emerged under the coalition government I think we’ve got several different structures which potentially can have real influence. One is the clinical commissioning groups in terms of the commissioning and procurement of services and who is actually going to deliver them, but also the vision of what type of services and how connected those services are. Some of the things you mentioned about taking a much braver approach to how land can be used and managed around a hospital is a really good example of that.

There is interest in what’s termed ‘social prescribing’, where rather than looking at prescribing medication a good example that links up with Transition agendas is the green gym, where people are doing environmental conservation, horticultural work and that’s actually seen and evidenced to have positive impacts both in terms of physical activity and mental health and wellbeing. And for instance, my team is leading work across North West prisons where that green gym approach has developed. We’ve got strong horticultural work where car parks are being turned into gardens with polytunnels.

But the other structure that’s potentially really interesting is Health and Wellbeing Boards. They have a role in developing overarching health and wellbeing strategies for the local authority areas. Again, I think what we need to be doing is identifying areas where there really is that interest and engagement to join things up and to have a brave vision so that they can almost be seen as pilot areas to develop new ways of thinking and articulating how we could move forward.

Part of your work is around policy. What would health policy designed to support this and to meet the aims of Transition and responding to the crisis set out in the earlier question look like?

I’d come back to some of the words I’ve already used. In some of the conversations I’ve been having recently with people who are working in some of those policy organisations, they are talking about that need for joined up narrative and I think narrative’s a very trendy word that’s replaced strategy in a lot of cases by this government.

What we tend to see is still this fragmentation, so we will have discussions about fuel poverty, we’ll have discussions about transport planning and about the obesity epidemic. Elsewhere we might have something about the need for preparedness for climate change in terms of the risks related to flooding etc, which are perhaps the most obvious public health risks that have confronted people in this country.

But actually what we don’t have very often is an articulation of how it all comes together and why there are things you can really be focusing on that are going to be hitting a number of different priority policy buttons. In the health field we’ve seen an emphasis on techniques like health impact assessment and certainly at an EU level and certain states such as South Australia where they’ve done some real trailblazing work around this idea of putting health into all policy areas so that we move out of this mindset where health is seen as the delivery of health services.

Actually if we can do that so we’re not just talking about health, but talking about this tripartite thing of health, wellbeing, environment, sustainability, resilience and equity, then I think we can do an integrated approach to policy that could have really far-reaching effects.

For people who are in Transition groups on the ground, how can they best engage with this shift in agenda in the public health field?

I think already some of them are in that I think some of the very tangible work that’s being spearheaded by Transition groups or in partnership with Transition groups are things like in Lancaster, the sustainable food cities work that’s coming out across Lancashire, looking at different sizes and pockets of the population.

To take Lancaster again because I know it better than some, they’re hosting a conference looking at fuel poverty and looking at a joined up approach. So already some of that work is happening. Perhaps some of the reservations that some people in public health would have if I was to talk to them about Transition would be firstly around the extent to which it’s successfully embraced a commitment to equity, social justice and diversity, and I think that’s something which has had more and more discussion in the last few years in a really positive way.

I think the second thing is around the way in which health tends to be articulated. I think there tends to be quite a strong emphasis on what I suppose for some people would be called spiritual wellbeing, so the inner transition focus. Whilst I think it’s important to engage with that, I think the perception of that from outside can be seen as offputting and can seem to be focusing so much on the micro inner that it fails to be dealing with the population and real determinants-level stuff that impacts on the health and wellbeing of people at large.

Just following up on that I think it’s quite interesting because if you look at an organisation like Public Health England which was set up after the health reforms last year, it’s got quite a strong programme within its health and wellbeing directorate, healthy people, healthy places. Part of my vision would be to add in a third ‘p’ there, so it’s healthy people, healthy places, healthy planet. The healthy planet bit tends to be dealt with by another section, and I think that’s probably symptomatic of where we’re at with how health is linked and joined up.

There’s quite a lot that Transition groups can engage with but I also think there’s quite a lot we can learn from in terms of the cutting edge work that might not be called health but is dealing with fundamental health issues.

You write and think about this a lot and are involved with it on the ground and making things happen. If everything were to fall into place beautifully over the next 10 years or so, what would public health look like in 10 years for you?

What it would look like is that actually we’d have something that was a lot more seamless, that we’d have health being seen as a core value and function within delivery organisations. We’d have that being seen as intricately related to and interconnected with other agendas rather than separate from them. I think we’d have a really balanced focus on acknowledging that there are very real needs and problems out there but there are also huge assets, capabilities and potentials so we’re moving away from that kind of negative needs-based culture to something which is actually celebrating and harnessing the assets and potentials of communities.

I think we’d also have something where there’s a real balance and mutual learning where we acknowledge the importance of government and other policy and delivery instruments but also bringing that together with the grassroots creativity, innovation and energy that I think characterises the Transition movement. At the moment I think there’s some way to go before that’s fully connected. 

Here is the full audio of my conversation with Mark:

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2 Jun 2014

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 month’s 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 bottom line and think “if we don’t get the patients through our hospital we ain’t gonna get paid and we’ll have to think very carefully about downsizing, closing wards or even closing the hospital”.

That is seen as a sign of failure sadly, not as a sign of success. Very rarely would you get a Secretary of State for Health standing up in the House of Commons and saying “I’m proud to announce we’ve done fewer operations this year because we have needed to do fewer, because we have prevented this whole range of preventable illnesses”. Normally politicians will congratulate themselves on the NHS undertaking more activity, which is not necessarily the vision we want.

You wrote “the system needs to help build resilience into people, families and communities, particularly in the light of increasingly frequent weather. This depends on supporting effective networks within communities locally and globally that enable the health system to provide support and services with people rather than just to people.” If people are reading this are part of an active community with lots of project going on, what’s the best way to reach out and try to interact and build those kinds of relationships with local health providers?

It’s important to remember that most healthcare is not delivered in hospitals, just in the same way as most health is won or lost outside the healthcare system altogether. Primary healthcare, that’s healthcare that’s delivered outside hospitals, in GP surgeries and elsewhere in the community: pharmacies or community psychiatric nurses or district nurses is absolutely the root of where a Transition healthcare system would be based.

The practical answer to your question is if one as a citizen feels very strongly about a much better model of health and healthcare, then logically the first people to engage are one’s GPs, one’s primary healthcare centre. There are an enormous number of GPs – in fact the Royal College of General Practitioners is one of the royal colleges that’s actually devoted a lot of time to thinking what would a sustainable health system look like. They know very well that much of it would be outside hospitals. In fact much of it would be outside primary healthcare.

Some GPs have over 50% of their calls done by telephone. Some hardly use it at all. And sadly, variation is something the NHS does very well. We shouldn’t do variation. If we know what the best way in which we can take care much more directly and much earlier to people, then we should be doing it more universally.

In communities which are very fragmented, where people don’t know their neighbours, where people don’t have these formal and informal networks of support, when things go wrong and sometimes quite trivially wrong, where traditionally they would have leant over the garden fence or spoken at the coffee morning or gone to speak to their vicar or other faith leader, they would now go immediately to their GP. That’s completely inappropriate. It’s disempowering, it’s not local, it doesn’t breed a mutual trust and reciprocity which we know healthy and resilient communities are based upon.

You wrote in something else that I read that “The default location of healthcare should be at home.” But the trend in the health service has been very much towards centralising into bigger and bigger regional hospitals and so on. Is there a case, do you think, are you arguing for localisation of healthcare in that way?

There are probably some things which we should centralise. If we have a superb hospital that does hip replacements superbly well, you want to travel to that hospital because you’re probably only going to have it done once or a maximum of twice in your life. So you should be prepared to travel to the very best place to do it. What we tend to have is a sort of sad compromise where most hospitals address most conditions.

But we know well that if there’s a specific condition, especially a specialised condition like, let’s say, heart surgery in young children, you actually really want to go to the very best places. We probably only need a few of those in a country the size of England. You do not want every hospital dabbling with children’s heart surgery.

You would want to concentrate some services which are highly specialised. But on the other hand, other services like blood pressure management, diabetes, rheumatology, many other things should be taken much closer to home. Certainly the preventable issues should, and certainly the public health issues around smoking, physical activity, excessive drinking, those sorts of services. We shouldn’t even medicalise those. They’re not medical issues – these are social issues, they’re political issues, they’re economic issues.

The short answer to your absolutely appropriate challenge is some things highly specialised we should concentrate and you should travel further to them. Most things you should travel less far and should be done default in the house or primary care. Primary care should be done in the house, secondary care should be done at your general practice. Specialist care should be done at the most appropriate hospital. We shouldn’t have every hospital doing every thing. It’s not safe, it’s not cost effective, it’s not sustainable and it doesn’t have good long term outcomes.

You have written that “doctors over-medicate almost all human conditions.” In terms of one of the key ways in which the NHS can reduce its carbon footprint is reducing medication a key part of that, do you think?

Yes, although I’m not sure it’s reducing medication. It’s realising and understanding that there’s not a pill for every ill and that pharmaceuticals are not the only intervention that can be effective. Like most powerful things, pharmaceuticals in the right place can be very effective and I suspect that I probably wouldn’t be alive if it wasn’t for pharmaceuticals.

So first of all, it’s just that there are many other very effective interventions like talking therapies, psychological therapies, cognitive behavioural therapy, many other non-pharmaceutical therapies which are equally effective and sometimes more. Don’t forget physical activity. Brisk walking a few times a week is a very effective way of keeping well physically and mentally.

Secondly, it’s not that pharmaceuticals in themselves are bad, but we waste them by the ton-load. Again, coming back to your earlier question about agency, there are very few incentives in the system to have a very much more judicious use of pharmaceuticals. We prescribe pharmaceuticals like there’s no tomorrow and if we do that there will be no tomorrow because of the resource use, because of the post-use environmental effects, because of the huge financial cost.

One of the big challenges in terms of a transition to a more sustainable system is that – and pharmaceutical companies know this – sadly, many of the ways we’ve evolved the health system tend to monetise illness, i.e. the system makes money out of people being ill. Very rarely do people make money out of people being healthy. It’s a much more difficult concept to monetise health. You can do it, you can reward systems for improving health, but it’s very rare.

How about paying pharmaceutical companies not to produce drugs to treat diabetes but paying them on the basis of preventing diabetes. How about that – how good would that look like? That would be a much more circular economy within the healthcare system.

I wondered if you had any last thoughts for people who are involved in Transition who are thinking along these lines, or any thoughts for practical next steps that might be taken in terms of trying to bring these two strands close together and more overlapped? If we really wanted to make the case in quite a high profile way and say – a community energy company is good for public health, what’s the best way to make that case really persuasive?

I wish I knew. It’s a 64,000 dollar question. My guess is that we need to think and talk and conceptualise health in a different way than we’ve normally done.  Not just living without mental illness or physical illness but living truly fulfilling, meaningful, connected lives, depend on roughly four things if you put things like your genes aside:

• Do you have a house, do you have somewhere to live?
• Do you have a job, are you in education or do you have a fulfilling role in your community?
• Are you connected socially, do you have friends, do you have a community you’re part of?
• Do you have access to services which are the icing on the cake for health which deliver things which none of the first three can do?

That’s about social care, it’s about healthcare, it’s about welfare. It includes culture and libraries and all those other things that make life worth living. If you take that as your concept of public health or community health or holistic health or health in the broader sense, then it’s absolutely clear that public health is by far the best investment we could make in local, meaningful, resilient, sustainable communities where it is just a much better place to live.

Part of the challenge is that we’re so addicted to what we currently know, that we don’t have the vision to see that it could be much better. It could be so much better for the present and for the future.  Sometimes we do lack vision and we do lack courage.  Things do not have to be this way and to live sustainable lives we don’t have to resort to living in caves.

There can be very much better ways in which to live which have the great added advantage of being future proof. That linking of all those issues directly with health and maybe bypassing the environment word, may actually be one way in which public health practitioners, public health professionals, people who are public health minded might be able to make that connection and make that frame to engage politicians, to engage policy makers, to engage the public and certainly would engage professionals. 

This article is abridged from the complete interview.  You can hear our full conversation below:

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