Our medical scepticism project revealed that many individuals in deprived communities have serious reservations about established mainstream healthcare services and professionals. This has raised the issue of how communities can play more of an active role in their own healthcare, whether via becoming more responsible for their health and wellbeing, patient-led initiatives, co-designed treatment plans with their doctors, better support structures for specific conditions or, harnessing innovation developed within the very communities which experience poor health outcomes.
What Centric has recently found, in research on health activism in Brixton, a project conducted alongside Dr Agnes Forster-Arnold from the London School of Tropical Medicine and Dr. Caitjin Gainty from Kings College London (Scepticism, Activism and Healthy Communities: A Centric-HS Pilot Project — Healthy Scepticism), is that many of these health activists at the granular level within locales, such as Brixton, are fulfilling an important role and filling a clear gap. Health activists, and those who are involved in the alternative medi-scape, have traction. This is as the power dynamic is more democratic, with more ownership for the patient/client and more input in their own health and choices.
Interestingly, the importance of choice in health and wellbeing has been present in such communities for decades, with its roots in the countries of origin of these individuals.
Pemunta et al. discuss how monetary transactions which form a key part of health interventions are not to be regarded merely as payments for medical services but, they also represent a key aspect of communication between client and health activist. While Hardiman and Mukharji (2012: 29-30) note that the therapeutic markets in which subaltern therapies operate are distinct subordinated markets. Hence, the act of 'negotiating as a customer', particularly in subaltern counterpublic spheres, is a form of 'empowerment'.
Within mainstream healthcare, as has been the case for older users from BME (Black and Minority Ethnic) communities, there has been a power gap as users have not felt that they have the requisite ownership, empowerment or agency over their health. They merely listen quietly to the dictates of people in white overalls or suits telling them what is best for them and their health. This approach to health is now being interrogated within the urban landscape.
Health activists and those innovating localised health and wellbeing interventions at the hard-end of community interaction have the opportunity to provide important guidance on health, wellbeing and nutrition to those who have traditionally opted out of mainstream health. There is a disruptive nuance in the locale with the failings of the NHS leading to a shift in terms of people looking at new ideas. It is vital that institutions tap into this curb-side nuance towards designing fresh approaches and informing the design of healthcare systems.
The Cen Labs Innovation Platform envisages an arena where ideas from the locale can stick and are used positively by the community. Rather than ideas being extracted without any benefit for the community, which has led to cynicism and distrust. There must be a platform where communities are empowered to come up with their own ideas on health. There must be equity on both sides, the power dynamic must shift, otherwise communities go further underground and offstage to corners where distrust grows further.
It is important to not view community as a homogenous bloc as there is a broad spectrum of perspectives within the urban locale. Cen Labs will be focused on the hard-end of the community where black women are not finding adequate support from health services.
To be truly impactful, the service-user must be involved from the outset which brings a continuum of involvement. This has been identified across our work on Med Scep with Impact on Urban Health, and also with Drs Caitjin and Agnes, and also in our work on chronic pain with Lambeth Health and Wellbeing Delivery Alliance.
The South London urban landscape has always had a creative flare, as counter-cultural movements have historically had to find their own way and carve out their own initiatives so, this was not new to the urban locale. Social injustices ranging from police brutality in the 1970s and 1990s, political marginalisation, educational barriers and health disparities means communities have historically innovated and formulated their own institutions and structures. Hence the development of the Saturday schools in the 1980s and other counterpublic spheres.
Associated with this are the market relations formed between vendors and customers within the urban locale when it comes to health-related products. Goldner (2004: 20) also refers to this by emphasising how consumers are central to alternative medicine, especially when market-based healthcare becomes more pervasive and entrepreneurs are allowed to market products directly to customers who have a range of options to test and experiment. Linked to this are the dynamics involved between seller (health activist) and customer, such as imparting advice, trust and knowledge sharing. This indicates a social character to market transactions where relationships of trust, confidence and interaction are established.
Interestingly, government now are now realising the importance of such informal support structures and systems, yet this is not new. It's now part of government policy and rhetoric. Goldner (2004: 15) suggested that the relationship between a patient and community complementary health practitioner is different. Primarily because the practitioner expects consumers to take individual responsibility for their own health and become empowered as a result. In this way, consumers become ‘health activists’ and integral proponents of complementary modalities.
Cen Labs will soon be developed to this end and we have projects in the pipeline on supporting people on waiting lists, app development, upskilling local health and wellbeing practitioners and also increasing knowledge and awareness of counterpublic health spheres within the urban space among healthcare professionals.
This has also forced Centric to begin thinking about innovation platforms to ensure the community ingenuity is harnessed and developed, helping people to understand their lived experience is not a deficit but in fact part of the equity. Ideas in the community must be taken seriously, and be listened to actively, they cannot be merely ignored and pushed under the carpet if we are to avoid the mistakes of the past.__________________
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