Sustainable Healthcare – can the community help provide solutions? College of Medicine Student Summer School 4 th September 2015 Norwich Research Park, Norwich, Norfolk Dr Michael Dixon Chair of Council College of Medicine

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“The greatest single advance in medicine will not be some new drug or procedure but an increased ability of patients to care for themselves” Ivan Illich “Medical Nemesis” 3

“It will always be a struggle if we continue with an overemphasis on mechanistic and technological approaches”. HRH The Prince of Wales “Integrated health and post modern medicine” Journal of the Royal Society of Medicine 2012

“The integrated approach takes what we know about appropriate, conventional, lifestyle and complementary approaches and applies them to patients”. HRH The Prince of Wales “Integrated health and post modern medicine” Journal of the Royal Society of Medicine 2012

“The future needs to be a future that empowers patients to take much more control over their own care and treatment”. NHS Five Year Forward View

“The future health of millions of children, the sustainability of the NHS, the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health”. NHS Five Year Forward View

“Evidence shows that when patients are involved in decisions abut their health and care the decisions are better, health outcomes improve, and resources are allocated more efficiently”. King’s Fund Report November 2014 “The State of Involvement”

“Our present society wastes and, by the slow draining process of enforced hypocrisy, empties most of the lives that it does not destroy. A doctor who has surpassed the stage of selling cures is unassessable”. “A Fortunate Man” John Berger and Jean Mohr 9

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Preliminary results on the use of a “Facilitated Social Prescription” to improve the health outcomes for those with Type 2 Diabetes and those at risk of Diabetes April

* * * Average (+/-SE) HbA1c levels over time * Significant reduction relative to baseline (p≤0.05), m data not complete. 30

* * Weight change over time (average +/-SE) * Significant reduction relative to baseline (p≤0.05), m data not complete. 31

* * Waist circumference over time (average +/-SE) * Significant reduction relative to baseline (p≤0.05), m data not complete. 32

* * * Average (+/-SE) Quality of Life Score (EQ5D ) * Significant increase relative to baseline (p≤0.05), m data not complete. 33

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The Green Dreams Project CIC Dr James Fleming MBChB MSc FRCGP uk Supported by:

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“We need to engage the communities and citizens in new ways building on the energy and compassion that exists in communities across England through better support for carers; creating new options for health related volunteering and designing easier ways for voluntary organisations to work alongside the health service”. NHS Five Year Forward View

“ We know that alienated and uncaring communities adversely affect the health and wellbeing of those living in them. Conversely, current evidence suggests that if you try to tackle some of those admittedly deep seated problems, not only do you begin to witness improvements in health and other inequalities, but this can lead to improvements in the overall cost efficiency and effectiveness of local services ”. HRH The Prince of Wales “Integrated health and post modern medicine” Journal of the Royal Society of Medicine 2012

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ASSET-BASED COMMUNITY DEVELOPMENT Harnessing social networks – Statutory services become more responsive Promotes health protection and community resilience Helps tackle health inequalities Has an impact on behaviour change Saves money 45

SOCIAL NETWORKS REDUCE MORTALITY RISK 50 % increased likelihood of survival for people with stronger social relationships. Comparable with risks such as smoking, alcohol, BMI and physical activity. Consistent across age, sex, cause of death meta-analysis of data [1] across 308,849 individuals, followed for an average of 7.5 years 1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley Layton.Plos Medicine July 2010, Vol 7, Issue 7. doi: /journal.pmed [1] 1] 46

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Well North, a Public Health England initiative to improve the health of the underprivileged across the North of England. 49

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Green Gym 53

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“For all the major health risks – including tobacco, alcohol, junk food and excess sugar – we will actively support comprehensive, hard hitting and broad based national action to include clear information on labelling, targeted personal support and wider changes to distribution, marketing, pricing and product formulation”. NHS Five Year Forward View

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