Inequality in health outcomes has been described as a ‘wicked problem’.
This is not said because of the social justice issues involved, but because of the fact that health inequality is created and maintained by a multiplicity of interacting factors. This complexity means that there are no simple levers at a national or local level that can be pulled or pushed to resolve ‘wicked problems’.
For example, many people think of health inequality as created by poverty – true, but it is more complicated than that.
Some people think that its a matter of individual responsibility – if people did all the right things to look after themselves we would not have the level of inequality that we have – true, but is more complicated than that.
Some people think its an issue about access to the right services, or levels of education – true, but is more complicated than that.
All of the above, and others, are important and interacting factors in the creation and maintenance of poor health. All this means that work on one factor or aspect of health inequality alone, whilst potentially beneficial in its own right, will not have the outcome of reducing inequality.
Public services are organised for the delivery of services to individuals and communities and can struggle to formulate an adequate response to ‘wicked problems’ like health inequality. It requires a long term focused effort from a range of different agencies and the active involvement of those whose health is targeted. Equally Well was conceived as non-traditional response to the ‘wicked’ problem of inequality – but there are others that we can also learn from. One such is the ‘Total place’ programme in England which has attempted to approach some of the ‘wicked problems faced by public services with a different mindset.
One of the central ideas of Total Place is that the long-standing machine metaphor of organisation and social systems is handicapping our ability to understand the environment we work in and how to change the behaviours of those systems.
I recently took part in a fascinating discussion as part of the Midlothian operational steering group for Equally Well , which centred on how the approach Equally Well was adopting to engendering change was different to more familiar approaches. I will write about this in another post but I revisited the Total Place document with that discussion in mind and the quote above resonated for me.
Although it is a fairly long document the following report is well worth reading for those interested in ‘doing things diffeently’ as it summarises and reviews the ‘Total Place’ experience and process.