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Citizens Transforming Mental Health

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Dr. Kwame McKenzie, Senior Scientist in Social Equity and Health Research at CAMH, blogs about one idea he believes could improve health and reduce health inequalities.

I am always up for a challenge but this was a particularly tough one. I was asked by the British Academy, the United Kingdom’s national academy for the humanities and social sciences, to propose new ideas to improve health and equity in England to be published in a report. The collection of opinion pieces on health inequalities by leading social scientists would suggest concrete approaches to policymakers.

Giving an opinion on the most important policy priority for improving mental health and decreasing disparities is challenging. While income equality, early years learning and access to green space are all important health issues, I believe that mental health is public health’s superglue. It is difficult to think of any health issue that does not rely on good mental health or any initiative that would not be derailed by poor mental health.

My idea is to transform mental health and well-being by changing the way public health officials work. The idea is that we can increase social capital and community efficacy – both of which have both been shown to improve mental health and equity – if public health gives some power to communities to choose priorities and develop new approaches to improving health. I suggested a form of participatory budgeting to decide on health priorities and to choose interventions.

This approach involves communities making decisions about how to spend public money. Citizens identify, discuss and prioritize public spending and have the power to decide how health care dollars are spent. Typically, community members identify priorities and people from within their ranks to help them work up those ideas. Then they sit with experts and local authority planners to produce actual proposals. Lastly, community members vote on which proposals to fund and the municipality implements them.

Participatory budgeting has been used all over the world and has been shown to be an effective way of making public decisions but it has rarely been used in health. When applying this approach to government, better decisions were made because the process was more inclusive. So we need to listen to what communities care about – whether it’s children’s health, cancer, stress or immunization – and give them a chance to influence their own health care.

What cannot be ignored is that 85 per cent of the gains we will see in health in the next 20 years will depend on behavioural change. That’s exactly the reason we need to involve people in thinking about their own health. Not only can they be part of decision-making, they should be involved. If you want people to be partners in their own health, you need to work with them to set up a partnership.

You only have to look at open source programming and crowd-sourcing to recognize that co-production is the way of the future. People expect to think collaboratively and be a part of something to move it forward. I argue a commitment to shared decision-making could be truly transformative for the public’s health. Rather than public health officials deciding what is best, ideas for improvement could in part come from the public, and professionals would help implement them. This could increase social capital, the effectiveness of communities and get the population to be true partners in their health because they would have a sense of control. What do you think?

Click here for the report, “If you could do one thing… Nine local actions to reduce health inequalities.”

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