How do you create health? Simple question

I was told a story recently about a schoolchild from a troubled background. Getting to school was an achievement. This day, classes required special pencils. The child had none. He couldn’t do the classes. The social worker and health visitor got involved. They ask if the child can stay at school, it being better than home. These decisions cost. The simple answer was to give the child a pencil to do what he wanted to do.

I wondered what this child would draw. In a Jackson Pollock painting, each splash on the wall is a mark of anger organised. The thing about drawing is that every mark matters. They are a product of your decision-making. You are the only person that can decide what to show, how deep, and how little. The beauty of owning these decisions is that you shape the space to do what you feel you want to do. The child could have drawn beautiful marks that make you weep.

Two documents were recently published on health in Scotland. The first is the annual report of the chief medical officer. The second is the publication of a mixed economy research entitled Good Places Better Health. In the annual report, Dr. Harry Burns suggests that often the definition of health is based on a deficits model: fixing problems.  Burns argues that this is not enough. He suggests that ‘a relevant environmental health agenda for the 21st century is as much about the creation of places which engender good physical and mental health, as it is about protection from hazards’. To really fix the problem, start thinking about the conditions necessary for that problem not to exist. Think ‘create health’.

In the Biology of Poverty, Harry Burns sets out a framework for understanding the various influences on a person’s health. These include the influences of the external environment, our perceptions of the world, our internal environments and behaviours. This comes together in an individual through senses of control: control of decisions about how to engage with the various influences on our lives. In this context, the environments we create, and the permissions we create matter. Better places are about taking on an assets approach.

‘Good Places Better Health’ focuses on the conditions necessary to create better health for children. It examines interrelated factors influencing four health outcomes: accidental injury, mental health and wellbeing, asthma and obesity. As a collection of ideas, it establishes an interesting brief for any placemaking activity: can this activity, whatever it is, help build better capacity to deal with or avoid accidental injury, improve mental health and wellbeing, reduce asthma and obesity? Can it build better agency in the individual to make their marks their way? If the answer is no, why do it?

In Scotland, as in most places, there is great concern about rising public sector service demand, public debt and volatile economics. In this, the assets model view is not a cuts story. It is a capacity story. Its purpose and outcome is greater individual and collective capacity to do things. The yield is sustainable human capital.

Simple question: How do you create health?