At the moment, it is understandably difficult to look beyond COVID. The boasting and blame games around vaccine roll outs continue, alongside the debate over who is, and isn’t, a priority for receiving the vaccine. Many places are increasing restrictions, while others are moving towards the “new normal” – whatever that actually means. I have also just seen the latest media round of “who has done worst” internationally in terms of COVID deaths. A league table no one wants to top - which perhaps explains why many in the UK appear so happy that we have dropped to sixth place within Europe. To dampen the mood, however, there is evidence emerging that London has seen a significant drop in life expectancy. While COVID has clearly played a major part in this, the fact is that positive trends in life expectancy were already stalling or slipping back. COVID has provided a bleak lens bringing existing failures of policy and practice into sharper focus.
On the positive side, I think the challenges of COVID and responses to the pandemic have demonstrated a number of important truths. Firstly: when the right factors are in place, countries and organisations can achieve great things that were previously considered beyond the reach of possibility. Around the world, those who work in health services have achieved miracles. Many national and local governments have mobilised resources of a scale not seen outside of military conflict. Voluntary sector groups and NGOs have, where enabled, shown that many of those considered hard to reach or engage with were nothing of the kind – so long as the barriers placed in their way were removed. Communities and the public, where empowered, have provided a huge boost in terms of supporting measures to suppress COVID and mitigate the social impacts of lockdown.
This leads to the second important truth. Complex problems need a range of responses from multiple partners. Partnership work is not something nice, or an optional extra if resources allow - it is central to delivering responses that are appropriate, effective, and sustainable.
This lesson was one that many of us thought had been learnt in the UK in terms of responses to drug problems. While there was never a golden age where every problem was dealt with perfectly, from 1995 until sometime around 2010 there was a policy framework and widespread understanding that neither national government, the police, local authorities, schools, or treatment services were going to have a major impact on their own. However, working together - and with significant financial investment - the UK made significant strides in improving access to treatment and, compared to what we have seen since, limiting the scale of drug related deaths and morbidity. But as the drugs field absorbed more money and became more established, it developed its own silo and ceased to work so well with key partners. Communities became less engaged, their voice increasingly muted. We achieved lots of targets, but increasingly missed the point.
Once this became coupled with disinvestment, we saw death and illness surge. Now, with new investment being made into drug treatment (and I am delighted the money is being made available) I hope there is a move to engage with partners, drug users, and communities about their goals and what they can contribute to reducing deaths, illnesses, and social harm. We need to rebuild and repair many of the networks that have withered.
The importance of broader-based approaches has been brought home to me by a book I have just reread. On the Other Side of Sorrow by historian James Hunter is about the Highlands of Scotland and looks at this region’s natural environment, culture, and communities. For centuries, this area has been “developed and improved” by experts from outside. Much has been done in the name of progress and modernisation. The reality is that neither the environment nor the people who live there have benefited - indeed the reverse is true: each externally imposed change has damaged nature and the local communities. Until recently, those who actually lived there were given little say and were often seen as being in the way of progress. More recent approaches seek to involve local people, recognising that they are a key part of the ecosystem. The indications are promising. As we look to tackle the major health issues in our communities, we would benefit from ensuring we understand the needs and ambitions of those who live within them. Not only are they an asset, but by listening, understanding, and enlisting their help we can avoid causing unintended harm and achieve sustainable benefits. Working with others from outside our own professional bubbles helps us see a vision beyond our own noses.