The NHS has an ongoing interest in the concept of health as a social movement and has commissioned and co-delivered work from NESTA and the RSA amongst others to explore this. One of the most sophisticated exploration of this was the NHS Citizen programme a few years ago which in the interests of full disclosure I was one of the architects of – but helpfully it has recently been written up as a case study by some academic colleagues in a warts and all kind of way which you can read about here. NHS Citizen existed in the uneasy space between informal social movement and organisational engagement and to a great extent this is why it failed – it was not clear if it was genuinely empowering for citizens or if it was there to support and not challenge the current system. NHS Citizen lives on but more of a brand than a social movement.
This work did provide me with an opportunity to explore this space and I was struck by the fact that while the NHS will talk of itself as a social movement its an exclusive one which patients exist on the boundaries of it. Patient led healthcare and the coproduction of health is another example of a move away from paternalistic and directive systems of care into something which better respects the knowledge and agency of the individual in need but its very different from an approach which connects people together rather continues to treat them as recipients of a system.
The coproduction of health has similarities but also differences from the concept of co-production of public services (worth looking at this NEF/Nesta report that provides a useful overview and definition of coproduction). Coproduction of service is closer to the concept of social movements because while there is still a public service framing there is an understanding that in shifting to coproduction the power has shifted to active individuals that are now co-deliverers. This leaves some uneasy questions about democracy but can be seen as a huge positive for stretched health and care systems and this boundary is best seen in the growing adopting of social prescribing as a way of bridging between health and social movements. This piece from the Kings Fund is written very much from a health perspective but provide a good overview of social prescribing while this project from the RSA took a more community focused approach which I will pick up when we talk about social movements of place.
The other lens of social movements in the health space is that of online community. I think online community is a different ‘thing’ to a social movement but many of its characteristics are similar. Its over 25 years old now but Howard Rheingold’s book on virtual community still gives the best introduction to what real community can feel like online. Online community was one of the first things that dazzled me about the potential of the internet and Rhiengold’s book captures that optimism. I think online community is still incredibly powerful but it can be toxic and damaging as well. I’ve juts been reading ‘Kill all Normies’ (HT to @snezh for the recommendation) which in short order lays out what that toxicity can look like.
That being said its important to recognise the fact that in the health space people are often seeking community first and campaigning second. Our own Cancer Chat community is a brilliant example of this. I’ll pick up the question of online community in the section of community of place as there is a lot in common there.