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Lord Nigel Crisp and the “Creators of Health”

As we continue to highlight the 2021 inVIVO Planetary Health conference, we are thrilled to share this 8-minute presentation from Lord Nigel Crisp, independent crossbench member of the House of Lords, co-chair of Nursing Now, and Chief Executive of the NHS in England from 2000-2006.  

In “Human-flourishing in a health-creating society,” Lord Crisp shares a quote that inspired him (and led him to publish a similarly titled book) by professor Francis Omaswa, former clinical director of the Ugandan health system: “Health is made at home, hospitals are for repairs.”   

If we think about the notion of creating health, he wonders — who are the “health creators”? What makes them successful, and how can they help us think about health in the future? 

“Health creators” are not the government, or health systems, but can be parents, teachers, employers — people who create the conditions that enable others to be healthy and to flourish.  

In looking at some examples of projects that successfully increased well-being in communities and individuals, what these health creators had in common included: they started with relationships; they set out with a vision but not a preconceived plan (they were purpose-driven, not plan-driven); and they let the people “being helped” be in control.  

Lord Crisp advises us that we all need to work better together to help individuals, communities, and our planet flourish — this means bringing the health creators together with those we think of as traditional “health providers,” such as the government and health care systems.  

We hope you will enjoy this terrific talk as well as a recent Prospect piece, What Aristotle can teach us about building a better society, that builds on Lord Crisp’s inspiring perspective and how “our health as individuals is intimately connected to the health of our communities, the health of wider society and, ultimately, the health of the planet.” 

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Learn more about Lord Nigel Crisp’s newly updated and extensively re-written book, Turning the World Upside Down Again, which argues that Western medicine must adapt and evolve to cope with the demands of the 21st century—including drawing upon the insights and experiences of lower income countries and disempowered communities.

Read our previous blog post featuring highlights from inVIVO Planetary Health’s 10th annual conference. With a theme of “From Healing to Flourishing,” the conference treated participants to more than 160 inspiring talks from scholars, artists, activists, scientists, researchers, health professionals, children, and more (see the program and bios here). 

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. 

When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) 

“When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” 

Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is some debate about whether people always experience suffering on the path to healing.

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. 

“The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.