Oxfordshire Health Humanities Project
Community Health Development Officers (CHDO) and Well Together (WT) are two novel public health programmes aiming to reduce health inequalities in the ten Oxfordshire wards identified as priority wards: Abingdon Caldecott, Banbury Cross and Neithrop, Banbury Grimsbury and Hightown, Banbury Ruscote, Barton & Sandhills, Blackbird Leys, Littlemore, Northfield Brook, Osney & St Thomas, and Rose Hill & Iffley. While wards contain a variety of communities and a range of living conditions, statistics of categories such as ‘Barriers to Housing and Services’ and ‘Income Deprivation’ rank these as the ‘ten most deprived wards’ in Oxfordshire, as well as among the 20% most deprived in England. Such statistical ranking, however, does not fully capture the nature of these wards or the issues at stake in developing and sustaining healthy communities.
The interdisciplinary Oxfordshire Health Humanities project uses empirical research to analyse the ways in which these programmes have been implemented, and how the programmes engage with community capacity for health and wellbeing. It highlights the role of social relationships in developing and maintaining healthy communities. While recognizing the key role that medical and public health structures play in health and wellbeing, the project focuses on the ways that communities access and engage with such structures: through social relationships that require trust and familiarity, and – crucially – through social relationships that encourage aspirations and expectations of improved health and wellbeing.
Statistical averages are insightful, but necessarily have limitations. Oxfordshire, for example, has health outcomes that are better than the national average: with male life expectancy of just over 80 years (compared with 79 nationally) and female life expectancy of 84 years (compared with 83 nationally). These figures show Oxfordshire to be a healthy county. Yet, as detailed analysis of Oxfordshire wards demonstrates, the overall county average conceals significant disparities between its communities. The gap in life expectancy between some Oxfordshire wards is as wide as fifteen years. If one categorizes the statistical average of how long people live by ward, instead of by county, this instead demonstrates that some areas of Oxfordshire are significantly below the national average. Contrary to county-level data, ward-level data highlights regions where communities struggle with children living in poverty, substantial unemployment, social isolation, and an inability to live long and healthy lives. Statistics such as those applied to Oxfordshire as a whole can hide substantial health problems by flattening out regions into a homogenous, quantitative average. Yet these figures can also be used to identify problems, such as the differences in health outcomes between wards, thereby highlighting significant health inequalities. Numerical data – whether statistical averages or population overviews – can be interpreted in a variety of ways. They are thus most accurate, and useful, when accompanied by detailed contextual analysis.
Likewise, characterising a ward as among the ‘most deprived in England’ does not capture the variety of its neighbourhoods and community resources – but it can help identify problems and suggest areas of focus. If wards are analysed only with statistical averages, their individual characteristics and strengths are lost. Similarly, portraying medical care and health through counts of institutions and financial assets alone obscures the key issues of how and why people access health care, choose healthy behaviours, and maintain healthy communities.
Health is not simply a biological and scientific feature, but also deeply social and cultural. Cancer screening programmes, for example, are useful only when people choose to access these services. Such choices require awareness of their provision, trust in health providers, and the desire to detect and prevent potential illness. All these depend on social sensibilities and cultural behaviours. Individuals consult friends and family and absorb social norms regarding who and what to trust, before deciding whether or when to access health services. Indeed, research demonstrates that simply disseminating more information is unlikely to produce greater engagement with public health programmes: rather than assuming a ‘knowledge deficit’ model, the way information is shared as well as who shares it is crucial to health communication. Medical technologies and public health services – whether disease screening, hospital care, or vaccination – are part of broader social networks and cultural practices, and often only a modest part of what supports and maintains health. In a famous analogy, health and medical care has been described as an iceberg: ‘only a very small part floats above the surface of public life. The visible part rests on a far larger but normally submerged basis.’ (C. Webster, Caring for Health: History and Diversity).
This interdisciplinary project provides a unique opportunity to apply humanities methodologies – including long-term contextualization, social and cultural analyses, and a review of methodologies to measure health – to current health concerns. It is also a unique partnership between the University of Oxford and Oxfordshire County Council Public Health, encouraging analysis of where community health and global health are located, as well as where they overlap.
Community Public Health Workshop Mapping Exercise
