Realities in Health Disparities: Researching Evidence-Based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems

We often hear 'the system' is broken, but what do we mean by this? How can changing the way we think about, define, research, evidence, monitor, evaluate and resource 'the system' lead to meaningful change for deprived communities? How will this change benefit those who have first-hand experience of trauma, homelessness, poverty, unemployment, displacement, poor mental health or imprisonment?

REALITIES takes a human-systems approach noting 'health and social care systems' (HSCS) are constructed mental representations of relationships existing in the world to promote health for people.

Our Scottish consortium of 57 people has five established asset hubs in Clackmannanshire, Dundee, Easter Ross, Edinburgh and North Lanarkshire with strong relationships uniting conflicting ways of seeing the world. Through phase 2, we co-produced a systems-level model with deprived communities, policymakers, practitioners and researchers collecting and respecting different types of knowledge and alternative evidence-bases (from arts performances to nature walks; words to statistics) as equally important to understand complexities of unjust and avoidable health differences.

Foundational funding evidenced REALITIES is able to transcend the challenge for our currently imagined HSCS. The medical model of disease shaping who and what is considered to be part of 'the health system' has brought benefits to human existence, though key actors within these place-based HSCS systems understand the limitations of this systems-framing for human flourishing. At present, they don't have a way to help reimagine them.

REALITIES provides exploration and method for this reimagining. A model representing collective pathways producing creative routes for people to get the healthcare they need at the right time of their journeys by co-researching and co-creating with them the "what, whom, how, and why" - leading to successful connections between individuals with health and social needs and community-based opportunities for health and wellbeing improvement.

We are a transdisciplinary collective of individuals with lived and felt experience of inequalities working alongside policymakers; local authorities; charities; artists; environmentalists and researchers from policy; health humanities; arts; psychology; human geography; environmental sociology; dentistry; medicine; statistics; economics; counselling; psychotherapy; management; medical anthropology; design and innovation.

We will:

understand what work is needed to enable places to reimagine and build 'systems' that create equitable health and wellbeing.
explore and explain how links between creativity, relationships and nature create healthier and more resilient communities and environments for people in deprived areas.
support creative, participatory processes, enabling communities to construct shared mental models (systems) using different ways of knowing (epistemologies) and perceiving reality (ontologies).
combine different ways of knowing, enabling a more complete representation of bio-psycho-social-political factors which create 'health' and ways in which these are experienced by marginalised people.
support communities to construct place-based versions of systems encompassing all aspects of health and wellbeing, and make purposeful changes in the nature of their relationships with each other and their environment.
explore the usefulness of 'standard' Health Economic evaluation tools to assess Social Return of Investment, working with communities to re-conceptualise and re-define measures of 'value' and 'quality of life' in relation to human experience.