What makes us healthy?


What makes us healthy? asks Jane Foot in her new research.  She challenges public services to work with disadvantaged communities, building on their strengths and assets rather than seeing them as a bundle of deficits to be treated.  Here she talks with film maker Isaac Densu, who lives on Broadwater Farm estate in Tottenham, about how this approach might work in practice.

Jane Foot: We have a Health Service, but it is essentially an illness service. What it does, it does really well, it helps when we’re ill.

But what I’m saying is we need to actively engage with creating health. So my book’s called What Makes Us Healthy? Not What Makes Us Ill, but What Makes us Healthy?  And that affects everybody.

In the book I describe ‘health assets’ –  the things in our world, and in our lives,  that make us healthy, that bring us wellbeing.  They’re our passions, networks, skills, they’re your friendships, they’re the associations and community groups that you rely on. It’s about participating, it’s about keeping on learning, it’s about being active.

These are all things that bring us health, and where we go for those is we create them ourselves. We create them with our neighbours, we create them with our families, with our community organisations.  We know that these are things that bring us health.  So, the health service is good, but we also need to start thinking about actively creating health. Because this is getting really significant, and the way we’re organising our world is not creating health, it’s bringing us illness.

Isaac Densu: So would you say that in disadvantaged areas, like Broadwater Farm where I’m from, that one of our problems is actually a lack of looking at our mental wellbeing? Because when I read the research I thought, “yes, this is the answer to all the pain that I’ve felt in this area over these last 26 years!” We don’t look at our mental wellbeing. Faced with poverty and faced with almost seclusion from mainstream society, you live in a depressed state, a very negative mind state.  And that affects the way I eat – most of my friends eat chicken and chips, which we know is bad for you physically!   So, would you say that’s one of the major problems of disadvantaged areas where I’m coming from, our state of mental health, or mental wellbeing?

JF: I think the problem with a disadvantaged area is lack of money, lack of power, lack of employment.  But there are other things as well that maybe we can do more about, which is our mental wellbeing. I would argue that if you have strong mental wellbeing, and you feel good about yourself, then you’re coping with the things that life brings. You’re much more likely to get angry and get organised about the things, the practical,  economic and social things that are making you poor and disadvantaged. I don’t think it’s either v or, but I do think mental wellbeing is a really important thing.  However, I don’t think we should assume that disadvantaged areas, for a better term, don’t have mental wellbeing. I mean, people cope.

One of the really interesting questions, that kicked off this whole area of research and study is some research about why it was that amongst all the people who suffer from similar socioeconomic problems, who’ve had similar terrible things happen to them in their lives, some people cope better than others. Some people are more resilient. Some people don’t get ill. So the question is, what is it that those people have that protects them against adversity? So a question for an area, somewhere like Broadwater Farm, is if we started asking about how people cope, what are the really good things in their lives that we could do more of? That we could sustain, that we could invest in, that we could support.  We could spend more time and money and thinking power to sustain the things that are bringing people mental wellbeing.  That would help people cope.

Now, it doesn’t solve inequality, but it helps people live with the situation and fight with the situation. So I think I would start with finding out how people cope, because people do cope on Broadwater Farm, people live their lives and they’re not all ill, and they’re not all having breakdowns. Some of them are happy people with happy families, and successful lives. You’re an example. What was it about your life that helped you cope, compared to some of your friends?

ID: I think that’s where I found synergy in your book. For me, it was dealing with with my mental wellbeing in a first instance. Because until I had myself in the right headspace I couldn’t do anything. I didn’t feel I could achieve anything.  I didn’t feel I could progress. I felt the world was against me.

And in doing that, I started thinking about my physical health, because now I’ve got a job, and I can’t feel tired at 12pm, that means I have to sleep earlier and eat better food. It has this rolling effect.

That’s why I’m so interested in the psychosocial. I think in areas like mine [Broadwater Farm] it’s so important to invest in psychosocial wellbeing.

I’d like to ask more about what you call ‘asset building’.  What do you really mean by that? Could you give me an example of maybe an asset that we could possibly use?

JF: Okay, let’s start with you. What was it that enabled you to cope and to blossom? What were the things that you found in your life, or in your environment? And are those things that we can build on?

ID: In my community we’ve got this sense of never giving up, and I tried to redirect that energy in a more positive way. 

Before, it was just this anger tactic. It was directed at the police, and other establishment figures. You’re angry with them, but that doesn’t get you anywhere in life. It kept me in this little bubble. So that’s one of my first things. Taking this spirit of “we can’t fail”.  Thinking I can do something with my life. I think that was the first step for me.

Essentially, it’s just perseverance, and looking at my mother’s personal struggle and always remembering her telling me “look, you’ve got everything in this country”. She does cleaning and is not very happy with it but she’s happy that she’s doing something, which I always found quite peculiar but I guess she has a different sense of ownership in Britain than me. She came here as an immigrant, I was born here, so I want different things.

JF: Well this is your home. You have to make it work.

ID: Exactly. This is my home, but a lot of the time I don’t think people in Broadwater Farm feel ‘this is my home’. Or the way they feel about their home is that it’s not the best home so I don’t care about it.  They have no sense of belonging.

JF: That’s the place to start. What are the resources on Broadwater Farm, in your community, that we can use, or we can build on, redirecting all that energy into something that’s going to be positive, rather than self-destructive? And how can we build a sense of belonging and a sense of home so that people feel they have some kind of security?

Some of that will be practical, physical improvements. This is not all airy-fairy stuff. I’m not saying, “If you change your mind, you change your world”.   You don’t.  But if you don’t change your mind, you’ll never change your world.  By changing your mind or changing the way you think about yourself or changing the way you think about things out there in your external environment, maybe you engage more positively, more creatively. You make the connections, you take up the opportunities, you use all that perseverance to make all those things happen for the good of you and your neighbours and your friends and your life and your family.   You find that energy, and the resources, in the community.

So we start with conversations,  asking people, “What’s really good about your life, about your family? What can we do more of? And how do you cope with the things you’re living with, and how can we help you cope?” We don’t know the answers to this and for me everybody will have different things that help them cope. Every community will have different things that are really working. That we can make something of.

ID: I think it’s a really intriguing approach because a lot of the works that are carried out in communities focus on the negative aspects of the community, and try to better them.  It is really interesting that you’re saying “let’s focus on the positive that community has and let’s expand on that, essentially to make them feel better about themselves.”

JF: That is my challenge to public services.  It’s precisely as you’ve said.  Public services tend to have a deficit model of the world.  It’s as if people on Broadwater Farm have all these needs and problems and they’re basically a big bundle of deficits, and more professional help is needed to fill the gaps.  Whereas I’m saying these people also have assets and resources, and you have to go in and speak to them as equal people, as people who have something to offer, who have passions and energy that you can work with. And you have to respect that these people are coping, and they have a lot of strengths, and we need to work with those strengths, and we need to have services (because we still need services and help) that build on people’s strengths rather than undermine them and make them dependent on professionals. It’s a very tricky balance, because I don’t want to suggest we don’t need services. Of course we do, but we need services that sustain our strengths, rather than treat us as…

ID: Patients.

JF: As patients, yes.

ID: I’ve been depressed in my life, but there’s no one you can talk to. You go and see the doctor, and the doctor gives you a pill.

I’m interested in how you envision someone like me connecting with other people in my community about their metal wellbeing, and the practical steps to moving forward to bettering themselves.

It is a communal thing, but at the same time it’s an individual experience. How do we influence someone’s exterior to then look at their interior? Because there’s no way of us physically getting in someone’s head, and saying we’re gonna tweak that, fix this. Maybe that’s why the NHS and other people have strayed away from it. It’s not a quick fix.

JF: No, it’s not a quick fix. I think there is more scope for self-help therapy, for instance, and self-help groups, which have some skilled professional input, but which are essentially people helping each other with the kind of mental stresses that end up with where you ended up. If you’d had people that you could talk to and talk with then you would be helping them as well as them helping you, in a confidential situation, where you’re able to get some skilled help, but you are also making those connections and making those networks to manage your own mental health. It’s something that you can learn. Now, this doesn’t deal with really serious mental illness, but it does help with people who are stressed and isolated and depressed in the way that we all are.

ID: Yes.

JF: And we all experience this. This is not something where there are some people who are ill and some people who are not. We all have these situations and we can learn, and there is quite a lot of experience of self-help therapy groups and self help support groups.  Maybe if we had the conversations on Broadwater Farm, people would identify that’s what they’d like to have. They might not call it a mental wellbeing group. They may call it a book group, they may call it a conversation group, or they might call it a childcare arrangement. They might call it a dominoes club, it doesn’t matter.

Making those friendships and networks where you can have those kinds of conversations can help. So it’s about self-help, and that might be something that would come out of a project of having these conversations. That might be a really positive product. Someone like you would be, for me, a key asset in that group, because you’ve been through it. What you’ve experienced is an asset that you bring to help other people who are going through it now, so those experiences are something we can draw on as a community, and there’ll be many other people who have experiences that we can draw on and give people support and advice and experience who are going through bad times now.

For me, having those conversations and seeing things that are sometimes seen as negative can be a positive if they’re used in the right way. Like your work with gangs. Some of the best work with gangs has been by people who were in a gang, so they have become an asset, whereas they were a deficit.

It all depends on the circumstances in which people are relating and using their energy and using that experience.

ID: Yes, talking about gangs is very interesting.  How could we apply your theory to gangs?  How could we get them to look at their assets – within their model as a gang – and use that to build self confidence, to stop them from being so self-destructive, to start to build up their community? Essentially, they’re a gang – that’s what they want , a sense of community and belonging and ownership. I know when I was a young person, that’s all I wanted – my ownership – because I had nothing.

JF: Maybe if we spent a bit more time helping young people, kids, feel that they had somewhere to belong and that they were respected and they had opportunities, then maybe they wouldn’t join a gang. It’s worth a try, and it’s certainly worth having a conversation with people about it, testing it.

ID: Two or three days ago I was having a conversation with a young man on my estate, and I was asking him “why are you living this life? There’s much more out there.” And he said something to me so profound that I was quite surprised that it came out of his mouth. He said “Isaac, life’s about making history. Who’s making history on Broadwater Farm?”   Immediately I knew what he meant.   He meant that those that are in politics will be written down and will be remembered for what they contributed to social growth, and contributed to society.   I was very worried, talking now about his mental wellbeing, because, as he sees it,  he has no ownership or sense of belonging in his experience of life.

JF: And no sense that he can make things happen.

ID: It’s interesting how I could take this theory [community assets] and say “look, you have this and this, and this is what you can contribute to Broadwater Farm, and that will make history.”

JF: I think that sense that you’ve got no meaning in your life and no sense of…

ID:…positive contribution.

JF: Yes, and you have no sense of your own agency,  that you can make things happen. It’s really interesting. Sixty years ago, medical sociologists were writing about precisely those kinds of things, that the reasons people cope and don’t get ill is because they have this sense of agency in their lives. They can see meaning. They feel that they can make things happen. They believe in themselves, and there you’ve got somebody who feels that lack of all those things, and it’s not good for him.  It will make him stressed and depressed.  Maybe not isolated, but unless he changes those feelings about his life then he’s not going to be a happy person.

ID: He’s not a happy person.  He’s quite ill at the moment, oddly enough.  So all this seems to be tied in together.

One of the issues that I was really interested in, in your research, is the sense of belonging.

I’m first generation of an immigrant. My mother came here in the early eighties, when there was an influx of West Africans coming into Great Britain.  Now, my mother has no problems with Broadwater Farm because she doesn’t see it as home.  For her, she has this vision of going back to Ghana, building a house in Ghana and retiring in Ghana, so she doesn’t mind working a cleaning job. She’d love to do something better, because then she could earn more capital to make her dream happen quicker. But essentially, that’s what’s prevalent for my Turkish friends, too, it’s what their parents are doing.   I know a few Afghans as well, and recently a lot of Polish people have been coming in, and when I talk to them it’s the same thing. “I’m just trying to work.” So how can we build communities in that mayhem?

JF: I suppose I believe that the people you’re talking about are really strong people. They have picked up their lives and travelled halfway across the world, made a new home, brought up their children in very difficult circumstances.  They have enormous resources and skills, and sometimes incredible skills that they’re not able to use here. They’ve got qualifications and knowledge and passions that this society doesn’t appreciate or allow them to practise.

So first of all there’s a mass of resources there that we can make something of. Your generation, the children of these people have also got potential strengths. You share a lot of understanding with the children of all these different immigrant communities. But what you share, that you’ve grown up here, you’ve probably got shared experience of the negatives, but you come with a lot of strengths, and some of the educations statistics show that it’s the children of migrants who are doing really well at school because their parents are passionate about education, they’re passionate about learning, they’re passionate about getting on. And maybe to build education for them, they see that as their way out for their children.

We know it’s not that simple, because there are a lot of problems with mobility and this is a very class-ridden and white-dominated society. But if we say that one of the main things that help people cope and that will bring them a sense of ability to make something of their lives is education, aspiration and skills, there are resources on Broadwater Farm in amongst these parents that could really support children to learn. If schools were more conscious of that, maybe…the schools on Broadwater Farm probably are very conscious of that….but it’s about looking out for resources.

That sense of belonging, I think, is a real problem, because I don’t think this society necessarily wants people to feel that they belong. In a way, there’s very mixed messages in Britain about whether or not children of migrants belong or don’t. At the very least you can belong in your area, you can belong in your town, your networks and in your associations. You can support your children, you can create your local businesses and local communities and your local economy, and that’s a way forward.   But it’s also a real problem, because in a way that exacerbates people feeling that they don’t belong to the wider society, they only belong in their own community, and we’ve somehow got to make steps out.

ID: Exactly, I think everything needs to mix. Because essentially we have a community in Broadwater Farm but it’s very segregated. It’s a community predominantly made of immigrants. People that have come into the country, people that are not born in the UK, that have come to make this their home. For me, that’s one of the scariest thing I faced. One of my greatest challenges, I remember, was being a runner [for a film company] and somebody saying to me  “it’s like Driving Miss Daisy” and I said “no, this is what everyone’s doing.” There was a middle class white boy doing the same thing as me!

But you have to overcome these hurdles and I feel like that’s the problem with these areas. We’re not mixing enough with other parts of society and we’ve been segregated and are only learning…we’re equipped with tools that don’t help us in mainstream society. We’ve got all this vast knowledge, but that actually won’t help me if I want a 9-5 working as an accountant, or if I want to work on a building site. That’s the problem, and that’s why you’ve got spikes of youth unemployment in such areas, because they’re equipped with skills they don’t know how to transfer into wider society, and, secondly, we just don’t belong.

JF: I don’t think that asset-based working or principles are the solution to the kind of things you’re describing, but I think we need to have a greater sense of the importance of mental wellbeing and that we can actively support people who are coping in this situation, and help them cope better, and help them have some resilience. If we don’t help people stay on top in this situation then they will have nothing. Their mental wellbeing will stop them getting a job, getting an education, fighting for things they want. They will be completely disempowered and isolated and depressed, and they will never engage with these arguments or do anything about this kind of inequality that you’re describing. It’s not, for me, that ‘assets’ solve inequality, but I think unless you feel good about yourself, you’re not going to engage with the situation that is producing inequality.


Jane Foot  http://www.janefoot.co.uk/ has worked extensively for local government and national bodies such as IDeA on community development and neighbourhood  governance, as well as teaching at Goldsmiths, University of London and City University in the fields of urban and regional studies.   Her most recent publication, What makes us Healthy? The asset based approach in practice – evidence, action, evaluation is the follow up to her 2010 publication, A glass half full

Isaac Densu is a film producer.  One of his first films, Street Life,looked at life on Broadwater Farm Estate, where he grew up and where he still lives.  He recently organised a showing of Mathieu Kassovitz’s film La Haine on the estate and has been working with film director Penny Walcock on a documentary about Birmingham gangs to be shown on Channel 4 later this year.


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