Covid-19 has shown us that many societies, including the UK, lack the resilience needed to cope with shocks such as pandemics and the effects of climate change. It has also shown that those suffering most from those shocks are people who are already disadvantaged. To address this, we need to establish a strategy to ensure that all sectors of society are able to protect their material and mental wellbeing. More than this, we need the strategy contribute to continually improving the lives of those who are most disadvantaged so that they can take full part in, and benefit from, the societies in which they live.
This article presents two potential ‘levelling up’ priorities for health, taking a behavioural science perspective. These are:
- Establishing a more effective risk management culture
- Building community resilience and social connectedness
Establishing a more effective risk management culture
Covid-19 revealed the low levels of infection control behaviours that are embedded culturally across British society. Research conducted in motorway toilets soon after the 2009 H1N1 pandemic showed the low levels of hand hygiene; we do not routinely sneeze into the crook of our elbows or carry tissues to use and dispose of when we sneeze. Many of us spend hours a day in crowded, indoor spaces such as public transport, shops and cinemas; unlike countries in South East Asia, there is no tradition of wearing facemasks in such places.
The impact of this, along with other poor pandemic preparedness, on illness, deaths and social and psychological harms hit already disadvantaged sections of society hardest – those living in overcrowded houses and working in public-facing and unsafe working conditions; those with underlying health conditions caused by poverty; those without the digital connectedness to easily book tests, vaccinations or keep up with education when excluded from school; and those without the financial or practical resources to be able to isolate from other household members and the broader community when infected. Minority and socio-economically deprived groups faced several barriers in applying infection control practices in their workplaces and homes, communities, and when travelling, reducing their life expectancy.
This raises the question of how best to embed infection control behaviours in the social practices of all communities in UK society, especially those most exposed to and also vulnerable to infections. An important point is that achieving this will require changing environments, procedures, rules and routines, and not leave the responsibility for this to individuals and their ‘choices’. To reduce deaths, disability and illness from traffic and from tobacco, restrictions have become part of the fabric of society – for example, traffic lights and pedestrian crossings, and the public smoking ban. Protective measures are enforced by legislation such as wearing seatbelts and not smoking in cars. Shaping environments can both create safe spaces and support protective behaviours to become routine and ‘normal’.
Maintaining behaviours in the long-term to reduce pandemic transmission was considered by the behavioural science group of the UK Government’s Scientific Advisory Committee (SAGE) and identified several important points. A literature review and expert consensus concluded that successful risk management and sustaining behaviour change involves: multiple layers of protection; a combination of physical, social and psychological measures; effective communication of risk and uncertainty; inclusion of key communities in its development; and continued monitoring, evaluation and feedback. This requires co-ordinated participation of an array of public and private sector organisations rather than a series of separate interventions, led and resourced primarily by national Government. As well as exercising their own responsibilities, national Governments are in a position to enable others to play powerful roles – local government, employers, educational institutions, public-facing businesses, and citizens.
Building community resilience and social connectedness
Community resilience refers to the ability of a community to use its assets to strengthen public resources and services to improve the community’s physical, behavioural, and social health to withstand, adapt to, and recover from adversity. This adversity may be underinvestment through years or decades of austerity policies, or the effects of a pandemic, or both. It forms the foundation of not just overcoming adversity, but also potentially changing, or even dramatically transforming, that adversity.
Communities may be defined by geography, interest, identity or circumstance. A resilient community is socially connected and can take collective action because it has developed resources to support such action – practical, informational and emotional. Such support is the basis of collective efficacy and empowerment.
Based on core concepts, principles and evidence from community and social psychology, guidance from the British Psychological Society recommends six steps to assist local authorities, local forums, heads of services and community groups to build community resilience. These are to form community groups; listen to and learn from at-risk communities; build collective identity between communities and local authorities; accommodate community attempts to help; keep the emergent community alive; and resource the community. A community-led movement that emerged during Covid-19 was mutual aid groups, in which those not usually active in their towns or villages stepped forward to help others and formed networks to achieve this. Activities included ensuring people had food and medicines, sharing information, and providing social and emotional support for people who were isolated or lonely. The energy and generosity demonstrated a great reservoir of latent goodwill and community spirit.
A qualitative study of Covid-19 mutual aid groups in the UK found that participation provided wellbeing in different ways: positive emotional experiences, increased engagement in life, improved social relationships, and greater sense of control. Those who viewed their participation through a political lens were able to experience additional benefits such as feelings of empowerment. However, it also found that it attracted largely middle class and highly educated people, showing limitations of this activity to contribute to levelling up. Some interviewees felt that some of their activity was patching up existing deficits in local communities that the state and local authority were not doing anything about. This underlines the importance of appropriate resources and support being made available to more deprived communities via local government to stimulate, strengthen and co-ordinate community mobilisation and train people in community-centred and ‘co-production’ approaches.
Community-based organisation has the potential to strengthen our social fabric for the benefit of everyone and be part of a levelling up agenda beyond the crisis of a pandemic. To achieve this, it has been argued that we need to integrate it more with local public services and democratic systems. But this also requires a new recognition by national and local government of the latent capability of ‘ordinary’ people to organise productively and enrich their communities, and that this is something that should be encouraged and supported, including resourced.
In conclusion, ‘levelling up’ will require strategic, targeted, evidence-based investment. Here, I highlight two potential areas to consider: establishing a more effective risk management culture and increasing social connectedness. These require changed social and material environments, as well as the application of evidence and principles from the social and behavioural sciences. In turn, this requires societal-wide change, supported and resourced by a government with the values and vision to achieve it.
Photo Credit: Hannah Busing on Unsplash
About the author
Susan Michie, FMedSci, FAcSS is Professor of Health Psychology and Director of the Centre for Behaviour Change at University College London. She is co-Director of NIHR’s Behavioural Science Policy Research Unit, leads UCL’s membership of NIHR’s School of Public Health Research and is an NIHR Senior Investigator.