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

我们经常听到“系统”坏了，但这是什么意思呢？改变我们思考、定义、研究、证据、监测、评估和为“系统”提供资源的方式，如何能为贫困社区带来有意义的改变？这一变化将如何使那些亲身经历过创伤、无家可归、贫困、失业、流离失所、精神健康状况不佳或监禁的人受益？《现实》采用人类系统方法，指出“卫生和社会保健系统”（HSCS）是对世界上现有关系的心理表征，旨在促进人们的健康。我们的苏格兰财团由57人组成，在克拉克曼南郡、邓迪、复活节罗斯、爱丁堡和北拉纳克郡拥有5个已建立的资产中心，它们之间的牢固关系将不同的世界观联系在一起。在第二阶段，我们与贫困社区、政策制定者、从业人员和研究人员共同创建了一个系统级模型，收集并尊重不同类型的知识和替代证据基础（从艺术表演到自然散步；从文字到统计），这对于理解不公平和可避免的健康差异的复杂性同样重要。基础资金证明了现实能够超越我们目前想象的造血干细胞的挑战。疾病的医学模式决定了谁和什么被认为是“卫生系统”的一部分，这给人类生存带来了好处，尽管这些基于地方的hsc系统中的关键行为者了解这种系统框架对人类繁荣的局限性。目前，他们没有办法帮助他们重新想象。《现实》为这种重新想象提供了探索和方法。一种代表集体途径的模式，通过与人们共同研究和共同创造“什么、谁、如何和为什么”，为人们在旅途的适当时间获得所需的医疗保健提供创造性途径，从而在有健康和社会需求的个人与以社区为基础的健康和福祉改善机会之间建立成功的联系。我们是一个跨学科的集体，由与政策制定者一起工作的个人组成，他们对不平等有着亲身经历；地方政府;慈善机构;艺术家;环保人士和政策研究人员；卫生人文;艺术;心理学;人文地理;环境社会学;牙科的;医学;统计数据;经济学;咨询;心理治疗;管理;医学人类学;设计和创新。我们将了解需要做哪些工作，使地方能够重新构想和建立创造公平健康和福祉的“系统”。探索和解释创造力、人际关系和自然之间的联系如何为贫困地区的人们创造更健康、更有弹性的社区和环境。支持创造性的参与性过程，使社区能够使用不同的认识方式（认识论）和感知现实的方式（本体论）构建共享的心理模型（系统）。结合不同的认识方式，使创造“健康”的生物-心理-社会-政治因素以及边缘化人群体验这些因素的方式能够更完整地呈现。支持社区构建以地方为基础的系统，涵盖健康和福祉的所有方面，并在彼此之间的关系和环境的性质上做出有目的的改变。探索“标准”健康经济评估工具在评估社会投资回报方面的有用性，与社区合作，重新定义和定义与人类经验相关的“价值”和“生活质量”的衡量标准。

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.