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

我们经常听到‘体制’被打破，但这是什么意思？如何改变我们思考、定义、研究、证据、监测、评估和为“制度”提供资源的方式，为贫困社区带来有意义的改变？这一变化将如何惠及那些亲身经历创伤、无家可归、贫困、失业、流离失所、精神健康不良或监禁的人？现实是从人类系统的角度出发，指出“健康和社会护理系统(HSC)”是对世界上存在的关系的心理表征，以促进人们的健康。我们这个由57人组成的苏格兰财团在克拉克曼南郡、邓迪、复活节·罗斯、爱丁堡和北拉纳克郡拥有5个既定的资产中心，它们有着牢固的关系，将相互冲突的看待世界的方式统一起来。通过第二阶段，我们与贫困社区、政策制定者、从业者和研究人员共同制作了一个系统级别的模型，收集和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)，对于理解不公正和可避免的健康差异的复杂性同样重要。疾病塑造谁以及什么被认为是‘健康系统’的一部分的医学模式给人类的生存带来了好处，尽管这些基于地点的HSC系统中的关键参与者理解这个系统的局限性--为人类的繁荣奠定基础。目前，他们没有办法帮助重新想象，REALITIES为这种重新想象提供了探索和方法。一种代表集体路径的模型，通过与人们共同研究和共同创造“什么、谁、如何和为什么”，为人们在旅行的正确时间获得他们所需的医疗保健--导致具有健康和社会需求的个人与基于社区的改善健康和福祉的机会之间的成功联系。我们是一个跨学科的集体，有与政策制定者、地方当局、慈善机构、艺术家、环保主义者和来自政策、健康人文、艺术、心理学、人文地理学、环境社会学、牙科、医学、统计学、经济学、咨询、心理治疗、管理、医学人类学的工作一起工作的不平等经历。设计和创新。我们将：了解需要做什么工作才能使地方重新想象和建立创造公平健康和福祉的“系统”。探索和解释创造力、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、更具弹性的社区和环境。支持创造性的、参与性的过程，使社区能够使用不同的认识方式(认识论)和感知现实(本体论)来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-政治因素以及被边缘化的人体验这些因素的方式得到更完整的表现。支持社区构建基于地点的系统版本，涵盖健康和福祉的所有方面，并有目的地改变它们彼此之间及其环境的关系的性质。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，重新概念化和重新定义与人类体验相关的“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.