COVID-19 has told us that health is made at home – hospitals are for repairs.

Our partner Lord Nigel Crisp, the former head of the English NHS, the world’s largest health system has written the following article on health and human flourishing. Nigel is featured in this year’s Investing for Global Impact Report: A Power for Good and has a wealth of experience in social impact. His latest book Health is made at home, hospitals are for repairs is available at

Written by Lord Nigel Crisp.

I learned the saying Health is made at home, hospitals are for repairs from an African friend, Francis Omaswa. It challenges us to think differently about health. Can health be made? Can we create health. Our health systems concentrate on tackling disease and injuries – doing the repairs – and on the causes of ill health. What about the causes of health?

The truth is that our health systems can’t deal with many of today’s major health problems such as loneliness, stress, obesity, poverty and addictions. they can only really react, doing the repairs but not addressing the underlying causes.

But there are people throughout our countries who are tackling these causes in their homes, workplaces and communities. The leaders and pioneers. People like the bankers Improving mental health in the City of London – reducing stress levels and providing support. The Berkshire teachers working with children excluded from school, helping give them a new start in life. And the unemployed men in Salford improving their community for the benefit of everyone living there. And many, many others.

They are opening up new ideas for us about health creation and quality of life and showing us what they mean in practice. Not waiting for government or health professionals to tell them what to do. Breaking new ground, taking the initiative and leading. They are not just preventing disease but creating health.

The nations of the world defined health at the World Health Assembly in 1948 as being about physical, mental and social wellbeing and not just the absence of diseases or injury. Our health systems and societies have concentrated on the physical. We are paying more attention to mental wellbeing now but still largely ignoring the social aspects.

Health is about our physical, mental and social wellbeing and not just the absence of disease and injury

Covid-19 has shown us how vital all these three are. Locked away from our normal life, we are suffering physically, mentally and socially. Health and wellbeing, as we all know, is about the freedom to be ourselves, our social life and relationships, what happens to us at school and work and our sense of fulfilment. And the pandemic has torn up our normal lives whether or not we have caught the virus ourselves.

It has also shown us some of the uncomfortable truths about our societies. How black, Asian and minority ethnic groups have been worse affected, how people on low incomes and in insecure jobs have suffered. And more broadly, how social factors have influenced our health and wellbeing.

We need to think about the causes of health and not just the causes of ill-health

The pandemic may have revealed starkly some of the causes of ill health, but we should also think about the causes of health and health creation. Health creation is about creating the conditions for people to be healthy and helping them to be so. It’s what our parents did for us. And what good teachers do, and good schools and strong communities. They all help create resilient, confident, capable and healthy people. 

There is history here and science. There is a tradition of salutogenesis (the origins or causes of health) in some parts of the world. And the ancient Greeks, Plato and Aristotle wrote about eudaimonia which is usually translated as human flourishing. It brings together the three elements of health and must surely be the wider goal of our health systems as well as our societies.

I spent part of last year meeting some of the health creators in the UK and seeing something of the extraordinary range of activities around the country that are contributing to our health and wellbeing. There is the policeman in Cornwall who was fed up with chasing young people for minor crimes and set up a dance club which is now run by the young people and has improved health in the area as well as reducing crime. The women in Yorkshire who started growing vegetables in public spaces bringing the community together around gardening, cooking and community feasts – and that has led to 150 similar groups around the country. And the Forest Schools around the country where young children learn in the open air and become stronger, more resilient and develop knowledge and a love for the environment.

Their work is distinguished by the way they all learn by doing – being entrepreneurial and experimental, – the develop their activities through building relationships – and they involve people in taking more control of their lives. 

As the former head of the English NHS, the world’s largest health system, I have become convinced that we need to find better ways to partner their creativity and invention in the community with the formal health systems and its professionals. We need to think of health in future in three inter-connected parts – health services (led by the professionals), prevention of disease and the protection of the public (tackling the causes of ill health) and health creation ( building on the cause of health and promoting human flourishing). All are essential for the future.

Health is made at home and in the workplace, the school and the community.


Lord Nigel Crisp is an independent crossbench member of the House of Lords and was the Chief Executive of the English NHS and Permanent Secretary of the UK Department of Health from 2000 to 2006.  His latest book Health is made at home, hospitals are for repairs is published by Salus and available at  Recording of webinars with some of the health creators he describes are on the website.

These are not merely developments on past practice, tweaks to the system or incremental change. They are not simply about clinicians starting to prescribe healthy activities as well as medicines. Nor about the NHS beginning actively to pursue prevention and promotion. Or engaging the public. Welcome as these things are, they maintain the control of the system and the professionals. And they keep us dependent on them. Business as usual.

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