We have misunderstood what health is. For decades, health policy in the UK has largely equated ‘health’ with the services that manage its absence: emergency rooms, waiting times, GP appointments, hospital beds. The National Health Service, in this prevailing model, is a system for repairing broken bodies; vital, heroic, underfunded, and overwhelmed. But perhaps it’s time to stretch the acronym. What if NHS also stood for something more radical? More humane? What if it became, in our minds and policies, a neighbourhood health system?
There is, of course, a place for hospitals and ambulances and specialists. But these are the scaffolding of late-stage response. They are not where health begins. Health is not primarily a matter of treatment, it is a matter of life: the daily patterns of meaning-making, relating, moving, eating, caring, working, resting, playing, and loving. These are things that arise in place, in neighbourhood, in relationship. They are seeded in belonging and nurtured in trust.
Yet the existing health system has become so stretched by rising demand and chronic conditions that it often has little energy to invest in what might reduce that demand. In this context, ‘prevention’ becomes just another technocratic strategy, an effort to identify risk earlier and direct people more efficiently to the same exhausted services.
A neighbourhood health system, by contrast, asks different questions. Not ‘how can we treat more people faster?’ but ‘what makes people flourish together?’ Not ‘how do we identify the vulnerable?’ but ‘how do we build communities where vulnerability is met with care rather than isolation?’ Health, in this model, is not an individual possession. It is an emergent property of place.
Belonging as infrastructure
Consider the concept of relational infrastructure. Not roads and buildings, but the threads of trust, reciprocity, and shared responsibility that make a place liveable. Strong communities produce better outcomes across education, employment, safety, and yes, health. Hilary Cottam reminds us that many of the most pressing issues we face, loneliness, chronic illness, depression, and addiction, are rooted in disconnection. The antidote is not more services per se, but more community.
If we truly believed this, we might begin to resource our neighbourhoods differently. We would invest not only in clinicians but in connectors. We would recognise that the quiet work of listening, cooking, organising, visiting, walking, gardening, and simply being present with others is not ancillary to health, but foundational. We would ensure that those doing this work, mostly women, mostly unpaid, are supported, valued, and no longer invisible.
The role of Universal Basic Income
But how would such a transformation be possible in a society where so many are caught in cycles of precarity? How can neighbourhoods flourish when residents are forced to compete for survival?
This is where the idea of Universal Basic Income (UBI) becomes not just an economic policy, but a public health intervention. By ensuring that every person has access to the material essentials, food, shelter, warmth, and rest, UBI creates the conditions for community life to thrive. It offers breathing space. It allows people to participate in the co-creation of neighbourhood health without requiring them to sacrifice their own wellbeing to do so.
Crucially, UBI acknowledges the multiple forms of work that constitute a healthy society, parenting, caring, mentoring, and neighbourliness, as valuable in themselves. It makes it easier to choose contribution over competition, solidarity over survivalism. And it allows us to reimagine what it means to be well together.
Towards a new common sense
To speak of a neighbourhood health system is not to downplay the need for excellent clinical care. It is to recognise that such care must be embedded within a larger ecosystem of human connection. It is to refuse the narrowness of the biomedical gaze and reclaim the language of health as something spacious, shared, and situated.
And it is to insist that health systems, if they are to be worthy of the name, must not merely serve individuals in distress. They must also seed the conditions for collective vitality.
If we are serious about creating healthy neighbourhoods, then we must stop pretending that this work begins in the clinic. It begins at the kitchen table. On the park bench. In the corner shop. In the willingness of neighbours to look out for one another, and of society to make space for such looking.
The future of health is not a service we deliver. It is a system of relationships we cultivate.
