Relational health focuses on the nature and qualities of relationships in order to create the conditions for health and address health inequalities
There is an increasing body of evidence demonstrating the association between positive relationships and health and wellbeing [1]. Moreover, positive relationships can also mitigate some of the negative impacts of adverse conditions and experiences [2,3]. There is also an increased understanding of schools, neighbourhoods, workplaces etc, as complex adaptive systems, and that health is an emergent property arising from the systemās complex nature [4,5]. Health, as an emergent behaviour of a complex system, is therefore a consequence of the nature of the relations that comprise such systems. These relations can be the relations that subsist within the system, as well as relations that exist between the system and its environment [6].
Hence, in order to understand how health is constituted in complex systems, we need to understand the relational nature of these systems and their distinctive ārelationalitiesā.
Relational Health is therefore concerned with understanding the relational dynamics of social systems to understand how the conditions are created for health/ ill health in and of the system. This focus on relationships within the system and its wider environment as determinants of health/ ill health takes the focus away from trying to affect individuals at risk of ill health or individual behaviours in isolation.
A Relational Health approach means the focus is on understanding the nature and the qualities of the relations which support the system to self-organise towards a more health creating āstateā.
Taking a relational approach is a challenge to much of the dominant discourses of prevention science and public health approaches. In particular, a relational health approach to understanding the nature of population health challenges is a radical departure from the way that health and health āproblemsā are currently conceptualised and addressed. For the most part, population health problems are identified and determined externally, ie from outside of the system and then programmes or policies developed to address the problem, which is usually aimed at targeting unhealthy behaviours or populations deemed to be more at risk. Such programmes tend to be evaluated on individual outcomes (and with a ālogic of coherenceā which renders context as static). Whilst this approach might have some effect in the short term, there is evidence suggesting that programmes aimed at supporting health can actually widen rather than reduce inequalities [7].
By comparison, a relational health approach insists that a necessary condition for systems to self-organise into becoming health creating environments is for the school or neighbourhood or workplace to identify and recognise the nature of the issues.
Addressing poor health and health inequalities by creating the conditions to identify the barriers to health is a fundamentally different starting point to most stakeholder engagement processes; whereby stakeholders are brought into conversations about the externally determined problem to understand what it means to them and what would be feasible and acceptable ways of addressing it. What is significant here is that the problem is still externally determined.
A relational approach starts with the recognition that more of the same can not deliver change on the scale that is needed and that new ways of delivering services are needed in response to what people identify as the barriers to a health promoting environment.
These new ways of working /delivering services start by understanding the current behaviour of the system by actively listening to understand the nature of the lived realities for people living and working in particular neighbourhoods or organisations. This approach requires practitioners, researchers and commissioners to engage people living and working in these areas to hear what the āproblemsā are for the service or school or neighbourhood and to develop new ways of working with the residents/ workforce to respond to these issues. The local partnerships which then form become a sustainable means for the identification of local problems and responding to them. The new relationality of the system becomes the process by which the system self-organises to a more health creating āstateā and becomes a sustainable way for the system to adapt and respond to changes in the environment.