Co-Design and the Four Dimensions of Health and Care

Roz Davies

20th October 2020

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I am fascinated by the idea of the fourth dimension. Not because I am a scientist or interested in space but because of the idea that there are other perspectives that relate to the world we live in that we may not yet fully understand but have the potential to make a positive difference. This article explains more about the scientific fourth dimension.

I have been attempting to use this concept to explain how we use co-design to change the relationship between the system and citizens who have valuable experiences and insights which could help to improve health and health care. 

The first dimension is clinical expertise and care, e.g. being diagnosed with type 1 diabetes and prescribed insulin as a treatment. As someone living with type 1 diabetes I would not survive long without this first dimension of healthcare and very much appreciate it. 

The second dimension is about understanding that our bodies are attached to our heads. Sounds obvious doesn't it, but our physical and mental health care is still not as joined up as it could be. Research suggests that of the 15 million people in the UK who live with long term conditions, more than 4 million of these people also have a mental health problem.  Looking ahead The Mental Health Foundation and NHS partners have developed a model that predicts that up to 10 million people will need either new or additional mental health support as a direct consequence of the Covid-19 crisis. Our MindWell Leeds Mental Health Platform had 5,000 visitors to the Covid-19 Hub Page the first month. Joining up and getting mental health support right has never been more important. Primary care networks, Improving Access to Psychological Therapies (IAPT) and Integrated Care Systems are just some of the initiatives which may help bridge the gaps but we have a way to go yet. 

The third dimension is about a holistic approach recognising that most of what affects our health and wellbeing isn't directly related to NHS services. The Health Foundation 'Healthy Lives' research says that; 'access to health care could account for as little as 10% of a population’s health and wellbeing', the rest is education, employment, housing and the extent to which community facilitates healthy habits and social connections. So simply dealing with the 'clinical' problem in isolation to understanding the wider determinants of health is unlikely to result in people reaching their full physical and mental wellbeing potential in a long term and sustainable way.  

The fourth dimension of health and care is about power. A complete transformational power shift towards power with and within people and communities. This is about truly understanding and valuing the insights, knowledge, talents and energy of individual citizens and the collective power of communities. It is also about people feeling powerful and a sense of control and self efficacy which Bandura and related research suggest has an impact on wellbeing. But it's not rocket science is it, that we might feel better and more able to cope if we are able to make informed choices and feel valued and connected. 

Four dimensional health and care is not an easy aspiration to meet and requires time, resource and willingness across citizens, communities, commissioners, decision makers, clinicians, designers and other stakeholders. 

Co-design at its best is an approach which helps to explore and unleash the power and potential of the four dimensions of health and care by creating safe spaces, starting with what matters to people and their whole life context, building relationships of shared understanding and trust, recognising and valuing diverse experiences and expertise and facilitating iterative and creative responses to shared challenges. 

I hope we can use the opportunity of resetting to move to the fourth dimension and co-design a personalised care approach which genuinely creates the conditions where people feel empowered and are powerful partners in health and care!

An acknowledgement of the courage and wisdom of the many people who share their time and insights drawing on their own experience of care to improve lives and services including the amazing George Norton, David Gilbert (Author of 'The Patient Revolution', Sue Sibbald, Alison Cameron, Derek Stewart, Shirin Telfouri and Kate Allatt (Author of Running Free) to name a few.  

I would love to hear your thoughts and good practice examples? Follow us on @wearemhabitat or email

Image Credits Casey Horner

Roz Davies

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