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People in the poorest areas of the UK are dying years earlier than those in wealthier areas. Inequalities in health are strongly determined by the conditions we live in. Local government holds many of the essential building blocks needed to create good health for all: access to secure housing, good jobs with fair pay, quality education, and much more. That’s why we’re working with the Local Government Association on our Shaping Places for Healthier Lives programme.

What is the Shaping Places for Healthier Lives programme?

We are funding five local government-led partnerships in England to take system-wide action on the wider determinants of health and inequalities in their local areas. There has been a lot of interest in this programme, with applications covering diverse population groups and varied themes (including social isolation, the built environment, mental health, food insecurity, housing, school readiness and education).

We were pleased to see widespread recognition that complex health challenges demand a different approach at local level: moving from siloed interventions (often services designed to treat symptoms) towards changing whole systems to address multiple root causes of these complex issues. Applicants showed openness and enthusiasm for trying new approaches and learning with their peers (and with us). They anticipated many benefits of taking a systems approach, including:

  • shifting the focus ‘upstream’ to the root causes of an issue
  • freedom from the constraints of separated budgets and priorities, in order to look afresh at issues and diverse perspectives
  • engaging with residents and uncovering assets in communities – and building on these, rather than focusing solely on symptoms or problems.

From the 110+ expressions of interest, in July 2021 we selected five local partnerships. Three are focusing on food insecurity, in very different settings and populations; the other two are taking community development approaches to the issues of mental health and fear of crime.

The five local partnerships tackling health inequalities

Bristol, North Somerset and South Gloucestershire Councils are working together to understand and address the drivers of food insecurity in five local areas of high need. They will collaborate with existing projects, identify and build on community assets, then develop and test actions at neighbourhood, council and regional levels. This includes joining up and learning from the many local initiatives established during the pandemic. The project aims to build resilience to food insecurity and establish long-term food security in the five neighbourhoods, and to understand which activities are transferable to other areas.

London Borough of Newham has the long-term vision of better understanding and addressing food insecurity for children and young people, so that ultimately none of them go hungry. They recognise that the problem cannot be solved in three years, but that sustainable step change will improve outcomes for families. Newham aims to embed a systems approach to food insecurity, building on, connecting and extending existing strategies and interventions.

Shropshire Council is bringing together statutory and voluntary services and communities to ensure all residents in this rural area have access to the support they need to prevent food insecurity. By co-designing solutions, they will reframe the challenge (to reduce stigma and increase referrals to support services), maximise incomes, including through underclaimed financial support and real living wages, and leverage community assets to connect and build local projects, thereby increasing access to food and skills.

Doncaster Council is focusing on mental health in Stainforth. The local community have been engaged in developing a clear vision of a community that supports good mental health, which forms the starting point for planned activity. ‘Shaping Stainforth’ will focus on relationship building to address an identified disconnect between generations in the community (which is causing distrust and a lack of community cohesion). Young residents will be involved in work to improve social mobility in the area, and build a community conducive to good mental health for the long term.

Northumberland Council is working to create the conditions for a safer and stronger community to flourish in Blyth, by addressing a fear of crime. The ‘Heart of Blyth’ project will provide opportunities for residents and voluntary, statutory and community organisations to come together, build connections, strengthen relationships, exchange knowledge and work towards a shared purpose. It will use creative and co-designed approaches to grow community pride, and develop a positive reputation and identity which can be communicated within the town and to visitors.

A new approach to learning

The Health Foundation and Local Government Association are collaborating with programme partners the Design Council (providing delivery support to councils) and Cordis Bright (our learning and research partner) to take a complex systems approach to action and learning. We will work closely with the five projects in a developmental way, enabling reflection and peer support, and bringing learning directly back into the projects to inform their evolution over the duration of the programme.

This approach to learning and research will help us to understand the features, benefits and any pitfalls of taking a complex systems approach to improving health. We recognise that changes in health outcomes over the 3-year programme period will be limited. Instead, we will look for sustainable changes to local systems of wider determinants, that would be consistent with improved health and reduced inequalities in the local areas over the longer term.

What’s next?

Alongside this Shaping Place for Healthier Lives programme in England, the Health Foundation has made an award to the Improvement Service in Scotland to run a parallel programme with common aims, ‘Shaping Places for Wellbeing’. This will support seven areas across Scotland to tackle local inequalities. We look forward to sharing more about this programme soon.

Louise Marshall (@louisemarsha11) is a senior public health fellow in the Healthy Lives team at the Health Foundation.

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