How can community involvement reduce health inequalities?

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Realising that people living just six miles apart in Morecambe Bay have a difference in life expectancy of more than 15 years made our Population Health Team think about how we could begin to work with communities to change this narrative.  

We made a start by sharing information about health inequalities with some local headteachers. This led to some great conversations with staff and pupils about how we could create better health and wellbeing for our children and young people.

One of the ways we began to address this was through The Daily Mile initiative. Three schools initially took up the challenge. Within a year, by changing little else, one of the headteachers had lost more than three stone in weight, and through a local research project demonstrated some remarkable changes in her school, with improved classroom focus, better results and healthier, happier children, (who are now less likely to develop diabetes or die early from cardiovascular disease). The success story began to spread and now 2,000 children and their teachers are running a mile every day at school. 

Our team are also involved in helping healthy eating initiatives. Many schools were dealing with significant hunger issues among their pupils and have now taken steps to ensure children have breakfast and a healthy lunch every day through breakfast clubs and with the help of FareShare. We have seen another headteacher, recognising the rise of mental health issues among pupils in her school, work with us to launch a Mental Health and Safeguarding Champions Network (a mixture of teachers, social workers, mental health teams and volunteers). This network is helping schools become more compassionate places, building resilience for children going through significant hardships.  

Working with schools has inspired us to engage much more widely with the rest of the public. Using tools from the ‘art of hosting’ network, Bay Health and Care Partners are co-hosting conversations that invite us all to reimagine Morecambe Bay as the healthiest place in the UK, rather than a place with some of the worst health outcomes. Over the past 18 months, more than 3,000 people in the Bay have taken part in conversations about how we can live life more fully together and enjoy better health and wellbeing. Simply by bringing people together, giving space for relationships to develop and creating an environment in which people can dream of a reimagined future, amazing things are being catalysed.  

Several wonderful initiatives have developed already, enabled by tiny seed funds. People who live with enduring mental health challenges have set up Mental Health Cafes, places of safety and connection. I’ve had patients tell me that they are only alive now as a direct result of the relationships they have formed in these cafes. The café culture is spreading to diabetes, chronic obstructive pulmonary disease, circulation and frailty; people learn more about the conditions they live with and support each other. Local churches have helped set up ‘listening services’ in several of our GP centres. People are taking pride over where they live and are cleaning up the streets. There are community choirs, new walking groups and mindfulness classes, all helping to break the cycle of loneliness, connect people and increase wellbeing and resilience.  

We are changing too: our clinical teams across the health and care system are learning to take more of a coaching approach in consultations, encouraging people to learn more about their own conditions, so they can care for themselves and each other more effectively. We are using social media to push basic health messages and increase knowledge. 

After hearing that people of all backgrounds genuinely struggle to make healthy eating choices I have spoken to big manufacturers and supermarkets, through the Consumer Goods Forum, about where their responsibility lies. We very much hope that a new healthy partnership agreement between Public Health England, the NHS and the Consumer Goods Forum will be rolled out locally over the coming months, as part of Healthier Lancashire and South Cumbria. However, we also know that junk food outlets are disproportionately over-represented in our financially poorer neighbourhoods. To change this will require district and county councils to seriously review their planning and licensing if we are genuinely going to partner with our communities to see a change in how our population eats. The lines of responsibility and choice are intertwined! 

In all of this complexity, we’ve seen that people really do want to work with us to improve their health and wellbeing. But we need to ask ourselves if the support we currently offer is the right support. What we must not lose sight of is that improving health and wellbeing is far easier for some individuals and communities than others. Being part of the Poverty Truth Commission has been transformational to my attitudes and practice. This non-party political movement started in Scotland and has now spread to nine areas across England. It is based on the principle that ‘nothing about us without us is for us’ and ensures that we really listen to the stories of those who have lived-expertise in poverty. Then, rather than try and fix their problems, we share learning together and begin to co-design and co-commission services that will actually help communities. We have to allow ourselves to become more uncomfortable, be confronted with inconvenient truths, really encounter the ‘other’ and be changed by the process.  

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Comments

Chris

Position
Policy manager,
Organisation
Macmillan
Comment date
06 September 2018

Great article. We should remember this for lifestyle and wellbeing, but also post-diagnosis of long term conditions - where people don’t have equal capacity to access services, use community care, self manage or advocate for the same levels of care.

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