Strong communities, wellbeing and resilience

Local authorities have a role to play in helping individuals and communities to develop social capital. There is growing recognition that although disadvantaged social groups and communities have a range of complex and inter-related needs, they also have assets at the social and community level that can help improve health, and strengthen resilience to health problems.

Several local authorities are pioneering these community asset-based approaches to improving health and building resilience for wellbeing.

How can social capital and community resources affect health?

• A person’s social networks can have a significant impact on their health. One largescale international study showed that over seven years, those with adequate social relationships had a 50 per cent greater survival rate compared with individuals with poor social relationships (Holt-Lunstad et al 2010). Social networks have been shown to be as powerful predictors of mortality as common lifestyle and clinical risks such as moderate smoking, excessive alcohol consumption, obesity and high cholesterol and blood pressure (Pantell et al 2013; Holt-Lunstad et al 2010).
• Social support is particularly important in increasing resilience and promoting recovery from illness (Pevalin and Rose 2003). Strong social capital can also improve the chances of avoiding lifestyle risks such as smoking (Folland 2008; Brown et al 2006). However, in the most deprived communities, almost half of people report severe lack of support (Halpern 2004), making people who are at greater risk less resilient to the health effects of social and economic disadvantage.
• Lack of social networks and support, and chronic loneliness, produces long-term damage to physiological health via raised stress hormones, poorer immune function and cardiovascular health. Loneliness also makes it harder to self-regulate behaviour and build willpower and resilience over time, leading to engagement in unhealthy behaviours (Cacioppo and Patrick 2009).

What are the possible priority actions for local authorities?

Asset-based approaches seek to bolster wellbeing at individual and community levels, helping to increase resilience to the wider corrosive effects of the social determinants of health and risky behaviours.

To build social capital and utilise community-based assets to improve health and wellbeing, local authorities can:

• support volunteering, which is beneficial for health and wellbeing (Mundle et al 2013) and can reduce social isolation, exclusion and loneliness (Farrell and Bryant 2009; Sevigny et al 2010; Ryan-Collins et al 2008). There are many options, including:
  • creating health ‘champions’: the Altogether Better collaborative in Yorkshire and Humberside has trained 17,000 volunteer health champions, who are estimated to have reached more than 100,000 community members through their work, achieving outcomes on obesity, workplace absence, and unemployment, among other issues (Hex and Tatlock 2011)
  • developing befriending schemes, which can help reduce isolation, particularly for people who have spent long periods in mental health institutions and are now living independently in the community (Dean and Goodlad 1998)
  • supporting social network interventions with a focus on improving informal and formal social networks. For example, Men in Sheds (Milligan et al 2013), focuses on trying to engage older men at risk of isolation, who may be less likely to get involved with more traditional schemes for older people such as coffee mornings.
• work with other public services in their local area to develop an asset-based community development approach, which involves:
  • mapping local community assets as well as needs as part of the joint strategic needs assessment (JSNA) process. This approach has been piloted successfully in Wakefield (Greetham 2011), with guidance developed by NHS North West (Nelson et al 2011).
  • In Cumbria, following a community asset mapping exercise, the foundation trust has developed six new health and wellbeing hubs (along with the Centre for the Third Age in Cockermouth) providing access to low-level interventions including befriending schemes, interest groups and local outings and more targeted activity such as Singing for the Brain, or chair-based exercise classes (Foundation Trust Network/ACEVO, no date). These activities enable people to maintain their independence, and to halt the slide into isolation and health breakdown.

The business case for different interventions

Evidence on the economic paybacks of investing in community assets is as yet limited. However, there is strong and growing evidence that social networks and social capital increase people’s resilience to and recovery from illness. There is less direct evidence on the wider benefits that such investments can have; studies and evaluations are lacking, and those that have been undertaken have been on a small scale.

There is better evidence on some of the individual components of a local strategic approach to building and utilising community assets (Knapp et al 2011). For example, every £1 spent on health volunteering programmes returns between £4 and £10, shared between service users, volunteers and the wider community. British Red Cross volunteers have been shown to generate cost-savings equivalent to three and a half times their costs (Naylor et al 2013). An evaluation of 15 specific community health champion projects found that they delivered a social return on investment of between around £1 and up to £112 for every £1 invested (Hex and Tatlock 2011).

Further resources and case studies

• What Makes Us Healthy? The asset approach in practice – evidence, action, evaluation sets out the evidence on social capital, social networks and health, and how they can build resilience to illness (Foot 2012).
• Development of a Method for Asset-based Working. This report, commissioned by NHS North West, focuses on developing a framework for an asset-based approach to complement needs-based assessments (Nelson et al 2011). It draws on the experience of asset-based approaches in Cumbria, Liverpool and Stockport.
• Preventing Loneliness and Social Isolation: Interventions and outcomes, presents evidence on the effects of loneliness and isolation on health, and reviews the impact of different interventions (Windle et al 2011).
• The Campaign to End Loneliness has produced a toolkit (2013) designed to help health and wellbeing boards address social isolation and loneliness as key determinants of the health and social care needs of older people.
• People-centred Public Health gives a thorough review of the evidence base, with case studies on what volunteers and lay workers such as health champions can achieve by working with their community to improve health (South et al 2012 – see reference appendix).

For references please see Improving the public's health: references appendix

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