Health inequalities have been defined as ‘avoidable, unfair and systematic differences in health between different groups of people’. These health inequalities can be due to a range of factors, including socio-economic status, where we live and work, our gender and ethnicity.
Public health initiatives are one way of seeking to reduce the symptoms and/or the causes of health inequalities.
Place-based approaches recognise that health inequalities have complex causes, so considers the whole community and allows collaboration with different sectors. They aim to tackle wider determinants of health rather than just solely trying to treat disease or the causes of disease.
An example of this approach occurred in Blackburn with Darwen, one of the most deprived areas in England. The charity ‘Change, Grow, Live’ (in partnership with the Blackburn with Darwen Council) worked collaboratively to deliver an integrated drug and alcohol recovery and prevention service to support vulnerable individuals and those living in areas with the greatest deprivation. The Council acted as a catalyst, with ‘Change, Grow, Live’ commissioned to provide the integrated recovery and prevention service. This programme led to greater self-reported physical activity levels, improved access to education and employment, and an increase in volunteering among service users.
Community-centred and asset-based approaches focus on using assets (skills, knowledge etc) within the community and allowing community members to be actively involved in the design, delivery and evaluation process of the project, whilst giving the people control over their health and wellbeing.
An example of this is Lunch Positive HIV support, a voluntary organisation used peer-led voluntary support initiatives such as lunch clubs to provide support to people with a HIV diagnosis on topics such as nutrition, and peer-led health improvement activities. In an evaluation, 94% of respondents reported this led to a positive impact on their emotional wellbeing or mental health, 87% found wider support networks through this, 54% now eat healthier meals on a regular basis and 87% felt more comfortable with their own HIV diagnosis, having a positive impact on self-care.
Successful initiatives in the UK
Other successful initiatives have included:
Nature4Health Project (Merseyside and Cheshire areas, England)
Mersey Forest (both a place and an organization) brought together various organizations, as shown in Table 1, to run an evidence based structured programme in green spaces for different age groups or groups with additional needs e.g. adults with dementia. This targeted initiative resulted in an increase in physical and mental wellbeing, as independent evaluation showed an increase in MET (amount of energy spent carrying out physical activity) mins of 31.1%. On the WEMWBS (Warwick-Edinburgh Mental Wellbeing Scale) scale there was a marked improvement in wellbeing with scores of over 6 points (usually 3 to 8 points is considered meaningful).
Take a Breather - Stopping the Monster Days (Tower Hamlets, East London)
Tower Hamlet’s Together, a local health partnership involving the borough council, a local clinical commissioning group and a GP federation worked with other organizations to create a quality-improvement driven interventions programme to reduce unplanned child hospital admissions for asthma and wheeze in the area. The programme involved many different interventions such as school learning programmes, strengthening smoking cessation pathways and asthma champions in various settings. It led to an 22% decrease in unplanned hospital admissions due to asthma/wheeze and a rise in asthma action plans from 40 to 75%. 92% of children identified as at high-risk of asthma attacks had their asthma control improved.
The Alchemy Project (South East London, England)
The Alchemy Project, led by Dance United (an arts organization) and the Early Intervention in Psychosis team at South London & Maudsley NHS trust, co-produced an action research project for two groups with common mental health conditions involving health-care professionals, peer mentors, and team-building exercises to produce a dance performance at the end of four weeks. Independent evaluation showed both groups had improvements in wellbeing (a 10 point increase in the WEMWBS score), as well as communication, trust in others, team working, relationships with peers and families.
Hackney School Streets (Hackney, London)
Hackney Borough Council developed and led a project aiming to improve air quality and make it easier for children to walk and cycle to school within the area. Street closures outside schools at certain times of the day reduced traffic by an average 68%, with a 74% drop in emissions (NO2, PM10, PM2.5) and a 51% increase in children cycling to school.
Arts-based project in Southend-on-Sea, England
Metal, an arts organization, collaborated with Southend Borough Council’s Public Health team to create an arts-based project to help improve mental health management in those with common mental health conditions, as well as those with dementia and learning disabilities. Out of the 64 volunteers who have taken the programme, 33 have gone on to higher education or employment after volunteering and 25 have returned as volunteers. Using the WEMWBS score, 84% said their self-confidence had improved, 50% said their use of GP and crisis team interventions reduced, 72% said symptoms of anxiety, stress and depression had improved.
Outreach NHS health check programme in Fenland, Cambridgeshire
An outreach programme to increase NHS health checks in migrant workers in Fenland, was developed and led by the Cambridgeshire County Council Public Health team with support from Fenland Health and Wellbeing Partnership. They used interventions such as an expansion of the Community Pharmacist’s NHS health check service into workplaces, use of health trainers and a health check van outside workplaces. The programme has led to an increase in the number of health checks in Fenland, an increase in number of health checks among the target population and an increase in number of employees engaging with the programme.
These successful initiatives often have a number of factors in common, as highlighted in Table 1. Multi-agency partnership working is common in almost all of these projects with different council departments, voluntary sector, businesses and/or health services all working together. Given the range of factors causing health inequalities these projects involve a joined-up, community-based approach rather than solely relying on individual behaviour change. They also take a targeted rather than a ‘one-size-fits-all’ approach. For example, the outreach NHS health check programme in Fenland, focussed on the migrant working population and used a local health trainer from the population’s background to help address any language and cultural barriers.
Table 1.
Case study | Lead body | Multi-agency partnership working | Peer-level support or voluntary support | Listening to user reps | Targeted initiative | Focus on social interaction | Other success factors |
Integrated drug alcohol prevention and treatment service in Blackburn with Darwen | Blackburn with Darwen Council and ‘Change, Grow, Live’ charity | Age UK, local mental health services, Department of Work and Pensions, local charities and primary care services | √ | √ | √ | Build relationship with the local community and gain their understanding into the issues at hand | |
Lunch Positive’s HIV support lunch club | Lunch Positive | √ | √ | √ | √ | Led by people with HIV as experts of need | |
Nature4Health | Mersey Forest | Local authorities, community groups, landowners, businesses. | √ | √ | √ | Tailor fitting activities in accordance with local culture and local need | |
NHS health checks outreach programme in Fenland, Cambridgeshire | Local public health team | Local businesses, community pharmacist, police, local health trainers, other local council departments | √ | √ | Using interpreters to address language and cultural barriers with migrants population | ||
Arts-based intervention for those with mental health conditions in Southend-On-Sea, Essex | Metal & Southend Borough Council’s Public health team | Arts Council England, Local economic partnerships, community groups, schools | √ | √ | √ | Free and accessible to anyone | |
Hackney School Streets | Hackney Local borough Council | Schools, local statutory teams, police, businesses, residents, traffic engineering teams | √ | √ | √ | Launched each school street with a play-themed celebration for children to help them understand | |
The Alchemy Project | Dance United & Early Intervention Team in psychosis at SLaM NHS trust | Arts Council England, local hospital charities, mental health charities, King’s College London | √ | √ | √ | ||
Taking a Breather – Stopping the Monster Days | Tower Hamlets Together partnership | Local council, GP federation, CCG, NHS leaders, researchers | √ | √ | √ | Using QI methodology in a partnership context to implement a wide range of interventions |
Successful public health initiatives in the UK have combined partnership working with local community assets, healthcare services and local councils to make public health a priority for everyone. They have focused on targeting service users with the most needs rather than opting for a one-size fits all approach and combining social interaction within their initiatives rather than focusing simply on physical health to improve connectivity and reduce social isolation.
Viknesh Akilan, August 2021
