Finding creative solutions to address health inequalities

Happy diverse group holding hands

Fair and equitable access to community sources of support is fundamental to tackling inequalities in our society.

This is the fundamental idea behind UK Research and Innovation (UKRI)’s mobilising community assets to tackle health inequalities research programme.

The number of people living in poverty, experiencing food shortages, unable to pay fuel and other domestic bills, or attain basic living standards, is increasing year on year.

These so called social determinants of health explain up to 80% of health outcomes, with clinical care only accounting for 20% and yet approaches for addressing health inequalities remain elusive.

Creative solutions

This stark realisation means that in order to tackle the root causes of poverty and health inequity we need to find ‘creative’ socio-economic solutions.

Research into health inequalities over the past two decades has shed light on to the role of community assets, sense of place and community engagement in tackling the major social determinants of health.

The COVID-19 pandemic highlighted the vital role that community assets such as parks and green spaces, libraries and community organisations have in supporting vulnerable or marginalised people, and especially the poorest people, living in the most deprived areas.

Cultural, community and nature-based activities helped to mitigate the adverse effects of the pandemic caused by public health restrictions, including psychological wellbeing, social connectedness and loneliness.

Furthermore, these sorts of assets showed that they can be agile and respond swiftly to major societal challenges, offering locally-based solutions to people who need it most.

Facing challenges

Many community organisations have unique insights and a deep-rooted understanding of the needs of their local communities, but they face significant challenges in relation to scale and sustainability, with small-scale, short-term funding preventing them from reaching all of those in need.

The changing structures of health and social care in the UK, following the introduction of ‘integrated care’, offers both a challenge and an opportunity.

Integrated care systems (ICSs) in England, and their devolved equivalents in Wales, Scotland and Northern Ireland, have been introduced to ensure that care and support across services and resources is more joined up in order to tackle inequalities in outcomes, experience and access to health.

Better outcomes

As James Sanderson, chair of our advisory board and Director of Personalised Care at NHS England, says:

We know that joining up care leads to better outcomes for people.

When local partners – the NHS, councils, the voluntary sector and others work together, they can create better services based on local need and what matters to people.

Harnessing community assets, finding the opportunities for connection, activity and purpose can support people to achieve good health and wellbeing outcomes.

The concept of integrated care recognises the vitally important role that the voluntary, communities, faith and social enterprise sector has in supporting and maintaining a healthy population.

Diverse systems

However, there are significant challenges to integrating this ‘community assets ecosystem’ with the health and social care system.

Both systems are very diverse, complex and there are huge regional variations; no one community looks the same. They have different population structures, different strengths and different weaknesses.

In order to bring about better integration between community assets and health, we first need to understand what the barriers and enablers of collaboration are, establish clearer processes to streamline partnerships and then build capacity and sustainability within the community asset ecosystem.

Further research to realise potential

Given the major contribution that community assets make to supporting vulnerable, marginalised and excluded communities, there is significant potential for community assets to be a key conduit for tackling health inequalities, but to realise this potential, further research is required into how best to integrate these two multifarious systems.

This is the key aim of UKRI’s mobilising community assets to tackle health inequalities research programme.

Led by UCL’s Culture, Nature and Health research group, this £30 million programme is supported by a partnership with the National Centre for Creative Health.

The research is the first of its kind in the world which seeks to develop new models for cross-sectoral working that will allow community and health partnerships to be scaled up.

Diverse range of projects

The programme is funding a diverse range of projects across the UK to investigate how equitable and sustainable community ecosystems can be developed, through which community assets can be integrated into and supported by systems such as ICSs (and their devolved equivalents) to address health inequalities.

The programme responds to research which suggests that, in order to tackle health inequalities, a new research approach is required, one which is multidisciplinary, and places lived experience and community expertise at its heart.

In January 2022 12 pilot projects began exploring how cultural, natural and community assets can be used to improve mental and physical health outcomes in communities affected by inequalities.

These projects adopted diverse approaches to exploring ‘asset-based working’, including:

  • the provision of community gardens in urban neighbourhoods in the Black Country
  • the social prescription of heritage activities in rural areas of the Scottish Highlands
  • improving nature-connectedness through creative activities in nature in schools in areas of deprivation in Cambridgeshire and Peterborough
  • the spread and scale of arts-based mental health therapy sessions within the NHS in the north-west of England
  • early-years support for babies and their carers in art galleries across Scotland

A further 16 projects were funded in phase two of the programme during 2023.

These projects focused on developing cross-sectoral consortia incorporating health, community, lived experience, academic and local authority partners.

These consortia researched the development of community asset hubs and highlighted the benefits of this cross-sector working in areas such as end-of-life care, support with housing and homelessness, reducing stigma around severe mental illness and in bringing together different and diverse community partners in some of the poorest areas of the UK.

The findings

This is what have we found so far:

  • community-based approaches offer targeted solutions to reaching those most in need, living in the poorest areas
  • asset mapping is required to identify strengths and gaps and to ensure that offers are relevant to the needs of the local community
  • local people need to be involved in decision making processes
  • it needs to be made easier for decision makers (such as commissioners, referrers, funders and health and community professionals) to tackle inequalities and identify the most vulnerable members of society
  • optimal funding and commissioning models are location specific, but co-location of services and collaboration across organisations and programmes is more effective and offers the most cost-effective solution to tackling inequalities

The programme recognises that the development of equal partnerships between researchers, the healthcare sector and communities is vital to identifying and meeting the specific need in local areas, but that building such relationships takes time and resources for capacity building within communities.

Collaborating across the communities ecosystem

There are fantastic examples which show that by collaborating across the communities ecosystem, it is possible to tackle major challenges such as food poverty, housing issues, debt and ill health.

Our evidence shows that this ‘creative health’ approach to thinking about public health offers a more targeted solution for those people experiencing the worst inequalities.

Exploring in greater detail

These ideas will be explored in greater detail in 12 new three-year projects funded from 2024, where place-based partnerships across the UK will work with some of the countries’ poorest communities to co-produce solutions for better integration between communities and health.

These 12 projects were selected for funding by panels of academics and people who are experts by their lived experience, in a novel process for UKRI that endeavoured to embed community voice and lived experience in the decision-making processes for funding, as well as within the research itself.

In taking this ‘creative’ approach both to the way the projects were selected and how their research will be carried out, we hope to achieve change that will benefit communities across the UK.

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