ControlHealth, the evidence and place based action
Role of place based programmes
While national policies are arguably the primary route through which health inequalities should be addressed (e.g. taxation and welfare systems), actions that address the local determinants of health also have a role.
Area (or place) based initiatives (ABIs) involve targeted action to a particular locality with combined actions to improve social, economic and environmental conditions. Yet historically, the evidence of positive health impacts is relatively limited. In recent years, public health researchers have attempted to evaluate ABIs using study designs called ‘natural policy experiments’, to assess impacts of ABIs where experimental designs (e.g. RCTs) are not possible. A retrospective study assessing the health inequalities impacts of New Deal for Communities (NDC) – one of England’s largest area based policy initiatives – found mixed findings, but overall, the NDC programme may have reduced some health inequalities across NDC areas. Another regeneration programme and linked research study, which has purposefully set out to measure longer term health impacts of regeneration is Gowell in Glasgow.
The Big Local programme
The focus of the Communities in Control study is the Big Local programme, which aims to put decision making into the hands of residents over how funding is used to make a difference in 150 geographical areas.
Local Trust administers Big Local, a long term programme funded by the National Lottery Community Fund in 150 neighbourhoods in England. Each of these areas is awarded just over £1 million to spend over a 10-15 year period. Big Local areas, typically neighbourhoods with an average of 7600 people, were selected in 2010-12 on the basis that they had historically ‘missed out’ on their fair share of Lottery and other funding.
The programme outcomes are:
- Communities will be better able to identify local needs and take action in response to them.
- People will have increased skills and confidence, so that they continue to identify and respond to needs in the future
- The community will make a difference to the needs it prioritises
- People will feel that their area is an even better place to live
In each local area, a Big Local partnership is established, which must have a resident majority. After consulting the wider community on local priorities, the partnership draws up a delivery plan and oversees its delivery. Usually areas decide to fund or invest in a range of different activities that have a focus on economic or environmental change or that aim to build social connections between residents.
Watch the video to find out more about Big Local or visit the Local Trust website (www.localtrust.org.uk).
How might place based programmes influence health?
Place based programmes like Big Local do not necessarily have the direct goal of improving health or reducing health inequalities. Nevertheless, residents’ health and wellbeing could still be influenced through the programme’s presence in a local area.
For residents actively involved in the local programme, there may be positive benefits that come from having greater individual control. Getting involved in local action may also lead to people forming new social networks in a local area, potentially addressing social isolation. These types of impacts are important in their own right for health and mental wellbeing.
If, in gaining greater collective control, residents can take action together or with others to influence improvements in their social, economic and physical environments, then health benefits may arise for local populations living in these areas. When residents’ knowledge informs neighbourhood decision making, this is also more likely to result in actions that are more appropriate and effective than those proposed by politicians and professionals making these decisions alone.
On the other hand, if people already face considerable burdens in their personal or working lives; dealing with stressful situations when volunteering may create additional pressures that put further strain on their health. The sheer effort of attempting to change things is also not an easy task. People may become disillusioned if the process of involvement is slow or it is felt their efforts do not make the difference they hoped.
Video courtesy of Local Trust