1. Better health for all Londoners - London strategies for tackling health inequalities with communities in the lead
Presentation to Dutch Congress on tackling health inequalities
Gail Findlay
Director of Health Improvement
Institute for Health & Human Development

2. What I will cover in my presentation
The London context  
Looking back – progress, successes & drivers of change
Current strategies in London tackling health inequalities
Looking forward - key challenges & opportunities
Missing link? - empowered and connected communities
The Well Communities framework approach
Well London in action – short film
Conclusions and key messages

8. Deprivation in London

9. Life expectancy

10. Health expectancy

12. London structures
Regional government: Mayor and Greater London Authority and Assembly Members
33 borough Local Authorities (LAs): local Mayors and Councillors
NHS structures – NHS England - London; Clinical Commissioning Groups (CCGs), Primary Care, NHS Trusts
Health and Well being Boards at LA level
Public Health positioning – locally in LAs; regionally in Public Health England London
Complexity ….. subsidiarity…politics

13. Looking back…
Black report (1980), Acheson Inquiry (1998), Marmot review (2010) …a good benchmark
Successes in London – eg: Educational attainment; Big Smoke Debate; London Living Wage
‘Convergence’ around London 2012 Olympics
Impact of National policy – austerity’; welfare reform; housing
Drivers of change – ‘austerity’; pressures on NHS

14. • • • • • ‘Campaigning for change’ • • • • •

15. Marmot policy recommendations … a good, evidence based benchmark
Give every child the best start in life
Enable all children young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Ensure healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention

16. Current strategies tackling health inequalities in London
London level – Mayor of London’s new Health Inequalities Strategy
Local Authority (LA) level – Health and Wellbeing strategies
Other relevant LA strategies eg: Community Resilience (Newham); Communities Driving Change (Tower Hamlets); anti-poverty (Greenwich)
Primary Care/Community/neighbourhood level – eg: Social prescribing; Well London
A broad fronted approach

17. What is the Mayor of London’s role in health inequalities?
The Mayor has 3 key roles around reducing health inequalities: Ensuring all his work contributes; championing work across the capital and directing support from City Hall.
However, the Mayor cannot reduce health inequalities on his own.
He is committed to working with others to address these problems now – the NHS, local councils, Public Health England, London’s organisations, businesses, community & voluntary sector, funders etc.
Mayor doesn’t set health policy or commissioning health or public health services

18. Why does London need a new health inequalities strategy?
Health & Social Care Act 2012 reforming the health and public health system
NHS Five Year Forward View establishing a vision for prevention
Introduction of Sustainability and Transformation Plans and place-based planning
National health policy change
London Health and Social Care devolution
New policy commitments from a new Mayor of London
Better Health for London ten shared ambitions
London health policy change
Population growth, and demographic change with more diversity and a younger population
Rising poverty, much driven by housing costs
Changing working patterns and the growth of the gig economy
Social and economic change
- Stark health inequalities still exist across the capital.
- Too many Londoners are still suffering ill-health due to social and economic exclusion.
- How long Londoners can expect to live in good health varies enormously across London.
Social and economic changes are also having an impact: a growing population, an increasingly diverse and young demographic, changes to the health and social care system, with some services devolved to London. The Mayor has also made new commitments to address health inequalities.

19. London Health Inequalities Strategy draft aims
The draft Strategy has 5 main aims:
1) Healthy Children: Every London child to have the best possible start in life.
2) Healthy Minds: A city which has the best mental health in the world.
3) Healthy Places: A society, environment and economy that promotes good mental and physical health.
4) Healthy Communities: London’s diverse communities to be healthy and thriving.
5) Healthy Habits: To make the ‘healthy choice’ the easy choice for all Londoners.

20. Aims
AIM 1 - healthy children: every London child has a healthy start in life
AIM 2 - healthy minds: all Londoners share in a city with the best mental health in the world
AIM 3 - healthy place: all Londoners benefit from a society, environment and economy that promotes good mental and physical health
AIM 4 - healthy communities: London's diverse communities are healthy and thriving
AIM 5 - healthy habits: the healthy choice is the easy choice for all Londoners

21. Reducing Health Inequalities in London needs a partnership effort
Multiple & cross cutting discussions to take place across the London system during Sept - Nov to stimulate system commitment to action
Work with partners to co-produce and work collectively with business, public sector and civil society partners to work on ideas/proposals to implement in the short to medium-term
Collectively developing a set of indicators that will help us measure our impact
Stimulate action (pledges) and propose to capture these on a London pledge board available in late Autumn 2017
Activity and progress steered by the London Prevention Board with its broad membership stimulating city-wide action
A vision to add & grow city-wide commitment to reducing health inequalities & celebrate success throughout 2018 & beyond
The Mayor is committed to working with partners to reduce London’s health inequalities.

22. Looking forward - key challenges & opportunities
Individual versus community orientated approaches
Medical versus social determinants model of health
Top down versus bottom up approaches
Translating policy into practice – the individual, top down, health behaviour change ‘drift’
No quick fix or single solution - the need for long term, broad fronted strategies ‘in for the long haul’ (Acheson 1998)
New focus on health creation
Empowered and connected communities – the missing link?
…but a very different way of working

24. A framework that enables communities and local organisations to work together to improve health and wellbeing, build stronger communities and reduce inequalities.

25. Recognised nationally & internationally
Ranked amongst 41 ‘best practice approaches’ across Europe by CHRODIS (2015).
What Works Centre for Wellbeing (2015), as a ‘pioneer’ and model for community engagement approaches in health and wellbeing.
Featured in the ITN documentary ‘Improve and Protect’ for the Royal Society of Public Health (2015)
Won a RSPH Award at the highest level in 2011 and was endorsed by Professor Sir Michael Marmot

26. The Well Communities approach
Refocusing of investment in Well Communities hubs
Work at very local level – focus in most deprived/highest need areas and ‘ripple out’ effect – proportionate universalism
Re focusing of investment to realise and develop community assets - especially people themselves in the target areas
Building on, adding value to, coordinating, integrating and bringing coherence and a more systematic approach to existing local work
Development of strategic and commissioning orgs, local delivery orgs
Rigorous project management, monitoring and evaluation
A ‘new’ approach??????? 26

27. Vision and mission
Empowered local communities, who have the skills and confidence to take control of and improve their individual and collective health and wellbeing.
Develop a robust, evidence-based framework:
for communities and local organisations to work together to improve health and wellbeing, resilience and reduce inequalities
that will influence policy and practice to secure real enhancements to wellbeing and reductions in health inequalities across all communities in our capital city and beyond.
Build a wider Well Communities alliance to share learning, further develop, and protect the fidelity of the framework approach as it is further collaboratively developed and refined.

28. Phase 3 Phase 2 Phase 1 - Building wider collaborations & partnerships
Scaling up and embedding in mainstream
Local Authorities, Housing Assocs., Primary & Integrated Care
London and beyond – rural, & semi-urban
Organisational development, toolkits, cascade training, resources etc.etc
Phase 3
Local commissioning model
Replicability and scalability
Primary Care based pilot
Housing Association based pilot
Phase 2
Initial development of model
20 LSOs across 20 London boroughs
Proof of concept
Phase 1
- Central advice & support services to ensure ‘fidelity’ of the model (not for profit)
- Building wider collaborations & partnerships
- Research and development of the model

29. Engagement & capacity building
Community focussed care (linking programme of action and new ways of working at primary and secondary care levels)
Better
health,
wellbeing
& resilience
Outcomes
Participation; support networks; empowerment;
self esteem; resilience; cohesion; employment; behaviours; use of services.
Intermediate outcomes
Linking programme & new ways of
working into primary & secondary care; hotspots for LTCs, multiple morbidities etc.
‘Community focussed’ primary & integrated care
Community led action on priority issues; refocusing of investment, services and public health initiatives & new ways of working.
‘Grassroots’ projects
Community development & capacity building:
Coordination & communications; stimulating local volunteering (WLDTs); young leaders/apprentices; training communities; outreach to vulnerable groups
Engagement & capacity building
Community, patient & stakeholder Engagement in needs and
assets Assessment: mapping; community cafes; appreciative enquiry; priority setting; co-production in Design of the local programme - ‘CEAD’

30. Common themes identified by Well London communities
Bringing the community together*
“I want to live in a community which I feel part of and safe in”
Community safety
Young People
“…scared of and for the ‘youth’… and ‘youth’ scared of each other”
Green space, parks, cleanliness
Skills and employment
Mental wellbeing
Fast food and healthy eating
Local communications*
Coordination* and sustained support*
*Action on these issues built into all project activity. 30

31. Volunteer Delivery Team
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32. Young Leaders

33. Training Communities

34. DIY Happiness
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35. Activate London
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36. Buywell and Eatwell
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37. Healthy spaces
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38. Be creative –be well
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39. Impact (Phase 2)
18,746 individuals participated - 35% of total ‘target’ population
Participant reported benefits strongly positive
Targets for proportion of participants reporting positive change exceeded in all five outcome areas: physical activity, healthy eating, mental wellbeing, social connectedness and volunteering
Statistically significant change demonstrated in relation to:
physical activity (total MET minutes of physical activities per week),
healthy eating (total quantity of fruit and vegetable in yesterday’s diet)
mental wellbeing (hope scale scores and its two subscales of agency and pathway).
Participants in high fidelity areas had significantly higher odds of reporting:
increased levels of physical activity
increased total physical activity MET minutes per week
better understanding of mental wellbeing

41. Participant impacts (phase 2)
82% more physically active
54% healthier eating
54% increased mental wellbeing
31% increased social connectedness
60% more volunteering

42. Other key outcomes Numbers accessing training and qualifications
Qualitative evidence and inspiring case studies:
people progressing to paid employment
Increased community cohesion
Increased community networks and connections
Increased capacity of local CVS
improved relationships and integrated working between local statutory and CVS orgs
Transformed community spaces
Additional resources levered into deprived neighbourhoods

43. Key learning/success factors
Target communities identified on basis of ‘natural neighbourhoods’
Intensive, inclusive & transparent community engagement from outset
Time built in to build relationships and trust
Clearly defined, skilled and resourced local coordination
The ‘heart of the community’ capacity building projects
Target area residents only
Well London volunteers identified and trained early
Special attention and resources to ensure young people’s engagement
Good lines of communication at all levels – Local Steering Group & Neighbourhood Advisory Groups
Senior representation on the Steering Group
Strong positive partnerships between all strategic, local players and community

44. Well London short 3 minute film:

45. Conclusions
Local government leadership key in tackling health inequalities
A broad fronted and community orientated approach
Addressing the social determinants of health
Avoiding the ‘individual, health behaviours’ drift
Health inequalities in all policies
Partnership – collaboration and coalition at all levels
Invest in health creation by engaging, empowering and connecting communities

46. More information: Contact: E-mail: g.findlay@uel.ac.uk
New Well Communities website
in development:
Short film:
Short animation: