Local examples of interventions to help tackle health inequalities
Please note: This work was not carried out by the Marmot Review Team and all links are external to this site.
Gloucestershire has launched a pioneering toolkit to help professionals create buildings and natural environments that support people to get more active.
How our villages, towns and cities are laid out, and how people move around them, all affect the amount of exercise that we get in our everyday lives.
The 'Active Planning' toolkit, a national first, provides a practical guide for planners, architects, and developers to help them 'design in' features which encourage physical activity, such as making stairs easy to find, and linking shops and workplaces to walking and cycling networks.
To download the toolkit, please click here.
Finnish authorities have drawn up this strategy with the purpose of achieving a socially sustainable society in which people are treated equally, everyone has the opportunity to participate, and everyone’s health and functional capacity is supported. The strategy has been produced in dialogue with interest groups and partners and together with the strategies of agencies in the adminstrative sector and the strategic lines in various policy areas constitute a strategic framework that is knowledge-based. The Finnish authorities have the will to put into practice and implement the strategy and are aware that it will require extensive national and international cooperation, interaction and open communication. In practice, it can only be done through democratic decision-making and in accordance with the policies of the Government Programme in effect at any given time. Social sustainability is both a means and an end.
To read the full strategy, please click here.
The Welsh Assembly Government has produced a new technical working paper as part of their Reducing Inequities in Health Strategic Action Plan. The paper, called Fairer Outcomes for All, includes the following key action areas:
- building health into all policies and all policies into health;
- giving every child a healthy start;
- developing health assets in communities;
- improving health literacy;
- making health and social services more equitable;
- developing a healthy working Wales; and
- strengthening the evidence base.
Click here to read the full paper.
Click here to go to the Welsh Assembly Government website.
This project works with a number of local partners who have some excellent examples of how they are tackling health inequalities in their areas.
Cornwall
Cornwall did a Health Equity Audit which is available on the IHAL website. Following this have employed a specialist health promotion nurse for people with learning disabilities. They are working on four key areas of sexual health, obesity, cancer screening and oral health.
Cornwall also has six 'Changing Places' (loos and changing rooms fitted with hoists etc. for people with complex needs). There are two in Penzance, one at Ships and Castles in Falmouth, one at Wadebridge Camel Trail, one at Falcare (Independent Sector) and one in the Priory Centre car park in St Austell. Radar Keys to enter the Changing Places buildings are available and links on the websites are being made available so that people know where they can get them from. More are planned for next year.
Sheffield
Sheffield has a project to help people with a learning disability train as ' Health Champions'. Their role is to help other people with learning disabilities to stay healthy.
Westminster
Westminster has a healthy living group, 'Choosing the Chance to Change', which was set up to support people with learning disabilities to lose weight. The 8 week course looks at choosing healthier foods and different ways of exercising each week.
There is also a 'Good Sexual Health Project for people with learning disabilities at Westminster' which provides:
- Sex and relationships education for people with learning disabilities through individual or group work.
- Sexual health training for staff working with/supporting people with learning disabilities.
- Suport work with parents and carers of people with learning disabilities.
- Opportunities for people with learning disabilities to access support around sex, sexual health and relationships.
For more information, please visit their website.
Community regeneration project in the most deprived area within Plymouth. Stonehouse Community Gym has adopted a social model of health that takes the focus for tackling health inequalities away from health care alone and incorporates individual lifestyle factors, social and community influences, living and working conditions and overall general socio-economic, cultural and environmental conditions.
For more information click here.
- NHS Bristol employ a public health specialist for people with learning disabilities
NHS Bristol, a commissioning PCT, employs a public health specialist for people with learning disabilities directly within the public health workforce. The role, situated within the equality and inclusion team, has enabled recent local assessments to be completed on a range of issues including sexual health, general health and the needs of older people. A local acute CQUIN includes meeting the needs of patients with learning disabilities in a local hospital. Commissioners have recently started consulting with people with learning disabilities, and people with learning disabilities are commissioned to deliver learning disability awareness training to all staff. The Public Health admin team includes a staff member with learning disabilities who helps any staff requiring support in writing accessible documents and reports. This public health specialist post is thought to be the only one in the country, and it was recognised by Sir Jonathan Michael in his report Healthcare for All, as an example of national best practice.
Lesley Russ, who currently holds this post, said “the needs of people with learning disabilities are frequently neglected in national health inequalities reports, the work of public health departments or JSNAs and other local needs profiles. As a result of this situation there is limited knowledge, ownership or evidence on the needs of learning disability populations and ownership of the issues are felt to sit outside of the remit of public health departments and mainstream health services. This issue has to be addressed for this population’s extreme health inequalities to be effectively tackled.”
- Belfast Health and Social Care Trust
Belfast Trust is the provider of health and social care to all of Belfast, from Regional Hospital Services for Northern Ireland to community health and social care. They have recetly launched their health inequalities strategy and action plan for 2010 - 2011.
To read the full health inequalities strategy, please click here.
To read the action plan 2010 - 2011, please click here.
- Cambridgeshire and Peterborough NHS Foundation Trust Peer Worker Programme
The Camridgeshire and Peterborough NHS Foundation Trust have signed the charter for employers who are positive about mental health. They have put in place a peer worker programme, which aims to inspire hope and optimism, and provide empathy, mutuality, and friendship. Peer support workers have a lived experience of mental health issues, and use this to motivate and encourage others. The programme has been successful in cutting re-admission rates and the use of seclusion and restraint measures.
Please Click here for more information.
The ReachOut Project is undertaken by the local Citizen's Advice Bureau, and developed in partnership with NHS North East Essex, Essex County Council and the Interaction Partnership. During the pilot, CAB staff knocked on doors offering advice and services to people in two areas of high deprivation. The reason for the involvement of the NHS is that "there is strong evidence that by addressing wider influences on health, such as low income, poor housing, low education, training or employment opportunities etc. we can produce real, positive benefits to the overall health of the community."
Please Click here for more information.
- Addenbrooke's Hospital Travel Plan
Cambridge University Hospitals NHS Foundation Trust has an 'Access to Addenbrooke's' strategy to encourage more sustainable and health methods of transport to the hospital. It includes the first ever NHS commissioned and managed public bus service and the Space Programme to encourage peole to leave their cars at home.
Please Click here for more information
- NHS Mid Essex Outdoor Gym
Chelmsford Borough Council has set up two new outdoor gyms, suitable for children age 8 to adults. The equipment is suitable for wheelchair users, and visitors can get a workout card to record their progress.
Please Click here for more information
- Luton PCT, Nourishing Neighbourhoods Objective
To help improve the health of people in hard-to-reach communities in Luton, this project makes fresh fruit and vegetables more easily available. In addition, it encourages physical activity through gardening and the promotion of sustainable local produce.
Please click here for more information
- Luton's Affordable Warmth Strategy
The Affordable Warmth scheme was officially launched in 2001, and is a multi-media referral portal aimed at providing holistic, robust services for vulnerable households especially those suffering from fuel poverty. The scheme ws awarded Beacon status for 'Tackling fuel poverty' in 2003.
Since 2001 the Scheme has helped over 5,000 households in the Borough of Luton, putting them in touch with services such as Warm Front, money advice, and a fast route into Social Services, home fire safety checks, emergency heating provisions plus much more.
Please Click here for more information
The Thetford Healthy Town Programme aims to make it easier for adults and children to live healtheir lives. There are three main areas of activity:
- Healthy living - helping people to become active and enjoy a healthy lifestyle
- Healthy travel - advice and support to get people biking and walking
- Healthy food - providing help so people can eat well and prepare healthy, inexpensive food.
Please Click here for more information
- Healthy Ambitions Suffolk
Healthy Ambitions Suffolk is a project aiming to make Suffolk the healthiest county in the UK by 2028. They aim to inspire people to make small changes that will have an impact on their health and wellbeing.
Please Click here for more information
- Bedfordshire Health Checks
The free NHS health checks in Bedford's local communities aim to provide health checks for 40 to 74 year olds to help detect the early signs of vascualr conditions such as heart and kidney disease, stroke or diabetes. The health checks are carried out in local settings such as community, voluntary, and faith groups so that all residents are reached.
Please Click here for more information
- Altogether Better programme, Yorkshire & Humber
The Altogether Better programme in Yorkshire & Humber seeks to reduce health inequalities using an empowerment approach to improved well-being. They have a network of 16 projects supporting more than 11 000 Community Health Champions across the region.
As part of this programme, three evidence reviews have been written by the Centre for Health Promotion Research at Leeds Metropolitan University and can be downloaded here or found on the external reports section of this website.
For more information about the Altogether Better programme click here.
- Vacant Lot Partnership, North and East London
Vacant Lot originated as an exploration of land use in urban social housing settings.
A temporary, carefully designed food growing area was created on the fenced-off and overgrown site of a former playground.
Residents of the surrounding blocks of housing were leafleted and came to help move soil and claim a growing plot.
Neighbours met for the first time. Being part of the Vacant Lot allotment allowed them to claim a piece of their familiar yet inaccessible surroundings as their own. Most importantly for them, they could plant; water, weed and watch things grow. Families grow vegetables to add to their dinner plates. City worker’s pass by in the evening to sweep around their plot and crop a handful of herbs to add to their evening meal. Grandmother’s teach their grandchildren how to plant and nurture a seed, a few seconds after learning themselves from the back of the packet. Birthday parties are held around the barbeque.
Wider links are formed, younger people help the more elderly with their weekly shopping and skills have been transferred such as a Vacant Lot user fixing another’s washing machine.
People say hello
The project is ongoing and in partnership with social housing providers and Groundwork it is currently being expanded to 20 new sites, addressing areas of deprivation across North and East London.
For more information click here.
- Sandwell Healthy Urban Development Unit (SHUDU)
SHUDU was developed in early 2009 to explore the potential of healthy urban development. The objective is to create a sustainable healthy borough in line with the Marmot Review policy onjective to create and develop healthy and sustainable places and communities. Read more abour SHUDU here
- Mitchell’s story: Personal health budgets
Key Message: Giving more power and control to an individual can make a big difference to the quality of their life.
Mitchell was born with complex health needs. Although his family were delighted to have him home rather than in the hospital, they found it difficult relying heavily on a home care package commissioned from the acute Trust, feeling powerless and scrutinised in their own home. Mitchell has had a personal health budget for nearly three years and it has significantly improved the quality of his life (and the rest of the family). He hasn't had a hospital admission during this time which is remarkable given the complexity of his needs. Read more about Mitchell’s story here.
- Wild Zones: Nurturing a generation of youth who love the earth and love their own lives
Wild Zones are places where adults, children and adolescents can co-create a new form of public space that is dedicated to unstructured free play in nature. This is an asset-based and intergenerational approach to public health and community development.
Wild Zones differ from parks and nature reserves because they offer opportunities to interact with the environment rather than leaving it untouched. People of all ages are invited to build dens, make sculptures from natural materials, dig holes and play with water, mud and rocks – all things that previous generations were able to do on empty plots of land, in woodlands, or in other marginal spaces in urban areas. The initial motivation for participating in Wild Zones is usually a chance for children to play in nature, but one of the greatest benefits is the visible contribution to community life the sense of social participation.
Between100-400 people have been coming to their monthly Family Play Days in Santa Clara, California. They are highly diverse ethnically and economically: families of Silicon Valley CEOs playing alongside illegal immigrants. They are moving back to England after several years working in California and will have their first Wild Zone Play Day on a housing estate in Abbey Wood on August 7, in partnership with Avant Gardening, NHS Greenwich and Greenwich Council on improving the wellbeing of people living on council estates in areas of multiple deprivation in Greenwich through a new multi-agency research initiative called Feeling Good About Where You Live. Read more about Wild Zones here
- Brighton and Hove Local Involvement Network (LINk)
Brighton & Hove LINk are working in communities to raise awareness of the importance of getting blood pressure checked. They have an outreach worker who does monthly Gypsy and Traveller site visits with a worker from a national Gypsy and Traveller charity. On these visits, the outreach worker also asks for any health and adult social care issues, and raises awareness of hypertension testing. This has been effective in raising awareness and identifying issues.Read more about B&H LINk here
- Nottingham Counselling Service
The Nottingham Counselling Service is an expanding local charity which has supported thousands of people in Nottinghamshire since 1975. Their core aim is to promote emotional health and wellbeing through by providing inclusive, accessible counselling services.
As an organisation they are already making significant contributions to reducing health inequalities within the local area.
Read more about Nottingham Counselling Service here
Read their 5-year strategy here
- Active Travel Erewash Project
In April 2010, Choose Cycling were given £9,500 funding from NHS Choosing Health in Erewash for the Active Travel Erewash Project. The main aim is to increase walking and cycling in the Erewash area, through local organisations. It was decided that the best way to engage businesses in this area would be to hold an “Active Travel Challenge” over the summer, getting businesses to compete against each other to see who can get the most staff to walk, cycle or run. The Challenge offers free incentives to engage in active travel, by offering prizes (some are health-related, such as recycled bikes) from local sponsors for both individuals and organisations as part of the Challenge.
Read more about the Active Travel Erewash Project here
- Asgard Project, Grimsby, North East Lincolnshire
The Asgard project began in 2008. It is about improving the health and well-being of disadvantaged young people in the area. The key aims of the project were to encourage personal responsibility for health and well-being, increase resilience by creating a proactive relationship with universal health and social care services, and promote teenager's economic independence.
Research was carried out to see what young people needed and wanted, and two key project elements began to emerge. One strand - 'the Asgard emergency care project' - targeted the young people ending up in A&E, through an 'outreach service' and support workers. The support workers acted as professional 'friends' and would help them access tailored support on a range of health issues. The other strand - 'the Asgard young people's employment project' - offered work placements to nine young trainees with the Care Trust Plus, the only organisation of its kind that has combined a PCT with the Local Authority Social Care Provision to integrate health and social care in the area). A third strand is in its consultation phase. The project has already helped 234 young people.
Read an article from the 'Every Child' journal about the Asgard project here
Read an article from the 'Primary Health Care' journal about the project here
See a powerpoint presentation focusing on the first strand of the project here
See a powerpoint presentation focusing on the second strand of the project here
MEND offers free, evidence-based obesity prevention and treatment programmes in the local community for children aged 2-13. Established in 2004, the MEND Programme was devised by child obesity experts at Great Ormond Street Hospital for Children and the University College London Institute of Child Health, to help children and their families become fitter, healthier and happier.
MEND works with local, regional and national partners to deliver over 400 programmes across the world which have benefitted over 20,000 families. In addition to MEND's healthy lifestyle programmes for children and their families, MEND offers class room resources, obesity management training for front-line staff and facilitated self-help programmes for adults.
An independent study published in Obesity Journal in February found that children who attended the MEND Programme experienced long-term health benefits, including sustained weight loss and improvements in cardiovascular fitness and self-esteem.
View a powerpoint presentation about the MEND programme here
Read more about MEND on their website: www.mendprogramme.org
- The Tenant's Dilemma: vulnerable people facing retaliatory eviction
Tenants living in the private rented sector have statutory rights. However, if they exercise these rights, they are at risk of being legally evicted. Under current UK law, if a landlord serves a Section 21 notice correctly, then the tenant has just two months to find a new home - there is no protection or right of appeal. This is commonly known as retaliatory eviction. Debbie Crew faced this very situation when she advised a woman with Crohn's disease who was living in unsafe premises. She was unable to help this vulnerable woman as the risk of eviction was too great, so she set off as a lone voice to try and raise the profile of the injustice of the issue that allows vulnerable people to live in unsafe homes.
This was no easy task as gaining evidence on the issue is difficult - there is no register of the private rented sector and properties are not required to be surveyed to ensure they are safe before they are rented out. Along with evidence from UK Citizen's Advice Bureaux and Shelter, Debbie surveyed 130 Environment Health Officers and Tenancy Relation Officers of whom a shocking 98% said that a change in legislation was needed. Debbie researched how this issue is dealt elsewhere in the world. Europe has a much larger private rented sector, and evidence shows the problem is limited because tenant's rights are prioritised. However, Australia, New Zealand and the USA have laws against retaliatory eviction and have done for over 40 years. Debbie compiled all the information into the report 'The Tenant's Dilemma', the launch of which kick-started a major campaign that spread nationally gaining the support of many leading housing experts and inspired the then Housing Minister Yvette Cooper MP to commission a review of the private rented sector.
Read the report, 'The Tenant's Dilemma', here
Read the press release here
- Fit for Life - Community First Coaching
Fit for Life is a unique initiative developed by Community First Coaching to support the growing number of people whose personal or working lives are affected by stress, anxiety, depression, suicidal ideation, poverty, unemployment and life trauma with the aim of:
-Reducing the high level of long term and sporadic anti-depressent use
-Reducing the number of repeated GP visits
-Reduce the huge financial cost in terms of services/ resources
-Provide an additional resource which responds to the needs of both the client/ patient and referring service
-Provide a positive, time bound, solution focussed service without negative stigma
-Promotion of measurable and validated results
-Promote self-help within their own community - supporting people ot 'deal' with life adversity
-Support people affected by work related stress to return to work faster and healthier
-People are empowered to take responsibility for their own recovery
The initiative was recently piloted to specific GP surgeries in Belfast.
For more information, please download this leaflet or visit the website www.communityfirstcoaching.co.uk.
This intervention serves the Aboriginal Community in the Northern Territory in outback Australia, an area of 322,514 sq km. It provides eye care for this area, where a lot of the population have problems accessing neccessary medical care.
For more information, please download this presentation.