LTP Priority: Personalised Care (universal community-based support) and Prevention
Population Intervention Triangle:
Type of Interventions: Community Centred Approaches: Service and community
Major driver of health inequalities in your area of work
The social gradient in physical and mental health outcomes – marginalised and poorer communities have poorer health.
Deprivation, Inclusion health groups and protected characteristics.
All inclusion health groups and protected characteristics are covered by community-centred approaches.
Community Centred Approaches
Scaling up a range of community-centred approaches is needed to impact on health inequalities. Evidence is included within PHE/NHSE guide (the ‘family of approaches‘ ) NICE guidance and NESTA Realising the Value. Building on the roll-out of social prescribing link workers, there is a need to develop a system-wide approach in order to have impact – creating the conditions for social prescribing to work within a wider place based approach. The family of community-centred approaches needs to be scaled-up at a neighbourhood level in an integrated way (across NHS, social care, public health, VCSE). Community-centred approaches directly address the causes of inequalities – marginalisation and powerlessness – by increasing control and empowerment, social inclusion, access to services and social resources, including social networks, and building community capabilities and resources (WHO). These protective factors also help buffer against disease (Marmot Review). Community-centred approaches engage those experiencing the poorest health and can provide a more effective and accessible approach to meeting outcomes than more traditional professional-led clinical approaches for marginalised communities. Community-centred approaches can be applied to priority clinical areas of the LTP e.g. mental health, cancer to provide more effective services to the most marginalised groups or can be non-disease specific in order to address the underlying causes of all-cause morbidity/ mortality. The evidence guide groups approaches into four delivery areas: strengthening communities (such as community-development and timebanking), peer and volunteer roles (e.g. health champions, walking for health, peer support for breastfeeding/drugs recovery), collaborations and partnerships (e.g. coproduction, participatory research) and increasing access to community resources (e.g. social prescribing, local area coordination, community hubs). Many of these approaches exist in pockets within Primary Care Networks. The preferred option is to scale up – systematise these at a neighbourhood level in an integrated way across NHS, social care, public health, VCSE). PHE’s current research into scaling community-centred approaches (in publication) also concludes that local areas achieve whole system working through 1. undertaking community insight to add meaning to local data. 2. having participation structures for decision-making and coproduction between communities and agencies. 3. building a thriving VCS sector. 4. developing the knowledge and skills of the workforce in community-centred practice. 5. having a strategic ambition across sectors to set short and long-term outcomes for building healthy communities. The secondary option is to scale one of the above mentioned interventions. e.g. volunteer and peer support for prevention, coproduction structures.
Important for reducing health inequalities: 1. not just choosing one approach to deliver in a few areas but to establish a strategic approach to scaling the family of approaches across the system at a neighbourhood (ward) level. 2. The intervention will only work if it is designed and delivered with communities. Supporting evidence from PHE guide; NICE guidance & quality standards:
- A guide to community-centred approaches for health and wellbeing (Public Health England, 2015)
- Community engagement: improving health and wellbeing and reducing health inequalities (NICE Guidelines, 2016)
- Community engagement: improving health and wellbeing (NICE quality standard, 2017)
Guidance for Commissioners