A few days after the announcement of the British referendum to leave Europe, I had the opportunity to visit the Well London initiative as part of the European Joint Action on Chronic Disease (JA- CHRODIS). CHRODIS JA is a European collaboration that brings together over 70 partners from 26 Member States and in Ireland the IPH collaborates with the Health Service Executive and European Institute of Women’s Health on the project. CHRODIS aims to promote sharing of knowledge across member states to enhance the prevention of chronic diseases, in particular heart disease, stroke and diabetes. This was the last of a series of site visits taking place as part of CHRODIS. The visits facilitate knowledge exchange on models of good practice in health promotion and a discussion on how transferable these models may be to one’s own country.
Day one of the visit began with an in-depth presentation and questions and answer session with representatives involved in the design, delivery and evaluation of Well London. Well London is one of the largest initiatives of its kind in the UK that aims to improve health and wellbeing and tackle health inequalities by acting on both health behaviours and the wider social determinants of health. The first phase, initiated in 2007 saw the development, delivery and evaluation of around 14 interventions in 20 of the most deprived areas of London. The evaluation of the second phase involving 11 neighbourhoods was published in September 2015 - this new evidence is now filtering through the UK and Ireland health promotion community. Well London uses principles of asset-based community development to co-produce change with, by and for the local community.
Our study group comprised Italians, Welsh, Icelandic, Spanish, Norwegian, German, English, Dutch and Irish public health and health promotion professionals. We visited Woolwich Dockyard Estate in Greenwich. There we met with local Well London co-ordinator Kelly-Ann Ibrahim and participants in the community garden, Men in Sheds, computer literacy and mental health first aid training initiatives.
These sorts of initiatives and, indeed, the practice of asset based community development will be familiar to many involved in health promotion; they are neither new nor unique to Well London. So what is new about Well London?
An approach – not a project
Most community development initiatives rely on short-term funding and therefore often have a limited capacity to engage in comprehensive longer term evaluation. What is new about Well London is that it is not a project –– the framework is designed to be embedded as a mainstream approach – a different way of working rather than a fixed term intervention. The approach fosters long-term sustainable strategic change and integrates with local infrastructure and commissioning processes. In summary, the aim is to make health promotion through asset-based community development the ‘business as usual’ model. It fits very well with the recent Public Health England Fit for the Future document which calls for “ a place based community centred approach with decision making at local level” to effectively support health promotion. In this way, it builds on learning from, and can easily integrate with, Health Action Zones and Healthy Cities initiatives.
Social determinants of health - the causes of the causes
Well London addresses social determinants of health as well as health behaviours. It achieves high levels of participation in deprived communities – an achievement that has proven elusive to many health inequality initiatives. Empowerment is the primary concept used to theorise the causal pathways by which activities impact on individuals and communities to produce change. Confidence, knowledge and skills, new education and job opportunities and expanded social networks and community cohesion were valued and also measured.
Implementation and evaluation
The scale and quality of the evaluations of Well London are impressive. A defined evaluation framework was devised which was theory based and assessed both process and outcomes indicators using mixed methods. Impacts were evaluated at participant, project, community and programme level. Within the evaluations there were randomised controlled trial components as well as a longitudinal cohort survey. The evaluation showed improvement between baseline and follow up in all five outcome areas of physical activity, healthy eating, mental wellbeing, social connectedness and volunteering.
A model of good practice...
Addressing health inequalities forms a central commitment of both the Healthy Ireland and Making Life Better public health frameworks. Well London has now been rebranded Well Communities as it seeks to demonstrate its applicability within other urban centres across England. I look forward to reading the findings from the cost-effectiveness evaluation due later this year. I think there is sufficient evidence to consider whether a similar flagship programme might bring benefit to Dublin or Belfast building on the strong bedrock of community development evident in our capital cities North and South.
Further information on the items mentioned in this blog can be accessed using the hyperlinks below: