HC 1048-III Health CommitteeWritten evidence from the People in Public Health (PH 132)

This submission is based on evidence from the People in Public Health research study at the Centre for Health Promotion Research, Leeds Metropolitan University.

Key points relevant to the inquiry are:

Greater community involvement in the delivery of public health is vital. Evidence shows that involved, active communities can help tackle inequalities, design better services and improve health.

The challenge of embedding community involvement in mainstream public health is in danger of being neglected—it seems to be “falling off the agenda”. This is despite the public health White Paper emphasising its importance.

Government policy needs to give this issue a higher priority. A systematic response is required if communities across England are going to be able to seize the opportunity to become involved in public health. Supportive systems and structures are essential for action.

1. The Importance of Community Involvement

The importance of local communities in public health was emphasised throughout the White paper “Healthy Lives, Healthy People”. It said “we need to think … about how to empower people and communities to make healthier choices in their lives” (p12) that we need to “harness efforts across society” (p22) and that “we are turning to local communities to devise local solutions which work for them” (p38).

Evidence from the People in Public Health study supports this aspiration. An involved, engaged community has many public health benefits. It can help services tackle health inequalities because community members can play a major part in finding solutions to local problems and they can reach out to people who face barriers to maintaining their health. Involving people can improve the health of individuals, lead to better designed public services able to address the root causes of ill-health; and provide gateways to wider participation, new life skills, further education and employment.

We also believe that the time is right for this to happen. This is because:

The Big Society idea is extremely relevant for health.

A number of practical approaches have been piloted and proven to work on the ground ^, —in some cases there is evidence that it saves costs in the long run.

We have reached the point where there is now a critical mass of UK research to support and inform local action.

2. Achieving Community Involvement

Healthy Lives, Healthy People did not discuss how community involvement would be achieved. The People in Public Health study identified many examples of good practice—yet these are often reliant upon committed individuals and, with some notable exceptions, still exist in pockets rather than being embedded in mainstream public health. The challenge is to scale the activity up and make it a “normal way of doing business”.

Evidence from our study is clear; community involvement does not and will not happen spontaneously. Supportive systems and structures are essential for action. Community Health Champions, featured in the White Paper (p43) and winners of the Prime Minister’s Big Society Award, are examples of this. Their 12,000 health champions are part of a much larger programme (Altogether Better) and are supported by local project staff.

These supportive systems need longevity; it takes time, commitment and consistency to establish sustainable community activity. Grassroots organisations cannot be “forgotten” then expected to re-emerge as necessary.

3. Potential Threats to Community Involvement

The People in Public Health team carefully considered the White Paper and observed subsequent discussions in light of the evidence collected. We feel that community involvement has increasingly fallen off the agenda, despite it being given much emphasis in the White Paper. We feel that currently there are significant threats both to current good practice and the rolling out of good practice. These are that:

Community involvement is becoming overshadowed by other changes within the public health sector.

Practitioners’ attention and resources are being diverted by organisational change.

Funding for structures to support community involvement will be lost or become erratic.

4. Recommendations for Healthy Lives, Healthy People

It is evident that, more needs to be done to ensure that the aspiration of increased community involvement in health becomes a reality. The policy recommendations emerging from our study are:

A systematic response. If communities across England are going to be able to seize the opportunity to become involved in public health, then a systematic response is needed at across all levels of the health service. The Department of Health’s volunteering strategy (2010) is a good start.

Commissioning can be used as a way of building a local infrastructure of delivery organisations to support community development and volunteering. Short term funding cycles undermine community action so therefore commissioning should be based on an understanding of the wider, long term benefits of involving members of the public.

Investment in local support systems. There needs to be some investment to support effective implementation—people need someone to contact and perhaps help them overcome barriers to volunteering, they need training that will build their confidence to undertake new roles, they need light touch support and someone to turn to if issues arise.

Government policy needs to ensure community involvement gets an increased level of focus. Without this the substantial benefits possible from this approach will not be delivered.

June 2011