Health Champions – “unlocking the power of communities”

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By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.

Challenges

While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.


If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

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Public health in Scotland … problems and solutions

scotpho logoBy Stacey Dingwall

On Friday 11 September 2015 I attended the annual seminar of the Public Health Information Network for Scotland (PHINS) at Glasgow Royal Concert Hall. Now in its 16th year, the event provides an opportunity to keep up to date with the latest developments in public health related issues and research at both the local and national level.

This year’s sessions were focused around two themes: health inequalities in Scotland, and active travel.

Health inequalities in Scotland: causes and interventions

The first speaker of the day was David Walsh of the Glasgow Centre for Population Health (GCPH). David outlined the findings of research he’s been involved in, looking at explanations for excess mortality in Scotland compared to the rest of the UK and Europe, and in Glasgow particularly. Currently, there are still 5,000 ‘extra’ deaths in Scotland than in England each year, i.e. excess mortality.

The session particularly focused on the findings of the 2013 study, Exploring potential reasons for Glasgow’s ‘excess’ mortality: results of a three-city survey of Glasgow, Liverpool and Manchester. These three cities are home to the highest levels of deprivation in the UK and consequently, the lowest life expectancies, with Glasgow being the worst of the three. David explained that over 40 potential causes for this were synthesised as part of the research, with the following identified as among the most plausible explanations:

  • The scale of urban change post World War 2 had a larger impact on Glasgow, in the form of slum clearances, the construction of poorer housing and large amounts of high rise flats, and limited investment in maintenance of this housing.
  • The ‘socially selective’ new towns programme created social divisions, with only the wealthier and higher-skilled able to move there.
  • Different responses at the local political level – Manchester and especially Liverpool vehemently resisted the Conservative policies of the time, however this was not the case in Glasgow.

The morning also saw a presentation from Jim McCormick from the Joseph Rowntree Foundation (JRF) on rising poverty levels in Scotland and the UK since the recession. Jim suggested that the increasing casual nature of work now seen in the UK is what is driving the rise of poverty. He highlighted the hourglass shaped economy we now have, due to the disappearance of mid-level semi-skilled jobs alongside a rise in higher- and lower-skilled jobs.

An analysis of whether a National Living Wage would bring different groups up to the JRF’s annual Minimum Income Standard by 2020 was also presented; according to their findings, the only group that will be close to it is single people without children.

Physical activity and active travel in Scotland and the UK

The first session after the break saw another presentation from GCPH – this time from Bruce Whyte on trends and challenges in active travel in Scotland (i.e. walking and cycling).

It was highlighted that travelling by car remains the most popular mode for people to travel to work, despite the fact that most of the journeys undertaken are short (i.e. less than two miles long). Bruce highlighted successful initiatives in this area in Glasgow, however, including the cycle hire scheme and the development of the Kelvingrove-Anderston cycling and walking route, on which GCPH published a report earlier this year. His presentation included comment from those who use the route on its health and safety benefits, and it was suggested that its success has led to impetus for similar projects in the city.

The following presentation came from Niamh Shortt of the Centre for Research on Environment, Society and Health (CRESH) at the University of Edinburgh. She looked at the findings from research into whether the physical environment has an impact on inequalities in physical activity and active travel. Tying in with the first theme of the day, this session noted the impact of health and income inequalities on physical activity rates and travel mode choices.

The morning was rounded off by Stuart Hay of Living Streets Scotland, a charity working to promote the benefits of walking and ensure that the country’s streets are fit to do so. Stuart praised the work of the Scottish Government in this area, highlighting the development of a separate walking strategy for the country. He concluded that we have the policy infrastructure in place, and it’s now time to ensure it is implemented.


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Read our other recent articles on public health issues:

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Is 20 plenty? The evidence for lower speed limits

20mph

Image from Flickr user Edinburgh Greens via Creative Commons License

By Donna Gardiner

This week (18-25 May) it’s Walk to School Week – where parents and children are encouraged to leave the car at home and experience the benefits of walking to and from school.

The campaign is particularly important given recent evidence which suggests that the number of children who walk to school is falling. The most recent Department for Transport National Travel Survey found that only 42% of children walked to school regularly in 2013, compared to 47% in 1995/97. Indeed, Britain has one of the lowest levels of children walking or cycling to school in Europe.

A recent YouGov survey of 1,000 parents of five- to 11-year olds in Great Britain found that speeding traffic was the main reason that parents no longer let their children walk to school. In particular, 39% felt that school-run traffic was dangerous. Almost two-thirds reported that they would like to see car-free zones outside both primary and secondary schools, as well as 20 mph speed limits in surrounding areas.

20 mph limits and zones

The introduction of 20 mph speed limits and zones has received widespread interest of late, with a number of large schemes, such as the one planned in Edinburgh, capturing the headlines. The Edinburgh scheme is particularly notable for its scale. It covers over 80% of the city’s roads – effectively making 20 mph the default speed for all of its urban areas. Implementation is due to start in late 2015.

At the other end of the UK, the London Borough of Hackney has this week begun the rollout of its own 20 mph scheme, through which more than 99% of the borough’s roads will become subject to 20 mph limits by October 2015.

The Edinburgh and Hackney schemes join a host of others across the UK, including those in inner London, Liverpool, York, Bath, Bristol, Manchester, Newcastle, Brighton, Oxford and Glasgow.

Support for further implementation

Numerous campaign and road safety groups have called for the greater implementation of 20 mph zones and limits across the UK, including the Royal Society for the Prevention of Accidents (RoSPA), Sustrans, the Campaign for Better Transport, CTC – the national cycling charity, 20’s Plenty for Us, The Slower Speeds Initiative and the European Transport Safety Council (ETSC).

The UK Government have also shown support for the wider implementation of 20 mph zones and limits. In 2013, they published revised guidance to make it easier for local authorities to implement 20 mph limits and zones in their areas, and earlier this year, new guidance which further supports 20 mph limits was published by Transport Scotland.

There is also clear evidence of the public’s desire for lower speed limits. A recent YouGov survey found that the majority of respondents supported the introduction of 20 mph speed limits in residential streets (65% support or strongly support) and busy shopping areas and busy streets (72%). Improved road safety and children’s safety were the key reasons for this, along with other reasons – such as making our streets more pleasant to live in, encouraging more walking and cycling, reducing noise and improving the quality of life.

The YouGov survey echoes the findings of the British Social Attitudes Survey 2013, which found 68% of people to be in favour of 20 mile per hour speed limits in residential streets.

Talking of the Hackney scheme, Cllr Feryal Demirci, Cabinet Member for Neighbourhoods and Sustainability, Hackney Council neatly summarises the anticipated benefits of 20 mph zones:

“We strongly believe this 20 mph rollout will be better for everyone. It will mean a safer, calmer and more liveable neighbourhoods for all residents, leading to more walking, cycling and playing outside, which in turn will have a positive impact on health and the community.”

Evidence of the benefits

But does the evidence support these anticipated benefits?

One of the most commonly cited benefit of lower speed limits is improved road safety, resulting from a reduction in the number and severity of collisions. There is widespread evidence that this is the case – for example, research published in the BMJ in 2009 concluded that 20 mph zones were effective measures for reducing road injuries and deaths. Specifically, their introduction was associated with a 41.9% reduction in road casualties, with the effect being greatest in younger children and for the category of killed or seriously injured casualties.

Similar findings have been reported elsewhere, for example, in a review of evidence reported to the London Road Safety Unit, in research by the DfT and by the SWOV Institute for Road Safety Research.

There is also evidence that lower speed limits may help to tackle health inequalities. This is because children and young adults are more at risk of road traffic accidents within poorer localities than in richer urban neighbourhoods. Indeed, in January 2014, Danny Dorling, Halford Mackinder Professor of Geography at the University of Oxford, went as far as to claim that implementing 20 mph speed limits was the main way in which local authorities could effectively improve the health of the local population and reduce health inequalities.

Similarly, research published in the Journal of Public Health in 2014 reported that targeting 20 mph zones in deprived areas may be beneficial. It also concluded that “20 mph zones and limits were effective means of improving public health via reduced accidents and injuries”.

Improved public health is another often cited benefit of lower speed limits. Evidence from Bristol and Edinburgh demonstrates that 20 mph zones do indeed encourage increased levels of physical activity, including walking and cycling, and there is also evidence that they improve resident quality of life, through increased opportunities for social interaction and less noise and air pollution.

The reduced levels of pollution also mean that lower speed limits can be better for the environment.

Finally, there is also some evidence that 20 mph zones may result in increased local economic activity – with improved walking environments having many potential benefits for local business. Research conducted by Living Streets in London also found that pedestrians tended to spend more than those arriving by car.

Driver concerns and attitudes

Despite the evidence in their favour, 20 mph zones are not always welcomed with open arms. There remain a number of concerns about the implementation of 20 mph zones, including fears that they may lead to increased levels of congestion, increased carbon emissions, suffer from a lack of enforcement, increase journey times, and increase emergency response times.

Most of these concerns have been countered by research evidence; however, attitudinal barriers remain. In an analysis of a YouGov survey of public attitudes towards 20 mph zones, Professor Alan Tapp of UWE Bristol, reports that a sizable minority of people (31%) claim that ‘If a 20 mph speed limit is introduced, I may not stick to it’. He also points out that 49% felt that ‘It is just too difficult to stay at 20 mph’ and almost a third of people (30%) thought that 20 mph is an example of a nanny state.

The way forward

So despite the progress that has been made, there is clearly still some way to go before 20 mph limits and zones become a fully accepted part of UK towns and cities. Implementing more 20 mph limits is only the start – it seems that there is also a need for local authorities to tackle the negative perceptions of 20 mph zones held by many drivers in order to ensure that 20 mph limits are adhered to in practice.

Sharing evidence of the positive benefits of 20 mph zones and demonstrating that many of the main concerns associated with them are ill-founded is likely to play an important part in encouraging more positive attitudes, changing driver behaviour, and in turn, make streets safer and more enjoyable for children and adults alike.


 

The Idox Information Service can give you access to further information on improving road safety. To find out more on how to become a member, contact us.

Further reading:

Addressing health inequalities: five practical approaches for local authorities (Perspectives in Public Health, 2014)

Reducing unintentional injuries on the roads among children and young people under 25 years (Public Health England, 2014)

Road safety and public health (The Royal Society for the Prevention of Accidents, 2014)

Achieving safety, sustainability and health goals in transport (Parliamentary Advisory Committee for Transport Safety (PACTS), 2014)

Unlimited aspiration for a calmer city (speed limits) (Local Transport Today, 2011)

Sign of the times (20 mph speed limits in Portsmouth) (Parking Review, 2010)

Review of 20 mph zone and limit implementation in England (Department for Transport, 2009)

Public Health Information Network for Scotland (PHINS) – 14th Seminar

Image of outside of the Glasgow Royal Concert Hall.

Image by Neil Turner under Creative Commons License, via Flickr

By Steven McGinty

On the 10th October I attended an annual event organised by the Scottish Public Health Observatory (ScotPHO) in the Royal Concert Hall in Glasgow. The event focused on health inequalities and the factors driving them. It brought together individuals from a variety of areas, including academia, public health organisations, local and central government, and the voluntary sector to review current evidence, highlight upcoming research and debate key issues with fellow professionals. Continue reading