Health inequalities and health creation

According to Office for National Statistics 2014 data, females in the most advantaged areas can expect to live 20.1 years longer in ‘Good’ health than those in the least advantaged areas. For males this was 19.3 years.

Social housing is often located in neighbourhoods that are relatively disadvantaged and where residents have relatively poor health outcomes. In some places, though, it is people living in localities with high levels of older private housing who experience the poorest health.

Housing organisations and councils, in their environmental health role, are focused on these localities and actively working to improve people’s health and wellbeing.

Focus on improving particular neighbourhoods with poor health 

Resident-led and asset-based community development

Attention to the wider determinants of health 

Focus on improving particular neighbourhoods with poor health

Increasingly, local authorities are finding ways of proactively addressing poor health within neighbourhoods they have defined as being in ‘health poverty’. They identify these neighbourhoods by bringing together datasets relating to factors such as income, physical and psychological morbidity, multiple deprivation (IMD), housing condition, and social capital. Once those at greatest risk of poor health outcomes have been identified, visits are made, an assessment of the household’s circumstances carried out and actions are taken to prevent worsening of people’s mental and physical health.

Liverpool Healthy Homes programme does this and, once identified, case workers work with vulnerable households to reconnect them to agencies that can help, including health services.

As a CCG or group of practices, you might want to consider ways in which primary care connects into this preventative work, or even look at establishing a similar programme with the local authority.

As a GP, and if your council has an established or emerging programme of this nature, you could refer those patients who you believe may benefit from a visit from a caseworker.

Resident-led and asset-based community development

Resident-led and asset-based approaches are rising in popularity across health and social care. Some housing organisations are actively taking forward programmes in disadvantaged areas where they own homes.

Programmes vary from locality to locality, but they have some common elements including:

  • a starting point that recognises residents as the solution to social and health problems, not the problem
  • a means of seeking and locating the assets and energy for change within the community and enabling that to flourish through connecting residents with each other
  • developing residents as and when appropriate to equip them to take up roles, such as neighbourhood leaders, community researchers
  • creation of a new dynamic between residents and service providers whereby residents play active roles in designing and running services, alongside providers.

Evaluations of resident-led and asset-based community development have shown significant improvements in health and cost-savings to the NHS.

For example, the Health Empowerment Leverage Programme (HELP), based on the Connecting Communities (C2) programme and commissioned by the Department of Health showed, through a cost-benefit model, the following:

  • Applying this model in three neighbourhoods, a health agency could expect to save over £1,414,000 over three years or £471,400 a year
  • Investment in the 20 per cent most disadvantaged neighbourhoods in a local authority or CCG area (say nine neighbourhoods out of 45) would produce a health saving of £4,243,000 over three years, or just over £1.41m a year.

See this 2 minute clip from a C2 programme in Kent

As a CCG or group of practices, you might consider commissioning, or contributing in other ways to, one or more resident-led or asset-based community development programmes in your locality, and invite housing organisations to participate.

Attention to the wider determinants of health

Housing organisations help their residents to keep themselves in good health in many ways. Many have healthy eating programmes, gardening and horticulture clubs, provide opportunities for exercising, support ‘stop smoking’ campaigns, help people to secure a job and offer advice on money matters including claiming benefits.

Many use the Warwick Edinburgh Mental Well Being Scale (WEMWBS) to assess the change in wellbeing as a result of engagement with the programme.

As a CCG or group of practices, you might want to identify ways in which you can work with housing organisations to enhance their ‘wider determinant’ programmes.

As a GP or practice manager, you might want to familiarise yourself with the range of services available from local housing partners, and guide your patients towards them as and when appropriate.