CAN-DO: Theory of Change

How can community assets help address health inequalities?

Over the course of the project, we worked with partners to develop a theory of change (ToC), systematically thinking through how community assets can help address health inequalities. This knowledge exchange and sharing of different perspectives provided a richness to the ToC that captures our shared intention to bring together community assets, statutory services, academics and citizens as equally valued partners in a learning system that takes collaborative actions to reduce health inequalities and that gathers, shares and uses stories, data and knowledge to learn, innovate and improve.

Context

Health inequalities in the UK continue to widen.

UK health policy has a focus on 'integrated care systems' which seek to bring together NHS, local authority and voluntary and community organisations to take on responsibility for the resources and health of an area or 'system'.

The 'levelling up' agenda is intended to support communities to thrive and make them great places to live and work – speaking to the wider determinants of health. However, in reality, communities and citizens have very little say in decisions that are taken about their health and place. And community assets that address health disparities are often poorly supported, distributed unevenly and diverse in aims and objectives. In addition, health and social care services are increasingly stretched with rising demand, squeezed budgets and high levels of workforce attrition.

Collaboration can be challenging with differences in values, funding, methods of evaluation, access to knowledge and differentials in power and may only work effectively in some contexts.

There is recognition that mobilising the strengths of people and place and re-imagining the relationships between citizens, the state and services, and the community and voluntary sector are key aspects to addressing health inequalities. This can make a meaningful difference to our most disadvantaged communities.

Approach

Co-learning and co-creation

Co-created research programme from the outset and parity of value of community knowledge.

Community led

Listening to community assets and working with them to understand how work is valued and how demand is managed. Releasing resources for genuine community led research and activity.

Connection

Focus on human relationships that foster learning about new ways of doing things.

Respectful and inclusive engagement

A shared culture of listening, learning and changing.

Shared responsibility for change

Working together across sectors, values and beliefs to create real system change.

Actions

Initiate a number of collaborative multi-sector actions to reduce health inequalities. We will:

devise a programme of work to develop shared understanding of health disparities
initiate an ongoing research and learning programme
develop effective ways to measure impact and change, and build analytic capacity
learn from community-led approaches
learn from innovative health-led approaches
facilitate direct investment in community assets
explore eco-system approaches to decision-making to reallocate resources
invest in asset integration strategies (e.g. hubs, community building, mapping)
build community capacity by connecting people with each other and with resources and organisations
understand the complexities of how space and setting can influence heath and wellbeing.

Outcomes

Effective mobilisation of community assets (people and place).
Barriers to (statutory) health services removed.
People feel skilled, purposeful, valued and connected.
Improved matching and flow of individual need to resources.
Strong, informed community assets with good local knowledge and a voice.
Shared learning community across voluntary, statutory and academic sectors.
Redistributed power and shifts in decision making.
Redistribution of resources.
Parity of esteem and advocacy for community generated knowledge.
Place based collaborative commissioning and localised decision making.
Strengthened evidence base and better use of data, knowledge and evidence to inform best practice.
Agreed structures that enable the creation, maintenance and valuing of long-term sustained relationships.

Impact

A dynamic and focussed learning system of collaborative and equally valued partners with positive changes for individuals, neighbourhoods, and care systems.

Reduced health inequalities.

Increased health and wellbeing and better access to healthcare for people from disadvantaged communities.

Improved population health.

More people engaged with community assets and more people contributing to community assets.

Our intention:

To bring together community assets, statutory services, academics and citizens as equally valued partners in a learning system that takes collaborative actions to reduce health inequalities and that gathers, shares and uses stories, data and knowledge to learn, innovate and improve.