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Urban health

Search, develop, deliver

11 February 2021
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7 min read

Our approach to long-term urban health programmes

At Impact on Urban Health, we take a programmatic approach to reducing health inequalities. By concentrating our efforts on defined areas, we can better target our resources and increase our impact.

We choose big, complex and long-term health inequality challenges that affect the people of Southwark and Lambeth and which have wider relevance for diverse, dynamic and unequal cities around the world.

We aim to understand the underlying causes of complex issues and then take a demonstrable approach through action-based projects to test ideas that others don’t have the capacity to. This allows us to continually refine our assumptions and strategy throughout the programme’s lifecycle.

Our current programmes focus on the health effects of air pollution, childhood obesity, preventing people’s progression to multiple long-term conditions and adolescent mental health.

We combine the best sources of data, lived experience, practical interventions and other evidence to form a three-phase approach: search, develop, deliver.

Search

This is the scoping phase and is where all our programmes begin. In the first 6-12 months, we focus solely on learning and absorbing everything we can about the subject, its impact, and its actors so we can better understand the issue.

Our adolescent mental health programme is currently in the search phase. The programme began by exploring the existing data, evidence, and perceptions alongside foresight analysis of how changes to urban living over the next 10 years might impact children’s and young people’s mental health.

We combined this research with expert interviews that indicated that behavioural disorders have far reaching and long-lasting impacts on health and life chances. Mental health issues do not affect all groups equally, children and young people from households on the lowest incomes are almost four times more likely to have a behavioural disorder. We also found that problems that start earlier in childhood are much more likely to become severe in adolescence and persist into adulthood.

To better understand the local context, we commissioned lived experience research and mapped existing activities to understand what services and support are available in Lambeth and Southwark. This indicated that awareness, understanding and investment in behavioural disorders is low. We think that they may be underrepresented in child and adolescent mental health services and overlooked by wider support services, policy and research.

A further evidence review suggested that external factors in children’s lives – environment, relationships and experiences – are strongly associated with behavioural disorders. We found good evidence for the effectiveness of a large numbers of prevention and early intervention programmes.

This integrated approach to discovery and understanding has narrowed our focus and allowed us to commission research to understand children’s, young people’s and family’s experiences of behavioural problems and the impact that they have.

This will allow us to target some initial pilot projects at the next phase of the programme strategy to understand how we might be able to prevent or intervene early in childhood behavioural problems and reduce the impact in adolescence and beyond.

Mental health issues do not affect all groups equally, children and young people from households on the lowest incomes are almost four times more likely to have a behavioural disorder.

Develop

From a foundation of data, evidence and research, we spend the next 18-24 months developing relationships with partners and building a pilot project portfolio that will test some of our hypotheses. By testing and learning what works, we can start small and learn quickly to develop the core strands of the programme.

To know where and what to initially focus on, we use the findings from our search phase to inform our pilot projects. From the search phase in our programme on the health effects of air pollution, we know that children, the elderly and those with heart and lung conditions are the most vulnerable to the harmful effects of poor air quality. We then wanted to understand in more detail where these groups lived and how these areas aligned with areas of high air pollution.

Our team worked with L.E.K. consulting to run data analysis that combined demographic, schools, income and health data with air quality data from the London Air Quality Network to help us understand the most at risk areas to focus on. These are areas with a high level of air pollution and a high proportion of people whose health is susceptible to air pollution.

Mapping the vulnerability and exposure of people to air pollution in Lambeth and Southwark

This analysis helped us to understand which neighbourhoods we should focus our work in. But it also helped us to better understand the linkages between air pollution and wider health inequalities. The communities who are most impacted by air pollution are also the most likely to be impacted by other causes of ill health – from unemployment to childhood obesity. The health effects of air pollution are inextricably part of the wider determinants that shape people’s health outcomes.

This insight has helped to shape our develop phase by focusing our attention on the communities most impacted – and sharpening our focus on air pollution as an issue of health inequalities. This means we are interested in solutions that will reduce the impact of air pollution on those most affected – and we think this change needs to be equitable, with a focus on those contributing most to local air pollution (whether these are businesses or specific communities). Our current pilot project portfolio includes:

  • Amplifying the voices of those most affected by air pollution – including working with Mums for Lungs and community researchers to understand engagement with minoritized communities
  • Exploring future trends for freight and logistics in London with Centre for London
  • Experimental street changes to reduce traffic in deprived neighbourhoods

Only by understanding what works from the develop phase can we begin to scale our interventions in our programmes to deliver the desired outcomes and reduce health inequalities.

The communities who are most impacted by air pollution are also the most likely to be impacted by other causes of ill health – from unemployment to childhood obesity. The health effects of air pollution are inextricably part of the wider determinants that shape people’s health outcomes.

Deliver

With an in-depth understanding of the issue, a strong evidence base, and good knowledge of what works, our deliver strategy turns to scaling and influencing.

We commit ten years’ worth of funding to our programmes with the majority spent in the final phase of our strategy to help us achieve healthy equity. We work and collaborate with numerous partners to build a programme portfolio that provides financial, strategic and practical support to scalable projects at every level of the system.

An example of this in practice is our Collaboration for Healthier Lives project. We brought a digestible representation of the international evidence base – essentially a menu of options of what, based on evidence, had the highest potential for impact in stores to a group of food retailers and manufacturers who had a mission to improve consumer health.

We also brought insights from ethnographic research with families living on a low income, to show the constraints and preferences they had when shopping. Finally, we used data to map which stores were located in areas of high childhood obesity to pinpoint where the collaboration should focus their activity.

From the evidence the project generated, we then worked with the government on the obesity strategy, which limits multi-buys on unhealthy food.

Mapping supermarkets and childhood obesity rates in Lambeth and Southwark

Throughout the final phase of our strategy, our aim is to apply international evidence in our local area in a way that makes sense for local people and local organisations.

In turn we hope that our projects create a cumulate impact that shows that a) change is possible on seemingly intractable issues such as childhood obesity and b) how change is possible – giving practical resources for other cities, policy makers and organisations working on this issue. We also aim to reframe understanding in people’s minds about issues, which are often mistakenly understood as ones of individual responsibility rather than health equity.

Our programme approach is a constantly evolving process, and we continue to adapt in line with what we learn from our place and our programmes. The lessons we learn from the impact we have in Lambeth and Southwark are relevant to other inner city urban areas with prevalent health inequalities.

By sharing more about our programme approach, we hope to open the door to collaboration with others who are tackling similar issues. Find out more about how you can partner with us.

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