Role of healthy places and sustainable communities in reducing health inequalities

Peter Goldblatt

• Social justice• Material, psychosocial,

political empowerment • Creating the conditions

for people to have control of their lives

www.who.int/social_determinants

Key principles

Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation, 1999-2003

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise their capabilities and have control over their lives

C. Create fair employment and good work for all

D. Ensure healthy standard of living for all

E. Create and develop healthy and sustainable places and communities

F. Strengthen the role and impact of ill health prevention

Fair Society: Healthy Lives: 6 Policy Objectives

Healthy and sustainable places and communities - policy recommendations• Prioritise policies and interventions that

both reduce health inequalities and mitigate climate change

• Fully integrate systems to address the social determinants of health in each locality

• Support locally developed and evidence-based community regeneration programmes that remove barriers to – community participation and action– social isolation

Reduce health inequalities and mitigate climate change Across the social gradient:

• Active travel

• Access to safe, good quality open space

• Improved food environment locally

• Improved energy efficiency of housing

Principles in reducing health inequalities

• Health inequalities result from social inequalities - ‘causes of the causes’ – the social determinants

• Address the social gradient in health through ‘proportionate universalism’

• Life course approach• Intergenerational focus• Address processes of exclusion• Develop strategies based on assets, resilience,

capabilities and strengths.• Human Rights framework

Prenatal Early Years Working Age Older Ages

Family building

Accumulation of positive and negative effects on health and wellbeing

LIFE COURSE STAGES

MACROLEVEL CONTEXT

WIDER SOCIETY SYSTEMS

Perpetuation of inequities

Fully integrated approach to health inequalities

People and Places

Critical linkage of health, wellbeing and resilience.

Evidence of linkage of low level stress, depression and exclusion are barriers to participation:

“ You can see the deprivation, all you have to do is look outside. Its in your face every day, litter everywhere, rats and rubbish. It’s a dump……it feels like people around you have no meaning to life. I keep my curtains closed at times….It doesn’t give you a purpose to do anything” (Focus group participant)

Many communities are characterised by lack of mutual trust, isolation and under developed social cohesion.

“ It is a deprived area ,there are no jobs , people are stressed out family and partner relationships and all things like that are going wrong” (June)

Green spaces that I can use

Lack of interesting activities in winter

Poor local job

prospects

Poor street lighting and

uneven pathways

Recyclingfacilities

Soaring fuel bills and poor insulation

Affordable transport

Spending time with

my neighbours

What enhances my wellbeing and health

What is detrimental to my wellbeing and health

Affordable healthy

food

Partnership with individuals and communities- an asset based approach.

I&DeA A Glass half-full:how an asset approach can improve community health and wellbeing.

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Health, wellbeing and resilience

• Evidence participation and improving life skills ameliorates impact of health inequalities through developing social support networks. (Bynner and Parsons 2006)

• Learning and skill development impact positively and fosters community action. “ I have learned ..I use my counselling skills with my family. I listen more and I know my daughter will say I am really proud of what you are doing ,Mum “ (Jane)

• Social networks create the conditions in which people thrive“ I would say that people in the group have more confidence. At one poInt they would have been sat at home doing nothing ,now they are out and are involved. Once you get there it ‘s amazing to see how far you can go.” (Joyce)

Coventry City Council

Deficit

• Start with deficiencies and need externally defined

• Respond to problems• Provide services for users• Focus on individuals• Clients as consumers• Passive recipients• Fix people with

programmes as the answer

Asset• Start with assets of

communities• Identify opportunities and

strengths• Invest in people as citizens• Emphasise civil society• Focus on neighbourhoods

and common good• Citizens as co producers• People take control• People are the answer

Creating conditions in which individuals and communities have control over their health and livesandparticipate fully in society