People are the key to building back fairer

*This blog post was originally published in the Bevan Foundation’s summer 2021 edition of exchange magazine.

Wales has been hit hard by the pandemic in death rates; Black, Asian and minority ethnic communities are twice as likely to die from Covid-19; and unemployment rates have risen to 4.8 per cent, with young people particularly hit hard and 67 per cent of people say their wellbeing has worsened. This is on the back of already significant differentials in life expectancy, with people from poorer neighbourhoods dying on average eight years younger than those who are better off.

Much has been made of building back better and, largely, the responsibility for this rests with local and national governments, but Wales also has strong communities and voluntary and community sector (VCS) which must be at the centre of the recovery and renewal approach, to avoid ‘top-down’ initiatives – which fail to create the blueprint for building back fairer. Involving communities in setting initiative agendas, design, development and delivery is critical if we are to make any headway.

Drawing on our experience working in Wales, we need to do three key things:

Privilege the voices of people with the worse health outcomes.

What are their priorities and what are their solutions? Working with (rather than doing to) communities draws on their strengths and wisdom to determine solutions for entrenched issues.

Ensure that anti-oppression work is central to any recovery.

Health inequalities are borne by people who are marginalised, including minority ethnic communities, disabled and LGBT+ people. It is not enough to be ‘pro’ these groups, we need anti-oppressive work in systems and practice.

Work closely with the voluntary and community sector.

We can learn from local communities through highly trusted local VCS organisations, and help initiate ideas. Mapping pathways, (such as the Third Sector Partnership Council work - Building Communities Trust) which help communities, VCS and public services to work together is hard but critical.

Since 2011, People’s Health Trust has invested heavily in addressing socio-economic causes of health inequalities in Wales. In Penparcau, Holyhead and Wrexham, we are funding nine-year initiatives which address locally determined priorities and put power into the hands of local people. This approach not only builds confidence, skills and aspirations of residents but also helps surface great ideas to tackle persistent inequalities.

Through Mon-CF in Holyhead, there is a focus on young people being in control of ideas about their future, including skills, training and employment. During lockdown, this initiative changed to support young people at serious risk of leaving school with no qualifications. Ongoing engagement meant easier relationships with young people, resulting in their gaining qualifications in Customer Service, Food Hygiene, First Aid and Health and Safety – critical for many employment opportunities. This has led to further conversations with the DWP and Job Centre Plus about other potential opportunities. A pathway to change for young people, led by young people, is being forged.

Our own independent evidence shows that the approach of supporting people to determine their priorities works by creating stronger connections, a greater sense of power to change locally and improved wellbeing. Eighty-one per cent of participants say that when people get involved in their local community, they can change the way the area is run. This is against 51 per cent in similarly socio-economically disadvantaged neighbourhoods.

This pandemic has laid bare the impact of existing health inequalities – any renewal must help to narrow this health gap and build preventative solutions. We must build relationships and models which are likely to endure, and support system change to tackle entrenched health inequalities – and people must be at the heart of this.