A family stand around a garden wall looking at each other and smiling

In this blog, Dan Pearmain, Head of Policy and Research, discusses the findings in the Trust’s latest Local Conversations programme evaluation and how community power can tackle health inequalities.

The government’s recently released Levelling Up strategy has been widely appreciated for recognising of the importance of community power as central to the efforts to repair the social fabric of neighbourhoods around the country. There are many places that have, for too long, lacked support to overcome the entrenched social, economic and health inequalities they experience.

We know from the ‘Marmot 2020: 10-years On’ report that health inequalities have grown over the past decade. The impact of the pandemic has only further exacerbated this trend, with mortality twice as high, as well as social and economic impacts falling hardest on those experiencing the highest levels of disadvantage. All of this context could be dispiriting, but People’s Health Trust’s research from 2016-2021 demonstrates that with the right support to nurture community leadership and support community power, things can begin to change even over a relatively short time period.

Following a five year evaluation of our Local Conversations programme, we now know that building community power will enhance wellbeing for those involved. From a statistically significant study of 2,852 responses:

  • 74% of Local Conversations residents regularly speak to their neighbours compared to 51% on average in England
  • 73% feel people can be trusted compared to 56% of people living in similarly disadvantaged neighbourhoods in England
  • 81% feel a sense of belonging to their neighbourhood compared to 62% on average in England
  • 83% believe that by getting together they can really change the way that their area is run compared with 54% on average in England

All of these outcomes are hugely positive and responses to the Office of National Statistics (ONS) questions within this survey reinforce the wellbeing benefits from being involved, as Local Conversations participants feel more satisfied with life, less anxious and have a greater sense that life is worthwhile than England averages.

The strength of outcomes achieved by initiatives such as Local Conversations is rooted in the process residents have been through. Action is driven by residents’ involvement and being listened to by people they trust, which is the essence of community power. As developments start to take place within neighbourhoods based on residents’ ideas, this creates positive feedback loops to reinforce their engagement, connection, control and sense of agency.

We know that in many of the Local Conversation areas, the growth of community power has led to priority-setting and local partnership working to achieve their aims. Whether this is about improving the mental health of residents, supporting employment prospects, developing opportunities for young people, or enhancing local built environments and green spaces, Local Conversations have sought to take action on things that matter to the people living locally and influence social determinants of health.

Despite the positive local achievements and wellbeing outcomes, self-reported levels of health remained extremely low for those involved in Local Conversations. People’s satisfaction with services was also lower than other similarly disadvantaged neighbourhoods and much lower than England-averages. The question arises around whether these two things may be related.

We know that efforts to work with statutory agencies including local authorities and health agencies could be very successful but they were not as widespread as would be hoped for across the programme. In order for community power to be drawn on, be valued and worked with more effectively it is important to systematically harness its value and embed it. This means building-in the provision of community perspectives into statutory systems rather than simply consulting with communities.

Integrated Care Systems are mandated to support greater community power through their inclusion of the voluntary sector, but this may not go far enough if the quality of that intervention is weak. Learning from both Scottish and Welsh Health Boards who have a longer history of involving the voluntary sector is important.

The Local Conversations evaluation demonstrates that community power does not just happen, it needs the right set of ingredients to support it. This includes patience, strong democratic leadership, skilled facilitation that drives involvement and a clear sense of a community-owned vision that will direct action towards identified priorities. Funding is needed to support community organisations that have the trust of people locally. Training may be needed to build the capacity of community leaders to draw out the wisdom and passion of local people, who may in turn need time to develop connections and come together to determine what needs to change to improve their neighbourhood.

For the aspirations of the Levelling Up strategy to be achieved, we will need all the ingredients of community power we describe above to be supported, alongside a systemic shift in how services are shaped and designed with a commitment to involving communities over the long-term. This is a hugely ambitious and important agenda – and it’s essential that we face the size of the task to put communities in control effectively, or the aspirations will remain unfulfilled and health inequalities will continue to grow.

This means commitments from national and local government to invest in and support the foundations of community power, alongside systemic shifts in the ways of working within local government. Through collaboration with community power at the centre, local systems and services can be influenced to respond to and improve people’s everyday experience of social determinants of health and reduce health inequalities over the long-term.

Dan Pearmain

Dan was Head of Policy and Research at People's Health Trust until 2022.