Towards a healthier nation: The case for a greater focus on neighbourhoods

As the new Labour government gets to work, we’re exploring some of the key issues our communities are facing, to highlight the role of neighbourhood-level interventions in addressing inequalities and promoting better outcomes. With the government’s shift towards a neighbourhood health service, Kyle Vanelli, policy officer at Local Trust, looks at the potential for neighbourhood-level action to transform the way we treat health on a national level.

A decade of austerity, expansive waiting lists, a workforce shortage, and long-term demographic pressures. For many, the NHS no longer inspires the same sense of security that it once did. As the Secretary of State for Health and Social Care, Wes Streeting, recently said, ”Anyone who works in or uses the NHS can see it is broken”.

The current state of the British healthcare system has no simple fix. While revamped funding and modernisation can alleviate short-term pressures, a more fundamental transformation is necessary to shift the focus of the system from reaction to prevention.

Building the capacity for citizens to live healthy lives is the only way that the long-term pressures on the British health system can be met. In the pursuit of this healthier society and an NHS that can rise to the challenge, the key might just be in our communities.

Communities are not backdrops

A growing body of research and evidence suggests that the most effective place to lead these changes is at the neighbourhood level.

Communities are not mere backdrops – they serve as the stage for daily life: the built and social environment, essential services, and interactions that take place on a day-to-day basis. In the words of Sir Michael Marmot, Director of the UCL Institute of Health Equity, “health starts where we live, learn, work, and play”.

Nowhere is the case for well-resourced, strong communities made more clearly than in the outcomes faced by what we call doubly disadvantaged neighbourhoods, which experience both deprivation and low levels of social infrastructure.

These outcomes become clear when we compare deprived areas with and without good social infrastructure – a term describing the physical places that support social relationships, civic activity in a community, and the physical and digital connectedness of a place.

The barriers to becoming a healthier nation

The double disadvantage of deprivation and poor social infrastructure has major implications for local population health. Residents of these areas see a higher occurrence of 15 of the 21 most common health conditions, including high blood pressure, strokes, and obesity. Residents are more likely to experience cancer, depression, and coronary heart disease, and see higher rates of disability. Compared to the national average, the proportion of adults eating healthy foods daily is also far lower.

These outcomes are deeply intertwined with the reality of living in these areas. Citizens may be poorly connected by public transport to essential healthcare and public services – if at all. There are few spaces where they can go to interact with their community and a lack of necessary amenities like childcare or places to exercise. Healthy food is often hard to come by in local supermarkets.

The social determinants of health – from employment opportunities to the quality of education – are skewed against communities who lack existing capacity to impact local change or alleviate the effects of poor social conditions.

The effect of strong communities on social determinants of health

In contrast, communities with good social infrastructure tend to live healthier, more fulfilling lives. They can take positive action to address local public health issues and often directly deliver services – whether it is providing affordable childcare, care for the elderly, or organising mental health programmes.

In Ewanrigg, the Big Local partnership successfully provided over 300 residents with mental health training, while establishing mental health interventions in local schools – tackling a crisis of loneliness and depression in an area that is both geographically isolated and deprived.

Communities also address many of the social determinants of health. Well-organised communities may lobby the local council for better environmental protections or to transform derelict public properties into green spaces. They often organise community activities that bring people together, promote exercise, and improve residents’ mental and physical health.

In light of the issues faced by the NHS, the growing interest in social prescribing reflects its potential to address the root causes of health issues while reducing long-term demand for clinical services.

Through Kingsbrook and Cauldwell Big Local, residents employed a community link worker to assist the local GP, connecting residents with non-clinical services offered by the community. This approach has saved the GP nearly £40,000 in appointment costs, as clinical care has been replaced with sources of community support including walking groups, diabetes support groups, and social programmes like debt advice.

Effective health policies require local input

Looking forward, there is a clear need to reform the healthcare system in favour of approaches that are preventative, actively involve citizens, and leverage the power of communities to reduce primary care costs. In its manifesto, Labour wrote that the NHS needs to move to a neighbourhood health service “with more care in communities to spot problems earlier”.

Building a healthier Britain will require us to treat health as a fundamental aspect of daily life rather than something that is treated at the point of care.

This looks different in different places. In Wigan, the local authority has saved £134million since 2010 by integrating social and medical services, to address non-clinical needs while actively co-designing health policies with residents. In Leeds, NHS Trusts have created neighbourhood teams that deliver integrated services and work directly with local communities to provide care closer to home.

These innovative approaches to transforming our healthcare system are united by the principle that effective health policies must actively involve the people they are designed to help.

As the NHS moves towards integrated care systems, there is incredible potential for a renewed model that actively involves the community and voluntary sector, considers the social determinants of health, and commits a greater focus towards neighbourhoods.

Local Trust is launching a series of papers exploring how learning from the Big Local programme can inform the delivery of the new Labour government’s five missions, and where these could have the greatest impact – at the neighbourhood level. These missions span policy across health, economic growth, education, crime, and energy.  

Read the first paper on Labour’s mission to “build an NHS fit for the future”.