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Health Inequalities, Community Engagement, Mrs Beeton and Emma Harrison

August 30, 2011

Lets get started – here are quotes from 2 influential women – who are both concerned with the quality of family life.

First, Mrs Beeton – here is an extract from her great book on Household Management published in 1861.

“Visiting the houses of the poor is the only practical way really to understand the actual state of each family …

Extending charity and benevolence to neighbours – Punch 1894

Great advantages may result from visits paid to the poor; for there being, unfortunately, much ignorance, generally amongst them with respect to all household knowledge, there will be opportunity for advising and instructing them, in a pleasant and unobtrusive manner, in cleanliness, industry, cookery and good management.”

Second  – Emma Harrison owner of A4E, multi-millionaire and founder of Working Families Everwhere (WFE) – this time on her website Working Families Everywhere.

Note that this initiative appears to have died completely – there remains a rather dead Facebook page here – which has had little activity since 2012.

I have slightly abridged this quote from the original – now defunct website.

“In December 2010, the Prime Minister David Cameron asked Emma Harrison to lead a drive to get troubled families working again. This initiative is focussed on the “100,000 never worked” families. These families will have their own champion who will help them “face up to and sort out their problems, whether they be parenting challenges, poor health, debt, addiction, dependency or lack of motivation.  Most importantly, it will involve helping people into meaningful employment to help create happy, working families with a new sense of purpose and an active role in society.”

With the strong backing of David Cameron she will ensure that this project is “highlighted in the media”. She also commits to “inspiring, recruiting, training and developing an army of “Emmas” who will be from communities up and down the country- people who are passionate about and capable of helping others.”

Health Inequalities and Communities

WFE had a high profile with the media with ambitions to reach 100,000 of the most socially excluded families and close links with the Prime Minister. It is a real challenge to those of us involved in such programmes as Health Trainers, Community Health Champions, and Community Development Initiatives such as the Health Empowerment Leverage Project pioneered by Hazel Stuteley.

What is the problem?

For many of us who have worked in the public health/heath inequalities field one of the reasons that we continue to fail to reduce health inequalities is because there is insufficient political pressure at a local and national level to bring about sustainable and long term change to society and public services. Instead governments and commissioners have relied on narrow strategies focussed on doing things to the poor – such as targetting clinical interventions at the most disadvantaged or lecturing them about their diets. This has not worked – services  still bend towards the middle classes and people still prefer chips to the mediterranean diet.

Initiatives such as Health Trainers, Health Champions and HELP take a different approach – working alongside communities – helping them build on their strengths, and by so doing supporting them in influencing services and developing new ones. They place a huge emphasis on peer led change at both an individual and community level, and try to recognise the political (with a small p) dimension to this change.

Increasingly these programmes are able to demonstrate success – very often helping people to improve their personal circumstances – often through employment or training, but doing so in a way that starts with the challenges that people face and through support from their own communities.

Superficially WFE appears to have similarities – it aims to bring people into a relationship with a dedicated volunteer exemplar who has three key characteristics (Caring, Capable and Creative) and who will put the family they are supporting onto the path to employment and integration into society. Sorted!

Concerns

First – the focus of our work through health trainers, champions and so forth has been about building on strengths within communities – not through parachuting middle class champions in. This is harder to describe and a slower process but works from where people are and does not see them as “not having a clue what to do next”.

Second – our approach has a starting point which recognises that people are rational and will want to focus on issues that are of immediate concern to them. We do have evidence that in many cases this leads to people becoming employed – but the point of connection initially may have been something completely different – attending a health walk, solving a debt problem or becoming involved in a social activity. My impression is that WFE is instrumental – its main focus is employment and this is not for negotiation

Third  – I don’t think that WFE is interested in the political dimension of peoples experience. Central to community health champions and HELPs work is the idea that empowered citizens are ones who will become engaged individually and collectively in seeking to improve conditions and services for their communities – the WFE model does not seem to offer anything here.

So what does WFE mean for us?

First – Emma is clearly a fantastic publicist and has done a great job cultivating David Cameron. The WFE model is attractively simple, has a great fit with the ‘Big Society’ agenda and appears to be cheap. Despite years of plugging away we cannot claim that Health Trainers, Community Health Champions or Connected Communities has the same degree of ownership at the top of Government. Ironically all of these programmes have played the game – piloting, evaluating, producing the evidence – yet despite the Governments commitment to evidence based policy making – it only seems to require a charismatic millionaire to come along for that to be be put to one side.

Second- the three WFE pilot sites are Blackpool, Hull and Westminster. Coincidentally these are all Community Budget sites who along with 13 other areas now have a dedicated budget – a ‘local bank account’ for tackling social problems around families with ‘complex needs’. By focussing on these WFE places itself and its parent organisation A4E in a good position to do what it does best – winning government contracts – in addition it will be well placed to access funding promised through social impact bonds.

This expertise in winning contracts could represent a real challenge – at a time when health trainers, health champions etc are making the case for funding locally.

I am actually not convinced that WFE will succeed – but with the energy, money and charisma of Emma behind it plus David Camerons support it will at the very least prove an unhelpful distraction for a couple years.

So what should we do?

I think that it is really important that we develop a clear position here and set out our stall. There is a risk that if we do not policy makers and commissioners will be seduced into thinking that this attractively simple proposal led by a charismatic millionaire from the private sector is the answer, and the evidence and good practice that we have spent years developing will just be ignored.

So when services are commissioned Health Trainers, Community Health Champions etc will struggle to demonstrate impact against more simplistic solutions like WFE.

We need to to speak powerfully to policy makers national and commissioners locally not just about individual programmes and projects – but offering scalable service models that provide a genuine alternative to WFE.

The emerging think tank on Active Communities for Health being co-ordinated by Leeds Metropolitan University and Altogether Better provides a good start. This will seek to bring together national organisations with a track record in community engagement and health.

14 Comments leave one →
  1. August 30, 2011 09:30

    Really insightful post Mark. But, is there not enough space for more than one approach to these mighty problems? The key will be that its fairly evaluated, and on a wide array of outcomes, so that we can really start to see which approaches work best in terms of delivering the things that people, families and society want and in what context. Let’s see if WFE does work – and on what basis. It’s great that these other programmes are “playing the game”, that’s to be admired and supported, since it will help them learn where things work and where they don’t. The same test needs to be applied to WFE.

  2. August 30, 2011 14:08

    No single solution or response is going to solve the problems we are facing in terms of potentially widening inequalities – and in my very fortunate position of supporting the work of both Community Health Champions and Health Trainers my thought is about how we link up with Emma and the work she successfully sold to government. The question may be – How much more can we achieve if we link up ?? And what can we learn from Emma about how to capture interest at the very top. We are certainly building and developing the evidence – but what more do we need to do for the proven contribution of community health champions and health trainers to be valued?

    • August 30, 2011 14:40

      Aha – yes I agree with you – and I did wonder about putting that suggestion in the blog – what held me back was a feeling that it may not be a very productive dialogue – but maybe I should not be so pessimistic!

  3. Nigel West permalink
    August 30, 2011 17:55

    Interesting! I broadly agree with your critique of the WFE approach.We certainly shouldn’t ignore Emma Harrison’s intervention, and I’m sure she’ll find some case stories of success. Do we have any media-friendly allies who could debate with her? Having attempted to engage with both BandAid and Jamie’s Ministry of Food over the years, to talk about community empowerment, with little success(!) I’m even less optimistic about prospects of constructive engagement with A4E in the current ideological and financial climate. Who are we trying to influence – Tory MPs, or senior officers in the DoH, NHS, Councils? Or the chattering classes through the media?

    I suspect there are enough people in need of support to keep us all busy … we need to continue to compile our evidence; our case should be that interventions like Community Health Champions and Health Trainers can keep NHS spending down as well as having other beneficial impacts on wellbeing (“Happiness, anyone?”) and community cohesion. My list of “why the Sheffield Community Health Champions programme works” would include; trusting and valuing people (including those who say they/ve never felt trusted and valued before); starting with people’s diverse interests and being flexible; appropriate, high-quality training; support and supervision from a community organisation so they feel part of a team.

    Do we try to find common ground around phrases like “self-help” and “strengthening communities” or recognise that ideological differences mean we’re wasting our time?

    • August 30, 2011 20:26

      Nigel – thanks for this – I think this is a really helpful list of suggested actions I would like to play these ideas into the emerging national actions that I refer to at the end of this piece – Looking forward to collaborating together in the future – best wishes Mark

  4. August 31, 2011 09:20

    A thought provoking blog and thanks for clarifying some of the concerns I had been having about WFE and how it will work. As well as Active Communities for Health work there is also the Health Equalities Alliance which has been set up following the Marmot Review. We are an alliance of national organisations and individuals who are keen to ensure that inequalities remain top of the political agenda. We are still in the early days of setting up but we hope to find some funding to do some research that could lead to a learning programme helping to support peer learning. Do get in touch if you want to know more. Thanks
    Karen Bollan

    • August 31, 2011 09:29

      Thanks Karen – sounds like we do need to connect – I will follow up the link to your website – best wishes Mark

  5. August 31, 2011 09:46

    Thanks for writing this Mark. I have just been struggling with ill defined incandescent rage at Emma Harrison. Good job other people are more constructive!

  6. August 31, 2011 10:27

    The double standards within Emma Harrison’s rhetoric are shocking and reflect similar issues with ‘big society’. Paid work is seen as the one-size-fits-all solution and the only way that people can justify their lowly existence. (No mention of lack of jobs. No mention of motherhood being a worthwhile occupation). But the real double standard is that this ‘intervention’ proposes that volunteering is a ‘stepping stone’ to paid work – i.e. that volunteering and community work isn’t valuable in itself. On the other hand the experts who are parachuting in will be volunteers – and their work is presumably worthwhile and valuable. What if the families turn round and ask their friendly expert why they aren’t doing paid work?

    Volunteering and community work is the core of big society. Yet no value is attached to it – neither for benefits nor the census (social status).

    • Penny Dembo permalink
      September 24, 2011 15:57

      I agree with what you say but I’m a bit concerned about your use of the term ‘motherhood’. Of course its a worthwhile occupation, but so is fatherhood. Sorry if I’m nit picking, and you may well have meant ‘parenthood’, but terminology does matter and there does seem to be a general trend in the media to talk about ‘motherhood’ and to ignore the gender-equality issues.

  7. September 1, 2011 10:12

    Dear Mark
    I enjoyed this thoughtful piece and your comments chime with our own experience with our family LIFE programme working with similar families – you can read about this and use our tools etc on http://www.alifewewant.com. Our experience is that the work needs to be genuinely family led, if change is to be deep, meaningful and lasting – like you we find that our families gravitate towards work and training but not because our programme pushes this and this is vital. We also focus on the wider socio-economic dynamics that your refer to (and without which we cannot understand these families’ experience). The early results from LIFE have been very strong and we are scaling to 6 locations this year.
    Hilary Cottam
    Participle

  8. Penny Dembo permalink
    September 24, 2011 16:21

    Hi Mark
    I like the comparison with Mrs Beeton, makes the point well. As Nigel West above says she’s sure to have some successful case stories to plug to the media, and I agree with you that its a big issue if her organisation doesn’t have to play by the same rules of producing proper evidence as other organisations. I saw Emma Harrison on a TV programme a while ago in a ‘competition’ with another consultant to get 2 men into work. She ‘won’ by getting a business friend to give her person a work trial. There was absolutely no comment on the programme that getting your mate to give your protegee a job isn’t actually a test of your methods of helping the unemployed, which is what the programme said it set out to do. Hope the government isn’t just hoping for some good headlines rather than proper analysis of the evidence and outcomes.
    Best wishes
    Penny

    • September 25, 2011 11:39

      Thanks Penny – great to hear from you – yes I think that Emma Harrison is very good at giving her work a good profile in a largely uncritical media – Mark

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