Health Inequalities, Community Engagement, Mrs Beeton and Emma Harrison

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.