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To tackle Health Equity we must get the Citizens Voice into Due North

January 19, 2015

citizens blog 1

In February there is a ‘one year on’ conference at the University of Chester to consider progress and next steps, since the launch of Due North the report that seeks to articulate a North of England analysis of how we tackle health inequalities.

One of the key points made by the original report is:

“The most disadvantaged members of society lack influence over how public resources are used”

Recommendation 3 of the report focusses on this area specifically:

“share power over resources and increase the influence the public has on how resources are used to improve the determinants of health”

Actions for bodies in the North of England include:

  • Regionalism and government structures – bringing policy making a bit closer than Westminster and developing a stronger collective local government voice across the North of England
  • Access to information – greater transparency of decision making at a local level
  • Participatory Budgeting – more involvement for citizens in financial decisions
  • Mutuals – create more collective forms of ownership
  • Building capacity in communities – to strengthen engagement

There are also a set of actions that government should consider which include:

  • Strengthening the role of local government – increase proportion of public expenditure spent locally, prioritising health equity spend, increase ability of local authority to raise funds
  • Expand role of local healthwatch to hold govt to account for action and progress on health inequalities
  • Co-produce national programmes with local government

There is nothing intrinsically wrong with these recommendations but I think they lack coherence and don’t sufficiently address the original challenge.

The actions feel as though their starting point is concerned with what local public sector bodies consider to be important, their role, their relationship with government; rather than challenging the way in which local public sector bodies relate to communities.

There is not enough about the lived experience of citizens and the relationship that the local state has with them. This means that this section (indeed the whole report) is weak on the role of the community and voluntary sector – especially grass roots community organisations.

So, while I support the calls for more regional government, greater access to information about need and services, and participatory budgeting I think the document over emphasises these at the expense of a weak section at the end (where else!) on community capability.

Regrettably this is reflected by the general lack of emphasis on the contribution of the voluntary and community sector as a whole.

We need more honest local debates about relationships with communities and citizens

If Due North is to achieve real change then I think it needs to revisit its approach to citizens and communities.

Lets face it the arguments articulated in Due North for localism are predicated on the belief that the strongest relationships with citizens happen best at a local level.

The credibility of any proposal to shift power from Westminster or to redress inequality rests on our ability to demonstrate that we can deliver these powerful relationships with citizens.

We have to recognise that we need to put our own house in order, a culture change is required at a local level too. The way Due North is written does not convince me that this is sufficiently recognised.

Of course it is possible to give lots of examples of action at a local level – from Doncaster through to Blackburn with Darwen – that is not sufficient!

We need to recognise that there needs to be ongoing debate with citizens and community organisations to develop a shared view about how to strengthen engagement, involvement and yes…..solidarity.

There is plenty of hopeful stuff going on. I am impressed by the work of the Co-operative Councils who have been leading some of the work here. Local Authorities such as Lambeth are doing really interesting stuff – including developing their Competency Model for Co-operative Councils looking at how to change their relationship with local citizens. I suspect that some of this work is informed by seminal reports like “The Relational State” whose strap line calls calls for “recognising the importance of human relationships could revolutionise the role of the state”

There is a great deal out there – the challenge is to locate this promising activity within a broader analysis of why this is important, where current deficits are and what we need to be doing differently.

We need to avoid leaping into our usual behaviour of renewing neighbourhood committees, laying on a bit of community capacity building and providing some better information and then saying job done”

What do you think?

11 Comments leave one →
  1. Sarah C permalink
    January 20, 2015 09:12

    Good summary Mark (and greetings from Lambeth, the cooperative borough!). I am sure you are right that the Due North work needs to take another step to become more citizen focused. Have you looked at the Citizens UK model of working where community institutions come together and use community organising to identify community priorities that the Citizens group then take to the people who have control over power and money (Councils etc) to get change, not in a passive way but through constructive engagement and local action? Might that work?

    • January 20, 2015 09:16

      Thanks Sarah – I am aware of the Citizens UK model – although not in great detail – my impression is that they are at their strongest in London – but I do know that there is activity elsewhere – including my home city – Sheffield. The process that you describe is hopeful – is it set out formally anywhere? Maybe someone from Citizens UK might respond – here?

      • Sarah C permalink
        February 11, 2015 11:24

        Thanks for your reply Mark, yes I think the Citizens work is wider in London but I would say very timely to consider the community organising model for the north of England not least because of the strong history of community activism in many towns and cities. I see someone from Community Catalysts has replied and they are doing some very interesting and practical work (they are working in Southwark I know) but it is the explicit commitment of Citizens UK to alter the balance of power in decision making on issues that affect communities that I see as unique along with their concept of membership; organisations join rather than individuals. I have looked at their website and can’t find anything specifically about their approach but a read of their various reports hints at it. Maybe contact them direct or the Leeds group
        Best wishes

  2. Lynne Friedli permalink
    January 20, 2015 22:38

    Hi Mark – I’ve tweeted about this and you’ve kindly acknowledged that. But I wanted to reiterate here my view that Due North does address issues of community power, and in a very direct and specific way, as well as citing recent and ongoing research that demonstrates the health and social impact of community control. For example, the report states:

    “The evidence presented to the panel therefore supports the conclusions of the Marmot review of health inequalities in England that the empowerment of individuals and communities should be at the centre of actions to reduce health inequalities. Policies that enhance the democratic engagement and collective influence of the North as a whole and
    of the communities within the North will contribute to reducing health inequalities. ” p.61

    The graph on that page, synthesising data linking ‘perceived influence’ and mental health/premature mortality in deprived areas struck me as important and interesting.

    I’d be very sorry if your blog discouraged people from reading Due North, or resulted in it being dismissed. I feel it is strong on political and economic analysis and relevant across the UK. As many people would (understandably) be deterred from reading anything commissioned by Public Health England, it seems especially important that Due North gets a fair hearing.

    best wishes and thanks for your blogs


    • January 21, 2015 10:40

      Hi Lynn – your comments are very fair. I agree with you that Due North is a useful and important attempt to address a number of issues that are too easily ignored – they include health inequalities, the North of England and the Social Determinants of Health. Like you I think that Due North stands as an exemplar compared to some of the material that is coming out of Public Heath England and I have said as such in earlier blogs..

      I think that Due North makes a powerful evidence based argument about the need to address the social determinants of health and I support its value base and principles. Evidence and Values are important but at the end of the day its actions that matter – and thats what I focus on in my blog.

      As I say in the blog I support the actions – but I worry that the actions on citizen voice are not strong enough and in the blog I try to highlight this. I am doing it precisely because I think Due North is a hopeful platform on which to build and also because I think that actions on citizen engagement are difficult (I find them hard) and we need to give more space, and thought to develop them .

      So – yes, I do support Due North and I would encourage people to read it and have high expectations of it!

      All the best – Mark

      • Lynne Friedli permalink
        January 21, 2015 11:28

        Thank you for your generous response. It’s a mark of your blogging and the way that you work, that you encourage, welcome and engage with debate in such a genuine way. In the current climate, there are so many pressing, and yes, life or death struggles for justice, recognising, building and nurturing solidarity (virtual or otherwise!) seems ever more urgent.

  3. January 21, 2015 12:01

    I just wanted to reinforce Mark’s point about the central importance of changing the conversation and the balance of power between public bodies and local people. In our experience local people have the best understanding of the problems in their area, imaginative and practical ideas about the best way to solve those problems and with help can help deliver those solutions. My organisation Community Catalysts (thanks for the # Mark) works through community partners to support the amazingly creative and resourceful people out there in local communities to turn their problem-solving ideas into practical and sustainable enterprises. In our experience scarce money and other resources are put to best use in an area if local people (not just the usual suspects) have been involved in thinking about what is needed and helping to put a plan in place to address those needs. We see too much waste.
    I will read Due North with interest and we (good northerners as we are) would love to be able to contribute our learning in some way

  4. Ben Barr permalink
    January 21, 2015 16:12

    Hi Mark, thanks for your current and previous blog on this, good points and useful discussion. I agree with you that at the end of the day its actions that matter. Although I don’t see so much in this blog that points to concrete actions (unlike your previous blog on Due North that did very helpfully focus on some specific actions.)

    I do think to address inequalities we need a shift in the democratic control that citizens have over how public resources and collective assets are used, and we tried to emphasise that throughout the report. The issue is how to achieve that. Clearly the contribution of the voluntary and community sector is crucial , but we need to do more than just emphasise this fact. Frequently strategies to ‘empower’ disadvantaged communities, focus solely on the people living in those communities, as if the problem resides there, rather than in the public and private institutions and systems that produce powerlessness.

    So there is an emphasis in Due North on what public sector institutions and local government need to do differently, not because this is what the public sector considers to be important, but because it is these institutions that need to change to become more accountable to the people they are supposed to serve. At least that was the intention. The voluntary and community sector is frequently presented as an alternative to the public sector. The distinction between VCS and public sector seems a bit artificial to me. We potentially need more public ownership to enhance community control, but that doesn’t necessarily mean state ownership, many publicly owned services are and should be in the VCS (Coops, credit unions, tenant owned social housing etc). It seems, to me at least, that local government and other public institutions need to change so that the voluntary and community sector are part of systems of local governance through which people can collectively influence the places in which they live and work. How to bring that about at scale is another matter.



    • January 22, 2015 09:19

      Hi Ben

      Thanks very much for the comments. I particularly like your second paragraph and your point that the ‘problem’ really lies at least as much with public and private institutions rather than with disadvantaged communities – I agree completely.

      That was the point I was really trying to make in the blog – I think that institutional leaders (VCS and Local Govt) need to do more work to be self critical of what we are doing with regard to how WE will change – and I don’t think that comes out sufficiently in the Due North report.

      You are right to say that I am weak on actions in this particular blog – not my usual style – it was partly to do with word count and also to be honest because I was struggling to think of particular ones – however, I have got some ideas and will stick them up in a future blog and obviously look forward to being challenged on them!

      all the best – Mark


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