Coordinating and Mobilising Cultural and Natural Assets to Combat Health Inequalities: From Local to National.

The Covid-19 pandemic has adversely and disproportionately impacted vulnerable members of society, and highlighted significant inequalities in the UK. These structural inequalities are not new; The Marmot Review (Fair Society, Healthy Lives; 2010) demonstrated that health inequalities result from social and economic inequalities. Furthermore it is widely acknowledged that there is a social gradient to health with people living in the poorest areas experiencing significantly poorer health. In the ten years since this initial review, circumstances have not improved with the most recent Marmot Review (10 years On; 2020) noting that increases in life expectancy have slowed over the past decade, with the slowdown greatest in more deprived areas of the country. Research into health inequalities over the past two decades has shed light into the role of community assets, sense of place and community engagement in tackling the major social determinants of health. In this project we will work closely with the National Centre for Creative Health (NCCH), NHS England's Personalised Care Group (NHSE) and other regional and national partners to coordinate a national programme of research, focused on creating a comprehensive evidence base for how cultural, natural and other community assets (such a legal and advice services) can be better integrated into health, social care and local (authority) systems, to tackle the root causes of societal inequalities. The research will focus on the implementation of Integrated Care Systems in England, and analogous systems in Wales, Scotland and Northern Ireland. Integrated care systems (ICSs) are new partnerships between organisations that meet health, social care and other services in an area, alongside other community-based organisations. The devolved nations have similar such systems, and the move towards integrated systems in the UK offers an opportunity to rethink how communities can be restructured to place inequalities at the heart of statutory provision and systems, strategic planning, and health promotion, prevention and intervention strategies, such as social prescribing. This is particularly important in areas which are very deprived, scoring low on socio-economic indices and which are asset poor. It can be argued that very deprived areas will benefit more from an integrated approach to health and social care, as a key feature of such areas is the significantly greater proportion of the population who have complex needs and are using multiple health, care and other services, who are often referred to as 'revolving door service users'; namely those people who are experiencing the worst health inequalities. By working in partnership with local, regional and national bodies we will amass a comprehensive evidence base offering new insights into how community assets can be repositioned to support communities and individuals facing severe inequalities in terms of mental and physical health, and social deprivation. Evidence syntheses, policy briefings, lobbying and a range of knowledge exchange activities will translate key learning from a series of test and pilot sites across the UK into actionable outputs directed at decision makers, such as Directors of Integrated Care Systems, key leaders in the NHS, Public Health England and local authorities, through to governments departments and arm's length bodies. We will use a hub and spokes approach for coordinating within the between test and pilot sites, supporting evidence gathering, communications and marketing, knowledge exchange and collaboration with key partners (such as NHSE, National Academy for Social Prescribing, and Arts Council England) to ensure community assets are revalued and better integrated into health systems across the UK to support levelling up agendas.