Section 2 - Opportunities for change

Local authorities are ideally placed to develop new approaches for improving population health and reducing inequalities, particularly given their focus on place, wellbeing and cross-sectoral working Working at a regional level also offers a range of opportunities to amplify, support and add value to local approaches through use of devolved powers, partnership working and networks, pooling of resources and expertise, sharing learning and good practice, and scaling up clear examples of good work in the area.

Closing the health and wealth gap through radical prevention

To reduce widening and persistent health inequalities, a radical shift is needed to put communities at the heart of public health and build healthy, resilient, connected and empowered communities 99 Radical prevention means taking action as a whole system to tackle the underlying causes of poor health and health inequalities (the ‘causes of the causes’), and shifting to more person and community- centred approaches to health and wellbeing.

Be4low are the key concepts underpinning a regional approach to radical prevention, focusing on the relationship between health and wealth This is reflected in the Marmot policy objectives, which remain as relevant during COVID-19 as they always have been, and in the priority areas identified by Coventry City Council for their 2016-2019 Marmot City programme and priorities for continuing the programme through 2020-2022 61,62 Action at each stage of the life course has the potential to improve health and social outcomes later on; raising aspirations and mental wellbeing in childhood increases likelihood of good educational outcomes, which in turn facilitates employment and career development.

Early intervention and prevention in the early years can have lifelong impact, as well as yielding significant return on investment Proportionate universalism is fundamental to Marmot principles: balancing universal action on the wider determinants of health with targeted intervention to actively close the health and wealth gap, and improve the health of the most disadvantaged fastest.

Radical Prevention

Inclusive growth

Economic growth that actively seeks to reduce inequalities and considers what is important to citizens

Wider determinants

Social, environmental, political, economic and cultural factors that impact on our health and wellbeing

Inclusive economy

Challenging the economic status quo and actively seeking to reduce inequalities in areas of little to no growth

Health inequalities

Reducing avoidable gaps in life expectancy and healthy life expectancy between the most and least affluent or privileged

We aim to:

Give every child the best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Embed health, social value and asset-based approaches in policies and decision making
Ensure healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention

Prioritise prevention and early intervention

Build resilience, aspiration and mental health in young people
Improved levels of education, employment and training

Target resources based on need

Help vulnerable people into work
Improve quality of jobs

Many local authorities have taken forward the recommendations and approaches outlined in the 2010 Marmot Review A survey by the King’s Fund conducted in 2011 found that over 75 percent of local authorities had incorporated the approach directly into their health and wellbeing strategies However, this was in the face of widespread reductions in public spending and intervention in almost all areas, with the poorest areas being the most affected. 101

Coventry’s Marmot City programme is a powerful example of where Marmot policy objectives have been adopted in developing the city and its economy Evaluation of the programme suggested that the programme helped to mitigate some of the effects
of austerity, and that the Marmot City branding facilitated partnership working and embedded consideration of the impacts that Council policies and investments have on health inequalities across the organisation. 102

The Coventry approach demonstrates the value of cross-sector collaboration and whole-system working, and can be adapted and scaled up to tackle persisting health inequalities at a regional level.

Inclusive growth within an inclusive economy

Regeneration and economic growth within the region bring a number of opportunities to act on the wider determinants of health The WMCA defines inclusive growth as “a more deliberate and socially purposeful model of economic growth – measured not only by how fast or aggressive it is; but also by how well it is shared across the whole population and place ”

Economic growth has potential to improve population health and wellbeing and reduce health inequalities through improving access to employment, raising income, increasing community safety, improving housing quality and affordability, raising aspirations and improving educational outcomes, providing a
high quality local environment and green space, enhancing social relationships and connectedness, and increasing opportunities for participation A recent report by the Health Foundation found that the COVID-19 pandemic had demonstrated that people’s health and wealth cannot be viewed independently and that economic development policies which look beyond narrow financial outcomes as a measure of success can be instrumental in creating more prosperous societies. 103

In practice, however, people living in deprived communities often see little benefit from economic growth and feel excluded from it Inclusive growth principles recognise that prosperity is measured not just by Gross Domestic product (GDP) and Gross Value Added (GVA), but by the health and wellbeing of the population and the extent to which everyone benefits from the growth This means levering current and future policy and investment opportunities in a way that leaves no-one behind, and considering what is important and meaningful to citizens.

It is important to consider inclusive growth within its broader context of an inclusive economy, and to actively seek to reduce existing inequalities across the life course even in areas with little or no current growth activity or where new investment may be limited An inclusive economy also recognises that not everyone will have or be able to work towards optimal health, but should still be supported to maximise their potential and quality of life A healthy and resilient population can also be a foundation of creating and maintaining growth, contributing to a virtuous cycle

Sustainability is a key element of inclusive growth A balanced, inclusive West Midlands economy (i e a fairer, greener and healthier region) is one that balances a thriving economy that meets the needs of all citizens with minimising the environmental impacts of growth, and improving air quality, biodiversity and green space The #WM2041 strategy104 sets out WMCA Board ambitions to reach zero carbon 21 years into its 80 year carbon budget, and to address the climate crisis in a way that is fair, inclusive, and promotes economic prosperity within the region.

Place-based approaches and community-centred public health

Areas of high deprivation are often characterised by more transient populations where people move on once they start to do better, so health outcomes appear to show no improvement over time Focusing on improving places and systems rather than targeting individual behaviour change helps to create environments where people want to live and work, and bring about sustainable positive change.

Place-based working enables the development of system-wide, population level interventions through focusing on engagement between civic organisations, services and communities 105 This is known as the ‘Population Intervention Triangle’ At the civic level, adopting a ‘health in all policies’ (HiAP) approach can help to embed health improvement and the reduction of health inequalities across policy areas acting on the wider determinants of health.

Population Intervention Triangle

Place based planning

Civic level interventions
Civic service integration
Service based interventions
Service Engagement with communities
Community-centered interventions
Strengthen Community action

Anchor institutions

As part of this approach, working with ‘anchor institutions’ such as the local authorities and NHS Trusts can help to embed innovation and good practice locally Anchor institutions are defined as large, typically non-profit organisations whose long-term sustainability is tied to the wellbeing of the populations they serve Anchors have ‘sticky capital’, i e their connection to the local population means they are unlikely to move, and have considerable influence on community health and wellbeing 106 Anchor institutions provide opportunities to look inward in relation to systemic inequalities and discrimination in our own organisations, for example in addressing pay and leadership gaps, and promoting healthy and inclusive working practices.

Local application and developing opportunities for action

Our interim report and call for evidence identified a range of stakeholder activities in responding to COVID-19, many of which are drawing on these approaches and principles A summary of these activities is provided below, building on the opportunities for action set out in the interim report and Box 5 Selected case studies provide examples of these activities, highlighting the role of faith, community and voluntary sectors in engaging with local residents, and the importance of partnership working and use of population health intelligence to improve ways of working across systems

Box 5: Opportunities for action on health inequalities in developing the regional approach to responding to and recovering from COVID-19

New public focus on health inequalities and public health, including the recently launched national strategy for tackling obesity
Increased public awareness of infection control
Promoting physical activity as an opportunity to be outdoors, socialise, get around safely and improve wellbeing, in line with regional and national strategies
New ways of working that maximise use
of technology, enabling more flexibility
and improving work-life balance as well as reducing environmental impact – working to ensure equal access to these opportunities and reduce digital exclusion
Changes to local delivery models
Role of communities, for example in driving a collaborative approach to population health management
Work streams to ensure that BAME inequalities are considered in all aspects of response and recovery
Drawing down resources to help address structural inequalities, for example through a formal submission to the comprehensive spending review
Understanding lessons learnt from the first wave from a healthcare perspective
Pooling and sharing of intelligence and engagement resources and analysis as a regional health systems network

Longer term opportunities:

Developing a Health in all Policies approach to embed consideration of physical and mental health across all WMCA policy areas
Using the Thrive model to improve workforce health and wellbeing, and to address inequalities in education, skills and employment across the region in line with inclusive growth objectives
Maximising the potential of the 2022 Commonwealth Games to drive down inequalities and deliver a lasting legacy that undermines inequalities, especially in communities hit hardest by COVID-19
Supporting regional collaboration to tackling health inequalities, especially for groups such as the homeless and migrant populations
Working with communities, and local and national partners, to improve the recording and routine analysis of demographic data so that we are actively monitoring inequalities and demonstrating progress across the region (e g in relation to death certificates recording of details such as faith and ethnicity)
Supporting local governments in their ambitions to protect and improve the lives of local citizens and work with them to ensure adequate funding for the public health function that has been so important in responding to the current crisis
Devolution presents a significant opportunity to co-ordinate action across the system in local recovery to improve the wider determinants of health, working in partnership with stakeholders across localities and sectors

Crisis response

The acute response to the pandemic has, understandably, been the focus of activity across organisations in the region, particularly to ensure that the most vulnerable citizens are supported However, this has not happened independently of longer-term change to address health inequalities In many cases, the emergency response has provided the foundations to establish new ways of working and strengthen relationships with communities and partners.

Case Study: Birmingham City Council - Food parcels for clinically shielded & vulnerable people

During lockdown, 7,395 clinically vulnerable people across Birmingham were receiving weekly food parcels, with around half of these provided by Birmingham City Council A Food Hub was established at Wholesale Markets, where supplies were sourced, stored, packed and distributed via National Express Accessible Transport.

Although initial deliveries were standard food parcels, the council also catered for limited dietary requirements in response to population needs, including diabetic, gluten-intolerance, nut allergy, halal and vegetarian.

The council’s Emergency Community Response Hub also ensured that people who were not shielding but still experienced difficulty accessing food supplies were also able to receive emergency food supplies Those included people over 70, those self-isolating due to illness, pregnant women, and people receiving support through adult social care The Hub also signposted and connected vulnerable citizens without assistance from family or friends to help and support Citizens with existing support networks (e g family and friends) were asked to continue to use this so that the council could focus on those most in need.

Case study: Birmingham City Council – Supporting rough sleepers and responding to homelessness during the pandemic

A number of challenges and barriers were identified for Birmingham’s homeless population, including:

No beds available in the acute wards for mental health (one specific example found that an ambulance was called but the person was later released with no support)
The helpline provided did not give the support needed
The mental health support had been positive when accessed via the health exchange, but if people already had a diagnosed / treated for mental health problem then it was sometimes more difficult to get the support needed from their registered provider
Many individuals have problematic substance misuse issues
Drop-in centres closed during lockdown – a Housing Options offer was established at Washington Court which has now moved to Sifa Fireside
Pre-COVID-19, rough sleeping went down to single figures at height of lockdown; however, numbers have since started to rise again (in the 30-40 age range)

An operation to get rough sleepers inside during the pandemic was largely successful – beds were initially secured with Holiday Inn and accommodation was then found for the majority of people (e g some people were moved into BCC flats, supported housing and emergency housing)

It was clear that a change of approach was needed regarding the new housing options offer, as the majority of people were referred into non-commissioned exempt-supported accommodation Given the number involved, this represents a significant dependency on this sector and should be approached with caution The Council is working to strengthen its control of standards and a support team is being commissioned to follow up on each person referred

Community engagement

Across the West Midlands region there has been substantial engagement with communities in local areas, by local authorities, services and the voluntary & community sector to understand how they have been impacted by the pandemic and the support they need This is not just in relation to COVID-19, but with long-standing health and wider issues that have placed some communities at greater risk of the virus itself and the economic impacts This is an area where it is particularly important to build on the work that has been done to reinforce relationships and develop networks over the longer term

Case study: Outbreak Management Plan, Lye

At the outset of the Covid-19 outbreak, it was recognised that migrant communities could be especially vulnerable to the impacts of the virus, particularly over the lockdown period Within Dudley Borough, Lye has a relatively large Roma population, and so partners acted quickly to consider the challenges for the community and plan a response

Representatives from community safety, neighbourhood policing, primary care, access and prevention, family support, the local church and Public Health met in March to consider the particular vulnerabilities of the community and the assets that could be called upon to address these Key concerns included language barriers to understanding health protection messages and access to the resources needed for people to support themselves and their families during lockdown

An action plan was developed which included:

Establishing routes for the distribution of food and essential supplies, including a foodbank based within the church and door-step deliveries
Translation and dissemination of key public health messages through a range of avenues, from word of mouth, recorded messaging on community Facebook pages and leafleting

Facilitating application processes for benefit claims
Connecting members of the community to housing support
Re-establishing elements of the Lye Community Project support to the Roma community in a Covid-safe form

All partners supported implementation of the plan, with Roma community members assisting food distribution efforts Public Health’s Roma Community Development Worker was key Using her unique relationship with the community and language skills, she provided a trusted source of information and support and facilitated access to services

The community have been hugely appreciative of the assistance provided Their feedback suggests that people were enabled to come through the crisis well, that they have felt valued, and could rely on services for the help they needed.

Case study: Legacy WM - wellbeing promotion, physical activity & nutrition for Bangladeshi women.107

Legacy West Midlands is a registered charity that has its roots in celebrating the heritage of post-war migrant communities in Birmingham, highlighting their relationship to the industrial, architectural, and cultural heritage of the city The charity is based at the community heritage site of Soho House in Handsworth, and delivers projects in the northwest inner-city wards of the city

A research project on food journeys in the Bangladeshi community revealed that the health of first-generation migrants was better than that of their children and grandchildren; funding was subsequently allocated by National Lottery to focus on the health of the local community through a project called Family Fit, which focused on health improvement from the whole family Women were particularly engaged and keen to participate in health services

Having the flexibility to go to out to wherever our community are makes it as easy as possible for people to participate in activities, and particularly removes some of the barriers for women – for example, work in schools with mothers after they drop their children off in the mornings The charity undertakes non-clinical health MOTs and runs various programmes including Zumba, Yoga and Food Nutrition, working at a number of local sites including Aspire & Succeed, Saathi House, Lozells Recreation Centre and Birmingham Asian Resource Centre.

Legacy WM’s Zumba sessions for women include a significant number from the Bangladeshi community, with some sessions sometimes having up to 40 participants.

“These women only sessions show the truly multi-cultural aspect of our work, with women entering the sessions wearing their hijab and niqab, and warming up to Ed Sheeran!”

Case study: Mosques and the Muslim Community in Dudley Borough

Engagement with Mosques and the Muslim community in Dudley Borough has been an important strand within the Covid-19 response The closure and subsequent reopening of places of worship has presented significant challenges across faith communities and many worshippers fall within one or more vulnerable groups.

Proactive contact was made with Mosques at an early stage in the pandemic, with a view to opening channels of communication to share information and respond to any concerns or needs for support In some parts of the Borough, relationships were already established, in others, this was an opportunity to make a connection.

Public Health’s engagement with and support to Mosques has included the following:

Providing resources and information for Mosque leaders to share with their community
Remaining in touch with Mosque representatives to ensure any concerns or queries can be raised and addressed
Responding to requests for specific information, including translation and design of materials
A virtual meeting for Mosques with Health Protection to provide an opportunity to explore safe reopening
Joint-working with Brierley Hill Mosque, which has acted as a central contact for several Mosques in the area, disseminating information
A Mosque representative is part of the Test and Trace Sub- group membership for voluntary, community and faith settings

Overall, representatives from the Mosques have been appreciative of the information and resources shared and the opportunity to liaise with Public Health for support during the Covid-19 pandemic The connections established have ensured that potential problems can be voiced and that the latest guidance is applied.

Data and intelligence

Improving data and intelligence, particularly around the recording of ethnicity in health and care settings, has emerged as a key priority for longer-term system improvement to address health inequalities, both regionally and nationally However, activity in this area has also focused on using population health intelligence to understand the relationship between existing inequalities and the impacts of COVID-19, and to address issues with access to services and research For example:

Report on Impact of COVID-19 on Inequalities - Solihull Metropolitan Borough Council – The report brings together the existing national evidence and analyses the probable impact on different groups The Council is in the process of developing a targeted Health Inequalities Strategy
West Midlands Language and communication service needs assessment - Health Protection Team, PHE West Midlands – Report included a descriptive study that aimed to provide a picture of the language and communication need within the health protection response in PHE WM, and the commissioning processes used by other PHE Health Protection teams for language and communications services
West Midlands Air Quality Improvement Programme (WMAir) - Research supporting the improvement of air quality, and associated health, environmental and economic benefits, across the West Midlands, with rapid analysis of the impacts of COVID-19 related emergency public health measures (March – May 2020) upon nitrogen dioxide (NO2) and particulate matter (PM) levels in Birmingham City

Key findings:

Reductions in NO2 concentrations associated with COVID-19 were of greatest magnitude for those living at the inner city and near-roadside locations, including areas of high deprivation
Changes were less marked in the north-east of the city; the location of more affluent (upper income quintile) LSOA areas Further (ongoing) research is required to better characterise these impacts upon different ethnic groups, including linkage to health outcome measures

Workforce wellbeing

It is recognised that workforce wellbeing is integral to reducing health inequalities, particularly in anchor institutions While this is partly about ensuring that staff in health and other public services are equipped to manage the challenges in their roles due to changes in priorities, scope and context, there is also an opportunity in terms of representation and improving the experiences of staff from diverse backgrounds

As part of their wider approach to reset and recovery, Sandwell MBC have a Staff Impact Working Group led by the Interim Director of Human Resources that has drawn on existing networks, HR data and staff engagement activities to capture experiences, views and thoughts from the workforce Key messages from the group are that although staff have coped well with adapting quickly to a new working style and maintaining service delivery in adverse circumstances, it is recognised that this style of working has not suited everybody equally for
a variety of reasons The findings from this work will be used to define the new operating model and embed this within the organisation, balancing staff needs with the organisation’s needs through continued regular communication and improvement of communication mechanisms in light of remote working - particularly with the frontline and those without remote access
Birmingham & Solihull CCG are developing updated ways of working with staff and communities, which includes establishing a Health Inequalities Task Group, which has set out priorities for action in the next 1-2 years This includes using the role as an ‘anchor institution’ to promote economic prosperity and to support staff

Innovation and system change

As well as an increased focus on health inequalities, the pandemic has provided opportunities to explore new ways of working and to collaborate across systems to develop interventions and approaches to addressing health inequalities – both within and across organisations

Black Country and West Birmingham CCG Wider Determinants Programme Advisory Group is undertaking a programme of work including a report looking at the system’s response to COVID-19 and lessons learnt; Phase 1 programme looking at wider determinants of health; and Phase 2 programme focusing on designing, appraising, implementing and evaluating interventions
West Bromwich African Caribbean Resource Centre redesigned its services to support the community during first wave and flagged a lack of funding to increase their offer, especially for second wave They are working with the local CCG to hold online workshops (report to be published) and make recommendations for CCGs to carry out Equality Impact Assessments

Case study: Emergency Active Travel Funding to Transport for West Midlands

As part of the Department for Transport’s allocation of its Emergency Active Travel Funding to Transport for West Midlands, the WMCA invested Active Black Country* to deliver an 8 week social prescribing of walking and cycling programme in collaboration with its 4 Primary Care Networks (PCNs)

The programme focused on testing the effectiveness of different methods in getting health care professionals to signpost people to walking and cycling and based on 3 stages

Recruitment: Each PCN identified a group of 10 patients who they felt would most benefit from getting them to walk and cycle This included people with hypertension and from migrant communities and those who practices identified as pre-diabetic, 67% of participants across the 4 PCNs were from BAME communities and predominately male
Advice and Guidance: A consultation with the patients and provision of an e-resource providing details on local walking and cycling opportunities and the benefits of taking part
Activation funding: a £50 personal budget for half of the patients involved in the programme to see if this provided greater incentives to get walking and cycling e g footwear, bikes and travel passes

The 8-week programme is coming to an end and has evidenced that 70% of patients taking part reported an improvement in physical health, 67% improvement in mental health and 93% stated they planned to continue being active

The programme also identified the importance of companionship in encouraging people to be active and the importance of health care and physical activity sectors working better together There are many lessons learnt including greater collaboration with PCNs and an opportunity to secure additional funding longer term

Michael Salmon, Head of Insight, Health and Wellbeing for Active Black Country said:

“Active Black Country is working hard to ensure that all health care professionals, along with dedicated social prescribers, have the knowledge and resources required to signpost patients and clients to community solutions where appropriate The resource that we have developed is a great way to encourage patients in primary care to access the wonderful parks and open spaces already available within their local community for the benefit of their health and wellbeing ”

*Active Black Country is one of the national network of Sport England funded Active Partnerships and is the strategic lead for sport and physical activity across the Black Country

Case study: St Margaret’s Unity Hubb108

This is a church supported project that uses church premises, but has been set up as a non-faith trust Running out of a beautiful church building whilst meeting the needs of the very diverse local community, working specifically with women, was something Unity Hubb was excelling at before lockdown They have managed to rethink their activities They started by delivering seeds, plants and compost to local families; in the first week to 43 families and then for some weeks to 15-20 families

They transferred many of their activities onto Zoom For example, they have delivered:

A cook together eat together event
Family crafting sessions where they delivered craft packs and an artist helped them over Zoom to be creative
Chai and chats

Rashta Butt, the Development Worker has also carried out one to one chats on the doorstep to a few of the most isolated of their participants They have promoted the church’s food bank, but also built on the goodwill in the community and collected for the Feed Birmingham campaign with a box outside the church

Recognising how much the women were loving planting and also how many of the older generation had grown up in agricultural communities and had skills to pass on Rashta set about persuading the local allotment team and the existing plot holders that they could take over a plot Thus, the “Diverse Garden” started in lockdown The plot has been divided into ten so each participant can manage a small area, but take pleasure in what they can achieve Other planting and crafting activities take place on a Tuesday The next plot has been handed over, which is testimony to the project’s success.

Even on a rainy Tuesday in October, 14 women turned up; three with children to plant, chat and do other activities That is real indication of what has been created; a diverse community with connection and purpose.

Case study: Redeemer Church, Northfield - Supporting the Local Community109

This church has adapted its offer to meet a wide variety of local needs This has included food shops, food parcels, connecting people to the local food bank, pharmacy runs, gas and electric vouchers, referral, and one off events such as an alternative Halloween party for children with activity and snack packs and supporting the Northfield VE Day on your Porch initiative They have made regular welfare calls and stayed in touch with their usual participants to check what they may be needing, even doing some of these at a distance in the front garden They have made a point of celebrating events such as delivering a birthday cake or holding a mini birthday party.

They have used available funding to buy a few participants’ tablets and have worked with them to get wifi access and to be able to join activities Their approach has also not just been delivering services, but creating connected communities One example is of two men who had previously met at a Redeemer Church event They connected them up; co-ordinated one to do the other’s shopping, and covered volunteer expenses

Through lockdown, they ran a virtual coffee morning each week, which some people attended every week Since then they have managed to restart their Place of Welcome, working within the social distancing restrictions They are working on a community craft project: embroidered bunting for the centre they use to remember this year! They have also organised some get togethers of over 50’s picnic lunches (5 guests and one from the church team) in their garden

Since lockdown lifted, they have been holding a mobile coffee morning which has enabled them to find and connect with more isolated and vulnerable people on the estate It has also meant they have been able to effectively signpost and partner with local organisations, referring people on for help with social care, food bank, gardening and more They go out with a car, individually wrapped pastries and coffee and tea and knock on every door of a chosen street They serve people a drink and have a chat on the doorway, in a socially distanced way They also have activity packs for children to distribute to under 5s In addition, in the first three weeks they made two referrals to Adult Social Care, three to a local project, Futureproof, bought a bed for an elderly man, an oven for an older woman.

Finally, they are running an all generation’s outdoor fitness group and a running group to ensure there is a safe way for local residents to get fit and healthy.

In addition to providing support to people on their local estate they feel they have ended up connecting more deeply with the area and working alongside council organisations in a way they would not have done otherwise.

Case study: St Germain’s Church, Edgbaston110 – Food distribution project

St Germain’s Covid-19 Community Response Team was established in April 2020 to meet the growing needs of the local community Initially they delivered food to those in need They have also provided a cooked meals service as they found many households in need did not have facilities or were unable to cook food A volunteer cook can produce halal food and culturally appropriate meals and there is always a vegetarian option.

Once lockdown lifted they encouraged those in need to come to the church to collect food and are open three days a week They give out 60-80 food bags each week, feeding around 160 people.

They have not found the demand going away and even by October half term were cooking 180 meals each session so 360 each week, feeding around 160 households each week They work closely with four hotels and a couple of hostels in the immediate vicinity which are current home for people who are homeless, have been subject to domestic abuse and are asylum seekers As with other vulnerable households they delivered food to many of these families in lockdown and latterly encouraged them to come into the church.

They recruited over 30 volunteers of all faiths and none People come to the front door asking for help and they are encouraged to become volunteers too In October 2020 six of the volunteers had been recruited in this way They also have support from members of the local community and many faith groups They have regular donations, for example, from a Sikh gurdwara, a group of Muslim women who collect and deliver tins of food and church groups which organise street collections for them.

The approach they take is broader than just food They help connect their families to other services too One example is the asylum seeking family of nine, soon to be ten One of the volunteers who can speak Arabic has helped secure a school place, has ensured the hostel moved them from a small single room to two rooms, made a referral to the baby bank for the forthcoming baby and introduced them to Migrant Help

They have collected resources, for example, winter coats and shoes and to pass on to people If they find that people need a particular thing they do a shout out to the community and can usually source what they need.

In the summer they opened for an additional day in the summer for families to come in they provided different activity packs every week to take away They were able to spend more time with people and tailor support to their needs

Finally, they have an emotional wellbeing service which is non- Christian counselling and also referral to other services such as drug and substance recovery This service operates three days a week

As well as providing support to hundreds of people they suggest it has exposed is a level of need that people did not know about previously

Section 2 Summary

There is a two-way relationship between health and wealth on both an individual and population level Inclusive growth and its role in reducing health inequalities needs to be considered in its broader context of an inclusive economy and wider determinants of health Radical prevention means taking action as a whole system to tackle the underlying causes of poor health and health inequalities and shifting to more person and community-centred approaches to health and wellbeing, in line with inclusive growth principles

Tackling health inequalities at a regional level means understanding how to lever current and future policy and investment opportunities in a way that benefits everyone, and actively seeks to reduce existing inequalities across the life course However, the relationship between civic organisations, services and communities at the local and regional levels is crucial to understanding the unique populations, needs and assets in each area, and where working as a regional collective might enable us to amplify and add value to local approaches

Despite the obvious challenges, the coronavirus pandemic has also highlighted ways to work differently and opportunities for positive change across the whole system – particularly in relation to engaging with communities and learning from the excellent work of the voluntary and community sector in understanding what is important to our citizens and the challenges they face The final part of this report considers these opportunities in the context of the key issues underpinning disparities in COVID-19 outcomes and wider inequalities in health and wellbeing, identifying commitments to action by local and regional stakeholders and recommendations for national government that would act as a catalyst for this change

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Health of the Region 2020