Across England, local government finds itself at a pivotal moment. National policy is increasingly clear that the future of public services lies in prevention, neighbourhood working and addressing the wider determinants of health.
Yet on the ground, councils and partners are under intense pressure to make short term savings, often by scaling back precisely the long term work that prevention depends on.
New evidence from Oxfordshire suggests that would be a mistake.
Five years after identifying our most disadvantaged communities, we are beginning to see encouraging signs that sustained, place based action can shift the dial on inequality. Some communities previously ranked among the most deprived nationally are now moving in a more positive direction.
That progress has not come from quick wins or isolated interventions, but from patient, collaborative work rooted in communities themselves. It offers an important lesson for the wider local government sector at a time when prevention is moving from rhetoric to policy reality.
What the data really tells us
It is essential to be honest about what the changes to Index of Multiple Deprivation (IMD) data does and does not show. Changes in deprivation measures are about correlation, not simple cause and effect. No single programme, council or NHS partner can claim credit for improvements in complex social outcomes.
What we can say with confidence, however, we are seeing positive changes in the way that partners are investing in the areas and communities that need it the most.
Equally important, the picture across the county is mixed. Some areas outside our original priority wards have worsened slightly, albeit from a much higher baseline of affluence. That underlines a crucial point for national and local policy alike: inequality is not static, and progress in one place does not mean the job is done elsewhere.
This is exactly why a county wide, Marmot informed approach matters. Targeting need must sit alongside a system wide commitment to prevention, rather than relying on short term projects or narrow definitions of ‘place'.
Understanding neighbourhoods before designing solutions
The last five years have taught us a simple lesson: the standard data is not enough. In Oxfordshire, our Community Insight Profiles combine the numbers with lived experience and local asset mapping. The aim is practical - showing not just where inequalities sit, but how they shape everyday life. And our interactive Director of Public Health annual report backs this up, using video and case studies to keep community voice front and centre.
We focused on communities flagged as being at higher risk of poor health outcomes, to hear directly what mattered most: priorities, strengths already in place, and what residents and local partners said would improve health and wellbeing.
The takeaway is one most councils already know: two places can face the same headline problems and still need different answers. Local history, trust, relationships and capacity decide what will work. Build with those realities, and you get results. Impose a one size fits all model from the centre, and you usually do not.
That matters as neighbourhood based approaches gather pace nationally. Councils are not just commissioners. They are convenors, system leaders and long term partners: uniquely placed to bring together data, local intelligence and community voice.
Partnership is not optional
None of the progress seen in Oxfordshire has been achieved by public health working in isolation. District councils, the NHS, voluntary and community organisations, and residents themselves have all played a role. Reducing health inequalities is collective work. It only succeeds when responsibility, learning and commitment are shared across the system.
This challenges more transactional models of partnership that prioritise short term outputs over long term relationships. It also requires honesty about timescales. Building trust in communities that have often experienced policy churn cannot be rushed to fit annual funding cycles or quick performance metrics.
As national policy increasingly emphasises integration and neighbourhood working, this kind of partnership maturity becomes even more important. Without it, the ambition of prevention risks being undermined by delivery models that are too fragile to last.
The risk of stopping too soon
Perhaps the most important message for decision makers is about timing. The gains we are starting to see are fragile. They rest on relationships built slowly and carefully in communities that need stability, not constant reinvention.
This is not the moment to take our foot off the gas. Scaling back investment now would risk eroding trust, losing momentum and undoing years of careful work just as progress begins to show. Prevention is often judged too quickly, but the costs of withdrawing support too soon are rarely measured with the same rigour.
From national ambition to local reality
Oxfordshire's commitment to being a Marmot County illustrates what it takes to translate national ambition into local action. Marmot is not a badge or a branding exercise. It is a long term commitment to tackling the root causes of inequality through sustained, preventative action and by putting communities at the heart of decision making.
For councils navigating reform, financial pressure and increasing expectations around neighbourhood delivery, the lesson is clear. Use the evidence. Back partnership working. Stay the course.
If we are serious about prevention as the future of public services, then we must be prepared to invest in it for the long term, especially at the very moment when it starts to work.
Ansaf Azhar is director of public health at Oxfordshire CC
