A whole council approach to tackling inequalities

The MJ Award winners St Helens set up an inequalities commission to understand the issues holding residents back from reaching their potential and to give them a voice, as Ruth Du Plessis explains.

According to expert in health inequalities Professor Sir Michael Marmot, between 2010 and 2020, the UK had the slowest improvement in health equity of any rich country except Iceland and the USA. There is data which indicates the rich are getting richer and the poor are getting poorer.

Glaring differences exist between communities and population groups, affecting everything from exposure to health hazards, susceptibility to poor outcomes, access to education and opportunities, housing, community safety and the ability of an individual or community to recover. For example, women who live in the most deprived parts of England spend more than 19 years longer in poor health compared to women living in the least deprived areas.

Before the pandemic, St Helens faced more economic and health challenges than other parts of England, and there were also differences in health across St Helens. For example, data for 2016-20 shows nearly a 12-year difference between the wards with the highest and lowest male life expectancy. St Helens was then severely affected by the pandemic, so it was expected that inequalities would likely be exacerbated.

At our health and wellbeing board (people's board), we discussed inequalities, particularly the data from the first Marmot Report, which suggested the cognitive scores of ‘better off' children improve above poorer children. We discussed, therefore, that perhaps with the right actions, we can reduce inequalities.

In December 2021, with the support of the Institute of Health Equity (we are also part of the Cheshire and Merseyside All Together Fairer initiative), we established an inequalities commission in St Helens. The purpose of the commission is to understand the barriers impacting residents reaching their potential, give local people a voice, and learn from expertise and best practices.

While we are still relatively early in our journey, we have learned some lessons. Some areas have set up a separate ‘inequalities team', however, we resisted doing this because we were concerned tackling inequalities would become a task for a small team rather than having a whole systems approach. We also resisted creating an entirely new work programme with task groups.

Instead, we got a commitment from a range of key partners to be part of an inequalities commission via the health and wellbeing board and have the support of the leader of the council and the St Helens NHS place lead. The commission has an independent chair, and work generated via the commission is picked up through already established groups, such as a fuel poverty working group, healthy weight strategy group and family hubs.

Another thing that we did early on was change the name from ‘health inequalities commission' to just ‘inequalities commission.' This was based on feedback from Cabinet members who felt having ‘health' in the title may limit people to thinking this is mainly about health and social care. In contrast, we want to focus on the underlying causes and actions to address them, such as improving school readiness, improving wages and living standards.

We were fortunate to obtain support from the Institute of Voluntary Action Research to help us engage with more than 50 local leaders via St Helens and Halton Voluntary and Community Action. We asked people who lived, worked or studied in St Helens to give their views (during the engagement events, we made a conscious decision not to wear ID badges, just name tags). Although we talked about the challenges we are facing, we focused much more on what we are proud of in St Helens, ‘Living a Good Life in St Helens', and what the solutions might be to the challenges we face. There was much enthusiasm as all of us learned something new about St Helens' great people and places.

People told us that in the short term, they were most worried about rising fuel bills and food costs, including lack of access to healthy foods. Thus, some of the first activities of the commission were to work together to increase the number of community food pantries and to make sure they were for everyone so there was no stigma in accessing them.

We also re-energised the fuel poverty working group, focusing on those vulnerable to respiratory illness (including providing 4,000 winter well packs). We have given out a few microgrants to support local groups, and one community member used this funding to help set up a ‘Positive People and Places' Facebook page, which now has nearly 2,000 members.

Ruth Du Plessis is director of public health at St Helens BC



St Helens Metropolitan Borough Council

Highly Commended:

Luton Borough Council

Belfast City Council

Sponsored by

The Health Foundation

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