Guidance

Reducing health disparities: the role of community businesses in community-centred systems

Published 21 July 2022

Applies to England

This guidance was developed in partnership with Power to Change.

Key messages

The key messages of this guidance are:

• communities should be at the heart of plans to level-up, recover from COVID-19 and reduce health disparities
• this requires radical, systemic change to devolve power to communities and create places that are truly ‘community-centred’
• community businesses help social and economic recovery through inclusive and sustainable local enterprise
• a whole system approach can help bring communities, statutory organisations, community businesses and other voluntary, community and social enterprise (VCSE) organisations together to tackle community determinants of health

Introduction

Widening health inequalities over recent years has placed greater emphasis on the need to put communities at the heart of public health. The pandemic has further demonstrated the role of communities in improving health and ensuring no community is left behind. Building connected, empowered, and resilient communities can help reduce health disparities and community businesses have an important part to play.

Many local health partnerships have been growing community-centred approaches by working alongside communities to address the things that matter to their health and wellbeing. These approaches can help to improve access to and effectiveness of services, increase community control and connectedness, take collective action on important issues and build on community assets. Although many areas have struggled to mainstream these approaches, they believe community-centred approaches can play a crucial role in reducing inequalities.

In 2020, Power to Change (PTC) partnered with Public Health England (PHE) to test out a new framework, developed from research,^{[footnote 1]} for taking a whole system approach to community-centred public health as part of action to reduce health inequalities and achieve inclusive and sustainable economies. This briefing provides a summary of the work and explores the role of community business as part of a local system approach.

Community businesses and health

Community businesses are businesses run by and for local people, making them community-centred by design. They generate income through trading and do so in a way that benefits the community they are located in and accountable to. Community businesses can be any type of business that trades services or goods for the benefit of their community, including shops, hubs, pubs, farms, leisure centres and many more.

Many community businesses engage with their local health systems to deliver activities and services to meet needs and address health inequalities locally. All community businesses will be addressing the wider determinants of health in some way through creating greater agency and pride in communities, generating jobs, increasing local wealth, improving the local environment and reducing social isolation.

A 2019 systematic review^{[footnote 2]} of the impact of community business on health found that health and social care related community businesses impact positively on health through improving:

• self-esteem
• social connectedness
• physical health
• mental health
• quality of life

Recent research shows that 95% of community businesses state that they reduce social isolation and improve health and wellbeing^{[footnote 3]}. Community businesses have proven to be crucial focal points in their communities, especially during the ongoing COVID-19 crisis, evolving to continue to meet the needs of their communities during the pandemic.

As local areas deliver COVID-19 recovery, community business can play an important role in delivering fairer, greener economies that address the needs and build on the strengths of communities. Be it reviving high street assets, running community growing centres or managing community hubs, community businesses contribute to improved health and more inclusive local economies, crucial for post-pandemic recovery.

What we did

The joint project between PTC and PHE aimed to test whether the whole system framework for community-centred public health (see figure 1) was relevant for community businesses and local authorities and their roles in working with other local partners, as one system, to place communities at the heart of decision making.

Within 2 localities we interviewed representatives of community businesses and local authorities and held online workshops with them and other local partners, using the Padlet online collaboration tool, to engage and record discussion. PHE also worked with VCSE bodies and regional networks to test the framework through workshop discussions and programmes.^{[footnote 4] [footnote 5]}

The interviews and workshops discussed the following questions:

• what is the strength of interactions between community businesses, local authorities and others in building community capacity and reducing health inequalities?
• what roles do we each have in this agenda and what local priorities, challenges and opportunities are we facing?
• how well are we working as a system? Where do we need to strengthen? (against the framework)
• what are our next steps for action?

A thematic analysis was undertaken of the data from interviews and workshops to produce 2 local reports. Themes were combined to summarise overall reflections.

Figure 1: a whole system approach to community-centred public health

Source: a whole system approach to community-centred public health.

Figure 1 shows the whole system framework for community-centred public health. It shows the elements needed of a successful community-centred public health system grouped under the headings of scaling, involving, strengthening and sustaining.

The values of trust, power and relationships are at the centre of the model and there are 5 principles to drive the successful delivery of community-centred public health. These are:

1. shifting mindsets
2. bold leadership
3. collective bravery
4. co-production
5. complex thinking systems

Reflections

Reflections from the 2 sites, supported by the wider research, included 4 main findings:

1. Commitment to community-centred system change

• there is commitment and momentum for partners to work together to further develop a community-centred system – this would build on what worked well in the pandemic to put communities at the centre of system change

• recovery from COVID-19 needs to be social as well as economic, and these should be treated as interconnected

• to reduce health inequalities and disparities we need radical change, with a strong focus on communities and community power, see the We’re Right Here campaign

• a focus on inclusive and sustainable local economies, driven by and with communities, should frame recovery and levelling-up strategies

• bold leadership and risk-taking is needed to deliver an integrated long-term plan that aligns local initiatives and scales community capacity development

• community capacity and resilience was important for the pandemic response and is relevant to other emergency planning, response and recovery including climate action

2. Relationships between communities, community business, VCSE and statutory services should be strengthened

• community businesses and other VCSE organisations often already have strong relationships with councils, but this can be developed further through regular joint planning and improved mechanisms for joint monitoring and delivery

• communities and the VCSE sectors should be central to COVID-19 recovery and health inequalities planning and delivery, and community businesses are ideally positioned to play an active role in this

• VCSE and community businesses have a unique role and are often best-placed to understand the needs and strengths of their local communities – when trusted and adequately resourced they are effective and efficient in responding to these

3. Integrated delivery mechanisms are needed to build and value community power

• there is potential to strengthen commissioning for social value and other mechanisms that mobilise local community assets and reduce inefficiencies of short-term and downstream delivery

• dedicated community capacity building can help reduce inequalities in the most minoritised communities, especially where existing community organisations are limited

• employing and valuing people from local under-represented communities in mainstream roles is needed alongside developing the skills of the workforce to empower communities

• mechanisms and structures for listening to community voice need improving, including coordinated community insight and analysis and continual feedback to communities and decision-makers

4. The community-centred public health whole system framework is a relevant and useful tool

• the whole system approach provides a welcome framework through which different places can consider the delivery of community-centred approaches to public health as part of priorities for COVID-19 recovery and reducing health inequalities

• the framework is a useful tool for connecting across departments and identifying shared priorities and actions within local authorities and between local authorities, the NHS and the VCSE – this is in line with the place-based approach to reducing health inequalities framework

Opportunities for the future

Delivering strong economic and social recovery, that reduces health disparities and levels-up outcomes for all, will require local and combined authorities to build on their existing relationships with communities, community businesses and the broader VCSE.

Levelling-up outcomes for all

The government’s levelling-up white paper prioritises restoring a sense of community, local pride and belonging and empowering local leaders and communities alongside policies to improve living standards and public services. It recognises that ‘strong societies and economies are built on strong communities’ and levels of social capital are not equally distributed. Levelling-up means ensuring everyone can:

• benefit from the opportunities that strong communities bring
• feel proud of where they live
• have opportunities to lead fulfilling lives
• have the chance to realise their full potential

A ‘bold new approach to community empowerment’ involves many of the approaches discussed in the workshops as part of the whole system framework, such as, communities having greater involvement in decision-making and delivery, growing the social economy, strengthening social value commissioning.

Reducing health disparities

The recent Marmot review for industry^{[footnote 6]} recognised that businesses can and should be a partner for good in creating healthier societies. Businesses with a strong social purpose attract and retain the best employees and improve employee wellbeing. The report recommends that business reduce health inequities within communities through local partnerships, procurement, supply networks and advocacy and lobbying.

Community businesses are well placed to make this happen and contribute to social and economic recovery. They provide an approach to restoring local pride, such as Nudge Community Builders in Plymouth, which in turn generate more wealth in an area, much of which remains within the local economy. Community owned businesses can work with local and combined authorities to ensure the right services are delivered for communities at a hyper-local level, building on their assets and strengths and meeting the needs of the most marginalised communities.

Practical steps for commissioners and leaders

Practical steps include:

• building strong and equitable partnerships between statutory bodies, communities, community businesses and VCSE as part of long-term planning, decision-making and collaboration

• building community capacity, with a particular focus on strengthening capacity within traditionally minoritised communities

• supporting the development of a strong and sustainable local infrastructure for community and VCSE capacity building, including community ownership

Key questions and resources

Localities wanting to develop a community-centred system may wish to use the resources and framework to support local discussions and action:

• community-centred public health: taking a whole system approach:
  • using the framework to audit and inform your local approach
  • exploring examples of whole system practice from elsewhere
• key questions for getting started:
  • is there a shared commitment across partners to strengthen community capacity and power?
  • how can we strengthen trust and relationships between communities, community businesses, VCSE and statutory agencies?
  • what more can we do to build on what’s worked well and learn from elsewhere to create an environment for change?
  • how can I provide leadership and act boldly to drive change?
• more detailed self-assessment using maturity matrix tools B and C from the place-based approaches to reducing health inequalities
• using results from the above in the 6-step approach to inclusive and sustainable economies

In summary, it is clear that communities, community businesses and VCSE are well placed to work more closely and in different ways with local authorities and the wider statutory system, including integrated care systems, to create more inclusive and sustainable economies and healthier places. They have been crucial to the pandemic response and can now form a key part of a more equitable recovery, addressing many of the challenges places face.

Through adopting a whole systems approach and working closely in partnership with communities and community businesses, local areas will be best placed to deliver local and national ambitions, reduce health disparities, and improve wellbeing and pride in place.

Power to Change

Power to Change is the independent trust that supports community businesses in England. Community businesses are locally rooted, community-led, trade for community benefit and make life better for local people. The sector owns assets worth £870 million and comprises 11,300 community businesses across England who employ more than 37,000 people (source: Community Business Market 2020).

From pubs to libraries, shops to bakeries, swimming pools to solar farms, community businesses are creating great products and services, providing employment and training and transforming lives. Power to Change received an original endowment from the National Lottery Community Fund in 2015 and a further £20 million grant in 2021.

About the National Lottery Community Fund

The National Lottery Community Fund is the largest community funder in the UK. They award money raised by National Lottery players to communities across England, Scotland, Wales and Northern Ireland. Since June 2004, they have made over 200,000 grants and awarded over £9 billion to projects that have benefited millions of people.

They are passionate about funding great ideas that matter to communities and make a difference to people’s lives. At the heart of everything they do is the belief that when people are in the lead, communities thrive. Thanks to the support of National Lottery players, the funding is open to everyone. They are privileged to be able to work with the smallest of local groups right up to UK-wide charities, enabling people and communities to bring their ambitions to life. More details are available on the National Lottery Community Fund website.

References

1. Stansfield J, South J & Mapplethorpe T. What are the elements of a whole system approach to community-centred public health? A qualitative study with public health leaders in England’s local authority areas. BMJ Open 2020 ↩

2. Stuart McClean, Sanda Ismail, Jane Powell, Mat Jones, Richard Kimberlee, Emma Bird, Pauline Shaw (2019), Systematic Review of Community Business Related Approaches to Health and Social Care (PDF, 540KB), London: Power to Change ↩

3. Higton J, Archer R, Francis N et al. 2021.The Community Business Market in 2021 (PDF, 2.1MB). London: Power to Change ↩

4. Pedro L, Cole A, Baylin E, Boys A. Community-centred approaches to health improvement. 2021 (PDF, 1.2MB). National Association for Voluntary and Community Action ↩

5. UK Health Security Agency (was Public Health England). The role of volunteering in community-centred public health systems: NCVO practice examples ↩

6. Marmot M, Alexander M, Allen J, Munro A (2022), The Business of Health Equity: The Marmot Review for Industry: Institute of Health Equity ↩