Health Inequalities and Why Place Matters?
Health inequalities in the UK are significant, with a growing gap in life expectancy between the most and least deprived areas. The extra costs to the NHS due to health inequalities are estimated at £4.8 billion annually, primarily from increased hospital use in deprived areas. Inequalities are profoundly influenced by social determinants such as education, employment status, income level, gender, and ethnicity, leading to significant disparities in health outcomes across different social groups. People with lower socio-economic positions are at a higher risk of poor health, which results in substantial social and economic costs to both people and societies. These systematic differences in health status among different population groups have significant implications for the wellbeing of people and the broader society.
Place matters significantly in addressing health inequities because it shapes the social and economic factors that contribute to disparities in health. By focusing on place-based approaches, interventions can target specific communities to address the root causes of health inequities, leading to more personalised and tailored solutions. These approaches consider the unique social determinants of health within each locality, ensuring that interventions are relevant and impactful. For instance, improving access to nutritious foods and safe physical activity opportunities in underserved neighbourhoods can directly reduce the risk of chronic health conditions like heart disease and diabetes.
What is a Place-Based Approach?
A place-based approach focuses on integrating services and resources within a specific geographic area to address the local needs and challenges of that community. This approach emphasises collaboration among local authorities, health services, voluntary local organisations, and community groups to create a cohesive strategy that leverages local assets and addresses local issues. One of the key enablers for successful place-based working is having a clear framework and guiding principles for decision-making at each level of the system, ensuring that all stakeholders are aligned in their objectives and methods.
Implementing place-based approaches involves several strategic elements, including good governance, community involvement, and innovative contracting methods. Community involvement is integral to the process, with local citizens and communities being actively engaged in governance and decision-making to ensure that interventions are relevant. By focusing on specific health needs and resources, these systems aim to reduce community health inequalities through targeted interventions, such as improving access to primary care services in underserved areas or investing in community-based health promotion programmes.
Place-based approaches also recognise the importance of the local environment in impacting health outcomes. The distribution of health-promoting aspects such as green spaces, physical activity opportunities, support services, and healthy food options is often inequitable, and proximity to these assets can significantly improve health regardless of socio-economic status. The Public Health Research (PHR) Programme is actively funding new research on the health and health inequality impacts of place-based interventions, particularly those likely to impact populations at scale. This includes a focus on economic evaluation to understand the value and distributive impact of these interventions.
Take a moment and watch Ashanti’s journey to reducing behaviours of concern through proactive support and consistent routines.
Core Principles
Place-based approaches in health and social care are designed to address the unique needs and challenges of specific geographic areas by leveraging local resources and fostering community integration. These approaches are characterised by several core principles that ensure their sustainability and are community-led. Four of the most critical principles are community engagement, localised decision-making, resource allocation, and integration of services.
Community Integration
Community integration is a cornerstone of place-based approaches, emphasising the active involvement of local residents and stakeholders in the community planning and implementation of initiatives. This principle ensures that the voices of people directly affected by health and social care challenges are heard and considered in the decision-making processes of the local services they receive in their communities.
Place-based approaches build on local knowledge and strengths, creating a sense of ownership and accountability among people. The engagement is about consultation and involves meaningful participation where community members are seen as equals.
Localised Decision-Making and Resource Allocation
Localised decision-making is another fundamental principle of place-based approaches. This principle involves decentralising authority and empowering local communities to make decisions about the design and implementation of health and social care initiatives. Localised decision-making ensures that solutions are context-specific and more effective by tailoring services and interventions to the specific needs and local circumstances. The approach requires governments and other stakeholders to share decision-making power with local communities, fostering local partnerships where all parties work together towards common goals. Localised decision-making also allows for greater flexibility and adaptability, enabling communities to respond quickly to changing needs and priorities.
Place-based approaches can address disparities and improve health and social outcomes for disadvantaged communities by focusing resources on specific geographic areas. Resource allocation also includes building local capacity and capability, ensuring that communities have the necessary tools and support to sustain their initiatives over the long term.
Integration of Services
Integration of health and care services is a pivotal principle within place-based approaches, aiming to create a seamless experience for people who require support from multiple facets of the health and care system. This principle is about breaking down the silos that traditionally exist between different services and ensuring that there is a coordinated effort to provide holistic care that addresses all aspects of a person’s wellbeing.
By integrating services, place-based approaches can offer more personalised care tailored to the specific health, wellbeing and social needs of people and communities. Integration requires robust collaboration between primary care, mental health services, social care providers, hospitals, and community-based organisations. They all must work together to deliver a continuum of care that is proactive, responsive, and centred around the needs of the community.
⇒ Read more about integrated care systems and why they are a central focus in health and social care.
Designing Health and Social Services Around Community Needs
Designing health and social services around community needs involves creating integrated, people-centred systems that prioritise the unique requirements of people, families, and communities. By embracing the person-centred approach, health services intentionally incorporate the perspectives of those they serve, viewing them as active participants rather than passive recipients. This method fosters trust and ensures that health systems respond to the needs and preferences of the community in humane and holistic ways.
Integrating health and social care services is a key aspect of public service reform, aiming to deliver services more responsive to the needs of the local community. The local authority and local councils have a major role in this process, fostering place-based partnerships and community-centred approaches to improve community health and wellbeing outcomes. Place-based working involves coordinating local health and social care services to deliver integrated, community-focused interventions that address the specific needs of the local area. By prioritising community needs and involving local stakeholders in decision-making, place-based partnerships can drive meaningful change and improve the delivery of services tailored to the unique requirements of the community with a focus on health and wellbeing.
Multidisciplinary Teams Working Within Communities
Multidisciplinary teams (MDTs) with place-based approaches can identify service gaps and make system changes, thereby improving the ability of agencies to share information and track families across different services. The size and structure of MDTs are tailored to reflect the specific needs and resources of the local area, ensuring that the services provided are relevant and sufficient. One of the key benefits of MDTs is their ability to provide more comprehensive care by bringing together professionals with diverse skills and expertise. This collaborative approach allows for a broader conversation, faster problem-solving, and more effective interventions for local people. MDTs can improve people’s outcomes by ensuring that care is coordinated and comprehensive regarding all aspects of a person’s health and wellbeing.
Place-based working is a crucial aspect of MDTs, as it involves coordinating local health and social care services to deliver integrated, community-focused interventions. It ensures that service delivery is designed around the specific needs of the community, fostering greater coordination and collaboration among local health providers, local councils, and community organisations. By prioritising community needs and involving local stakeholders in decision-making, place-based partnerships can drive meaningful change and improve the delivery of services tailored to the unique requirements of the community.
Positive Health Outcomes
Place-based approaches in health and social care have demonstrated significant positive outcomes by meeting the unique needs of local communities through integrated, community-centred strategies. They leverage local resources, involve community stakeholders, and focus on the social determinants of health to improve overall wellbeing and community health and reduce health inequalities.
The positive outcomes enabled through place-based support include:
- Improved Physical and Mental Health and Behaviours
- Enhanced Social Determinants of Health
- Reduction in Health Inequalities
- Community Integration and Empowerment
- Integrated Care
- Positive Economic Development and Impact
- Improved Life Expectancy and Quality of Life
- Proper Use of Local Assets
A location-specific approach understands that person-focused methods are most effective when paired with a comprehensive understanding of community resources. We also respect that people have unique perceptions of what constitutes their community. Integration must go beyond health and care and include a broad range of community-based partnerships. The emphasis should be on shared learning for improvement and the development of wellbeing outcomes that align with co-production values.
Place-Based Approach With Leaf Complex Care
Over the past decade, there has been an increased recognition of the need for a more integrated approach to health and social care. The place-based approach acknowledges that people who require complex care may require long-term support, encompassing personal care and housing, welfare, and other crucial needs. The heartfelt expression, “I want a life, not just a service,” powerfully captures the profound disparity between the services available and the lived experience of people. This longing for a life of fulfillment serves as a poignant reminder of the fundamental gap between conventional care and the deeply personal aspirations of people.
Supporting People's Goals and Safety to Live the Life They Deserve
Supporting people to live full lives in their own homes is the moving force behind the care and support Leaf Complex Care provides. By focusing on person-centred care and involving people in developing their care plans, our care teams encourage people to have control over their support, fostering improved wellbeing and community integration.
→ Supported Living Accommodations in Birmingham
We understand that privately supported living options play a significant role in the place-based approach by contributing to the range of services available to support community members.
Read more about Leaf Complex Care’s supported living services in a home-like environment in Birmingham and delivering complex care in people’s own homes.
Further guidance on how we can work together and provide humanised support that will positively impact people’s wellbeing and all aspects of life:
Leaf Complex Care provides complex care and support across the UK, with offices in Bristol, South East, Birmingham and Somerset.
