Invitation to Tender Co-design Facilitation: Collaboration for Healthy Lives

The greatest influences on our wellbeing and health are factors outside of health care – such

as education, employment and housing. Over the last six months the Health Foundation has

been gauging interest and appetite for a collaboration that builds mutually beneficial action

on the wider determinants of health. Focusing on these wider factors, can create the

conditions for good health and address issues necessary for a flourishing society including

productivity, inclusive growth and environmental sustainability. Nine potential collaboration

partners have agreed to take part in a co-design process that will explore scope for concrete

activities that increase collective understanding and action on the wider determinants of

health. We are seeking an organisation or individual to facilitate this co-design process over

a six month period starting in early November 2017.

Contact:

Sarah Lawson

Policy and Programme Support Officer

sarah.lawson@health.org.uk

020 7257 8000

11 August 2017

The Health Foundation

90 Long Acre

London

WC2E 9RA

020 7257 8000

www.health.org.uk

Contents 1.0 About the Health Foundation ...................................................................................... 3

2.0 Details of the work ...................................................................................................... 6

3.0 Deliverables ............................................................................................................... 8

4.0 Costs .......................................................................................................................... 8

5.0 Tender response requirements ................................................................................... 9

6.0 Instructions for tender responses................................................................................ 9

7.0 Selection criteria ......................................................................................................... 9

8.0 Selection process ..................................................................................................... 10

9.0 Confidentiality ........................................................................................................... 10

10.0 Conflicts of interest ................................................................................................... 10

11.0 Information required to assist the Health Foundation carry out due diligence on

potential suppliers ............................................................................................................... 12

Appendix 1: The social determinants of health and the work of the Health Foundation ....... 14

Appendix 2: Collaboration for Wellbeing and Health: Background Paper ............................ 17

1.0 About the Health Foundation

The Health Foundation is an independent charity committed to bringing about better

health and health care for people in the UK.

Our aim is a healthier population, supported by high quality health care that can be

equitably accessed.

We carry out research and in-depth policy analysis, run improvement programmes to

put ideas into practice, support and develop leaders and share evidence to encourage

wider change.

We believe good health and health care are key to a flourishing society. Through

sharing what we learn, collaborating with others and building people’s skills and

knowledge, we aim to make a difference and contribute to a healthier population.

Background to project

During 2017, the Health Foundation started implementing a long-term strategy to bring about

better health for people in the UK. The aims of the strategy are to:

• Change the conversation so the focus is on health as an asset, rather than ill

health as a burden

• Promote national policies that support everyone’s opportunities for a healthy life

• Support local action to address variations in people’s opportunities for a healthy

life

This project is part of the delivery of this strategy. The full strategy, ‘Healthy lives for people

in the UK’ is available here:

http://www.health.org.uk/sites/health/files/HealthyLivesForPeopleInTheUK.pdf

Scoping work Over the past 6 months we have been reviewing action in the UK and US on the wider determinants of health to develop insights into how we might support local action to improve the public’s wellbeing and health. An introduction to what we mean by wider determinants of health can be found in Appendix 1. We have found:

• There has been progress in addressing factors that impact on health, including

education, housing and work. However, overall it is patchy and requires scale.

• Public and professional understanding about what creates health and ownership of a

health creating agenda outside of public health is still limited.

• The focus on this agenda is often for different and disconnected purposes.

• Issues are complex, can feel overwhelming, and require joint solutions and a long-term view.

• There is a lack of capacity, know how, and levers to create change, within a context of shrinking resources and ‘space’ to build partnerships, particularly community led partnerships.

There is lots of good work underway but we are struck that this could have more impact if

there was greater collaboration. A collaboration that facilitates:

• the translation and linking of the wealth of existing data and evidence so that it

provides insights and is acted on beyond the sector that has generated it

This could involve ‘linkage’ of national organisational agendas (eg inclusive growth,

education, community development & the public’s wellbeing and health) by

translation of benefits of one sector to another.

• the amplification of these insights through sustained communications efforts to reach new audiences and generate new connections, particularly at local level.

This could involve developing a framework to communicate the factors that contribute to the public’s wellbeing and health and building a joint communications strategy to disseminate this.

• access to support on the know-how on change.

A co-ordinated local support offer potentially including training/coaching/partnership facilitation/leadership/communities of practice and skills gap support.

We might also want to test initial views on some potential ‘offers’ under these three areas:

Translation - Jointly funded team to translate outputs from partners to wider

audiences and communicate the impact of the wider determinants of

health

- Discrete areas of joint working to translate benefits of action from

one sector to another, eg common currency for health benefits in

economic evaluations.

Amplification - One off or regular joint communication on the relationships between

social determinants, potential action and wellbeing and health in

order to model joined up thinking required at local and national levels

- Joint communications work, including jointly funded posts, to

promote current or new initiatives (a prize or challenge, or new data

tool, consensus on what creates health etc).

Support offer - Development of accessible guidance/support on approaches and

techniques on the ‘how to’ of change and to address skills gaps.

- Partnership working to support action on the ground (which might

focus on a number of places) – i.e. a local support offer which could

include leadership support, partnership facilitation,

coaching/mentoring, network /communities of practice, training on

community engagement methods and evaluation.

- Pooled grant fund to facilitate cross sector action on social

determinants

Further details of our scoping work are in the background paper attached in Appendix 2.

Organisations participating in the Collaboration for Healthy Lives co-design

Organisation Description of organisation

Big Lottery The Big Lottery distributes 40 per cent of all the money raised for good causes by the National Lottery. In the 2014-15 financial year, they awarded more than £1 billion to projects with a social mission. https://www.biglotteryfund.org.uk/

Confederation of British Industry (CBI)

The CBI is a membership organisation that speaks on behalf of 190,000 businesses of all sizes and sectors. Together they employ nearly 7 million people, about one third of the private sector-employed workforce. http://www.cbi.org.uk/about/about-us/

Institute of Health Equity (IHE) The UCL Institute of Health Equity was established in 2011 and is led by Professor Sir Michael Marmot. The aim is to develop and support approaches to health equity and build on work that has assessed, measured and implemented approaches to tackle inequalities in health. http://www.instituteofhealthequity.org/

Joseph Rowntree Foundation (JRF)

The Joseph Rowntree Foundation is an independent organisation working to inspire social change through research, policy and practice. Its vision is for a prosperous UK without poverty, where everyone can thrive and contribute. https://www.jrf.org.uk/

Local Government Association (England & Wales) (LGA)

The LGA is a membership organisation. In total, 415 authorities are members of the LGA for 2017/18. The LGA are the national voice of local government, working with councils to support, promote and improve local government. https://www.local.gov.uk/about

New Philanthropy Capital (NPC) NPC provides expert advice to charities, social enterprises, grant-makers, donors, and corporate clients. It combines this work with its role as an independent think tank, giving an overview of future trends, the latest thinking on how to improve the impact of charities and their funders, and insights on the issues that matter to the sector..http://www.thinknpc.org/

People’s Health Trust The People’s Health Trust was set up to address health inequalities in Great Britain and create fairer places in which to grow, live, work and age. Through our funding and support, the Trust encourages resident-focused approaches. People’s Health Trust is funded through 51 society lotteries, that operate through The Health Lottery. Each society lottery donates its good causes money to People’s Health Trust. https://www.peopleshealthtrust.org.uk/about-us

The Health Foundation As above. http://www.health.org.uk/about-us

What Works Centre for Wellbeing The What Works Centre for Wellbeing provides independent high quality evidence on what organisations – Governments, Charities, Businesses – can do to improve wellbeing. https://whatworkswellbeing.org/about/

Participating organisations bring together a mix of evidence, reach, and know how in

facilitating national and local change on the wider determinants of health. They have

committed to a time-limited co-design process, lasting approximately six months starting in

October/November 2017 and ending in March/April 2018, and a time commitment of

approximately three to four days per organisation. We have directly invited the individuals we

want to participate and have been clear that we don’t anticipate any further delegation. We

have also been clear that any workshops would be scheduled at least two months in

advance, if not longer, to ensure attendance.

We envisage that the co-design process will build a sense of shared purpose, surface

respective ambitions, contributions and reservations about a coalition, facilitate a collective

discussion on potential next steps, and test initial views on some potential ‘offers’. The

output from the co-design process will be an action plan for establishing a collaboration and

its initial work programme, which individual organisations can then use to consider their

appetite and commitment to further collaboration.

We have asked a range of individuals and organisations to act as an advisory group in the

development of the collaboration, particularly to test ideas. Membership of this group may

vary depending on the focus of the collaboration as it develops, but is likely to include

individuals and organisations from a mix of sectors, working at local and national levels.

2.0 Details of the work

Objectives

• To continue to build a sense of shared purpose among the participating organisations

• To surface respective ambitions, contributions and reservations about a collaboration

• To facilitate a collective discussion on potential next steps, and agree aims and

objectives for any collaboration and/or projects

• To produce an initial work programme, including proposals around structure,

governance and funding.

Approach

We have outlined a broad approach below, but are happy for applicants to make

suggestions to this based on their experience and preferred models. There will need to be

clarity established early on about the role of organisations taking part in the co-design, given

that a number of organisations participating might be interested in bidding for work the

collaboration might generate. We are seeking to clarify the role of organisations as part of

the co-design, which is entirely separate from any later delivery function.

Stage 1: 1:1 discussions between external facilitator and potential collaborators:

We envisage a series of 1-2-1 sessions with potential collaborators to understand individual

perspectives on the objectives and outcomes of the collaboration, their potential contribution

and who else we might want to engage.

This could include:

- Ambitions for the collaboration, including the unique contribution it might bring and

potential outputs. Individuals may be aware of previous collaborations of this type

and how we can avoid duplication.

- The knowledge, resources and skills each individual can offer and where they might

want support from other organisations in the collaboration.

- Potential audiences for outputs and further suggestions of who to involve in the

collaboration.

Stage 2: Synthesis:

The facilitator will review the interview insights, and bring them together to identify: common

themes and language; similarities and differences in views or areas of interest; and any

misunderstandings or redlines. This will be fed back to participants to reflect on/ respond to

and inform the shape of a co-design workshop.

Stage 3: Building on the common ground

Work with the group, possibly through a workshop or series of workshops, to build

relationships and begin to develop ideas around the shared interests and common ground.

This should include further testing of potential ‘offers’. Not all participants will know each

other and there will need to be some time for relationship and knowledge building among

those involved.

Stage 4: Testing with some of the potential audiences/ other collaborators

1:1 discussions and possibly some group work with potential users of any collaboration

outputs, through the advisory group (‘sounding board’ of experts), the public and others

depending on the issue and the audience.

Stage 5: Building some common objectives

Using outputs from stages 2 and 3, we would anticipate some group activities to start to flesh

out some specific areas for joint action. The purpose would be to reach a stage where

individual organisations can go back to their Boards to seek approval to move forward on

specific areas of work.

The role of the provider

The provider will need to undertake all administration, such as the scheduling of workshops

or other events. We anticipate that neutral locations and venues are used and would expect

the provider to identify these and book them. We will arrange times for the initial 1-2-1

interviews and the first workshop to ensure there is no delay in starting the work.

Although the Health Foundation is commissioning this co-design, it will be taking part as one

of the participating organisations. Whilst any contractor will be contractually accountable to

the health foundation, they will also be accountable to the collaborating organisations for this

work. We will expect any contract to seek regular feedback from the collaborating

organisations. We would expect six weekly updates, face to face or by phone, on progress in

this work, but this will be separate from our participation role, and may also involve other

participating organisations.

3.0 Deliverables

Output

• Agreed aims and objectives for further collaboration, and/or projects and the

conditions necessary to achieve these.

• If appropriate, an initial work programme, with a timed action plan for further

development. This should include proposals around structure, governance and

funding.

Specific deliverables are described in the section on ‘Details of the work’ above and include:

interviews, interview synthesis, workshops, and advisory group involvement.

The work must be complete by March 2018. A provisional timeline, which may change

depending on the exact content of the co-design agreed, is provided below to give an

indication of our expectations.

Provisional Timeline

Preparation for 1-2-1 interviews w/c 30th October

Interviews* w/c 6th and 13th Nov

Synthesis w/c 20th and send out to participants

Workshop 1* w/c 27th Nov

Synthesis of findings/ideas and circulation

w/c 4th Dec

Initial ideas testing with advisory group

11th -22th Dec – may involve bringing people together or could be done electronically with some face to face meetings.

Workshop 2 w/c 15th Jan

Refining of ideas/findings and circulation

w/c 22-26th Jan

2nd round of idea testing with advisory group

w/c 5th Feb

Workshop 3 – final workshop w/c 19th Feb

Organisations go to boards March/April

*1-2-1 interview meeting times and a workshop date will be organised by the Health

Foundation in advance of the contract being awarded to ensure availability in the

collaborators diaries.

4.0 Costs

Responses to this invitation should include accurate pricing, inclusive of expenses and

VAT. It is emphasised that assessment of responses to this tender invitation will be on

perceived quality of service and demonstrable ability to meet the brief, rather than

lowest cost, but value for money is a selection criterion.

We anticipate this work will cost <£60,000, including VAT. The budget should include

VAT & expenses (including venue hire and administration). It does not need to include

the travel expenses of those organisations participating in the co-design or advisory

group. We would expect it to include the elements described above.

5.0 Tender response requirements

5.1 Please complete the attached tender response form in Arial typeface (font 11

points). The Health Foundation will only accept proposals submitted using this

form. Full proposals must be submitted by 10:00 on 1st September, should

specify cost, and must include any VAT. Please email your proposal to

sarah.lawson@health.org.uk.

6.0 Instructions for tender responses

6.1 The Foundation reserves the right to adjust or change the selection criteria at its

discretion. The Foundation also reserves the right to accept or reject any and all

responses at its discretion, and to negotiate the terms of any subsequent

agreement.

6.2 This work specification/invitation to tender (ITT) is not an offer to enter into an

agreement with the Foundation, it is a request to receive proposals from third

parties interested in providing the deliverables outlined. Such proposals will be

considered and treated by the Foundation as offers to enter into an agreement.

The Foundation may reject all proposals, in whole or in part, and/or enter into

negotiations with any other party to provide such services whether it responds to

this ITT or not.

6.3 The Foundation will not be responsible for any costs incurred by you in

responding to this ITT and will not be under any obligation to you with regard to

the subject matter of this ITT.

6.4 The Foundation is not obliged to disclose anything about the successful bidders,

but will endeavour to provide feedback, if possible, to unsuccessful bidders.

6.5 Your bid is to remain open for a minimum of 180 days from the proposal

response date.

6.6 You may, without prejudice to yourself, modify your proposal by written request,

provided the request is received by the Foundation prior to the proposal response

date. Following withdrawal of your proposal, you may submit a new proposal,

provided delivery is effected prior to the established proposal response date.

6.7 Please note that any proposals received which fail to meet the specified criteria

contained in it will not be considered for this project.

7.0 Selection criteria

7.1 Responses will be evaluated by the Foundation using the following criteria in no

particular order:

• Ability to deliver on all required services or outputs, using a clear theoretical

framework

• The quality and clarity of the proposed service

• Evidence of experience and success (including references) of similar projects

involving multiple national organisations

• Ability to engage and challenge senior individuals in national organisations and

facilitate the building of cross-sector relationships and projects

• Responsiveness and flexibility, including evidence of good anticipation and plans

for handling the issues likely in such as project

• Value for money

• Financial stability and long-term viability of the organisation (Due diligence will be

undertaken on all shortlisted organisations)

• Ability to work with others

7.2 It is important to the Foundation that the chosen provider is able to demonstrate

that the right calibre of staff will be assigned to the project; therefore, the

facilitator who will be responsible and delivering the project should be present

during the panel interviews if you are selected.

8.0 Selection process

8.1 Please email electronic copies of your full proposal plus any accompanying

documents to Sarah Lawson, Policy and Programme Support Officer,

sarah.lawson@health.org.uk by 10:00 on 1 September 2017.

8.2 A response to your application will be made by 17:00 on 12 September 2017.

8.3 Interviews will be held week commencing 18 September.

8.4 Final decision will be communicated by 17:00 on 22 September 2017.

8.5 Start date to be agreed following the final decision [and would be as soon as

practicable].

9.0 Confidentiality

9.1 By reading/responding to this document you accept that your organisation and

staff will treat information as confidential and will not disclose to any third party

without prior written permission being obtained from the Foundation.

9.2 Providers may be requested to complete a non-disclosure agreement

10.0 Conflicts of interest

10.1 The Foundation’s conflicts of interest policy describes how it will deal with any

conflicts which arise as a result of the work which the charity undertakes. All

external applicants intending to submit tenders to the Foundation should

familiarise themselves with the contents of the conflicts of interest policy as part

of the tendering process and declare any interests that are relevant to the nature

of the work they are bidding for. The policy can be found and downloaded from

the Foundation’s website at the following location:

http://www.health.org.uk/about-us/

11.0 Information required to assist the Health Foundation carry out due diligence on

potential suppliers

11.1 Is your organisation a legal entity (Company, Charity, LLP)?

11.2 What is the date of your last registered Financial Statements (please attach these

to this document)

11.3 What is the date of your last annual return? (if applicable)

11.4 How long has your organisation been in existence?

11.5 How many staff does your organisation employ?

11.6 What is your organisation’s VAT number?

11.7 Has your organisation provided services to the Health Foundation previously?

11.8 Has the person representing the organisation provided services to the Health

Foundation previously?

Yes / No

Please specify what your type of organization is (including description if not

registered as one of the above)

Year of incorporation or registration

VAT registration number

Company and/or Charity registration number

Yes / No

Date of latest Financial Statements:

Date of Annual Return

11.9 Which other organisations are you currently working with?

11.10 Supplier references: (please note that if you/your organisation has not worked with

THF before we will be contacting your references if you are shortlisted for interview

or if you are the only supplier)

.

Name, address, phone number and email address of second referee:

Name, address, phone number and email address of first referee:

Appendix 1

The social determinants of health and the work of the Health Foundation

About our work at the Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. We spend about £30 million each year supporting grants, research and policy analysis, and we have built up a strong body of knowledge as to how to bring about change in complex health care systems. Why we are exploring this area Research has shown that access to health care accounts for as little as 10% of a population’s health and wellbeingi. Whilst our work to support those improving the way that health care is delivered remains as important as ever, we know it is far from sufficient on its own to improving people’s health in the UK. In 2017 we began implementing a long-term strategy to improve health as well as health care. Through this strategy we aim to:

• Change the conversation so the focus is on health as an asset, rather than ill health as a burden

• Promote national policies that support everyone’s opportunities for a healthy life

• Support local action to address variations in people’s opportunities for a healthy life For more detail on our approach see: http://www.health.org.uk/sites/health/files/HealthyLivesForPeopleInTheUK.pdf

What are the social determinants of health?

In 2010, Michael Marmot’s review evidenced that health is influenced by political, social,

economic, environmental and cultural factors. These factors shape the conditions in which

we are born, grow, live, work and age, and are affected by the distribution of power, money

and resources.

The numerous social determinants of health are shown in the diagram belowii.

How the social determinants influence health

The social determinants of health operate throughout our lives. They are largely, or

completely, outside of individual control and there are many direct and indirect ways through

which they can influence our health and wellbeing. For example these include:

• Work: insecure and poor quality employment can lead to increased risk of poor

physical and mental health, often through feelings of stress and a loss of control.

• Education: people with university degrees have better health and live longer lives

than those without. This is because higher educational outcomes are related to better

physical and mental health, as well as income, employment and quality of life.

• Housing: damp, cold, inadequate and insecure housing can lead to physical

problems such as respiratory problems, as well as feelings of anxiety and

depression.

• Communities and social networks: social capital brings a range of benefits

including a source of resilience, a sense of control over life, and a buffer against risks

of poor health. In many deprived communities, stress, isolation and depression are

common.

• Neighbourhoods: the availability of shops with healthy foods, and access to green

space, is more limited in deprived neighbourhoods, limiting opportunities to lead a

healthy life.

The Marmot review recommended that action be taken on 6 policy objectives to address

health inequalities:

1. Give every child the best start in life.

2. Enable all children, young people and adults to maximise their capabilities and

have control over their lives.

3. Create fair employment and good work for all.

4. Ensure healthy standard of living for all.

5. Create and develop healthy and sustainable places and communities.

6. Strengthen the role and impact of ill-health prevention.

For more information:

This video further illustrates the social determinants of heath at play.

In 2008, the WHO Commission on the Social Determinants of Health made the case that

although health care and ‘lifestyles’ are important determinants of health, it is the social

environment that explains the causes behind these factors.

Dalghren and Whitehead, WHO

European Strategies for Tackling Social Inequities in Health

Royal College of Paediatrics and Child Health

The State of Child Health Report 2017

Sir Michael Marmot

Social Determinants of Health video

Summary of the Marmot Review 2010

The Health Foundation

Healthy lives for people living in the UK

Robert Wood Johnson Foundation

Culture of Health http://www.rwjf.org/en/how-we-work/building-a-culture-of-health.html

County Health Rankings http://www.countyhealthrankings.org/

iMcGovern L, Miller G, Hughes-Cromwick P. Health Policy Brief: The relative contribution of multiple

determinants to health outcomes. Health Affairs. 21 August 2014.

iiAdapted from Dahlgren G, Whitehead M. Policies and Strategies to promote social equity in health:

Institute of Futures Studies: 1991.

Appendix 2

Collaboration for Wellbeing and Health: Background Paper May 2017 Introduction Good health is an asset necessary for a prosperous and flourishing society. Yet, political and public attention tends to be focused on the task of alleviating the burden of disease rather than investing in wellbeing and health. The factors shaping our health – as well as inequalities in health – are social and economic determinants including our housing, education and employment, and our physical and social environment. It is hard to find a sector that doesn’t have a bearing on our health. This means that creating healthy lives for people in the UK requires a collective endeavour that is broader than individual disease areas, specific sectors or approaches. Motivating and enabling sectors, which do not commonly or routinely consider their impact (positive or negative) on wellbeing and health, requires evidence of the social and economic benefits to them of doing so and the language and mechanisms to galvanise action around a common goal. The Health Foundation is setting out a long term strategy to achieve this1. First, we will be building evidence about the impact of health on social and economic factors. By understanding the contribution that wellbeing and health makes to wider societal outcomes, policy makers will be better placed to make decisions about the relative value of investing in good health through action on the social determinants versus spending that addresses the consequences of ill-health. Understanding health as an asset could fundamentally re-position policy discourse and action. Second, we want to build a cross sector collaboration for action to support healthy lives. A collaboration where health is a shared value and that supports greater action and investment on the social determinants of health. To take this idea further, we are proposing to support a process through which a small group of organisations with a broad interest in this space could determine more precise objectives, shape and nature of the collaboration. Current situation Work on the social determinants of health has been underway for decades – this is not something new. However, the message about what ‘creates health’ outside of healthcare has still not been widely heard and understood beyond the public health community. Despite increases in life expectancy, healthy life expectancy is decreasing and inequalities persist. At the same time the number of households unable to afford an acceptable standard

1 For more information on our approach see: http://www.health.org.uk/sites/health/files/HealthyLivesForPeopleintheUK.pdf

of living is rising and over half of all poverty is now found in working households2’3. The conditions that create health are getting worse rather than better. This is all in a context of austerity, which has led to significant reductions in public services and reduced support to the voluntary sector against a backdrop of increasing pressure on services. Only by addressing the wider determinants of health are we likely to move towards a prosperous and flourishing nation. Doing so will require more, concerted action across multiple sectors and interests. What have we been doing? Over the past 6 months we have been reviewing action in the UK and US on wider determinants to develop insights into how we might support local action to improve health. We have been drawing together and learning from the:

• work of Professor Sir Michael Marmot and the Institute of Heath Equity

• work of the Robert Wood Johnson Foundation

• engagement we undertook in the development of our long-term strategy, including local perspectives.

The Marmot Review4, and the work of the Institute of Health Equity, contributed to increasing recognition of the impact of the wider determinants of health and led to over 70% of local authorities in England5 working towards implementing the six recommendations for action. Work based on these recommendations is having an impact, and shows that health inequalities are not inevitable. Although the starting position in the US is quite different to the UK, our review of the work of the Robert Wood Johnson Foundation (RWJF) has highlighted some useful insights. The RWJF aims to build a ‘Culture of Heath’6 and have developed a strategy that is built on:

• a framework which focuses on what action can be taken

• community engagement and action leading to sustainable health creation

• partnerships with organisations with extensive local reach • a communication strategy promoting simple, clear messages to local areas, and

reframing the debate from healthcare to health creation • a focus on ‘wellbeing’ not health, facilitating the structured engagement of new

sectors

2 Marmot indicators 2015: A preliminary summary with graphs. Available from: http://www.instituteofhealthequity.org/projects/marmot-indicators-2015 3 Wider determinants of health: March 2017 statistical commentary. Public Health England. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/596516/Wider_Determinants_of_Health_March_2017_statistical_commentary.pdf 4 Marmot M. Fair Society, Healthy Lives. The Marmot Review; 2010. Available from: www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review 5 http://www.ucl.ac.uk/impact/case-study-repository/marmot-review 6 http://www.rwjf.org/en/how-we-work/building-a-culture-of-health.html

• a long term view – a 10 year commitment

• ongoing evaluation of what is creating change across communities – the study of 30 places, ‘sentinel communities’7, including monitoring changes in public understanding of what creates health.

Our review of the health landscape in the UK has pointed both to the need for greater collaboration of those with an interest and role in the determinants of health, and to a number of opportunities that could be harnessed to this end.

• There is more potential to capitalise on the public health move into local authorities and support public health teams to engage different parts of the local system in their health creating role. We see this happening in some places, but not universally, and there is not sufficient infrastructure to support this. The arrival of the business rate retention scheme will place greater imperative on local authorities to think about ‘health creation’ as a foundation of ‘wealth creation’.

• Outside of the public health sector there is highly relevant analysis and action framed largely through the productivity and inclusive growth lens. Making more explicit the relationship between these issues and people’s long term wellbeing and health – for example, where good health is both a necessary foundation of a flourishing society and an outcome of good work - we may collectively have more impact.

• Business is increasingly engaging in their role in supporting good health. However, this perspective is largely confined to their role as employers and more could be done to harness this interest in terms of their role as community leaders.

Running through all our findings is the need for: ongoing evaluation; systematic engagement of communities; greater awareness of the underlying social causes of health inequalities across different sectors; and the capacity, know how and mechanisms to enact change. What conclusions have we drawn? Bringing this learning together we have found:

• There has been progress in addressing factors that impact on health, but overall it is

patchy and requires scale.

• Understanding about what creates health and ownership of a health creating agenda

outside of public health is still limited – professional and public.

• The focus on this agenda is often for different and disconnected purposes.

• Issues are complex, can feel overwhelming, require joint solutions and a long-term view.

• There is a lack of capacity, know how, and levers to create change, within a context of shrinking resources and ‘space’ to build partnerships, particularly community led partnerships.

What are we proposing?

There is lots of good work underway but we are struck that this could have more impact if

there was greater collaboration. A collaboration that facilitates:

• the translation and linking of the wealth of existing data and evidence so that it

provides insights and is acted on beyond the sector that has generated it

This could involve ‘linkage’ of national organisational agendas (inclusive growth,

community development & health) by translation of benefits of one sector to another.

• the amplification of these insights through sustained communications efforts to reach new audiences and generate new connections, particularly at local level.

This could involve developing a framework to communicate the factors that contribute to health and building a joint communications strategy to disseminate this.

• access to support on the know-how on change.

A co-ordinated local support offer potentially including training/coaching/partnership facilitation/leadership/communities of practice and skills gap support.

A proposed timeline for developing a collaboration is outlined below.