Coordinating and Mobilising Cultural and Natural Assets to Combat Health Inequalities: From Local to National.

新冠肺炎大流行对社会弱势群体造成了不利和不成比例的影响，凸显了英国的严重不平等。这些结构性不平等并不新鲜；《土拨鼠评论》（公平社会，健康生活；2010年）表明，健康不平等是社会和经济不平等的结果。此外，人们普遍承认，在健康方面存在社会梯度，生活在最贫穷地区的人的健康状况明显较差。自首次审查以来的十年中，情况并没有改善，最近的土拨鼠审查（10年后；2020年）指出，在过去十年中，预期寿命的增长有所放缓，在该国较贫困的地区放缓幅度最大。过去二十年来对卫生不平等现象的研究揭示了社区资产、地方感和社区参与在解决卫生的主要社会决定因素方面的作用。在这个项目中，我们将与国家创意健康中心（NCCH）、英国国民健康服务体系的个性化护理小组（NHSE）以及其他地区和国家合作伙伴密切合作，协调一项国家研究计划，重点是创建一个全面的证据基础，说明文化、自然和其他社区资产（如法律和咨询服务）如何更好地融入健康、社会护理和地方（当局）系统，以解决社会不平等的根本原因。研究将集中在英格兰综合护理系统的实施，以及威尔士、苏格兰和北爱尔兰的类似系统。综合护理系统（Integrated care systems, ics）是满足某一地区卫生、社会护理和其他服务需求的组织与其他社区组织之间的新型伙伴关系。权力下放的国家也有类似的制度，英国向综合制度的转变提供了一个机会，让我们重新思考如何重组社区，将不平等置于法定规定和制度、战略规划、健康促进、预防和干预战略（如社会处方）的核心。这在非常贫困、社会经济指数得分较低、资产贫乏的地区尤为重要。可以说，非常贫困的地区将从综合保健和社会护理办法中获益更多，因为这些地区的一个关键特点是，有复杂需求并使用多种保健、护理和其他服务的人口比例要大得多，他们通常被称为“旋转门服务使用者”；也就是那些经历最严重的健康不平等的人。通过与地方、区域和国家机构合作，我们将积累一个全面的证据基础，为如何重新配置社区资产提供新的见解，以支持在身心健康和社会剥夺方面面临严重不平等的社区和个人。证据综合、政策简报、游说和一系列知识交流活动将把来自英国各地一系列测试和试点地点的关键学习转化为针对决策者的可操作产出，这些决策者包括综合护理系统主任、NHS的主要领导人、英格兰公共卫生部和地方当局，以及政府部门和独立机构。我们将使用枢纽和辐条方法在测试和试点站点之间进行协调，支持证据收集，通信和营销，知识交流以及与主要合作伙伴（如NHSE，国家社会处方学院和英格兰艺术委员会）的合作，以确保社区资产被重新评估并更好地融入整个英国的卫生系统，以支持升级议程。

The Covid-19 pandemic has adversely and disproportionately impacted vulnerable members of society, and highlighted significant inequalities in the UK. These structural inequalities are not new; The Marmot Review (Fair Society, Healthy Lives; 2010) demonstrated that health inequalities result from social and economic inequalities. Furthermore it is widely acknowledged that there is a social gradient to health with people living in the poorest areas experiencing significantly poorer health. In the ten years since this initial review, circumstances have not improved with the most recent Marmot Review (10 years On; 2020) noting that increases in life expectancy have slowed over the past decade, with the slowdown greatest in more deprived areas of the country.Research into health inequalities over the past two decades has shed light into the role of community assets, sense of place and community engagement in tackling the major social determinants of health. In this project we will work closely with the National Centre for Creative Health (NCCH), NHS England's Personalised Care Group (NHSE) and other regional and national partners to coordinate a national programme of research, focused on creating a comprehensive evidence base for how cultural, natural and other community assets (such a legal and advice services) can be better integrated into health, social care and local (authority) systems, to tackle the root causes of societal inequalities. The research will focus on the implementation of Integrated Care Systems in England, and analogous systems in Wales, Scotland and Northern Ireland. Integrated care systems (ICSs) are new partnerships between organisations that meet health, social care and other services in an area, alongside other community-based organisations. The devolved nations have similar such systems, and the move towards integrated systems in the UK offers an opportunity to rethink how communities can be restructured to place inequalities at the heart of statutory provision and systems, strategic planning, and health promotion, prevention and intervention strategies, such as social prescribing. This is particularly important in areas which are very deprived, scoring low on socio-economic indices and which are asset poor. It can be argued that very deprived areas will benefit more from an integrated approach to health and social care, as a key feature of such areas is the significantly greater proportion of the population who have complex needs and are using multiple health, care and other services, who are often referred to as 'revolving door service users'; namely those people who are experiencing the worst health inequalities. By working in partnership with local, regional and national bodies we will amass a comprehensive evidence base offering new insights into how community assets can be repositioned to support communities and individuals facing severe inequalities in terms of mental and physical health, and social deprivation. Evidence syntheses, policy briefings, lobbying and a range of knowledge exchange activities will translate key learning from a series of test and pilot sites across the UK into actionable outputs directed at decision makers, such as Directors of Integrated Care Systems, key leaders in the NHS, Public Health England and local authorities, through to governments departments and arm's length bodies. We will use a hub and spokes approach for coordinating within the between test and pilot sites, supporting evidence gathering, communications and marketing, knowledge exchange and collaboration with key partners (such as NHSE, National Academy for Social Prescribing, and Arts Council England) to ensure community assets are revalued and better integrated into health systems across the UK to support levelling up agendas.