Tackling health disparities through social innovation: a multi-stakeholder coalition for inclusive health in Brent, London

生活在伦敦布伦特区的人们面临着许多挑战，包括贫困——布伦特有三分之一的家庭被列为贫困家庭。然而，这种贫困在整个自治市的分布并不均匀，尤其是两个区——斯通布里奇和哈尔斯登——失业率最高，家庭收入低，犯罪率也很高。这两个区也是该区黑人人口最多的地区。历史上对警察和政府服务的不信任也一直存在，尤其是在这两个区。同样，整个自治市镇的健康模式反映了较为贫困地区之间的差异，与最贫困地区相比，男性的预期寿命几乎少12年，女性少9年。在最贫困的地区，儿童肥胖率更高，布伦特四分之一的六年级儿童被认为肥胖。布伦特一半以上的家庭使用绿地的机会有限。心脏病和糖尿病的发病率也很高，尤其是在黑人和其他种族背景的人群中。布伦特也是英格兰Covid-19死亡率最高的地区之一，但疫苗接种率最低。居民们自己也强调了一些关于健康和福祉的问题，包括住房不足；营养不良，咖啡馆和餐馆缺乏健康食品选择；缺乏安全的绿色健身空间，青少年俱乐部等社交场所也很少；高犯罪率和反社会行为；家庭暴力;缺乏对精神卫生问题的支持；难以获得保健（特别是全科医生）和其他服务，以及数字排斥，特别是老年群体。布伦特理事会获得了中央政府的资助，以应对这些挑战，并设立了“布伦特健康事务”，与国民保健服务合作伙伴和社区团体一起工作。他们最初的重点是增加疫苗的吸收率，但这已经转移到解决自治市镇更广泛的健康不平等（包括糖尿病和精神健康问题）。我们提议的研究将以合作伙伴之间的初步工作为基础，探索一种创新的基于社区的干预措施，以解决布伦特的健康差距问题。在这一阶段，我们希望研究如何利用和部署社区的物质、知识和机构资产，以解决健康差距问题。这些差异可以被描述为“综合征”，指的是增加一个人对伤害的易感性或使其健康结果恶化的生物和社会相互作用。我们的研究团队将以伦敦布伦特区（Brent）为例，研究在地学习，将BHM项目作为应对健康差距的社会创新实例。促进多个机构之间的合作——这是社会创新的一个关键特征——BHM处于开发和部署解决方案的最前沿，以应对布伦特地区的系统性健康挑战。除此之外，这项研究将研究这种创新是否以及如何导致不同行为者的包容和代理，以应对该行政区的健康差距和更广泛的社会挑战。政策、空间和互动将是我们分析的关键。我们将开展参与性行动研究，以确定布伦特的社区资产，并绘制其改善健康的潜力。然后，我们将与合作伙伴合作，制定一个框架，共同设计包容性社区主导的干预措施，利用这些资产改善健康和福祉。这将使我们有机会探索整合知识合作生产的不同合作模式和政策杠杆，然后形成一个联盟，提供和衡量共同设计的社会创新干预措施，利用综合方法解决已确定的健康差距。

People living in the London Borough of Brent face a number of challenges, including poverty - with one in three households in Brent being classed as poor. However, this poverty is not distributed evenly across the borough, with two wards in particular - Stonebridge and Harlesden - having the highest rates of unemployment and low household incomes, as well as crime. These two wards also have the highest black population in the borough. There is also historical mistrust of police and government services in the borough, particularly in these two wards. Similarly, health patterns across the borough reflect the divisions between the more deprived areas, where life expectancy is almost 12 years less for men and 9 years lower for women compared to the least deprived. Rates of childhood obesity are higher in the most deprived areas, and a quarter of children in Year 6 in Brent are considered obese. More than half of Brent households have limited access to green spaces. There are also high rates of heart disease and diabetes, particularly among people from black and other ethnic backgrounds. Brent also experienced some of the highest Covid-19 death rates in England but has one of the lowest vaccination rates. Residents themselves have highlighted a number of issues around health and wellbeing including inadequate housing; poor nutrition and lack of healthy food options in cafes and restaurants; a lack of safe green spaces for fitness, and few other areas for socialisation such as youth clubs; high crime rates and anti-social behaviour; domestic violence; lack of support for mental health issues; difficulties in accessing health (in particular GPs) and other services, and, digital exclusion particularly for older age groups. Brent Council was awarded central government funding to address these challenges and set up 'Brent Health Matters' (BHM), who work along with NHS partners and community groups. Their initial focus was on increasing vaccine uptake, but this has shifted to addressing wider health inequalities in the borough (including diabetes and mental health issues). Our proposed research will build on initial work between the partners to explore an innovative community-based intervention to tackle health disparities in Brent. In this phase, we want to examine how physical, knowledge and institutional assets in a community can be harnessed and deployed to address health disparities. These disparities can be described as 'syndemic', which refers to biological and social interactions which increase a person's susceptibility to harm or worsen their health outcomes. Our consortium will use the London borough of Brent as a case study for place-based learning, examining the BHM programme as an instance of social innovation in response to health disparities. Fostering collaboration among multiple agencies - a key feature in social innovations - BHM is at the forefront of developing and deploying solutions to systemic health challenges in Brent. Among others, this research will examine whether and how this innovation is resulting in the inclusion and agency of different actors in responding to health disparities and broader societal challenges in the borough. Policies, spaces and interactions will be key in our analyses. We will undertake participatory action research (PAR) to identify community assets in Brent and map their potential to improve health. We will then work with partners to produce a framework for co-designing inclusive community-led interventions that will utilise these assets to improve health and wellbeing. This will give us the opportunity to explore different collaborative models and policy levers for integrating knowledge co-production, before forming a consortium to deliver and measure co-designed social innovation interventions to address identified health disparities using the syndemic approach.