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

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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.