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

新型冠状病毒疫情对社会弱势群体造成了不成比例的不利影响，并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造成的。此外，人们普遍承认，健康存在社会梯度，生活在最贫困地区的人健康状况明显较差。在自首次审查以来的十年中，最近的土拨鼠审查并未改善情况（10年）;（2020年）注意到在过去十年中预期寿命的增长有所减缓，在该国较贫困地区的减缓幅度最大，对过去二十年中健康不平等现象的研究揭示了社区资产的作用，地方感和社区参与解决健康的主要社会决定因素。在这个项目中，我们将与国家创造性健康中心（NCCH），NHS英格兰的个性化护理小组（NHSE）和其他地区和国家合作伙伴密切合作，协调国家研究计划，重点是创建一个全面的证据库，以了解文化，自然和其他社区资产（这种法律的和咨询服务）可以更好地纳入保健、社会护理和地方（当局）系统，以解决社会不平等的根源。研究将侧重于综合护理系统在英格兰的实施情况，以及威尔士、苏格兰和北方爱尔兰的类似系统。综合护理系统（ICS）是在一个地区与其他社区组织一起提供健康，社会护理和其他服务的组织之间的新伙伴关系。权力下放的国家也有类似的制度，联合王国向综合制度的转变提供了一个机会，可以重新思考如何对社区进行重组，将不平等问题置于法律规定和制度、战略规划以及健康促进、预防和干预战略（如社会处方）的核心。这在非常贫困、社会经济指数低和资产贫乏的地区尤为重要。可以说，非常贫困的地区将从健康和社会护理的综合方法中受益更多，因为这些地区的一个关键特征是，有复杂需求并使用多种健康、护理和其他服务的人口比例明显更大，他们通常被称为“旋转门服务用户”;即那些经历最严重健康不平等的人。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，为如何重新定位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英国各地一系列测试和试点地点的主要经验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、英格兰公共卫生和地方当局的主要领导人，以及政府部门和独立机构。我们将使用中心和辐条的方法在测试和试点之间进行协调，支持证据收集，沟通和营销，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理事会）的合作，以确保社区资产得到重新评估并更好地融入英国各地的卫生系统，以支持提高议程水平。

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.