ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing

我们成长的社区和社区对我们患上的疾病和我们的寿命有着终生的影响。健康是关于避免疾病和长寿，但也是关于感觉身心健康，感觉安全，成为社区的一部分，有期待的东西。我们周围世界的许多方面直接影响我们的健康或影响与健康有关的行为。这些所谓的“更广泛”的健康决定因素包括我们居住的房屋和公寓、我们的道路和商业街的设计、公园、绿地、图书馆、画廊、博物馆、体育和娱乐设施的可用性和质量、娱乐机会、与他人联系的场所和活动、我们周围的商店和企业、污染水平、学习机会、我们可以找到的工作，以及我们是否有足够的钱维持收支平衡和参加社会活动。改变不健康饮食、饮酒、吸烟和缺乏锻炼等与健康相关的行为的尝试取得了重要但有限的成功。例如，如果不解决更广泛的决定因素，提高对儿童肥胖症与健康问题之间联系的认识，以及运动和健康饮食的重要性，将取得有限的成功。这些更广泛的决定因素包括但不限于，儿童可能路过的许多快餐店，无法获得高质量的游戏和娱乐设施，学校操场的门票被抢购一空，儿童步行或骑自行车上学不安全的街道，缺乏高质量的锻炼绿地，选择糟糕的健康食品的商店，取代体力活动的屏幕时间增加，学校食品质量差，以及对一些人来说，收入不足，无法购买健康食品。我们的ActEarly方法侧重于改善两个儿童贫困程度较高的地区的儿童健康，这两个地区分别是约克郡的布拉德福德和伦敦的塔哈姆莱特。在为这项工作做准备时，我们与当地社区、地方当局和其他当地组织合作，并建立了共同的优先研究领域：健康的场所、健康的学习和健康的生计。我们将这些主题方面的专家与当地社区和地方当局的代表聚集在一起，开始制定一系列办法，以改善这些地区的儿童健康。例如，在我们的健康场所主题中，我们将共同努力：绘制当地社区资产图，并了解如何改进这些资产并为更多人使用；制定健康街道方法，提高绿地质量。在我们的健康学习主题中，我们将共同努力，发展由学前教育、学校和社区学习场所组成的本地“积极证据网络”。这些网络将帮助制定和评估各种改善儿童健康的方法。在我们的健康生计主题中，我们将在福利咨询服务搬迁以改善获得机会、允许育儿假、确保学校毕业生的最低基本收入、提供生活技能培训以及让当地社区参与决定如何使用地方当局预算等方面共同努力。为了了解这些方法对儿童健康的影响，我们将开发强大的数据资源，汇集我们各地的现有信息，以衡量当地环境、与健康有关的行为和健康结果的变化。研究团队将利用这些数据并与当地社区合作，了解我们的倡议有多成功。我们将我们对早期生活干预的重视、我们高度协作的方法以及开发本地数据来源以实现对多项倡议的评估，称为“早期行动合作实验室”。我们希望这一方法将促进为儿童创造一个更公平、更健康的未来，并成为如何与社区合作改善健康状况的全球榜样。

The communities and neighbourhoods where we grow up have a lifelong influence on the illnesses we get and how long we live. Health is about avoiding disease and having a long life, but is also about feeling well in mind and body, feeling safe, being part of a community and having things to look forward to. Many aspects of the world around us influence our health directly or influence health related behaviours. These so called "broader" determinants of health include the houses and flats we live in, the design of our roads and high streets, the availability and quality of parks, green spaces, libraries, galleries, museums, sports and recreational facilities, entertainment opportunities, places and events to connect with others, the shops and businesses around us, pollution levels, learning opportunities, the jobs available to us and whether we have enough money to make ends meet and to participate in social activities. Attempts to change health related behaviours such as unhealthy eating, drinking, smoking and lack of exercise, have met with important but limited success. For example, increased awareness of links between childhood obesity and ill health and the importance of exercise and healthy diet will have limited success if broader determinants are not also tackled. These broader determinants include, but are not limited to, the many fast food outlets that children may walk past, lack of access to high quality play and recreational facilities, sell off of school playing fields, streets that are not safe for children to walk or cycle to school, lack of high quality green spaces for exercise, shops with poor choice of healthy foods, increased screen time replacing physical activity, poor quality of school food, and, for some, insufficient income to buy healthy food. Our ActEarly approach focuses on improving the health of children in two contrasting areas with high levels of child poverty, Bradford in Yorkshire and Tower Hamlets in London. In preparation for this work we have worked with local communities, local authorities and other local organisations and have established shared priority areas for research: Healthy Places, Healthy Learning and Healthy Livelihoods. We have brought together experts in these themes with local community and local authority representatives to begin to develop a range of approaches to improving child health across these areas. For example, within our Healthy Places theme we will work together to: map local community assets and to understand how they can be improved and used by more people; develop a Healthy Streets approach and improve green space quality. In our Healthy Learning theme we will work together to develop local "Evidence Active Networks" of pre-school, school and community learning venues. These networks will help develop and evaluate a wide range of approaches to improve child health. In our Healthy Livelihoods theme we will work together on approaches such as relocation of welfare advice services to improve access, enabling parental leave, ensuring a minimum basic income in school leavers, providing life skills training and involving local communities in decisions on how to spend local authority budgets. To understand the effect of these approaches on child health we will develop strong data resources that bring together existing information from across our localities to measure changes in the local environment, health related behaviours and health outcomes. Teams of researchers will use this data and work with local communities to understand how successful our initiatives have been. We describe our emphasis on early life interventions, our highly collaborative approach and development of local data sources to enable evaluation of multiple initiatives, as the "ActEarly Collaboratory". We hope the approach will promote a fairer and healthier future for children and a global example of how to work with communities to improve health.