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Co-producing public health: a communities approach is key to reducing health inequalities - Annamarie Hassall, National Children's Bureau

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It seems very obvious that local health services should be built around the needs of the families and communities they serve, and that this will contribute to better health outcomes in the long term. So it’s good to see that new opportunities for taking this approach forward are emerging all the time.

With the transfer of responsibility for the improvement of young children’s health to local authorities this October, and as we reflect on the success of the health visitor programme, how we prepare the next generation for healthy and fulfilling lives will once again come under the spotlight.

Evidence shows that there is much more that can be done to improve outcomes and reduce inequalities in infants and young children. The report last year from NCB and the Royal College of Paediatrics and Child Health, Why children die, throws this into stark focus. The proportion of infants who are born with low birth weight, and indeed of those who die before their first birthday, is higher in the UK than many of our European neighbours.

Shifting to evidence-based public health services to improve outcomes through a healthy pregnancy, addressing smoking for example and promoting good and affordable diet and nutrition is making a difference, not just for a pregnant mum but has far reaching benefits for wider family health. Where this is working well, individuals and communities feel empowered to make change and understand the changes needed for a healthier lifestyle.

Nationally there is much more to be done to support breastfeeding, a known protective factor as higher rates of breastfeeding correlate with lower rates of inpatient admissions, especially for respiratory infections, wheezing and asthma in babies under one year old and reduce mortality in addition to the longer term benefits for child weight. In Lambeth over 200 practitioners including health visitors, dietetic services, maternity units at Guy's and St Thomas' NHS Foundation Trust and King’s College Hospital along with parents and breast feeding peer supporters work to one vision, coordinating accurate information and resources. They use a multi-media approach, an app called Breast Start, breastfeeding support groups and weaning and healthy eating sessions.

The strategy works: breastfeeding rates increased to 94.1%, exceeding the England average of 74% and supporting 5,720 breastfeeding mothers in 2013/14. Also in Lambeth, a new project is underway which will radically change how agencies and services collaborate and work with pregnant mothers, fathers, babies, their families and communities. The 10 year project, led by the National Children’s Bureau, has investment from the Big Lottery Fulfilling Lives: A Better Start and will see an innovative programme implemented by the Lambeth Early Action Partnership (LEAP), making strong use of the latest evidence and science to ensure that the most effective interventions and support is offered.

Crucially, it will introduce Parent Champions who will make links with parents, help them access services and introduce them to other people in the area. New research tells us that the most effective way to communicate healthy lifestyle messages to parents is through other parents. Trained to pass the messages on in an accessible way, this approach complements the professionals’ role and can have great success in finding families that may not otherwise engage. Parent champions will take their place alongside health visitors and colleagues in other agencies to ensure an ongoing connection between the community, peer to peer support and good access to services.

LEAP is joined by four other projects in Nottingham, Southend, Blackpool and Bradford taking forward similar partnerships across voluntary and statutory agencies. Going forward it will be vital that projects like LEAP and statutory agencies can learn from emerging practice and embed what is evidenced to work, spreading good practice across the whole country. We must use every opportunity to ensure that all children, regardless of background or locality, get the best start in life.

 Annamarie Hassall MBE is the Director of Programmes at the National Children's Bureau

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