C3 Collaborating for Health works alongside communities to promote sustainable, healthy habits.
C3 Collaborating for Health (C3) believes that engaging members of the community is the best way to break down the barriers to living a healthy, safe and secure life; and to generate sustainable change.
Supporting local people to engage positively with their physical and nutritional environments can include improving the spaces that the community already has, which may be being underused or poorly maintained; creating new green space; making physical activity opportunities more attractive and accessible to local people; or improving access to healthy food and drinks in shops and restaurants. When a community feels that they have ownership of their space, and that they have the power to make and sustain positive changes, communities can be transformed.
Enacting and delivering change
Our work with communities is underpinned by our experience and knowledge of working with those people who find it hardest to live healthy lives in some of the most disadvantaged communities in Europe. We know the evidence. We know that the only way to see specific changes in communities requires a holistic approach and takes time. We know that communities want to make their own change – the days of enacting change upon them are over. Providing the support network that communities can use to make their own decisions about what they want to see will deliver cost effective and sustainable change. We know that people live tight geographical lives – if change is going to be sustainable then the community’s needs must be met in their community spaces, not near them.
We know that the assets of disadvantaged communities (the people and spaces comprising the community) need to consistently over-perform if we are to break the cycle of deprivation. The mobilisation of these assets is critical to success. We know that the communication of opportunities and activities may be the most important part of the entire community engagement process – there are pivotal communicators and important opinion formers within communities; and we should make the most of them.
Introducing the CHESS process
Community Health Engagement Survey Solutions (CHESSTM) works because it is created with the community, by the community. It is a process for engaging community members in an investigation about their health in relationship to the built environment; and it sits at the heart of C3’s community engagement strategy. It identifies quick positive changes which can be made almost immediately and compiles a longer-term plan with identified actions. We use the CHESS process to structure our engagement: this allows us to examine the unique nature of the space we are investigating and establish baseline data about the environment – the food and physical activity environment, including the walkability and safety of an area, and how easy (or not) it is to access the opportunities within a community.
We seek the views of the community on what they would like to see changed in their environment to make it more healthy; and find the community members and stakeholders who want to co-produce healthy changes in their area, to create the conditions within which change can happen. This involves using the CHESS mobile tool alongside community members collecting quantitative and qualitative data on local assets, such as spaces for physical activity and places for food shopping or eating, that make an area conducive or otherwise to good health. The data collected is then discussed at insight sessions, where community members think about what interventions they want to see locally to make it easier to be healthy. The results can be put to local decision-makers by the community as an argument for change.
CHESS emerged out of an international research project in India, China, Mexico and the United States, which examined the built environment in impoverished communities. The researchers realised that involving local residents in collecting data on the built environment in their neighbourhood offered the potential to also ask them questions about what makes an area healthy or not, why some areas experience worse health than others and what might be done to change that. It gives community members the opportunity to explore for themselves the implications of improved access to healthy foods, physical activity opportunities, clean streets, tobacco and alcohol matters. It encourages them to think critically about what the health implications are of the built environment in their area and take action to improve it. In this way, CHESS addresses not only the causes of chronic disease but also issues around social justice and equity.
CHESS has been used extensively in areas of London and around several underserved communities in the United States to engage young people with healthy food options. It was used in the North of England and in Scotland for two years to engage two communities around healthy eating and physical activity. Now it is in use in four areas of Northern France and three in Southern England, addressing obesity and unemployment in areas traditionally dominated by the heavy industries which are now largely defunct. The longer a person experiences unemployment, the higher their risk of living with obesity becomes, with rates reaching up to 32.7% after a year or more of unemployment. 16 organisations have come together to address these two issues holistically via the Adding to Social capital and individual Potential In disadvantaged REgions (ASPIRE) programme.
ASPIRE’s challenge is reflected in local statistics: whilst the national unemployment rate in France is around 10%, the Hauts-de-France region is the worst affected at nearly 13%. People living with obesity there exceeded 20% in 2016, six percentage points above the French average. Equally, according to a UN report one quarter of British adults are living with obesity, with levels having more than trebled in the last 30 years: 63.1% of people in South East England and 62.7% in South West England are currently overweight.
It is clear that a worryingly high proportion of people are considered to be overweight or living with obesity in these two areas; and the highest levels are recorded in areas of high economic deprivation. An OECD report exploring the relationship between education and obesity states that ‘obesity tends to be more prevalent in disadvantaged socioeconomic groups’. While eating healthily is often unachievable on a budget, knowledge of how to cheaply grow and prepare fresh fruit and vegetables can make some difference, along with influencing local shops to sell more healthy produce.
ASPIRE will give people who are living with obesity/overweight and/or people who are experiencing unemployment the tools they need to make healthier lifestyle choices and improve their employability. Current healthcare and employment services rarely work together to tackle the issues as a single problem, despite the evidence that they are linked. The project will encourage a ‘grow your own, eat your own, sell your own’ ethos inspiring a new model, co-created using partner expertise in both fields. This model will holistically combine the necessary support to increase employability with access to local healthy food produce and consequent weight loss. It will be implemented at seven sites, using innovative technology to enable participants to develop a sustainable relationship with food and provide them with the skills and support they need to improve their health.
CHESS works because it recognises that behaviour change alone is not enough to prevent chronic disease, nor can we tell communities what to do. CHESS is created with the community, by the community, for the community. If we truly want to prevent chronic diseases, we must create the conditions in local communities within which change can happen.
C3 Collaborating for Health