A community-centred public health approach - examples in Stockton-on-Tees

This community-centred public health approach recognises the important role of trust, relationships and power across communities and partners, to work well together and bring about change (Public Health England, 2020).

A community-centred public health approach will help deliver on the priorities in the Health and Wellbeing Strategy and the Stockton-on-Tees Plan. It will also help us collectively put into practice the five core principles the Health and Wellbeing Strategy sets out for working together effectively to improve health and wellbeing and address inequalities:

1. Health is everybody's business
2. Communities at the centre
3. Commit to prevention and early intervention
4. Levelling the playing field
5. Place-based approach

We already have many good examples of using a public health community-centred approach in Stockton-on-Tees, to put these principles into practice.

Health is everybody's business - work and health

We are working closely with small and micro businesses across the Borough to support them with workplace health and wellbeing. In 2024 to 2025, 41% of the working age population (16 to 64 years) in the Borough were economically inactive due to long term sickness. Recent research (Health inequalities in 2040: current and projected patterns of illness by deprivation in England) has shown that inequality in health and ability to work will persist to 2024 based on the current trends, so it is important we continue to focus action on the issues that drive this including deprivation, chronic obstructive pulmonary disease (COPD) and obesity-related disease. 87% of registered businesses in the Borough employ less than 10 people, so it is important we work closely in partnership to support local people to be healthy for work, and to enable businesses to support their employees to be healthy. This is particularly relevant to smaller businesses, where sickness absence rates can have such an impact on business continuity. We have worked with partners to undertake insights work with these businesses, to understand what is important to them and what help they need, to shape support to them.

Communities at the centre - Active Stockton Partnership and Community Wellbeing Champions

In some of our areas of greatest deprivation, 35% of adults are physically inactive (Sport England Active Lives survey 2023 to 2024). This year the Council's Public Health and Sport and Active Life teams have worked in close partnership with local community representatives, Tees Valley Sport and Sport England, to carry out insights work to understand more about the perspective of local people. The conversations focused on five areas of the Borough and particularly focused on hearing from specific communities for example people with disabilities, people from different ethnic backgrounds, and young people with support in place who are moving into adulthood (transitions).

The insights highlighted issues far beyond specifically physical activity and covered wide-ranging factors that impact on wellbeing, from access to green space to perceptions of safety.  A range of participating partners and Council colleagues, including the Chief Executive and Leader of the Council, gathered to hear the findings which will be used to inform the next steps of work with Sport England, but will also inform wider work including on neighbourhood health and the Pride in Place neighbourhood trailblazer recently announced in the Borough. There is the opportunity to embed learning from the work in the Council's and partners' approaches to working with communities - particularly the importance of spending time and building trust, listening and responding to what is important from the communities' perspectives and often not approaching discussions from the perspective of statutory organisations.

The concept of health creation also fits with a community-centred public health approach to healthy communities and healthy place, empowering communities and 'designing in' opportunities to improve health and wellbeing. Health creation is the improvement to health and wellbeing when 'individuals and communities achieve a sense of purpose, hope, mastery and control over their own lives and immediate environment' (Manifesto for Health Creation - The Health Creation Alliance, 2017).

This sense of health creation is also linked to the NHS 10 Year Plan, and is based on:

• listening and responding
• truth-telling
• strengths-focus
• self-organising
• power-shifting

Existing local work with grassroots community groups and community representatives forms a good foundation for creating health. An example is the local Community Wellbeing Champions - a network of 138 individuals and organisations across the Borough working to improve health and wellbeing and working in partnership with Public Health (who commission Pioneering Care Partnership as the coordinating organisation).

Prevention and early intervention - National Neighbourhood Health Implementation Programme

This national pilot programme is an exciting opportunity to work across partners and local people to design different ways of providing care and support - more focused on prevention, and closer to communities.

Communities in our area of focus have the highest rates of economic inactivity in the Borough. Chronic disease and risk are also higher in this neighbourhood than in England as a whole.  For example, 3.65% experience coronary heart disease (3.04% in England); 15.53% have hypertension (14.63% in England); and 14.32% are obese (11.55% in England).

The area also has some great strengths, including many voluntary and community sector organisations and grassroots community groups who understand and work closely with local people; and the Community Wellbeing Hub in Wellington Square which provides a range of one-stop shop support including on housing, mental wellbeing, employment and domestic abuse.

As learning emerges from the first phase of the neighbourhood health pilot work, it will help inform how we work together in and with other neighbourhoods and communities across the Borough.

Levelling the playing field - peer advocacy

Some individuals in the Borough experience severe and multiple disadvantage that affects their health, wellbeing, housing, ability to work, and relationships. They can also find it difficult to access support. Often these complexities stem from previous trauma or difficult family relationships and the research points to an approach that centres on building relationship, trust and is consistent.

Public Health commissioned Recovery Connections (funded through Integrated Care Board inequalities money) to trial a peer advocacy approach, based on evidence and with evaluation by Teesside University built in. Peer advocates with lived experience meet with individuals identified by the Adults safeguarding team and work with individuals to understand what is important to them - for example seeing their children, being able to work, or restarting a hobby or interest they previously enjoyed. The individuals developed goals as a result and began working towards these with the support of the peer advocate. In 2024 to 2025, 27 individuals engaged fully with a peer advocate; 44% co-produced goals and 83% are in regular contact with their peer advocate following this. Good outcomes are emerging and the initiative is underpinning the Council-wide work on complex lives and will inform the approach to neighbourhood health.

Place-based approach - planning and food

Recognising the impact of the built and natural environment on health and wellbeing, Public Health explored how health could be better embedded into Council planning processes, based on research evidence and case studies from other councils. As a result, a Health Impact A​ssessment (HIA) tool was developed and implemented, to be completed by developers and aiming to ensure that health and wellbeing are considered early in decision-making and inform actions to address any potential negative impacts of development. HIAs are especially valuable for assessing impacts on vulnerable or disadvantaged groups. The first HIAs have recently been submitted by developers for consideration. A focus on health is also being built into the new Local Plan as it is developed, which sets out a framework for how places are shaped in the Borough including housing, road networks and green space.

Recognising the importance of access to healthy affordable food for health, the Health and Wellbeing Board will be undertaking a deep dive in the coming months, to understand how to maximise the impact of access to healthy food and the food environment. This builds on existing good work across the Council, voluntary and community sector and learning from regional public health and wider partners including the Good Food Local initiative. Once such example is the Grow Your Own initiative, combining access to fresh food with the mental and physical health benefits for local communities, of gardening and growing food.