Creative Health at Birmingham City Council Public Health: Public Health Researchers in Residence

Health inequalities are continuing to rise, and a response from Birmingham City Council Public Health to alleviate this burden, is to explore and promote different models of service redesign that improve quality and experience of health for all our citizens.

To do so, we are working to create whole system change by implementing Public Health Research Officers in Residence at the heart of our creative organisations in Birmingham, who will champion the pivotal role of creativity in achieving equitable health outcomes.

Adopting a Health in All Policies approach, we will create a detailed evidence-base that will inform upon our Creative Health Strategy in Birmingham.

Many cities and regions have emerged within the space of creative health but as a city, but Birmingham wishes to be a leader. We want to build a fully connected, creative and agile creative health system through which people and ideas can move freely across the disciplines and across sectors to achieve equitable health outcomes for all.

The Health and Social Act (2022) introduced a re-structure of the NHS into Integrated Care Systems (ICSs), which have, in relation to creative health, provided us with the opportunity to rethink how the reduction in health inequalities is addressed at a local level.

It is important for us to recgonise the importance of creativity to achieve our aims of a thriving future, in which our city and its citizens are empowered to turn challenges, into opportunities, driving prosperity and public health across Birmingham.

To succeed in our ambitions we must, support a full range of people, talents, skills, ideas and approaches that enable systems and infrastructures to thrive and work collaboratively. To do so we are investing clusters of research and development excellence throughout the city, so that key health inequalities that our citizens face in Birmingham can rapidly find solutions in relation to management and treatment and prevention and promotion.

This is an exciting new chapter for Birmingham City Council Public Health, and with our Creative Health Strategy we hope to create transformational change.

The success of the Creative Health Strategy is dependent upon actively engaging and building partnerships with local organisations, harnessing their local knowledge, strengths and championing local creative health assets.

Our creative organisations are key to our local areas, through the services they provide, the wealth they generate and the people they connect, engage, and empower. Taking a place-based approach to creative health can facilitate policymaking that is led by local stakeholders, responds to local needs, and wants, and builds on the artistic, cultural and heritage activity that already exist.

To support thriving research and development clusters across Birmingham, we are championing and joining up where possible academic, business, policy, and communities to create diverse high valuable quantitative and qualitative data on the value and benefits of arts, culture, and heritage upon public health. We working to ensure that a key output of our research and development work is developing preventative measures and interventions to improve our citizens health, reducing the inequalities our diverse communities face, enhancing community resilience in a rapidly changing environment with the development of new insights and understanding.

Our Public Health Research Officers (PH ROs) conduct research that benefit the cause of furthering the evidence base of Creative Health in Birmingham by working in partnership with arts, cultural and heritage organisations for the benefit of individuals, communities, and organisations.

Our PH ROs can be viewed as a Researcher-in-Residence at arts, culture, and heritage institutions in Birmingham. This is a relatively new approach to co-producing evaluation and research in the public health system and to facilitate service implementation.

Our model embeds researchers into the organisation and aims to facilitate the translation of evidence into practice (where available) or develop the evidence base where this is weak or highly contextualised, and/or needs adapting to local context. The approach is action-orientated and participatory, seeking to impact the development and implementation of service innovations in real time by working alongside front line teams, managers, and directors.

When approaching how to work in collaboration with creative organisations our key research question was, “How can large scale creative organsaitons contribute to the reduction of health inequalities in Birmingham.” Our primary objective is to develop generalisable mid-range theory about how whole-health system change/s can support the creation of improved knowledge, evidence, and experience for the reduction of health inequalities in a rapidly shifting wider-policy context between health and creativity. Our secondary objective was to generate feedback about individual, groups and community innovations and use and develop the method of embedded researchers seeking to mobilise evaluation findings and other evidence addressing complex and shifting questions.

The activity in which the PH RMOs undertake is a mixed method, prospective, comparative case study design by being embedded within creative organsaitons using and collecting primary and secondary data. Research includes a phased, iterative co-design moving from description to explanation to develop mid-range theory about organisational integration and implementing new ways of operating to achieve localised public health outcomes.

They use a mixed approach to data collection using semi-structured interviews, focus groups and workshops, ethnographic observations of naturally occurring events, studying archived and publicly accessible material, and including findings from service evaluations and existing evidence.

Our approach to research and development with the PH RMOs combines operational service evaluation with an action-orientated, participatory approach to research. We are seeking to impact the development and implementation of service innovations in real time. We will:

• Place our researchers as key members of the delivery team, rather than an external observer of change.
• Drawing data from a range of sources, theoretical and empirical (individual and group, interviews, documentary analysis, participation observation). The researcher will feed insights back to stakeholders ongoing as implementation progress.
• Supporting their host organisation to develop its capacity in public health intelligence by helping understand the benefits of public health focused work, and rigorously evaluating work and bringing together a critical mass of existing knowledge sources within both the creative and health systems.
• Developing a culture of improvement, in which a system wide-framework of metrics with agreed upon accountabilities between local authority and the host organisation about how measures are being collected, analysed, and presented in real time (such as designing system-wide, context and service specific dashboards)
• Agreeing outcomes measures that are meaningful and relevant to Birmingham citizens which include inclusive and person/community-centred measures.
• Apply formative evaluation methods so learning can be shared and fed back in timely fashion, such as producing reports and presentations, as required, and providing external representation at national, regional, and local levels.

We have partnered with four large scale creative organisations in Birmingham:

• Birmingham Museums Trust
  • Working collaboratively on the agenda of Museums, Heritage, and Public Health
  • Our research focus in on Oral Histories as a methodology for populational health improvement
  • A set of oral histories from an inner cities project dating back to the 1970s is being thematically analysed using our Food System Strategy thematic areas, to draw out the public health value of this historic records. Then a new set of oral histories will be recorded, aligned to Birmingham begin a ‘super-diverse city’ to gather the views, opinions and experiences of our citizens food and culture in Birmingham.
  • In this work, oral history can be used as both a research methodology and intervention tool to inform public health practice. By reframing oral histories as community health assets, public health draws on lived experiences through both historical and contemporary narrative, giving an overview of the changing food landscape in the city.
• Birmingham Hippodrome
  • Focused on the impact of theatre on the mental health and wellbeing of young people. Using a data-led approach, they will identify the role creative practice can play in reducing health inequalities for young people, especially in communities impacted by lower levels of cultural provision.
  • The research officer will design and deliver an ongoing programme of data collection and impact evaluation to quantify the effectiveness and impact of Hippodrome Unlocked creative programmes and interventions and to influence this approach with the Rep and other theatres across Birmingham.
• Ikon Gallery
  • Focused on developing a detailed evidence base on the impact of an art gallery on the public health.
  • Research focused on establishing long-term partnerships with: inner-city libraries to engage with, and research/evaluate, creative health activities; universities to co-produce evaluation/research with inner-city communities, considering the impact of creative activity on health and wellbeing, education and citizenship outcomes; both within gallery spaces and in community hubs; and with prisons to engage with,
  • and research/evaluate, creative health activities.
• Midlands Arts Centre
  • Researching across MAC’s varied community programmes to develop a comprehensive evidence base on the impact of dance and music participation upon public health across MAC’s varied community programmes.
  • Research will also consider MAC’s location situated in Cannon Hill Park and the way in which the natural environment can enable positive social interaction and healthier lifestyles, such as gardening and walking clubs within a creative context.

One of the aims of our funding of these roles was to build capacity for high quality involvement in engagement activity to ensure that research opportunities and outcomes are evidenced, accessible to, and representative of, those who have been traditionally underserved by research activity within the context of person, individuals, groups, communities, and settings.

Birmingham has high levels of spatial deprivation, deep-rooted poverty, and high social and economic challenges that impact upon the high levels of disease burden and health inequality across the city. Increasing and enhancing existing and new research involvement and engagement work, specific to Creative Public Health work in Birmingham is an important remit in which the PH RMOs will address this challenge and identify areas of unmet need.

There is a plethora of excellent engagement, involvement, and creative public health work of local organsaitons across Birmingham and many existing initiatives which aim to further this remit. In line with this, the PH RMO will link, strategically, these aims to enhance those links between local communities and research, improving access and opportunities for research, particularly with underserved, marginalised populations, groups, and geographies.

The PH RMOs will support these aims and our research and development principles by:

• Showcasing examples of existing good practice within Birmingham, which have been effective in relation to Creative Public Health and increased research potential.
• Outlining next steps and future targeted projects to build upon current work.
• Working with their host organisation to maximise Creative Public Health implementation work.

The wider-strategic impact of this investment aligns closely with our public health grants purpose which is to improve health in local populations. As the city councils public health function, we are actively investing in developing and fostering the conditions for creative public health to be integral to the health and care system.

Creative public health can contribute to the development of flourishing and healthy communities through partnerships formed at a local level, specifically in this instance with our anchor creative organisations and work to ensure that health inequalities are not reinforced. The Creative Public Health Programme represents a new shift from Birmingham City Council Public Health. The programme will make a significant contribution to meeting the aims of the Joint Birmingham Health and Wellbeing Board Strategy 2022-2030 and the Birmingham and Solihull Integrated Care Strategy, 2023-2033.

Regan McDonald, Public Health Research Officer at Ikon Gallery says:

Ikon is at the cutting-edge of contemporary art in Birmingham- its been really exciting to work with such a dynamic team to bring creative health to the forefront of our practice and making health research integral to our forward programming.”

Sophie Beckett, Public Health Research Officer at Birmingham Museums Trust says:

The creative health programme at Birmingham Museums Trust ascribes new meaning to our vast collection, giving space for us to reconsider our objects as community health assets. Working ‘in place’ with public health experts and engaging directly with local communities creates a collaborative discourse, facilitating an approach grounded in community need. Within the Trust, this work has helped us think critically about our working model, opening up opportunities for research-led development.”

Jay Rowe, Public Health Research Officer at Birmingham Hippodrome says:

Birmingham Hippodrome is excited to be developing and expanding the West Midlands' largest theatre-in-education programme. With an eclectic offer of applied drama, subsidised ticketing and creative CPD offers for school staff, we are bringing exciting opportunities and that special, "goosebumps" feeling directly into the curriculum of local schools.

Our talented team of artist-facilitators bring a variety of theatrical skills, including physical theatre, harlequinade and spoken word, into Birmingham classrooms. With our public health-centred evaluation, we are investigating the real impact of this work on the attainment, wellbeing and behaviour of children and young people.”

Katt Wright, Public Health Research Officer at Midlands Arts Centre says:

Midlands Art Centre (MAC) is a vibrant, cultural hub located in the heart of Cannon Hill Park, Birmingham. Among its rich offerings, MAC promotes a diverse range of accessible dance and music programmes for all community members, enhancing skills, creative expression, and social interactions. Through this unique Creative Public Health strategy, I am excited to collaboratively explore community engagement and the values derived from these practices. Additionally, this provides a fundamental opportunity to promote co-production and community-led research to investigate the impact of dance and music on our overall health and wellbeing.”

The focus of our approach is to develop a dynamic relationship with and between public health and creative sectors, which improves the quality and relevance of Creative Public Health research, and broaden the principles, values, accountability, and transparency of research.

The involvement of the public, communities and organsaitons within the work conducted by Birmingham City Council Public Health and our Creative Public Health Programme is a right for those aforementioned areas to have a say in what and how we fund and carry out research and hope they will be aware of and choose to contribute to research.

We will look to co-produce a Creative Health Strategy, which will outline strategic delivery of the collective actions we will take to develop the evidence base on the value of arts, culture, and heritage upon public health in Birmingham.

Rhys Boyer
Senior Public Health Officer, Birmingham City Council
Email: [email protected]

Creative Health Programme at Birmingham City Council