In 2015-17, the Healthy London Partnership teamed up with Uscreates to work with three London boroughs (Haringey, Hackney and Tower Hamlets) to research and develop social interventions to address the growing levels of childhood obesity.
According to the UK Government’s obesity strategy, nearly a third of children aged 2 to 15 are overweight or obese. The drivers leading to widespread obesity are complex and evolving; they include social, environmental and economic factors meaning that a preventative approach to obesity cannot be solved by the formal health sector alone.
The Healthy London Partnership wanted to explore how innovative commissioning models could lever in partners from outside the formal health service, and how they could become more ‘activist agents for health-related changes’. They also recognised that a human-centred and collaborative design approach - with its focus on underlying behaviours, iterative way of exploring ideas, and use of local community assets - is best placed to tackle this myriad of issues in a sustainable way.
Healthy London Partnership commissioned us, Uscreates, to run a co-design project across three of the most deprived areas of London (Seven Sisters, Isle of Dogs and Haggerston) with the ultimate aim of developing interventions that would help local residents to lead healthier lives.
We adopted an agile and design-led approach with two key phases; to better understand, and to deliver design solutions for each of the three communities:
- Ethnography with local people and community based co-design
- Prototyping with social incubation
The approach differed from both the traditional commissioning model and service design process in that:
- Our approach used behavioural economics theory (COM-B) to understand how to change local community behaviours to healthy eating.
- The research phase gathered insight but was also used as an opportunity to build relationships and trust within the community. Additionally, while early stage prototyping served to communicate our ideas, it also served to heighten excitement, energy and assets (for example buildings, volunteer support) from the community.
- The interventions were community asset based and tapped into local resources and capabilities.
- We incorporated social incubation into how we delivered it and made these initiatives sustainable.
The lived experiences of local families informed our ideas:
We found that time-poor parents were more influenced by convenience than health in their food choices and needed to develop their confidence in making healthy choices.
This led to Make Kit; an affordable and confidence-building healthy eating recipe pack.
We found that young people went to fast food outlets on the way home from school because there was nowhere else nearby where they could get low-cost, hot and tasty food.
This led to the creation of Snack Stop, an after school tuck shop selling healthy snacks and hot Caribbean and other locally popular food from a local restaurant owner.
In the Isle of Dogs, we found that parents often wanted to get healthy food for their kids, but they didn’t know how or didn’t have the confidence to do this.
This led to Active Local Links which provided parents with information and support to get involved in healthy activities in their local area.
As well as this behavioural insight, we also built our ideas around the interests and capabilities of local people on the ground, and worked in partnership with communities to develop and prototype the initiatives.
The project has achieved impact within the local communities, and the learnings have informed a guidance for health commissioners about how to adopt a place-based approach to health-based commissioning, fully utilising the assets of the voluntary, community and social enterprise (VCSE) sector.
Two of the three initiatives are running independently since Uscreates’ support finished, which is a particular achievement given that one in three social enterprises usually succeed. Make Kit has showed that it has potential to change people’s eating behaviour (for example 83% of survey respondents reported to have more confidence in cooking healthy meals) and has gone on to secure a further £30k in funding and won a Health Transformation Award. London Sport are now funding Active Local Links through their Clubworks programme and they are putting on swimming course, tennis clubs, keep fit classes and CV workshops.
It has also informed guidance for health commissioners on how they can work with VCSE organisations to commission sustainable outcomes, not just commissioning them, but also providing wider support to create a thriving VCSE sector, and incubating initiatives that can improve health outcomes so that they are sustainable in the long-term without direct health funding. This is a radical change in health commissioning and there is an opportunity for service design to be at its heart.
How is the new approach being sustained?
In Hackney, the council has provided additional funding and in-kind support to Make Kit in the form of space in its Town Hall to sell the recipe kits to council staff on Fridays, which can subsidize packs for lower income residents, which might be offered through social prescribing. In Tower Hamlets, London Sport’s Clubworks programme is now funding Active Local Links which continues to be run by local volunteers and provides tennis, swimming and CV writing activities. In Haringey, the school has reinvigorated its own healthy tuckshop.
(i) Impact of an agile, collaborative and design led approach:
- Progressed insights to ideas to implementation in a relatively short space of time. The rapid delivery is important for communities with 'intervention fatigue'; as seeing quick results helps to keep stakeholders motivated and enthusiastic.
- Drew in energy and inspired action. By creating a tangible prototype or ‘thing’, people were quickly able to see how it could align with their interests and how they could get involved.
- Allowed the interventions to be shaped to local nuances and become embedded in the community, increasing the likelihood sustainability as they were not reliant on outside support. In some cases, these initiatives also acted as catalysts for further community action for example, activating the primary school in Haringey reinvigorated them to refresh their own healthy food offering.
- Kept stakeholders involved in all stages allowing local people to develop a sense of ownership over the initiatives.
(ii) Potential for place-based commissioning
- The project has shown that it is possible to deliver health outcomes outside the formal health system, and how local businesses, the voluntary sector and social enterprises can make a difference to young people’s health.
- A place and asset-based approach enabled the projects to pull in different types of support, which a traditional commissioning model may not have allowed. For instance, as well as the crowdsourced funding, 150 hours of the social entrepreneurs’ time and 45 hours of volunteer time, Make Kit also secured some pro bono business-modelling advice from a corporate partner, and was given use of a space at Fellow’s Court, a local community asset.
- An incubation and nurturing approach - rather than simply grant-funding - allows interventions to become financially sustainable, and not rely on public funding.
- Initiating health programmes through social ventures creates added social value over and above addressing obesity. The project not only indicates how health commissioners can reach out to assets across local communities to deliver health outcomes, but also how they - by doing so - can achieve wider social outcomes. For instance, volunteering opportunities created through Snack Stop or Active Local Links serve to bring people together thereby reducing social isolation and galvanising communities. Creating social ventures also has the potential to boost local economies by generating business in the local area. For instance, the restaurant owner running Snack Stop was able to attract new customers to their restaurant.
Head of Public Health
London Borough of Hackney
020 8356 302
The Healthy Communities project reports can be found here
Healthy London Partnership has produced a New Commissioning Guide, with support from Uscreates and other partners, which will be available on their website shortly.