Communities, both of place and of identity, form an important part of the public health system and the assets within communities, such as local knowledge, social networks and community associations, are resources for health (1). The Public Health England (PHE) whole system approach to reducing obesity programme offers an opportunity to test out a ‘whole-of-government, whole-of -society’, approach to health, advocated by the World Health Organization (2). This will involve understanding the role of civil society in addressing obesity and then building social action that will eventually be self-sustaining and lead to changes in community norms around food, diet and physical activity. Social action will also lead to improved environmental conditions, as community members take part in designing and changing more healthy environments (3), for example improvements in green space. There is a strong evidence base about the benefits of community engagement as a strategy to address health inequalities and social exclusion, which will be needed if a whole system approach to obesity is to be effective and reach the population groups with the greatest need (4).
A whole system approach requires a significant re-orientation to deliver community engagement and mobilise community assets at a population level. This ambition has to be translated into pathways that lead to change and this represents an area for study. Based on the notion of a family of types of community-centred approaches for health and wellbeing, PHE and NHS England have developed a conceptual framework that can be adopted in local areas. It is suggested that a whole system approach will require adoption of approaches across all four strands: strengthening communities using community development; volunteer and peer roles; collaborations and partnerships between communities and services; and improving access to community resources and social activities (5). This PhD study will examine what is needed to implement a whole system approach to obesity which builds in community engagement and social action at all levels of the system and what impacts that has both organisationally and in communities.
The theoretical framework will use the notion of a health ecology, and build on contemporary understandings of evaluation within complex systems (6). Community-based interventions do not lead to outcomes in a linear way, therefore a systems approach to evaluation requires understanding of cultural factors and the dynamic relationship between the communities and the intervention (6).
Whilst the broad orientation of the PhD will be investigating pathways for change, there is scope to focus on either organisational pathways to realise community assets or on growth of community-led social action, using the concepts relevant to social movements. The focus will be on identifying the factors that support change and what actions need to be taken by local government to build community capacity around addressing obesity, and how those actions can become sustainable. Part of the PhD will be to develop an output to support local authorities in working in this way.
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Please contact Professor Jane South for further details
Email: [email protected]
Tel: +44(0)113 81 24406