Abstract
Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the 'biomedical model' which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on 'downstream' interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.
Highlights
Areas with high levels of child poverty tend to have increased rates of obesity, polluted roads with low walkability, poor quality green spaces for play and exercise, high fast food outlet density and food poverty; poorer levels of child development, school readiness and educational attainment, higher school exclusion rates, poor performing schools and lower entry into further education; unsafe neighbourhoods, higher levels of youth crime, physical decay, poor public services and poor quality, overcrowded unfit, temporary/rented and unaffordable housing[1,2]
Addressing them can improve health outcomes[3], but too often non-communicable disease (NCD) have been attributed to bad choices rather than framed as emergent properties of complex systems
Outcomes we anticipate being affected in the short term are both child/adolescent/young adult/family-centred and place-based: i) child; ii) young person; iii) family; iv) community, all of which affect the risk of NCDs
Summary
Areas with high levels of child poverty tend to have increased rates of obesity, polluted roads with low walkability, poor quality green spaces for play and exercise, high fast food outlet density and food poverty; poorer levels of child development, school readiness and educational attainment, higher school exclusion rates, poor performing schools and lower entry into further education; unsafe neighbourhoods, higher levels of youth crime, physical decay, poor public services and poor quality, overcrowded unfit, temporary/rented and unaffordable housing[1,2]. Our City Collaboratory approach will provide a whole-system environment where the public, scientists, policy leaders and practitioners work with each other to develop and test system-wide early life upstream prevention solutions, supported by efficient platforms for robust evaluation. The Collaboratory model consists of a multistep interactive cycle that places local communities at the heart of decision making and active participation in both shaping and using the research, and connects academic expertise with real-world policymakers (see Figure 1) This cycle consists of: a) raising ideas (informed by evidence synthesis of epidemiological and other sciences), b) moving them through a critical cycle of engagement with stakeholders and by using Citizen Sciences[15], c) co-producing prioritised intervention strategies using internal and external experts, d) implementation (using whatever method is deemed optimal) and e) evaluating impact. We have started our co-production activities, developing, refining and prioritizing the suite of activities outlined in each work tisation
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