What are the elements of a whole system approach to community-centred public health? A qualitative study with public health leaders in England’s local authority areas

Abstract

ObjectivesThe aim of the study was to identify key elements of whole system approaches to building healthy communities and putting communities at the heart of public health with a focus on public health practice to reduce health inequalities.DesignA mixed-method qualitative study was undertaken. The primary method was semi-structured interviews with 17 public health leaders from 12 local areas. This was supplemented by a rapid review of literature, a survey of 342 members of the public via Public Health England’s (PHE) People’s Panel and a round-table discussion with 23 stakeholders.SettingLocal government in England.ResultsEleven elements of community-centred public health practice that constitute taking a whole system approach were identified. These were grouped into the headings of involving, strengthening, scaling and sustaining. The elements were underpinned by a set of values and principles.ConclusionLocal public health leaders are in a strong position to develop a whole system approach to reducing health inequalities that puts communities at its heart. The elements, values and principles summarise what a supportive infrastructure looks like and this could be further tested with other localities and communities as a framework for scaling community-centred public health.

Using complex systems mapping to build a strategic public health response to mental health in England

“…This could help j JOURNAL OF PUBLIC MENTAL HEALTH j improve multi-sector collaboration, as well as generating a more comprehensive understanding of the conditions necessary for effective programmes and policies (Langellier et al, 2019). The engagement of local stakeholders and community members could produce wider insights and support ownership and adoption of effective communitycentred solutions to public mental health challenges (Allender et al, 2015;Stansfield et al, 2020).…”

“…Equitable, sustained improvements in population mental health, along with many other contemporary public health challenges, will not be achieved through simple, linear causal models and siloed interventions, but through complex systems approaches (Rutter et al, 2017;McManus, 2017). Public Health England (PHE) (the national public health agency) has applied such approaches within whole system work to tackle obesity (Public Health England, 2019a) and health inequalities (Stansfield et al, 2020). PHE research into universal public health approaches has identified the need to "further investigate the benefits of using complex systems mapping to facilitate a whole systems approach to children and young people's mental health to understand more about the complex interplay between factors and the benefits of adopting a whole systems approach" (Public Health England, 2019d).…”

A systematic scoping review of community‐based interventions for the prevention of mental ill‐health and the promotion of mental health in older adults in the UK

“…While we have suggested that a breadth of support and services across Connector, Gateway, Direct and Systems approaches is important in responding to the complexities of influencers on mental health in older age (as at any age), the lack of consistent measurement of outcomes, even within categories, is a challenge for service de- Despite the UK focus and context-specific nature of funding and implementation, the broad framework, typologies, and content examples described may also be applicable beyond the UK thanks to its theoretical underpinning and 'whole system' framing (Stansfield et al, 2020).…”

Mental health recovery and transformation: lessons for action

“…Communities responded swiftly to support neighbours in need, inequalities widened at the community level and the need for a more community-oriented response became evident (South et al 2020;Lent and Studdert 2021;The Kings Fund 2021). The needed public health system change includes sustaining the practice we have seen in the pandemic to gather and respond to community insight, work alongside and support community action, foster trusting relationships to make decisions with communities, invest in a thriving voluntary and community sector, measure and value community determinants of health such as sense of belonging and community resilience and scale a range of community-centered approaches into all public health action to reduce health inequalities (Stansfield, South, and Mapplethorpe 2020).…”