www.fuse.ac.uk

Key messages from a review of health and wellbeing strategies What we aimed to do How we tried to achieve it What we found

What we aimed to doThe research aimed to investigate: how LAs have interpreted the statutory

guidance for HWBs; the extent to which there is variation in the

aims and content of HWSs; how the word ‘evidence’ has been interpreted

and used within HWSs and the relationship between HWSs and JSNAs.

How we tried to achieve it

A qualitative documentary analysis using thematic content analysis

Sampling frame – all upper tier local authorities in England

Sampling in proportion to the percentage of population in each region

Sample covered breadth of local authority types

What we found: structure and scope Strategies varied in timescale, spanning one (n=7) to five

years (n=8). They also varied considerably in length, from one to 92 pages, with an average page length of 25

The scope of the objectives varied from the high level and strategic, such as: • “Objective 7: promoting the health and wellbeing of

new populations in [Place Name]” to the more operational and action-orientated:• "Increase the number of mothers under the age of

25 who initiate breastfeeding from 17% by 10% year on year for two years."

Extract from the table comparing the structure and content of HWSs

What we found: use of evidence Most often, evidence was used to mean ‘evidence of need’. This

was usually identified through the JSNA and was mostly locally gathered intelligence rather than from a national source of research evidence

There were few instances of evidence cited to mean effectiveness of interventions and these often did not cite specific sources

Five HWSs cited academic journals in the context of evidence of need, not effectiveness. Statements resulting from community engagement or local opinion were included alongside other sources of evidence

“The JSNA, and the data which informs it, provides the key evidence-base for health, public health and social care commissioning across the local area.”

“Listening and responding – People living in [Place Name] know best about the greatest problems and challenges to their health and wellbeing. We will listen closely to learn what really matters and how we could make a difference by developing the way we engage and communicate with residents.”

What we found: link between HWSs and JSNAs

Most HWSs referred to JSNAs with some strategies acknowledging the statutory guidance and making explicit links between their JSNA and HWS

“The strategy is based on the city’s Joint Strategic Needs Assessment (JSNA) and

feedback from local organisations, patients and the public.”

Conclusions and implications LAs have varying interpretations of what should be in a

HWS Public health agencies and academics can support the

development of effective HWSs by improving the accessibility of evidence and conducting research when evidence is absent

Whilst the new public health system is still evolving, one year on an opportunity exists to develop clearer guidance about the production and purpose of HWSs

Qualitative research exploring the views of LA elected members and officers, including public health specialists, may help to shed light on underlying problems and highlight potential solutions

Acknowledgements

The work was undertaken by Fuse, a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research council, Medical Research Council, and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, is greatly acknowledged.

Opinions expressed in this presentation do not necessarily represent those of the funders.

Round table discussion (1)1. How important is the different meanings of the use of the

word evidence between public health and local authorities?2. If it does matter, how we can reach a meaningful use of the

word that improves effectiveness of public health interventions used in local authorities (Hard to word this one because I have a strong view!)

3. What strategies have already been used to influence local authority officers and members?

4. How can those strategies be used to improve the influence of health and wellbeing strategies?

5. What would be the barriers and facilitators to increasing the use of evidence of effectiveness in health and wellbeing strategies?