CHESS: Civic Health Equity: from Silos to Systems

Background: The UK experiences some of the largest differences in health between places in Europe with people in poorer areas dying on average 9 years younger and living for 19 more years in poor health than those in more affluent areas. These health differences are largely due to economic differences between places leading to higher risks of poverty and its health consequences in places such as Liverpool City Region. These risks have increased following multiple recent crises, exacerbating inequalities.

The Challenge: Across city regions multiple organisations invest in Household Socio-economic Support (HSS) services, for example welfare advice, cash benefits and employment support to try and address these risks. Increasing devolution of these welfare services provides an opportunity to experiment and learn. There is, however, limited evidence of the health impacts of these programmes and the combined benefits of integrating employment, welfare, education and health support across a city region.

Aims and Objectives: CHESS addresses this major problem. By applying quasi-experimental methods, using whole population linked data across LCR (1.6 million people) we will evaluate the health impact of 5 HSS interventions, supporting around 110,000 people per year, investigating differential effectiveness across population subgroups, and synergies across intervention components (e.g. combined effect of action on household income, education and employment).

Our aim is to understand whether, how and for whom current HSS works in LCR, and how it can be adapted, integrated and targeted to maximise benefits for health and health equity. Our objectives are:

To quantify the health impacts of different components of HSS in LCR whether these differ by combination and integration of components and by different population groups.

To estimate the costs and benefits of HSS.

To understand the experience of participants and providers of HSS and the implications of this for service redesign/adaption.

To develop a real-time household vulnerability tool for all 800,000 households in LCR enabling the pro-active identification and targeting of households with socioeconomic support.

To use research findings to adapt system design with stakeholders, to maximise health and health inequalities benefits, refining actionable insights for other city regions.

Anticipated impact: The research will indicate the critical components needed for developing adaptable local social protection systems to meet new challenges (e.g. pandemics, energy crises), that promote health and wellbeing, and prevent a downward spiral following crises. This will lead to major benefits for disadvantaged communities, who are most at risk of economic shocks, in LCR and similar city regions.