ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing

The communities and neighbourhoods where we grow up have a lifelong influence on the illnesses we get and how long we live. Health is about avoiding disease and having a long life, but is also about feeling well in mind and body, feeling safe, being part of a community and having things to look forward to. Many aspects of the world around us influence our health directly or influence health related behaviours. These so called "broader" determinants of health include the houses and flats we live in, the design of our roads and high streets, the availability and quality of parks, green spaces, libraries, galleries, museums, sports and recreational facilities, entertainment opportunities, places and events to connect with others, the shops and businesses around us, pollution levels, learning opportunities, the jobs available to us and whether we have enough money to make ends meet and to participate in social activities. Attempts to change health related behaviours such as unhealthy eating, drinking, smoking and lack of exercise, have met with important but limited success. For example, increased awareness of links between childhood obesity and ill health and the importance of exercise and healthy diet will have limited success if broader determinants are not also tackled. These broader determinants include, but are not limited to, the many fast food outlets that children may walk past, lack of access to high quality play and recreational facilities, sell off of school playing fields, streets that are not safe for children to walk or cycle to school, lack of high quality green spaces for exercise, shops with poor choice of healthy foods, increased screen time replacing physical activity, poor quality of school food, and, for some, insufficient income to buy healthy food.
Our ActEarly approach focuses on improving the health of children in two contrasting areas with high levels of child poverty, Bradford in Yorkshire and Tower Hamlets in London. In preparation for this work we have worked with local communities, local authorities and other local organisations and have established shared priority areas for research: Healthy Places, Healthy Learning and Healthy Livelihoods. We have brought together experts in these themes with local community and local authority representatives to begin to develop a range of approaches to improving child health across these areas. For example, within our Healthy Places theme we will work together to: map local community assets and to understand how they can be improved and used by more people; develop a Healthy Streets approach and improve green space quality. In our Healthy Learning theme we will work together to develop local "Evidence Active Networks" of pre-school, school and community learning venues. These networks will help develop and evaluate a wide range of approaches to improve child health. In our Healthy Livelihoods theme we will work together on approaches such as relocation of welfare advice services to improve access, enabling parental leave, ensuring a minimum basic income in school leavers, providing life skills training and involving local communities in decisions on how to spend local authority budgets.
To understand the effect of these approaches on child health we will develop strong data resources that bring together existing information from across our localities to measure changes in the local environment, health related behaviours and health outcomes. Teams of researchers will use this data and work with local communities to understand how successful our initiatives have been. We describe our emphasis on early life interventions, our highly collaborative approach and development of local data sources to enable evaluation of multiple initiatives, as the "ActEarly Collaboratory". We hope the approach will promote a fairer and healthier future for children and a global example of how to work with communities to improve health.

Upstream interventions such as education and social housing have improved health but prevention research has tended to focus on single, individual behaviours, favouring those well placed to make good choices. This has seen the healthy become healthier but has done little for the less advantaged. There is limited interventional research addressing the broader determinants of child health that are amenable to local action.

Our vision: To promote a healthier, fairer future for children living in deprived areas through a focus on improving environments that influence health and enhancing life chances.

Aim: To develop a whole system City Collaboratory that provides research-ready, people-powered and data-linked test beds for multiple but interlinked interventions to improve child health and reduce longterm NCD disease risk.

Objectives: To co-develop and evaluate interlinked interventions across themes prioritised by our local communities and partners: Healthy Places; Healthy Learning and Healthy Livelihoods.
Research and methods: 1) Establish a North-South prevention research Collaboratory uniting broad interdisciplinary expertise within the complex adaptive system. 2) Design and test innovative upstream interventions that have genuine user co-production and focus on early life. 3) Evaluate the impact of these interventions and other natural experiments on health, educational and social outcomes harnessing enhanced local data infrastructures. 4) Develop whole systems modelling of longer term impact. 5) Deliver meta-evaluation of the Collaboratory approach.

User engagement and impact: Our Collaboratory approach will ensure we establish shared priorities, co-production of initiatives, co-evaluation, embedded research in local decision making and national and international dissemination.

Applications and benefits: ActEarly will provide a global exemplar of how to work with communities to address broader determinants of NCDs and health.

This grant is funded by the UK Prevention Research Partnership (UKPRP) which is administered by the Medical Research Council on behalf of the UKPRP's 12 funding partners: British Heart Foundation; Cancer Research UK; Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Health and Social Care Research and Development Division, Welsh Government; Health and Social Care Public Health Agency, Northern Ireland; Medical Research Council; Natural Environment Research Council; National Institute for Health Research; The Health Foundation; The Wellcome Trust.

In this section we focus on demonstrating ActEarly's close alignment to the national UKPRP Impact Framework, using headings from within that document.
THE PURPOSE: We will develop data and evaluative platforms that will enable efficient but robust evaluation of upstream interventions applied at population level within the context of complex city systems. Co-production processes will drive system level changes within local populations. Our policy simulation modelling will predict longer term impact on NCDs and generalize findings to regional and national levels. Our focus on areas of high child poverty will reduce inequalities. Our strong local intelligence will ensure targeting of interventions and resources to areas of most need.
THE NETWORK: ActEarly is designed to foster whole system research that builds on our City of Research track record. This approach brings together transdisciplinary researchers, policymakers, practitioners and communities with common purpose to produce high quality, innovative and impactful research. Our focus on co-production and data enables targeting of core resources to meet local needs. Our emphasis on building trusting and beneficial partnerships helps sustain enduring relationships and define new ways of working between universities and wider society.
USERS AND BENEFICIARIES: The key users and beneficiaries will be local communities with who we will develop interventions, particularly in those areas with higher levels of poverty and poor health. Longer term impact from translating our findings beyond Bradford/Tower Hamlets will affect areas nationally and possibly internationally.
ENGAGEMENT OF POLICYMAKERS AND IMPLEMENTERS: Including: 1) Local authority teams e.g. Public Health, Environment, Housing, Transport, Education, Culture, Community Development, Benefits, Business; 2) Public Health and NHS teams in CCGs and Health and Wellbeing Boards; 3) Community groups; 4) Third sector organisations; 5) Industry and commerce. We will undertake formal mapping of these groups to ensure effective involvement in co-production activities so that interventions are realistic, sustainable and aligned to local priorities. National agencies with which we will engage include: PHE, NHSE, Government Departments, Parliamentary Working Groups, NICE, Think Tanks.
INFORMATION FOR DECISION MAKERS: We will ensure language and format is appropriate to the needs of our diverse partners and supports their decision making processes. This will be facilitated by reciprocal representation of ActEarly and local government and embeded research approaches.
ESTABLISHING A NEW PREVENTION RESEARCH AGENDA: ActEarly will develop a novel transdisciplinary approach to support prevention research. Our focus on environments shifts the research agenda from individual behaviour change interventions towards broader environment changes to improve health.
SYSTEMS THINKING: We will use formal system mapping approaches to capture shared understanding of systems components and formalize this within models which highlight where the key leverage points in the system need to be influenced to maximize impact. We will provide examples of how to integrate transdisciplinarity, systems thinking and co-production to understand and influence the complex systems influencing population health.
CHANGE RESEARCH FUNDING LANDSCAPE: The development of the Collaboratory approach provides the infrastructure necessary for research funders to be able to invest in research that can influence and evaluate upstream determinants of health. We expect to be able to use this as a platform to leverage substantial additional funding to drive forward research.
BUILD CAPACITY: We are excited about the potential of the Collaboratory model to provide training in transdisciplinary, highly engaged, co-produced research targeted at better population health. We will support specialty training and seek funding for new doctoral training to support this approach.