Poverty Reduction's Influence On Risk factors for non-communicable diseases: A systems approach (PRIOR)

People from poorer backgrounds have higher levels of chronic diseases e.g. heart disease, chest problems and mental health conditions. We also know of the vicious cycle of debt leading to poorer mental and physical health. In some parts of our cities, there is increasing food and fuel poverty leading to terrible consequences, including children having lower life expectancies than their parents and more chance of multiple diseases developing during their working age. To prevent people from becoming poorer, many councils work with employers and other agencies, such as voluntary groups, to develop 'poverty alleviation' activities. Health professionals often measure poverty to find where the most deprived communities live and target health activities in these areas and then measure the impacts on health, taking into account poverty. Many health policies have focused on lifestyle changes for the individual. This relies on high levels of health and digital literacy and changing behaviour being the individual's responsibility. Financial literacy has also suffered the same problem. People are expected to know how to avoid debt, spend wisely and develop skills to improve their wealth. We also know that poorer people suffer from many mental and physical diseases earlier in life than those from richer backgrounds. We noticed from when we speak to people from these communities they tell us how their finances mean they are not able to make healthy choices for themselves and their families or able to navigate the latest digital technologies. They also describe their frustration with the vicious cycle of being in debt and not being able to provide all that is needed to thrive. The importance of place and community on how people make healthy and other life choices is becoming an important area for research, policy and practice. This unique programme called "Poverty Reduction's Influence On Risk factors for non-communicable diseases: A systems approach (PRIOR)", aims to combine all the professional disciplines, charities and the voluntary sector in poverty alleviation with the public and business. The aim is to improve health and wellbeing, with a focus on mental wellbeing, through the co-design, co-financing, implementation and evaluation of poverty alleviation strategies which include education interventions, improving health, financial and digital inclusivity and literacy, a microgrant scheme, and non-communicable disease (NCD) prevention through incentivised schemes to improve wellbeing. We will focus on the most deprived communities in Manchester, Cheshire and Doncaster to demonstrate improved social capital and cohesion, employability and improving public spaces. By changing the various systems that influence poverty and health, we will be able to reduce the burden of NCDs on the most vulnerable in our communities. Health promotion theory is based on developing 'organised efforts of society' to help individuals make "the health choice the easy choice". Financial inclusion interventions, similarly, make sure people have good understanding of their finances. Our project management only has five universities because we will focus on our consortium including the wide range of people who directly work with individuals in communities. We will work together with communities, bringing our own expertise to come up with novel solutions e.g. health, digital and financial literacy training, microgrant schemes, incentivised healthy options. They will decide on what is important and how best to implement it. We will then use robust methodologies to bring about system change to measure whether it is effective both for the individuals and is affordable. We know the system has a huge impact on the choices that an individual will make, so we will change the systems to ensure everyone fairly has the skills they need whilst comparing this to areas without our way of working. This evidence can be used in other places at little or no additional cost.

The vision is to transform deprived communities in the North of England through equitable place-based interventions that empower individuals to escape debt and poverty and improve their mental and physical health. We will focus on the most deprived communities in Manchester, Cheshire and Doncaster demonstrating improving social capital and cohesion, employability, improving public spaces. The aim is to bring about systems change through interdisciplinary work with all the professional disciplines, charities and the voluntary sector in poverty alleviation in these three areas and co-produce interventions with the communities themselves and linking with business using big data techniques. The objectives include co-design cost-effective interventions that will improve the socio-economic determinants of mental and physical health through educational interventions for health, digital and financial inclusivity and literacy, community-led interventions including microgrants, wearable technologies and incentivised schemes to reduce the risk factors for NCDs; produce a sustainable model of co-financing interventions using a public/private partnership for scalability, dissemination and replication; demonstrate improvement in health and wellbeing using validated tools on socio-economic and health indicators to determine success. The methodology will be a controlled pre-post study that will allow economic, clinical and societal benefit. The process evaluation will be through Rapid Cycle and realist approach.
We have user groups in each of the three active areas and will build on this during the CDG phase to align with the rest of the Consortium. They will be integral to the entire programme being part of the co-design, implementation and evaluation. The control sites will not have this level of co-production. The comparison between active and control sites will be useful in defining the benefits, providing a contemporaneous evidence base that can be scaled.

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.