BLOG: Devolution could improve health by focusing on area-based regeneration

Past regeneration programmes that improved housing and the local environment were linked with better health. Devolved institutions should learn from them, argues Richard Crisp.

Devolved institutions should upgrade housing and the physical environment in their most disadvantaged neighbourhoods if they want to help those with the poorest health, suggests our research.

City regions should recognize that improvements in housing and environmental conditions in poorer localities are strongly correlated with better mental health, according to our research into past regeneration programmes. By contrast, programmes dedicated simply to improving health have delivered marginal benefits to health and well-being.

Our findings are important because place-based regeneration programmes were largely discontinued in 2010 by the Coalition government. This represented a change in policy from that pursued by governments over 20 years, during which the place-based approach was championed, most notably by the £2bn New Deal for Communities (NDC) programme, implemented by Labour from 1999.

Evaluation of New Deal for Communities

Our team evaluated the NDC programme in a series of studies by the Centre for Regional Economic and Social Research (CRESR), based at Sheffield Hallam University. This evaluation and a subsequent evidence review for the Joseph Rowntree Foundation suggests that the NDC programme, although showing only limited success in terms of fostering local economic growth and tackling worklessness, had a considerable impact on the wellbeing of people in poorer neighbourhoods.

The holistic NDC regeneration programme took a broad approach towards improving the lives of Britain’s most deprived communities. This included support not only for creating employment and economic development but also for improving outcomes around housing, education, skills development, health and community safety. Our evaluation of the NDC programme shows that improvements to mental health were strongly correlated to perceptions of area improvement.

It’s not difficult to speculate why such environmental improvements might make such a difference. If you went around these places in the 1990s, before holistic, place-based interventions began, you’d have seen plenty of signs of physical neglect – boarded-up houses, wrecked cars, graffiti and fly-tipping. Our evidence suggests that, if you improve the physical makeup of an area, it’s associated with better mental health.

Limited impact of dedicated health improvement programmes

Our research looked at the impact of a wide range of area-based interventions (ABIs). Our findings suggest that programmes, such as Health Action Zones, which focussed simply on improving health, achieved only marginal benefits in this regard.

The current alternatives to the now abandoned place-based approach look likely to be less effective, at least on paper. On the one hand, the Localism Act 2011 creates rights for communities to, for example, acquire and run assets or services or develop Neighbourhood Plans for their areas. But such activities require money, skills and expertise, which are often lacking in low income communities. Recent research into small-scale, community-led initiatives suggests that, where communities are taking charge, there may be benefits for health and wellbeing, but these developments are happening in small areas and are unlikely to impact on health on a wide scale.

On the other hand, devolution is handing money and power for economic and social development to combined authorities and other city regional institutions that operate on much larger geographical scale than programmes such as the NDC. So whereas the NDC covered, for example, areas with approximately 8-10,000 residents, devolution to city regions, such as Greater Manchester, operates across far larger clusters of local authorities. And unlike NDC, there is no strategic requirement to use devolved funding and powers to tackle high levels of disadvantage at the neighbourhood level. As a result, the poorest communities could fall through the cracks of this change in approach to urban policy.

Message to devolved institutions

Nevertheless, devolved institutions could undertake neighbourhood regeneration and achieve some of the health benefits delivered through place-based approaches like the New Deal for Communities. These institutions understand their local areas and devolution hands them control over a diverse set of policy levers that, potentially, could improve the lives of the worst off.

Our message, therefore, is that it would be unwise to expect that community-led forms of activity can fill the vacuum at a neighbourhood level left by the loss of New Deal for Communities and other holistic regeneration programmes. The best hope might be that devolved institutions harness the new policy and practice levers at their disposal to take a more integrated approach to tackling the problems of their poorest communities. At the very least, they should heed some of the lessons from the past.

Dr Richard Crisp is a Senior Research Fellow at the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University. He has undertaken a recent series of studies for the Joseph Rowntree Foundation on the prospects for delivering ‘inclusive’ growth in city regions. He was previously involved in the National Evaluation of the New Deal for Communities Programme which was commissioned by the Department for Communities and Local Government (DCLG) and ran until 2010.
Dr Crisp will present at a SPHR@L Seminar on “Do spatially targeted initiatives improve health and well-being?” His presentation is on Thursday, 29th September 2016, 12.45-2.00 pm at LSHTM, Room G9 (Jenny Roberts Room) 15-17 Tavistock Place, London WC1H 9SH.