Putting communities at the heart of public health

Communities, both place-based and where people share a common identity or affinity, make a vital contribution to health and wellbeing,1 This is supported by a strong evidence base around the effectiveness of community engagement in addressing health inequalities2 and epidemiological evidence on the critical importance of psychosocial factors such as sense of control and social networks for population health and wellbeing,3 Mainstream public health in England has not always reflected the importance of community-based prevention, resulting in effective community approaches lacking visibility in comparison with individual lifestyle interventions. This is beginning to change, with a growing recognition that community-based assets, such as local knowledge, people's skills and commitment, social networks and community organisations, are vital resources for health,4 The King's Fund, for example, recommends building social capital and utilising community assets as one of nine key areas for local government to take action on to improve health and reduce inequalities.5In 2015, Public Health England (PHE) together with National Health Service (NHS) England published 'A guide to community-centred approaches for health and wellbeing'.1 This document argues that local government, the NHS and community and voluntary organisations all have important roles to play in creating healthy communities and in opening up opportunities for members of the public to contribute to health improvement where they live, play and work. Such opportunities can increase the sense of control among people who are marginalised and dlsempowered by adverse socioeconomic circumstances. We believe that the public health workforce can offer leadership in translating that vision into practical action at a scale that has an impact on population health and reduces inequalities. This requires a shift in mindset to see communities as part of the solution, not the problem, but it also requires practical tools and approaches that work on the ground,OPTIONS FOR CHANGEThe guide to community-centred approaches for health and wellbeing presents options for public health commissioning and practice linked to sources of evidence, A new family of community-centred approaches groups ways of working with communities into four main strands:* Strengthening communities;* Volunteer and peer roles;* Collaborations and partnerships;* Access to community resources.There is undoubtedly scope to make public health more person- and community-centred within the whole-of-society approach advocated by the World Health Organization.6 The NHS Five Year Forward View argues that 'we have not fully harnessed the renewable energy represented by patients and communities' and new, more empowering relationships should be built (p. 9),7 For public health practice, this means routinely drawing on community Insights and growing community capacity so that people can play a vital role in setting local health priorities, developing prevention programmes and delivering healthy activities. This is not a case of either community or lifestyle; community-centred approaches are part of a solution-focus to reducing risk factors and enhancing protective factors, Place-based approaches and community development address the 'causes of the causes' by enabling people to take personal and collective action on the things that affect their health, whether that is accessing services, improving poor housing or lack of shops selling fresh vegetables,EVIDENCE INTO ACTIONPHE is encouraging local leaders, public health commissioners and practitioners to use the family of community-centred approaches as a resource to support practice. Ultimately, it is what is done on the ground that will make the difference. National Institute for Health and Care Excellence (NICE) guidance is clear that community engagement principles and methods have to be considered in a local context. …