Well London: communities working together for a healthier city

London is culturally and economically one of the world’s leading cities. Despite this there are great inequalities in health outcomes between the wealthiest and poorest boroughs. Compared to London as a whole those living in the city’s most deprived areas:

• Have Lower life expectancy - The difference in life expectancy between those living in the most and least deprived neighbourhoods of London is 7.2 years for males and 4.6 years for females;
• Can expect to live fewer years without a disability;
• Have lower mental well-being
• Have children less likely to reach a sufficient level of development when they start school.

About 40% of the capital’s children live in low-income households. In Inner London, the child poverty rate is even higher, at about 50%. (Additional resources can be found in the Further Information section).

This deprivation and poverty contributes to poor health and mental wellbeing especially in the young, ethnic minority communities and the elderly.

The Well London project was a four year programme targeting 20 of the most deprived communities in London to promote healthy physical activity, healthy eating and mental health and wellbeing by delivering integrated interventions using a community development model. Well London has resulted in high levels of community participation, and bolstered community cohesion and empowerment to enjoy healthy and fulfilling lives. 

To combat all of the problems affecting the 20 communities the Well London project had the following overall aims:

• To change perspectives on mental health – tackling stigma – and promoting positive mental welfare
• Increasing peoples opportunities to become more active
• Improving understanding of, and access to, healthy food
• Develop healthy spaces
• Ensure that projects were relevant to the communities’ culture and tradition.

A key objective of the Well London project was to develop a locally focussed and community-led approach that improves community health and well-being and is effective and sustainable in even the most deprived neighbourhoods.

Well London sought to engage and empower people to build and strengthen the foundations of good health and wellbeing in their communities through:

• increasing community participation in activities that enhance health and wellbeing.
• building individual and community confidence, cohesion, sense of control and self esteem
• integrating with and adding value to what is already going on locally
• identifying, designing and taking action on health related needs and issues
• building capacity of local organisations to deliver activities and making strategic links locally and regionally so the improvement in health and well-being is sustainable for the longer term

The project also had a mission towards capturing the learning and experience gained to influence policy and practice to secure improvements in well-being and reducing health inequalities within London but also communities across the world. To achieve this, the project would develop robust, evidence based models and benchmarks for health and well-being.

The project has resulted in widespread community activity with nearly 15,000 community members taking part. It has also resulted in increased consumption and access to healthy food, increased physical activity, and improved mental outlooks amongst the residents of the 20 target areas.

Through Well London large numbers of individuals have accessed training and qualifications. Due to the training and and other skills developed, the project has brought at least 200 community members into employment.

The projects have also resulted in additional resources and funding levered into these deprived areas. Well London has succeeded in building the capacity of local community service volunteers. This project has also succeeded in improving relationships and integrated working between statutory and community volunteer organisations.

The following example provides a snapshot of the impact that Well London had upon the communities it targeted.

Case Study: Woolwich Common (Greenwich)

At the start of the programme in 2007 the estate had a terrible local reputation, with noticeable vandalism and neglect by service providers. Key problems in the area included:

• barriers between different community groups and a lack of common identity
• lack of facilities for young people
• insufficient pride of place.

University of East London acting as project lead used funding, matched by the local NHS, to enable the appointment of a community development worker to be a visible presence in the area, and coordinate activities and build community relationships.

Well London was able to:

• work with residents on a healthy spaces project to improve the play area and communal spaces on part of the estate through the Groundwork project. A forum was created to bring everyone on the project together, and workshops were held to allow local people to co-design the project.
• Use events, such as community feasts, that bringing people together to interact and breakdown boundaries
• The main Be Creative Be Well project was focused on young people and encouraged and supported volunteers to manage the programme itself. They benefited from training in community development and youth work practice, creative thinking about citizenship and community engagement, people management and sustainable development – training that would enhance their chances of employment. 
• At the suggestion of residents an after school club was set up. One of the pupils involved commented that before he had sat at home feeling despondent that he was failing in English and Maths. Since the after school club was established they had gained new confidence and later took a health trainers course.
• Alongside these project activities a residents association and a youth forum were established.

786 people participated in the Woolwich Common Well London programme. Of these 85% reported that they were eating more healthy food; 82% reported that they were able to access healthy food more easily; 72% reported increased levels of physical activity; and 80% said they felt more positive.

The residents association is thriving (with a community run website). Residents attend a safer neighborhood panel and the MP now runs a regular surgery on the estate. The project has also enabled improved communication with service providers which has improved their responsiveness to needs.  Well London has helped to lever significant additional funding on to the estate. This has included funding for the physical improvement works on the estate. Woolwich Common will also benefit from £1million over the next 10 years from the BIG Lottery’s Big Local Trusts programme. 

Chinyule Egbuji, from Woolwich commented that ‘because of Well London, community cohesion has improved a lot.’

How Well London projects impacted upon residents’ lives and wellbeing across London

The Well London Delivery teams enabled integration and promotion of Well London projects and other health and wellbeing services. Volunteer training built local capacity and increased community participation in beneficial activities. Delivery Team volunteer testimonials suggest that this involvement was a important step to returning to work:

‘It’s brilliant, I am really enjoying myself. It’s the first time I’ve had a job or been accepted for one in five years and I’m really making the most of the opportunity.’

DIY Happiness – educated and enabled women in the 20 boroughs to connect with their communities, increase their activity, improve their outlook on life. The Project was showcased in the The Guardian Newspaper

Jocelyne a participant in the Changing Minds project said that her participation had resulted in a significant improvement in her mental wellbeing.

“Now I have an aim and objectives on how to achieve it. This is a long way away from where I was nine months ago when I lived in isolation with a low self-esteem”

Buy Well has resulted in the creation of food co-ops and community cafes, also advice provided to shop keepers has meant they have been able to sell more healthy produce.

A participant from one of the Eatwell cook and eat courses said that her involvement had improved their confidence with food and meant she was 'not so anxious about my children, and realise healthy eating is crucial to their long term and short term health.”

Outcomes far exceeded the targets set by BIG Lottery Fund.

• By the end of project delivery in March 2011 a total of 14,772 people had participated in Well London activities of whom:
• 79% reported an increase in healthy eating;
• 76% reported increased access to healthy food;
• 77% reported higher levels of physical activity and 82% said they felt more positive.

A range of additional outcomes were also achieved:

• Significant numbers volunteering: 401 in ‘Well London Delivery Teams’ project alone across the 20 areas (the target was 200)
• Significant numbers accessing training and qualifications - over 800 training opportunities were created by the Training Communities project

The Well London programme received funding of £9.46M from the BIG Lottery.  Each community benefited from approx £300,000 of project delivery resources.  This was not provided as a cash sum but comprised a range of resources including training for local residents, funding to commissioned local delivery organisations, and salaries of Partner staff who worked with local communities.

Each partner organization had staff who were responsible for delivery of the programme. They were either employed specifically for the Well London programme or it was included in the duties of existing staff.  

The programme was also able to lever in additional funding. For example Groundwork levered in nearly £151,000 for open space activity.   A further £2M will come from the BIG Lottery Fund over the next 10 years for BIG Local Trusts in the Well London Woolwich Common and White City areas. The Wellcome Trust is providing an additional £740,000 for the Cluster randomized control trial.

• The factors affecting health and wellbeing are many and interrelated –an integrated, community development based approach is crucial in empowering communities to tackle these issues themselves.
• Inclusive and transparent community engagement is essential. Even so, it is difficult to translate the findings into clear plans of delivery and this needs time.
• Characteristics of the place are as important as characteristics of people in determining levels of health and healthy lifestyles and need local work and community knowledge to identify and target.
• Training opportunities are a great incentive for people to participate and help to create strong outcomes.
• Don’t underestimate issues relating to young people. Fund work with young people appropriately.
• Make extra efforts to recruit volunteers to the programme from the outset and train them early so they can encourage other residents to take part from the start of project delivery.
• When coming in new to an area you need time to build relationships and trust with both the target community and with local service providers, and to find out what is really happening in an area.
• Whilst it is important to target communities and necessary to keep them very local, they need to be natural geographical communities. Target boundaries should not cut across natural boundaries or join communities that don’t see themselves as joined.
• Strong, positive partnerships with other strategic players will make interventions more successful.

Well London delivery, funded by Big Lottery, in the first 20 communities finished at the end of March 2011 and the emerging evidence from the project and programme level evaluations point to significant, positive impacts and outcomes on a range of measures.  The results of the cluster randomised control trial will be available in 2012.  In the meantime Alliance partners are determined not to lose the momentum in realizing the great potential for replicating, scaling up and further developing this Well London approach in other communities.

With Big Lottery endorsement an exciting legacy strategy has been developed that will take the Well London approach into a second wave of communities.  The interim evaluation report and a Well London ‘tool kit’, which captures the learning from work with the first wave of Well London communities, will soon be available. This will include a Well London ‘commissioning framework’ for commissioners and ‘manual of operations’ for future local delivery organizations and partnerships.

Pdf of Well London Project explanation
Link to Well London website - http://www.welllondon.org.uk/4/about-well-london.html

The Guardian - 'Mind Matters', Article on Well London DIY Happiness Project

Information on Deprivation in London: 'London's Poverty Profile' - City Parochial Foundation and New Policy Institute