Key messages from a review of health and wellbeing strategies  What we aimed to do  How we tried to achieve it  What we found

What we aimed to do The research aimed to investigate:  how LAs have interpreted the statutory guidance for HWBs;  the extent to which there is variation in the aims and content of HWSs;  how the word ‘evidence’ has been interpreted and used within HWSs and the relationship between HWSs and JSNAs.

How we tried to achieve it  A qualitative documentary analysis using thematic content analysis  Sampling frame – all upper tier local authorities in England  Sampling in proportion to the percentage of population in each region  Sample covered breadth of local authority types

What we found: structure and scope  Strategies varied in timescale, spanning one (n=7) to five years (n=8). They also varied considerably in length, from one to 92 pages, with an average page length of 25  The scope of the objectives varied from the high level and strategic, such as: “Objective 7: promoting the health and wellbeing of new populations in [Place Name]” to the more operational and action-orientated: "Increase the number of mothers under the age of 25 who initiate breastfeeding from 17% by 10% year on year for two years."

Extract from the table comparing the structure and content of HWSs Does the strategy have: Strate gy refere nce a Timescale (years) Strategy length (pages) A vision ? Aim(s )? Object ive(s)? Priori t(ies) ? 1.LB (3) 28NoYesNoYes 2.LB (2) 12Yes NoYes 3.MBNot stated1Yes No 4.U (3) 92No d No Yes 5.U (4) 16No Yes 6.LB (3) 16No e Yes 7.UNot Stated49NoYes 8.C (3) 12Yes NoYes 9.MB (5) 36YesNo Yes 10.LB (1) 16No Yes 11.U (2) 32YesNo e YesNo 12.M B Not stated b 38Yes NoYes 13.C (3) 20YesNo Yes 14.U (3) 29YesNo Yes 15.C (3) 32No Yes 16.C (3) 34Yes NoYes 17.C (3) 20Yes NoYes 18.U (5) 24YesNo Yes 19.LB 2010/ /13 (2) 40NoYes 20.LB (1) 16No Yes 21.U (2) 33YesNo Yes 22.LB (2)24YesNo Yes 23.C (5) 18YesNo 24.C (3) 38Yes NoYes 25.C 1 year - no start date 24Yes NoYes 26.M B (3) 34Yes NoYes 27.M B (2) 8YesNo Yes 28.U (3) 40Yes NoYes 29.C (5) 26No Yes 30.U (5) 30NoYesNoYes 31.C (1) 18No Yes 32.U (5) 26 c YesNoYes 33.C (5) 24No e No Yes 34.C (1) 33NoYesNoYes 35.C (4) 27NoYesNoYes 36.U (1) 13No YesNo 37.U 2012/ /14 (2) 26Yes No 38.U (5) 16YesNo Yes 39.M B (3) 18YesNo Yes 40.M B (3) 10YesNo Yes 41.U (3) 13Yes NoYes 42.U (2) 22Yes NoYes 43.C (2) 17Yes 44.U (3) 9Yes NoYes 45.U (3) 24Yes NoYes 46.M B (3) 16No Yes 47.U (1) 12Yes NoYes

What we found: use of evidence  Most often, evidence was used to mean ‘evidence of need’. This was usually identified through the JSNA and was mostly locally gathered intelligence rather than from a national source of research evidence  There were few instances of evidence cited to mean effectiveness of interventions and these often did not cite specific sources  Five HWSs cited academic journals in the context of evidence of need, not effectiveness. Statements resulting from community engagement or local opinion were included alongside other sources of evidence “The JSNA, and the data which informs it, provides the key evidence-base for health, public health and social care commissioning across the local area.” “Listening and responding – People living in [Place Name] know best about the greatest problems and challenges to their health and wellbeing. We will listen closely to learn what really matters and how we could make a difference by developing the way we engage and communicate with residents.”

What we found: link between HWSs and JSNAs  Most HWSs referred to JSNAs with some strategies acknowledging the statutory guidance and making explicit links between their JSNA and HWS “The strategy is based on the city’s Joint Strategic Needs Assessment (JSNA) and feedback from local organisations, patients and the public.”

Conclusions and implications  LAs have varying interpretations of what should be in a HWS  Public health agencies and academics can support the development of effective HWSs by improving the accessibility of evidence and conducting research when evidence is absent  Whilst the new public health system is still evolving, one year on an opportunity exists to develop clearer guidance about the production and purpose of HWSs  Qualitative research exploring the views of LA elected members and officers, including public health specialists, may help to shed light on underlying problems and highlight potential solutions

Acknowledgements The work was undertaken by Fuse, a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research council, Medical Research Council, and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, is greatly acknowledged. Opinions expressed in this presentation do not necessarily represent those of the funders.

Round table discussion (1) 1.How important is the different meanings of the use of the word evidence between public health and local authorities? 2.If it does matter, how we can reach a meaningful use of the word that improves effectiveness of public health interventions used in local authorities (Hard to word this one because I have a strong view!) 3.What strategies have already been used to influence local authority officers and members? 4.How can those strategies be used to improve the influence of health and wellbeing strategies? 5.What would be the barriers and facilitators to increasing the use of evidence of effectiveness in health and wellbeing strategies?