1. Profiling ‘Empowerment’ as an outcome within an economic evaluation framework of urban regeneration programmes Camilla Baba Dr. Emma McIntosh Prof. Carol Tannahill

2. Why measure empowerment? Economic context of the PhD Define Economic evaluation What are Population health interventions? What is ‘Empowerment’? Definition Components/attributes Link to health GoWell data analysis What is ‘GoWell’? Previous work on empowerment Data analysis 1 Presentation Outline

3. “The comparative analysis of alternative courses of action in terms of their costs and consequences” (Drummond et al. 2005) 2 Economic Evaluation Choice Programme A Programme B Costs ? Consequence/benefits?

4. Population Health Interventions Aimed at whole communities/general population Not focussed on just one aspect of health Addresses wider context Involve a number of sectors and funders A form of complex intervention “ Research conducted from a complex perspective might consider how and whether these components work individually and together. It might consider the synergies between them, phase changes and feedback loops, and the interactions between multiple health and non-health outcomes, as well as the process by which these components bring about change in communities” (Petticrew, 2011:397). 3 Economic Evaluation of Population Health Interventions 1

5. How to measure population health interventions? Non-standardised Ability to have different forms (and consequences) in different contexts Have to conform to specific theory driven processes Downstream interventions “more narrowly defined ‘clinical’ interventions, such as drugs, devices or medical procedures” (Drummond et al. 2006:7) Upstream interventions Tackle rising health inequalities “The challenge is to reduce the difference in mortality and morbidity rates between rich and poor and to increase the quality of life and sense of well-being of the whole local community” (NICE, 2012). 4 Economic Evaluation of Population Health Interventions 2

6. Challenges Applying standard economic evaluation methods to population health interventions by looking at the costs and consequences across many sectors Processes involved in the intervention must be considered Economic evaluations must monitor and include the entire process of the intervention thus demonstrating the cost of an intervention’s success or at what cost it has failed Adopt the societal perspective Must consider the long-term impact of the intervention – will costs/outcomes continue beyond the original scope of the intervention? Need to ensure this manifestation or ‘knock-on’ impact is included in the economic evaluation? Ensure ALL relevant costs are calculated. Public health interventions are often based on multi-sector agreements and funding 5 Economic Evaluation of Population Health Interventions 3

7. “Urban regeneration is the process of renewal or redevelopment of the social and built environment through policies, programmes and projects aimed at urban areas which have experienced multiple disadvantage” (MacGregor, 2010:38). 6 Urban regeneration programme A population health intervention?

8. Why do we need to measure Community Empowerment (CE)? KEY QUESTION How do we identify, measure and value community empowerment within an economic evaluation framework and apply it to an urban regeneration context? 7 Project context INPUT (£) URBAN REGENERATION PROGRAMME OUTCOMES (BENEFITS)

9. s Conducted in first year of PhD Wide-ranging nature of empowerment literature 8 Empowerment Literature Concept of "Community Empowerment" (CE) Business manage- ment Public Health Education Health promotion Gender studies Healthcare provision Public Policy Urban Studies International development History Psychology

10. “Rallying call of sorts” – Barr (1995) “By Empowerment I mean our aim should be to enhance the possibilities for people to control their own lives” (Rappaport, 1987:119) Key features of empowerment A relational concept It can be used in a number of contexts and at various levels Process or outcome? Is there a final ‘end’ or is empowerment itself a process? So what components or attributes can be associated with ‘empowerment’ (at any level)? 9 What is ‘Empowerment’?

11. 10 Components/Attributes Individual Empowerment (PE)Community Empowerment (CE) Sense of Control/mastery Leadership Self-esteem/worth Access to Information Collaboration/Networking Resource Mobilisation

12. 2 reviews examining the relationship empowerment has to health: Woodall et al. (2010). Empowerment and Health and Well-being: Evidence Review. Leeds: Centre for Health Promotion Research. Wallerstein, N. (2006). What is the evidence on effectiveness of empowerment to improve health? Copenhagen: WHO Regional Office for Europe. Areas where empowerment interventions/strategies have improved individual health Self-esteem/efficacy, sense of control, increased awareness, behaviour change, sense of community, networking and social support. Empowered Communities seek to improve their health 11 Health Improvements through Empowerment

13. Surveys – 2006, 2008, 2011 15 deprived neighbourhoods in Glasgow undertaking regeneration Questionnaire – homes, neighbourhood, health/wellbeing, communities, personal circumstances 12 “ A research and learning programme that aims to investigate the impact of investment in housing, regeneration and neighbourhood renewal on the health and wellbeing of individuals, families and communities over a ten- year period”

14. Aims What are the characteristics of respondents who identify themselves as being empowered ? (e.g. Age, gender, length of time living in the area, employment status etc..) Is there any evidence to suggest that respondents who participate in social clubs/associations are ‘empowered’ individuals? Is there a link between empowerment and health? What is the cost of activities/actions that create empowerment? 13 Quantitative Data Analysis Plan

15. 14 GoWell empowerment analysis 2. People in this area are able to find ways to improve things around here when they want to 3. The providers of local services, like the council and others, respond to the views of local people 1.On your own, or with others, you can influence decisions affecting your local area CE Index I enjoy living here I feel I belong to this community I feel part of the community Sense of Community Index It is likely that someone would intervene if a group of youths were harassing someone in the local area To what extent do you agree that this neighborhood is a place where people from different backgrounds get on well together? Someone who lost a purse or wallet around here would be likely to have it returned without anything missing Community Cohesion Index Neighbours look out for each other Exchange things with neighbours Stop and talk in the neighbourhood Visit neighbours’ homes Neighbourliness Index Current GoWell CE Analysis

16. Established GoWell Empowerment Questions The respondent’s relationship with their landlord How respondents feel about where they live Respondents perception of their neighbourhood How informed respondents are about proposals to improve or develop their local area Other questions of interest Characteristics of individuals and their lives How respondents feel about their community and local area How well respondents describe their relationship with their neighbours How friendly are they with their family and friends, do they live close to them Respondents involvement with, and support of, any social groups, organisations etc. Their self-reported health (mental and physical) 15 GoWell survey

17. 16 SF-12 Gandek, Ware et al. (1998)

18. Hedonic perspective of well-being refers to an individual’s subjective experience of happiness and life-satisfaction Eudaimonic perspective looks at a person’s psychological functioning, their self- realisation and their relationships with others All of the time Often Some of the time Rarely Never 17 WEMWBS Question I’ve been feeling optimistic about the future I’ve been feeling useful I’ve been feeling relaxed I’ve been feeling interested in other people I’ve had energy to spare I’ve been dealing with problems well I’ve been thinking clearly I’ve been feeling good about myself I’ve been feeling close to other people I’ve been feeling confident I’ve been able to make up my own mind about things I’ve been feeling loved I’ve been interested in new things I’ve been feeling cheerful

19. What will this achieve? Identify potentially influencing factors on the creation of empowerment Provide further evidence if PE and CE could be linked. Can we use individual utilities to measure and value community utility Provide guidance on those health states that may be connected to feeling empowered and should be included in the creation of my further empirical work.How to measure empowerment; what economic evaluation technique is most appropriate Potentially show if local service providers efforts to produce engage with residents. Guidance for which activities to include in a future economic evaluation of their work 18 Further work

20. What does an empowered resident look like? ‘’On your own, or with others, you can influence decisions affecting your local area’ Respondent’s perceived influence: 19 Profiling empowerment

21. 20 Profiling empowerment Gender

22. 21 Profiling empowerment Time lived in area

23. isfiedisfied 22 Profiling empowerment Age:

24. Self-esteem/efficacy sense of control increased awareness behaviour change sense of community, networking and social support 23 Question I’ve been feeling optimistic about the future I’ve been feeling useful I’ve been feeling relaxed I’ve been feeling interested in other people I’ve had energy to spare I’ve been dealing with problems well I’ve been thinking clearly I’ve been feeling good about myself I’ve been feeling close to other people I’ve been feeling confident I’ve been able to make up my own mind about things I’ve been feeling loved I’ve been interested in new things I’ve been feeling cheerful Profiling empowerment

25. isfiedisfied 24 Profiling empowerment

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29. Thank you! Any questions? Camilla Baba, PhD Student HEHTA, University of Glasgow, UK