St Helens Borough Council: Promoting the wellbeing of marginalised communities through engagement and empowerment

Prior to the COVID-19 pandemic, the Merseyside borough of St Helens was facing significant economic and health challenges. Data for 2016-20 showed an almost 12-year difference between male life expectancy in its most and least deprived areas. St Helens ranked high on the list of England’s most health-deprived council areas (Indices of Multiple Deprivation 2019). 

These effects were deepened by the pandemic and the cost-of-living crisis. In 2022/23, 16.9 per cent of children in St Helens were living in low-income families – up more than 20 per cent on the previous year. 

St Helens Borough Council and its partners are working to tackle these challenges. At the heart of this work is a desire to engage with local people and empower them to have their say in the building blocks for health and prosperity. Another important element is to celebrate what is great about the borough. 

In 2021, the St Helens People’s Board (the Health and Wellbeing Board) agreed to establish an independent, multi-agency Inequalities Commission. This was timely, as across Cheshire and Merseyside, the Institute of Health Equity was supporting local areas to establish a joint approach, ‘All Together Fairer’, to improve health equity and the social determinants of health in the sub-region. 

Linking into this, the St Helens Inequalities Commission was set up to give local people a voice, explore the barriers preventing people from reaching their potential, learn from evidence and experts, and make recommendations to the system. 

The commission shines a spotlight on issues which create and perpetuate inequalities across St Helens. Its aims include to: 

• identify key challenges, interventions and actions which have greatest impact on reducing inequalities
• hold services and public bodies to account on tackling inequalities through constructive support and challenge
• integrate the understanding of marginalised communities with the knowledge of experts and local leaders, to shape projects and services to build greater equality
• living a good life in St Helens
• raising youth expectations
• social isolation and loneliness
• tackling stigma. 

Core members – including representatives from public health, the NHS, the voluntary and community sector and the business sector – meet regularly. There are workshops involving expert speakers and specialist organisations, and business meetings where the partners explore how to embed the work that has been identified through these workshops. 

Each workshop explores a particular topic, with a focus on community engagement and hearing from people with lived experience. Topics have included: 

Work generated through the commission is picked up through established groups such as the fuel poverty working group, healthy weight strategy group and family hubs. As well as being a sub-group of the People’s Board, the commission reports to the NHS-led Integrated Care Partnership and to All Together Fairer at the sub-regional level. 

At early community engagement events, residents said they were worried about rising fuel bills and food costs, including lack of access to healthy food. In response, commission members worked together to increase the number of community food pantries and reduce the stigma experienced in accessing them. 

Another early action was to re-energise the fuel poverty working group, focusing on helping people vulnerable to respiratory illness to keep warm in winter. 

Ruth du Plessis, Director of Public Health for St Helens, said: “We have embraced the evidence that community empowerment is the best way to promote the aspirations and wellbeing of marginalised communities, and encouraged them to lead the way on the message they want heard.” 

In 2023, the Inequalities Commission won an MJ (Municipal Journal) Award for its whole-council approach to tackling health inequalities. The judges said it was an ambitious and innovative approach which had already led to their work having greater reach. They said the emphasis on shifting the framing of conversations with local residents to focus on positives was commendable. 

It was clear from this early engagement work that stigma played a role in exacerbating inequalities. Stigma in this context is a set of negative beliefs which a particular community group has about something. It can affect everything from families not taking up free school meals to people not accessing services or facing differential treatment when they do.

Volunteers and service users of the St Helens drug and alcohol service, provided by Change Grow Live, developed an anti-stigma charter. It promotes inclusive language and behaviours which prioritise the individual over their experience of addiction. They also created a film, ‘Sticks and Stones’, exploring their lived experience of stigma. This has helped to ignite conversations and change across a range of local organisations. St Helens Council’s public health team facilitated the first showing of this film at a local cinema, to an audience of 200 – including many local service providers. 

With the support of IVAR (the Institute for Voluntary Action Research), the Inequalities Commission has engaged with a range of local people with lived experience of stigma to champion their message and amplify their voices. This work is now helping partners across the borough, and the region, to look at how they can create system change to tackle this issue. 

Ruth du Plessis said: “The evidence that stigma disempowers people and perpetuates inequalities is stark but rarely given the focus which it deserves. 

“I am so amazed by the bravery of some of our local people to share their experience of stigma and challenge us to ensure that we don’t deliver services in a way that creates or compounds stigma and its effects. Together we can and must do better to stop discrimination and marginalisation.”

For more information contact Dr Alice Lacey-Campbell, Public Health Specialty Registrar: [email protected]