ActEarly has made a great start and is already breaking new ground – for example, putting co-production at the centre of everything it does. Such an approach is much needed but it can throw up challenges and I talk through some of these in this blog. I’m sure there are many of you who have thoughts about these challenges, so all comments are welcome.
What’s in it for us?
We want communities to co-produce our research so that it is underpinned by their needs, their concerns and their hopes for better times. Achieving this will require a range of methods and the contributions of local communities and individuals. The onus is on us to show them why their involvement is so important and that we’re listening. As our research develops we hope that will become clear to see. But we can also think about the best ways of recognising their expertise and efforts. Things to consider range from standard reimbursement and incentives, through to formal training and some form of accredited recognition of local people’s contributions.
On a similar note, ActEarly research will rely on local people providing data about themselves and their families’ day to day lives to help us understand what we can change, how we can change it and whether it makes a difference. But can we also present this information in a way that’s useful to our communities, families or individuals, for example providing straightforward access to their own information, and summarising information about their local environment that could help them make good choices around how to stay healthy.
Different interests and priorities
ActEarly involves academics and public health, local authority practitioners, charities and other organisations. Sometimes we have different priorities for example in crime prevention, criminologists might look at crime from a structural perspective, focusing on tackling the root cause by reducing poverty, whereas police officers might be concerned with the motivations of individual law-breakers and how they might be dissuaded from committing further crimes. It’s not that the police officer doesn’t understand the pressures of poverty, or that the criminologist isn’t aware of the importance of policing and making sure people feel safe, it’s just that each has a different views about the best approach to reducing crime. Similar tensions would probably be found if we talked to social workers, teachers, community workers and so on. Politicians might also experience these challenges but these are often consumed by the relatively short term agendas prompted by the electoral cycle. So, some balance, some judgement, some wider thinking, and lots of listening is needed if we are to all work together on this.
ActEarly is using a complex systems approach to deliver its research. This approach is innovative and is a move away from a traditional linear approach of testing one intervention against one, or just a few, outcomes. Our approach will help us see the impact of change across the whole system, it is about improving rather than proving. That said, there’s been lots of talk about complex systems but few examples of how they work in practice, so we are in some ways taking a leap into the dark. Using the rich datasets available to us can sometimes mean a focus on numbers and statistics rather than the lived experiences of those living and working in Bradford and Tower Hamlets. It can also mean that we focus most on health and wellbeing outcomes and less on things like justice and rights. But a concern with these can offer an effective way to help us to address how we can mitigate the powerful externalities that can get in the way of any local changes we want to promote. For example, if we are exposed to a year or so of post-brexit recession that drive further cuts to local authority budgets, that might change our focus from promoting improvements to trying to design ways of mitigating harm. There is a book by Robert Tsai (Practical Equality: Forging Justice in a Divided Nation) that focusses on the law but is also relevant to us. He says we should ask these questions about each system change; is it reasonable, is it rational, is it fair, are their consequences that are cruel, have all relevant voices been heard? We can only capture this sort of understanding by looking deeply as well as broadly.
One more thing
The central tenet of ActEarly is reducing inequalities in health, wellbeing and opportunity. There is currently a growing conversation around what we mean by equality, as well as Tsai’s book there are others, here are some contributors:
Ronald Dworkin: there is a difference between treating people equally and treating them as equals – there is procedural equality and representational equality, an equality of resources and an equality of welfare and achieving any or all of these things involves engaging different priorities.
Jeremy Waldron: people can be equal and unequal at the same time – we should aspire to recognising and preserving an underlying deep equality. What are the key components of “deep equality?”
Elizabeth Anderson – prioritarianism – sorting out people with needs from people with wants (not a new debate).
Richard Arnstein: equality is about equalizing the distribution of misfortune, he calls this “luck egalitarianism”.
Lots to think about, lots to talk about, and most importantly lots to do!
Neil Small, University of Bradford, March 2020