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Durham Research Online
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Reframing 'participation' and 'inclusion' in public health policy and practice to address health inequalities : evidence from a major resident-led neighbourhood improvement initiative.

Lewis, Susan and Bambra, Clare and Barnes, Amy and Collins, Michelle and Egan, Matt and Halliday, Emma and Orton, Lois and Ponsford, Ruth and Powell, Katie and Salway, Sarah and Townsend, Anne and Whitehead, Margaret and Popay, Jennie (2019) 'Reframing 'participation' and 'inclusion' in public health policy and practice to address health inequalities : evidence from a major resident-led neighbourhood improvement initiative.', Health & social care in the community., 27 (1). pp. 199-206.

Abstract

There is a need for greater conceptual clarity in place‐based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident‐led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident‐led partnerships across England are tackling the day‐to‐day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth.

Item Type:Article
Full text:(AM) Accepted Manuscript
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Status:Peer-reviewed
Publisher Web site:https://doi.org/10.1111/hsc.12640
Publisher statement:This is the accepted version of the following article: Lewis, Susan, Bambra, Clare, Barnes, Amy, Collins, Michelle, Egan, Matt, Halliday, Emma, Orton, Lois, Ponsford, Ruth, Powell, Katie, Salway, Sarah, Townsend, Anne, Whitehead, Margaret & Popay, Jennie (2019). Reframing “participation” and “inclusion” in public health policy and practice to address health inequalities: Evidence from a major resident-led neighbourhood improvement initiative. Health & Social Care in the Community 27(1): 199-206, which has been published in final form at https://doi.org/10.1111/hsc.12640. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Date accepted:16 July 2018
Date deposited:14 March 2019
Date of first online publication:09 September 2018
Date first made open access:09 March 2020

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