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Issue 2, July 1998, pp.10-11.

Health Action Zones
Linda Bauld and Ken Judge

What are Health Action Zones?
Health Action Zones (HAZs) are new kinds of partnerships established in England to pioneer creative approaches to modernising services and responding to social exclusion. The first wave of eleven HAZs began life in April 1998. Their aim is to bring together a multiplicity of public, private and voluntary organisations to reshape local health and social services and to improve the health of their local populations, especially those who are most disadvantaged. The eleven areas (see Table 1) share common problems of deprivation, social exclusion and evidence of health inequalities. They show diversity, however, in their existing partnership arrangements and vary fundamentally in their scale and complexity.
There are four main 'types' of HAZs:

• the most complex HAZs are those linking multiple local authorities and health agencies such as Tyne-and-Wear;
• then there are HAZs such as City & East London based on a single health authority that encompasses a number of local authorities;
• in many ways, the least complex HAZs in organisational terms are those built on a partnership between a single health authority and a single local authority such as Bradford;
• finally, there are HAZs being developed in new unitary local authorities such as Plymouth that form only part of the local health authority.

Table 1

While there is considerable uncertainty about detailed HAZ plans, it is apparent that the eleven HAZs are addressing the challenge in a complex variety of ways. Nevertheless, they all share the general aims illustrated in Figure 1.

The starting point for Health Action Zones is the complex raft of national policy initiatives launched since the May 1997 election. These include The New NHS and Our Healthier Nation, welfare reform and welfare-to-work, regeneration, education action zones and many others. HAZs will be expected to respond in innovative ways to these new initiatives. At the local level, the essence of HAZs is that the partnerships they build should be trailblazers for new approaches to holistic government. HAZs have three immediate goals:

• to reshape health and social services;
• to empower local communities;
• to facilitate user participation and to tackle the root causes of ill health.

This approach is expected to produce significant health gain and to reduce inequalities in health.

To achieve these ambitious aims, HAZs are developing in a wide variety of ways. In this short piece, we highlight some of the developments which are directly related to health inequalities.

Tackling the root causes of ill health
Our Healthier Nation identifies the wide range of factors that impact on health. If Health Action Zones are to tackle health inequalities, they cannot avoid developing strategies that address the causes of health problems, including poverty, unemployment and social exclusion. But HAZs also need to create opportunities for healthy lifestyles by expanding access to health information and access to services and programmes which facilitate healthy behaviours. Four key examples are: healthy food at affordable prices; the development of Healthy Living Centres; 'healthy schools' initiatives; and access to health information, particularly using information technology and through the media.

The successful HAZs have already begun to think in imaginative ways about how to take forward these two agendas. For example, a number of bids identify school exclusion and bullying within schools as priority areas. Others plan to use the New Deal to increase the employment of specific disadvantaged groups, either through their own participation or by encouraging local businesses to get involved.

The eleven successful HAZs detail specific problems related to health which they wish to tackle, or specific groups within the community whose health will be addressed by specific initiatives. Several HAZs focus on improving access to mental health service for ethnic minority groups. For example, Manchester, Salford and Trafford intend to address the problems of young African Caribbean men in the Moss Side area of Manchester.

Figure1: A model of Health Action Zones


There is also a widespread focus on improving young people's health. East London, for instance, has initiatives related to anti-smoking, anti-bullying, substance misuse and sexual health measures, among others. Lambeth, Southwark and Lewisham also very much centre their HAZ bid around improving the health of young people, incorporating a focus on babies and children and including initiatives to develop parenting skills and to encourage breast feeding.

Improving access to services is another recurrent theme. Generally, the Primary Care Groups are seen as key, as is the expansion of IT services to allow public access. Integrated care management and assessment arrangements across agencies is highlighted in Northumberland's approach. Access is also linked to community empowerment, with involvement and development being mentioned in all the bids.

Targets and Goals
The ultimate aim of Health Action Zones is to improve the health of their population and to reduce health in equalities. Achieving changes in health status will take a long time, but it will be important for each HAZ to monitor progress. For example, The New NHS White Paper states that:

'An early task for each Health Action Zone will be to develop clear targets, agreed with the NHS Executive, for measurable improvements each year.'(l)

At present, there is some uncertainty about the initial focus of the HAZ programmes because detailed plans for each of the HAZs will not be finalised until Autumn 1998. Nevertheless, the broad thrust of what is intended can be identified.

Most areas intend to set targets to reduce mortality and morbidity rates. For example, by the end of the first 7 years of HAZ status, Tyne and Wear aspires to have improved life expectancy so that it is in the top 10 per cent in Europe. Other HAZs focus on specific reductions in health inequalities. For example, targets have been set to reduce the number of children living in damp and cold housing, the number of homeless people sleeping rough, the number of wards with more than 25 per cent of families living in poverty, the percentage of the population who are unemployed, the extent of domestic violence and the level of crime.

Specific conditions that HAZs intend to address include reducing rates of coronary heart disease and cancer, reducing teenage pregnancies, tackling diabetes, improving dental health and preventing substance misuse. For example, Bradford has a set of objectives related to reducing diabetes, to be achieved by a range of means including setting up 15 diabetic centres in existing primary care facilities. East London aims particularly to reduce the incidence of cardio-vascular disease by preventative means such as: health promotion; increasing opportunities for physical activity; and improving primary care and hospital based services to treat the disease.

Conclusion
It is clear that Health Action Zones do not lack ambition in the goals that they have set for themselves. Whatever the final shape of the HAZ programmes, there can be no doubt that collectively they represent an important part of the Blair government's attack on social exclusion. But achieving enduring success will require continuing effort, imagination and a recognition on the part of central government that challenges must be combined with genuine support and encouragement well beyond the next general election.

References:
1. Secretary of State for Health (1997) The New NHS, London : The Stationery Office.