Data, evidence and
lived experience

How we use data, evidence and insights into people's lived experiences to guide our work on complex urban health issues.

Over recent years, we've been honing our approach to tackling complex urban health issues. We take a place-based approach in the London boroughs of Lambeth and Southwark, underpinned by curiosity and an eagerness to learn and share.

We take a close look at a combination of:

• Data from a variety of sources

• Evidence on what works – and doesn't

• Lived experiences of local people

Together this forms a starting point for our place-based approach through our programmes, and we hope it's of interest to others working in urban health.

Data

Interrogating multiple data sources, exploring correlations and visualising insights on maps helps us spot where to target our efforts.

Data plays a critical role in our strategy. It helps us better understand the issues we focus on, pinpoint where we can target our efforts and informs the specific impact we want to have.

We analyse a broad mix of data, from publicly available sources like the Office for National Statistics and the London Datastore to anonymised records from our local GPs and new data that we commission ourselves.

We know urban health issues are complex and impacted by many factors. So we combine our use of data, evidence and lived experience to better understand our place and explore the connections between people's health and their context.

_{^{Satellite images Ⓒ}}

Working in Lambeth and Southwark
means we can focus on a defined
geography. However, like many
other urban areas, our boroughs
are far from homogenous.

Around 600,000 people live here, in diverse
areas from lively Little Portugal in Stockwell
to leafy Dulwich or the bustling London Bridge,
spread over more than 55 square kilometres.

Similarly, the prevalence of health
issues is not equally spread.

Take childhood obesity for example. It’s one of
the challenges we focus on. When we first
started exploring the issue, in 2017, we knew
that the average rates in Lambeth (25%)
and Southwark (27%) were higher than
the average in England (19%).

That’s a start. But we wanted to
understand if and where variation
exists within our geography.
^{_{Percentage obese children in Year Six by MSOA 2017}}

We used data from the National Childhood
Measurement Programme to explore the variation
in rates of childhood obesity in neighbourhoods
across our boroughs.

Zooming in to a neighbourhood level showed
us a clear and significant variation in childhood obesity
rates across wards in our boroughs. In Southwark,
this stretches from 9% in Village Ward
all the way to 35% in Chaucer.

Mapping this showed us that many of the areas
with the highest rates concentrate across a band
or 'corridor' running across the north part of
the two boroughs.

We approach complex urban health issues with a
commitment to exploring how wider factors – including environmental, social and economic – impact on
people's health.

In that context, we set out to explore the reasons
behind the geographical concentration of high
childhood obesity rates. Using data from the
Office for National Statistics, we looked at income levels
across the boroughs. This revealed a strong overlap
between the areas in our boroughs with the lowest
median income per household and the areas with the
highest childhood obesity rates.

Knowing the incredibly strong link between childhood
obesity and income, we set out to understand more
about the area and communities living there. We
explore characteristics like ethnic background, type
of housing, or employment.

The data pointed to higher
levels of ethnic diversity in areas with
high levels of childhood obesity. This helped
us better understand the make-up of the
neighbourhoods where we might work.

^{_{Satellite images Ⓒ}}

Working in Lambeth and Southwark means we can focus on a defined geography. However, like many other urban areas, our boroughs are far from homogenous.

Around 600,000 people live here, in diverse areas from lively Little Portugal in Stockwell to leafy Dulwich or the bustling London Bridge, spread over more than 55 square kilometres. Similarly, the prevalence of health issues is not equally spread.

Take childhood obesity for example. It’s one of the challenges we focus on. When we first started exploring the issue, in 2017, we knew that the average rates in Lambeth (25%*) and Southwark (27%*) were higher than the average in England (19%*). That’s a start. But we wanted to understand if and where variation exists within our geography.
^{_{*Percentage obese children in Year Six by MSOA 2017}}

We used data from the National Childhood Measurement Programme to explore the variation in rates of childhood obesity in neighbourhoods across our boroughs. Zooming in to a neighbourhood level showed us a clear and significant variation in childhood obesity rates across wards in our boroughs.

In Southwark, this stretches from 9% in Village Ward all the way to 35% in Chaucer. Mapping this showed us that many of the areas with the highest rates concentrate across a band or 'corridor' running across the north part of the two boroughs.

We approach complex urban health issues with a commitment to exploring how wider factors – including environmental, social and economic – impact on people's health. In that context, we set out to explore the reasons behind the geographical concentration of high childhood obesity rates.

Using data from the Office for National Statistics, we looked at income levels across the boroughs. This revealed a strong overlap between the areas in our boroughs with the lowest median income per household and the areas with the highest childhood obesity rates.

Knowing the incredibly strong link between childhood obesity and income, we set out to understand more about the area and communities living there. We explore characteristics like ethnic background, type of housing, or employment.

The data pointed to higher levels of ethnic diversity in areas with high levels of childhood obesity. This helped us better understand the make-up of the neighbourhoods where we might work.

The data helped draw a clear picture, at neighbourhood level, where the highest rates of childhood obesity concentrate and the correlation with income. It also gave us a better picture of the areas where we're beginning to focus our work.

Our deep dive told us that these areas are highly diverse and that there's significant variance across our boroughs.

The exploration also revealed other surprises. Our analysis to date in Lambeth and Southwark showed no statistically significant correlation between rates of childhood obesity in an area and the number of fast-food outlets.

To improve our understanding of the
'childhood obesity corridor' and other
areas where we work, we look at
the assets of the area more detail.

So when we think about who we
might partner with and how we could
work to create change in the local
environments where children spend their
time, we consider a number of factors.

Take the area between Burgess Park,
Peckham and Camberwell in
South London, for example.

How many primary and
secondary schools are there
that we could potentially work
with to improve school meals
and physical activity?

What about supermarkets?
Which supermarkets might we
approach to test ways to
move consumers towards
healthier shopping baskets?

And how about takeaways and
restaurants? What local businesses
exist in areas where childhood obesity
rates are particularly high and how
can we work with them to provide
healthier options?

^{_{Map data Ⓒ}}

To improve our understanding of the 'childhood obesity corridor' and other areas where we work, we look at the assets of the area more detail. So when we think about who we might partner with and how we could work to create change in the local environments where children spend their time, we consider a number of factors. Take the area between Burgess Park, Peckham and Camberwell in South London, for example.

How many primary and secondary schools are there that we could potentially work with to improve school meals and physical activity?

What about supermarkets? Which supermarkets might we approach to test ways to move consumers towards healthier shopping baskets?

And how about takeaways and restaurants? What local businesses exist in areas where childhood obesity rates are particularly high and how can we work with them to provide healthier options?

We also look for data that can tell us how residents feel about where they live, giving us an even more nuanced picture of how our work could support people and communities.

We conducted a targeted survey around North Lambeth and Waterloo, inviting responses from anyone in the community to share how they feel about where they live and how it affects their health.

The responses were equally positive and negative - with most negative comments relating to food and environments, and most positive comments focused on local activities.

We could see exactly where people spend their time and how they feel about those areas, down to particular roads, junctions, parks and playgrounds.

By knowing more about the assets in our place, and how
people feel about them, we built our understanding of the interconnected environments where children and families
spend much of their time.

The responses were equally positive and negative - with most negative comments relating to food and environments, and most positive comments focused on local activities.

We could see exactly where people spend their time and how they feel about those areas, down to particular roads, junctions, parks and playgrounds.

By knowing more about the assets in our place, and how people feel about them, we built our understanding of the interconnected environments where children and families spend much of their time.

"We use data in three ways – to look at need, to look at opportunity, and to look at how those things intersect in terms of place, people or health issues."

Hear Rob Parker, our Head of Data and Analytics, explain how we put these three factors together to build our approach to improving public health.

Evidence

Learning from experts and what others have tried elsewhere to help guide what we do.

We learn from evidence to guide the new and existing projects and initiatives we support. We also create evidence to help us get started and guide our work, sharing what we learn with others.

We take a careful and nuanced approach to evidence. We seek national and international insights as well as local.

We try to understand what other examples have achieved, the outcomes, but also how and why.

What aspects of putting the project in place helped with its success?

Were there any key elements that made it work – for example the right infrastructure or systems readiness – without which the project may not have happened or been sustained?

Evidence informs and shapes the types of initiatives we back through our programmes.

For example, there is little evidence available on how to slow down people's progression to multiple long-term conditions. We believe looking at people's finances and how these impact their health could help us direct some of our efforts.

To help us explore this, we've partnered with academics from Glasgow and borrowed methodology from an initiative in the US, which used financial diaries as a tool to reveal hard-to-see aspects of the financial lives of working Americans.

As a result, we are now running a year-long project to explore the financial lives of local people living with multiple long-term conditions using a mix of tools including financial diaries. We expect the findings to guide how we, and others, can help minimise any negative impact of finances on people’s progression to multiple conditions.

In the case of our childhood obesity programme, we also learn from others' evidence and have started to create our own.

This ranged from Amsterdam's remarkable work to halt rising rates in the city to efforts around the corner from us in the London borough of Tower Hamlets. In our Bite Size report on childhood obesity we focused largely on evidence from behavioural sciences. These study our decision-making as humans, our habits and how these affect key aspects of our lives, including our health.

Behavioural insights show obesity in both children and adults is overwhelmingly impacted by our environments. For children this means their homes, schools, and streets.

Where we live plays a major role in our health, in positive and negative ways. The evidence shows the environments that surround us hold many of the cues that drive our eating and physical activity. We know from evidence on food purchasing that we all now have easier access to a wider variety of highly palatable, energy dense food than ever before.

For example, we've gathered evidence about the availability of takeaways in urban areas and on consumer behaviour including the disposable income needed to reach the recommended amounts of healthy foods.

Along with the link between childhood obesity and income being at the core of our work, we focus most of our efforts on initiatives that help change the environments where children spend most of their time - their homes, schools, and streets - and where most decisions about food are made, including large supermarkets and corner shops.

While we're still learning, evidence from other cities, behavioural sciences, ethnography and our own research helps guide our decision-making about the projects we back through our programme today.

Lived experience

Applying insights from the realities of local residents' lives.

Donna, mother of one, on local food options and affordability

Focusing on a specific place gives us the opportunity to learn with local communities about what works and what doesn't.

With our partners, we seek a deep understanding of the people, assets and dynamics in our boroughs to get us started and inform our approach.

We don't stop at initial insights. Through the projects we support, we continue working with residents and favour people-centred design approaches that take time to get right.

Across both our current programmes, we've sought to understand people's daily lives more deeply. By spending time with people and paying close attention to their lives and habits, we learn which ideas are more likely to work.

We've commissioned in-depth research, spending time with people living with multiple long-term conditions in their homes and neighbourhoods. We often explore lived experiences through distinct lenses - such as looking at shopping habits or how people's finances impact their health.

In our childhood obesity programme, understanding how families on low incomes live, shop and eat is key to achieving our goal of reducing rates in our area and beyond.

We've worked with Shift to produce Families and Food - an ethnographic study of local families with young children on low incomes living in areas of high childhood obesity.

The research analysed over 1,000 entries in families' food diaries. It mapped where they bought food and reported on hours spent with families as they cooked, ate and shopped.

Local families frequently tell us that they are struggling to make ends meet. This often means little money or headspace to prioritise health when making decisions.

At the same time, temporary, poor or shared accommodation limits opportunities to cook or store goods.

What we see and hear informs our work, including stories like Lela's.

Lela is a 24-year-old single mum with two sons, aged two and five years old. They live in a one bedroom flat on an estate in Kennington.

The flat is small and the kitchen is dark, a home environment that Lela finds stressful. This is made worse by her constant worrying about money and bills. Her household income is under £15,000. She's training to be a delivery driver for a supermarket.

Lela's meals

Once a week Lela goes food shopping at the superstore, a 10-minute walk from home. With money being tight, grocery shopping is often a stressful and embarrassing experience. Lela tries not to spend more than £20 a week on food.

At the checkout, she’ll put through her items in order of priority and when she reaches £20 she leaves whatever else is in her basket.

Lela’s usual routine is to cook her children’s evening meal during the day, so it is ready for them when they come back from school.