Abstract
The ARC Healthy Living Centre is a community-led health and wellbeing charity based in Sally's Wood estate, Irvinestown, County Fermanagh. It opened in 2001 when four derelict social houses were renovated into a community centre, in an area which, at that time, had some of the highest levels of poor health, unemployment, and crime in the county.
Understanding that poverty was making people sick, and that good employment and an adequate income could reduce stress and enable people to have more control over their lives and health, it became obvious that it was not possible to address health inequalities via interventions which emphasised individual lifestyle change alone. To be effective ARC advocated for broader social reform. Early participatory research showed a need for child-based services, support for residents struggling with addiction, and more opportunities to access advice and work. Residents were dissatisfied with the condition of their homes and the level of crime and fear of crime they faced. ARC responded with practical actions and services, and platforms were established allowing local people to engage with and influence those who were tasked with delivering services.
As the services developed, ARC worked closely to the 6 policy objectives in the Marmot Review (2010) to address health inequalities:
1.Give every child the best start in life: ARC is the accountable body for Cherish Sure Start, delivering in 13 wards across Fermanagh and Tyrone
2.Enable all children, young people and adults to maximise their capabilities and have control over their lives: ARC runs a summer scheme catering for up to 250 young people, a childcare centre and a child contact centre
3.Create fair employment and good work for all: Additional psychological support has been contracted for staff
4.Ensure healthy standard of living for all: ARC has set up a community food initiative, delivers a low threshold addiction service, and has incorporated other support and wellbeing services including financial advice and foodbank provision
5.Create and develop healthy and sustainable places and communities: There are bimonthly community information exchange forms with residents and quarterly interagency meetings
6.Strengthen the role and impact of ill-health prevention: The community is empowered through access to a range of early intervention services such as hypertension checks, falls prevention courses, social prescribing, and fuel poverty support
Over two decades of community-based practice have led to multiple positive outcomes in the local area: decreased antisocial behaviour and reported crime, increased rates of breast-feeding, reduced numbers of void dwellings, with NI Housing Executive noting increased tenant satisfaction and housing retention, and a high uptake of Sure Start services - consistently within the highest in Northern Ireland.
The ARC story suggests that a community-embedded, preventative approach to addressing health inequalities can be effective and sustainable over time and provides transferable ideas for policy makers and communities attempting to tackle similar challenges elsewhere. However, providing job security to those employed by the ARC centre is an ongoing challenge as most services do not receive core funding.