Why is co-production necessary?  Don’t we already know what works?

We’ve been trying out the same approaches for a  long time and not all of them have worked. We think we know what works based on research data.  But we have also seen in research that there’s been less participation and involvement from those from black and multi ethnic backgrounds. We collect both quantitative and qualitative data. Sometimes, the way that’s been collected has not necessarily provided an accurate picture of what’s going on. Getting people involved in the solutions is really critical. We know that some of our policies haven’t worked and  we need to understand why. The people who can tell us why are those we’ve been “doing the things to”.

It is obvious that each one of us would want to be involved in anything that pertains to us. This should be an issue of social justice – involving people in matters that affect their lives should be the normal thing to do.

Overcoming resistance

Not all evidence has been developed in a way that has been inclusive and has taken in the considerations of black and multi-ethnic communities. So, we start off with what we know, which is absolutely where we should start from.  But how do we now deliver this in such a way that people can relate to it and resonate with and can own? So, it shouldn’t be  a health initiative, it should actually be seen as a community initiative with mutual vested interest of all relevant stakeholders.

Taking the example of vaccination, the narrative of the community should be ‘we’re protecting ourselves and one another,’  not them saying, “we’ve been told we need to take the vaccine”, which is less likely to resonate if they already have concerns or experiences with the health service that have not been that positive.

What’s the worst that can happen if you don’t involve the beneficiaries when constructing a policy or rolling out an intervention?

If you’re providing something that is not working, at best, it’s a waste of resource and doing everyone a disservice. At worst it could actually be doing more harm than good to all concerned.

We could actually have an intervention that is absolutely brilliant and proven to work. However if we don’t think about race in our delivery, we may actually be putting up  barriers, leading to inequities –  certain groups not having the same opportunity as others to really benefit.

An example is weight management interventions: in some cultures being slightly overweight  may be seen as being more favourable in terms of body image. People need to understand why we’re asking them to lose weight. We  need to sit down together as equal partners to understand their viewpoint and consider how we all bring our experience and expertise together to come up with an appropriate and effective approach.

When you think its co-production … but it’s not

What we’re quite good at doing is having the almost finished package and then saying, ‘can this work?’ Real co-production would be ‘this is the health issue we have – how can we address it?’ So, it’s actually sitting around the table and saying  ‘we are concerned because those from black and multi ethnic communities are at greater risk of high blood pressure. What can we do? This is what the evidence is telling us. How do we work with this? We come together and we hopefully create something that, right from inception, has taken into account all the different dimensions, with race and cultural issues being quite central to this.

Quite often we tinker around the edges and that’s not the best approach, and it can often be seen as tokenistic.

We also need to be really honest about what co-production is and what isn’t. Ideally we may want  to do co-production but if we are faced with real life operational constraints, whether it’s around tight time scales, resource or funding, then we need to be  upfront and transparent and say, ‘this is what we’d like to do, but we can’t do it. And then, ‘what’s the next best thing?’ and look to mitigate any negative impacts of the different approach.

Where to start? 

We often start with the data, but we may want to first start off thinking about the communities we want to work with. We may already have  existing relationships with certain communities and want to consider how to build on these, ensuring we are  being inclusive particularly  for those who are less likely to engage using our usual mechanisms.

To do this properly, we need sufficient time, which is not always an option with our pressured timescales and the requirement for quick results.

Therefore right at the start, we’ve got to think ‘how much time do I have to deliver this?’ If I’ve got a blank sheet of paper, then it’s very much recognizing that I need to allocate an appropriate amount of time to get this done properly.

We are producing a guide for those wanting to do Co-Production.

It is recognised that for true co-production, there are some important key ingredients. That’s the purpose of the guide that we are pulling together.

It gives pointers for us in our Public Health practice to consider. For us to really think through, “if I want to do co-production, how do I do it?” We can also assess the activities we are already involved in and say, ‘actually is this really co-production?’ And if it’s not, then it’s okay to be  honest to say it’s not. There may actually be justifiable reasons for this. However as much as possible we must take into account certain key factors, of which an anti-racist approach is vital. This  ensures that within the constraints of the work, we are getting input from our black and multi-ethnic communities in an appropriate manner.

This is one of the main outputs of this workstream, because as Public Health professionals, we need to have  clear standards of work. And it’s not just about doing co- production well, it’s also about using an anti-racism lens, recognising the structural racism in society, and taking the required appropriate actions.

Once we publish and start using the guide, it will be  important that we also evaluate what we’re doing. The practice of taking an anti-racist approach to co-production is  a process – it’s a journey and we’re learning as we go along. We should not just look at the impacts but ensure that there are no unintended consequences in doing our work. Adopting this approach is definitely one of the ways to  address racism as a Public Health issue headlong!