In CommonHealth Catalyst we will be undertaking all of the preparatory work to build a consortium drawn from communities and around the public sector that will eventually be able to make decisions about what research is needed in order to tackle health disparities. Health disparities are the unfair distribution of health status between different groups of people, and they are especially bad in Lanarkshire in Scotland, which is the proposed site for our project. In this preparatory stage we need to: (1) learn from the past to shape solutions for the future by drawing on local public health statistics and updating, and identifying gaps, in the data. We will then undertake work facilitated by historians and local community partners to examine historic patterns, trajectories, and some of the causes of health disparities locally, as well as previous community responses. We know that health is often much poorer in former industrial areas, and Lanarkshire was previously very focused on heavy industry, including coal mining, steelworks, and so on. Through discussion on these historical factors, and through best practice in public engagement, we will create meaningful dialogue between community representatives, practitioners, and decision makers, with a view to improve consciousness of the drivers of deprivation, and thus poor health. This process will be assisted by the development of an animated film drawing on the life stories of local people. By bringing everything out into the open, we will look to build new - hopefully optimistic - stories, and shared commitments for change between the public sector and communities. (2) Assets-based approaches are about 'doing with' (rather than 'doing to'), and they look to build on the strengths and mobilise the knowledge and skills of local people. We will map the health and wellbeing ecosystem in Lanarkshire by drawing on best practice in community development, augmented by a novel approach employing health economics. We will identify community 'assets', including arts, heritage and cultural assets, and identify programme budgets for health and social care. We will look for such knowledge to be drawn together and illustrated maps drawn with the support of local artists. We will develop a holistic description of the potential for shifting and scaling of resources informed by the generation of evidence: scaling up the conditions for working in partnership, while making the details locally adaptable. This allows us to take the learning from Lanarkshire to other places where such action is also needed. With the support - both as co-investigators and as project partners - of representatives drawn from different sectors, this work will support and facilitate collaboration between researchers, the public sector, and community activists and practitioners directly to ensure that community assets better connect with the local healthcare system and research on health disparities. Our approach will be sensitive to place, context, history, and culture. It will allow us to grapple sensitively but robustly with important local issues such as the legacy of industry and deindustrialisation in the area. We will deliberately create a collaborative consortium, fit for knowledge brokerage and mobilisation. This will have to involve effective cross-sectoral interorganisational relationships and build trust, networks, partnerships, and work to overcome real or perceived differences in power. CommonHealth Catalyst will enable community organisations to forge longer-term, more sustainable relationships with the formal public health systems across Lanarkshire, and embed the principles of 'co-production' into health services improvement. Ultimately we will be looking to improve public health within some of the most deprived communities in the UK, creating the conditions for effective partnerships to allow this to happen.

We often hear 'the system' is broken, but what do we mean by this? How can changing the way we think about, define, research, evidence, monitor, evaluate and resource 'the system' lead to meaningful change for deprived communities? How will this change benefit those who have first-hand experience of trauma, homelessness, poverty, unemployment, displacement, poor mental health or imprisonment? REALITIES takes a human-systems approach noting 'health and social care systems' (HSCS) are constructed mental representations of relationships existing in the world to promote health for people. Our Scottish consortium of 57 people has five established asset hubs in Clackmannanshire, Dundee, Easter Ross, Edinburgh and North Lanarkshire with strong relationships uniting conflicting ways of seeing the world. Through phase 2, we co-produced a systems-level model with deprived communities, policymakers, practitioners and researchers collecting and respecting different types of knowledge and alternative evidence-bases (from arts performances to nature walks; words to statistics) as equally important to understand complexities of unjust and avoidable health differences. Foundational funding evidenced REALITIES is able to transcend the challenge for our currently imagined HSCS. The medical model of disease shaping who and what is considered to be part of 'the health system' has brought benefits to human existence, though key actors within these place-based HSCS systems understand the limitations of this systems-framing for human flourishing. At present, they don't have a way to help reimagine them. REALITIES provides exploration and method for this reimagining. A model representing collective pathways producing creative routes for people to get the healthcare they need at the right time of their journeys by co-researching and co-creating with them the "what, whom, how, and why" - leading to successful connections between individuals with health and social needs and community-based opportunities for health and wellbeing improvement. We are a transdisciplinary collective of individuals with lived and felt experience of inequalities working alongside policymakers; local authorities; charities; artists; environmentalists and researchers from policy; health humanities; arts; psychology; human geography; environmental sociology; dentistry; medicine; statistics; economics; counselling; psychotherapy; management; medical anthropology; design and innovation. We will: understand what work is needed to enable places to reimagine and build 'systems' that create equitable health and wellbeing. explore and explain how links between creativity, relationships and nature create healthier and more resilient communities and environments for people in deprived areas. support creative, participatory processes, enabling communities to construct shared mental models (systems) using different ways of knowing (epistemologies) and perceiving reality (ontologies). combine different ways of knowing, enabling a more complete representation of bio-psycho-social-political factors which create 'health' and ways in which these are experienced by marginalised people. support communities to construct place-based versions of systems encompassing all aspects of health and wellbeing, and make purposeful changes in the nature of their relationships with each other and their environment. explore the usefulness of 'standard' Health Economic evaluation tools to assess Social Return of Investment, working with communities to re-conceptualise and re-define measures of 'value' and 'quality of life' in relation to human experience.