In 2019, the Index of Multiple Deprivation (IMD) identified 10 wards in Oxfordshire that had small areas within the 20% most deprived nationally.
Since then, profound transformation has been underway. Not in hospitals or clinics, but in community centres, coffee mornings and through conversations. The most recent IMD data (2025) shows the gap between some of the most deprived and least deprived communities in Oxfordshire appears to be narrowing.
Oxfordshire is often recognised for its culture, heritage and natural beauty, with health outcomes that outperform national averages. Yet, despite the improvements, pockets of inequality remain. Between some areas, life expectancy varies by as much as 13 years for females and 10 years for males. The University of Oxford's Health Humanities project is working with Oxfordshire County Council, the NHS, ICB and voluntary organisations to evaluate two community health programmes and better understand inequalities across 10 communities that were among the most deprived areas in the country in 2019.
The Community Health Development Officers (CHDO) funded by Oxfordshire County Council and the ICB-funded Well Together (WT) programmes – including community capacity building staff - aim to improve wellbeing and reduce health inequalities in these wards. They do this through working in partnership with local communities to understand their strengths and assessing what more could be done to help those local places thrive, with flexible grants to fund a wide range of local activities.
A recent Phase 1 evaluation of the programmes, conducted by the University's Health Humanities project team, offers a compelling blueprint for reimagining public health; not as a service delivered, but as a relationship nurtured. Drawing on humanities-based methodologies, the evaluation highlights the role of social relationships in ensuring health programmes are trusted and accessible. Health inequalities are often framed as issues of insufficient infrastructure, but in Oxfordshire's most vulnerable communities, inequalities also stem from erosion of social cohesion and of the underlying building blocks of health such as secure employment, decent housing and clean air.
The CHDO and WT programmes aim to strengthen these building blocks by expanding local capacity, fostering social connections and co-producing interventions with communities. This is also helped by Oxfordshire's Marmot Place work with the UCL Institute of Health Equity. Current projects focus on giving children the best start in life, addressing rural inequalities, supporting fair employment, strengthening primary care networks and informing policy research. The Health Humanities evaluation reveals many residents feel their communities are unfairly characterised and long-term cycles of changing health provisions can result in disengagement from local resources. Yet, these same communities also possess strong neighbourhood identities and local organisations that can be powerful assets, if we choose to invest in them.
The evaluation shows the most effective interventions are place-based and relationship-led. CHDOs and WT community capacity builders were standout contributors due to their consistent presence, communication skills and strong local partnerships – all key ingredients in establishing trust.
One coffee morning, the report notes, can spark a chain of engagement: volunteering at a community larder, accessing support services, or attending health screenings. These seemingly small interactions underpin resilient, healthy communities.
A key recommendation from the evaluation is to avoid ‘parachute projects' – short-term initiatives that fail to take root. Instead, it advocates for ‘rooted research': long-term, equitable collaborations that honour community memory and continuity. Measuring success may therefore require longer term evaluation approaches.
As the report notes, ‘while policy cycles are usually short, communities have long-term memory'. They remember who listened, and who stayed.
As public health professionals, policymakers and communicators, we must shift our lens. Success should not be measured solely by reach or financial input, but by the quality of relationships and the trust they foster.
This means working across organisational boundaries to build strong partnerships between local authorities, the NHS, voluntary and community groups, and residents; recognising shared goals across systems; funding community led initiatives that prioritise continuity over novelty; supporting local leaders who are embedded in their communities; and treating social relationships as legitimate, measurable health infrastructure.
The CHDO and WT programmes offer more than a model; they offer a mindset. One that sees health not just as an outcome, but as belonging, trust and shared aspiration. If we want healthier communities, we must first become part of them.
