Katie Miller and Maddy Thompson
Tackling health inequalities in UK communities is an ongoing challenge. Longstanding funding issues within the NHS increasingly require organisations to creatively do more with less. North Wales has long faced health inequalities. The North Wales Population Needs Assessment 2022 reports that it has some of the most deprived areas in all of Wales (North Wales Social Care and Well-being Services Improvement Collaborative, 2022). The ongoing cost of living crisis has provided additional pressures, worsening health inequalities as more families face difficulties affording necessities such as food and heating.
The Betsi Cadwaladr University Health Board (BCUHB) became conscious that to effectively tackle health inequalities, a whole systems approach was required. As such BCUHB led an innovative programme of work—the Inverse Care Law (ICL) programme—to develop local partnerships to address health inequalities. The programme supported three local teams, or ‘innovation clusters’, to pilot a whole systems approach to address health inequalities in their communities.
As the evaluation partners, we used ripple effect mapping to understand the collective and growing impact across the three innovation clusters. The mapping process adapted a collaborative, participatory model-building ripple mapping approach (Nobles, Wheeler, Dunleavy-Harris, et al., 2022), working with stakeholders in interactive workshops to draft the maps. Over 40 stakeholders were engaged in developing seven hand-drawn ripple maps, which we then integrated to create individual innovation cluster maps and a single collective map that presents a holistic representation of the wider intended and unintended impacts of the programme over time.
The ripple map approach captured evidence of significant impacts and is an important tool for visualising the programme’s success. On a broader scale, the project showed the importance of leveraging this ripple effect mapping to capture a holistic understanding and evaluation when testing and learning from service re-design.
KEYWORDS: systemic design, ripple effect mapping, participatory model building, health inequalities, inverse care law
RSD: Health & Well-being, Mapping & Modelling, Methods and Methodology
