Summary of the impact

The Healthy Settings Unit at UCLan www.uclan.ac.uk/hsu has contributed to the adoption of the `whole system' settings approach to the promotion of health and wellbeing within a range of sectors nationally and internationally — including higher education and criminal justice. This impact has included: recognition of higher education as a key setting for health improvement by the UK Government, World Health Organization (WHO) and International Union for Health Promotion and Education (IUHPE); implementation of Healthy Universities as a model for promoting student, staff and community wellbeing by an expanding number of higher education institutions (HEIs) within the UK and globally; and investment in and roll-out of a whole system Healthy Prison model across North West England — stimulating extensive national and international engagement and debate.

Underpinning research

The research comprised a mix of praxis-based theoretical and empirical studies:

Phase I (1995-2001) used action and case study research, rooted in UCLan's commitment to establish one of the first Healthy University initiatives in the UK. Drawing on this experience, Dooris developed a social ecosystem model, conducted an evaluation of UCLan's Healthy University programme, and collaborated with WHO to develop settings-based theory and formulate a strategic framework for Healthy Universities.

Phase II (2001-2007) was largely concerned with theory development. Drawing on insights from Phase I and synthesising findings from wider literature, Dooris formulated a generic conceptual framework for healthy settings that identified three characteristics: an ecological model of health promotion, a systems perspective and a whole system organisational change focus. Additionally, he proposed a number of new models to guide healthy settings practice and highlighted three key challenges to the evaluation of healthy setting initiatives — relating to the construction of the evidence base for health promotion; the diversity of conceptual understandings and real-life practice; and the complexity of evaluating ecological whole system approaches. Drawing on complexity theory and critical realism, this work was further developed in collaboration with colleagues from Canada and other countries. In order to test these theoretical developments, Dooris also undertook international empirical research with global leaders in healthy settings.

Phase III (2008-2013) combined regional and national-level empirical research with further theory development. A multi-method study (£10,000 funded by Higher Education Academy/ Department of Health) conducted by Dooris and Doherty examined Healthy Universities activity in English HEIs and explored the potential for a national programme to be developed. The findings confirmed that higher education offers significant potential to impact positively on the wellbeing of students, staff and wider communities; and demonstrated widespread interest in adopting a whole system Healthy Universities approach — reflecting an increasing recognition that investment for health within higher education will contribute not only to health targets but also to mainstream agendas such as staff and student recruitment, experience and retention; and institutional and societal productivity and sustainability. The research also highlighted support for a National Healthy Higher Education Programme. Building on this, Dooris and colleagues were funded by HEFCE to conduct a high-profile implementation project (Section 4) and commissioned to conduct consultative research leading to a new conceptual model and recommendations for the development and operationalization of a National Healthy Universities Framework for England (£25,000 funding from Department of Health via Royal Society for Public Health). In parallel with this, Baybutt and Dooris applied learning from Phases I and II to criminal justice settings — evaluating the Target: Wellbeing Pan-Regional Prisons Programme (£756,000 combined implementation and evaluation funding from Big Lottery); researching the effectiveness of an Offender Health Trainer Service; and examining the benefits of adopting a whole system approach to regional tobacco control. Throughout this phase, Dooris and colleagues also collaborated to develop new thinking and theory regarding the integration of health and sustainability within and across settings.

References to the research

Details of the impact

[Numbers in square brackets refer to underpinning research listed in Section 3; letters and `Contact X' in square brackets refer to sources used to corroborate the impact in Section 5.]

a) International Level

The reach and significance of Dooris' generic research on healthy settings [2] is evidenced by his publications being cited on the WHO Healthy Settings global web portal [A]. The Healthy Universities research [1, 3, 4] was a catalyst to WHO reinvigorating its engagement with higher education as a setting — and UCLan was acknowledged as key in the genesis of Healthy Universities and being one of only two universities worldwide to be linked from this portal [A]. Furthermore, Dooris is the European Healthy Universities representative on a WHO Working Group on Implementing Health 2020 and Strengthening Public Health through Improved Collaboration and Synergy of Health Promotion Networks [Contact 1].

The generic settings [2] and criminal justice research [5, 6] in 2013 acted as a lever for the WHO Health in Prisons Project Steering Group to prioritise international research into the whole system prison approach, being undertaken by Baybutt and Dooris on behalf of its Collaborating Centre.

The research [1-6] made a significant contribution to the decision of IUHPE to adopt healthy settings as a priority theme and recognise universities and prisons as important settings [Contact 1]. Dooris chaired IUHPE's Global Working Group on Healthy Settings until 2011 and was a key member of the Executive Scientific Committee for its 20^th World Conference in 2010, with lead responsibility for convening the conference stream on healthy settings. A meeting convened by Dooris at this conference led to the establishment of a European Health Promoting Universities Network www.eurohpu.aau.dk: this has 15 member countries, with Dooris as the UK focal point. Additionally, Dooris was the invited keynote speaker leading the healthy settings stream at 2012 IUHP European Conference and a key note speaker on healthy settings at the 2013 Nordic Health Promotion Research Conference, the 2013 Danish Public Health Society Annual Conference and the 2013 Australian Health Promotion Association Annual Conference. Baybutt was on the planning group for the Healthy Settings sub-plenary at the 21^st World Health Promotion Conference in 2013 and the invited specialist speaker on prisons, health and justice [Contact 1; Contact 2].

Dooris' work [2] underpins Section 4 of Ireland's 2011 Health Promotion Strategic Framework [B], which explicitly draws on his conceptual research — and the Irish Health Service Executive have commissioned Dooris' Healthy Settings Unit to transfer the learning from their research through developing and delivering a `train the trainers' course, extending the impact into health promotion practice.

b) National Level

The Healthy Universities research [1, 3, 4] has made a significant contribution to national strategy and guidance. Building on a case study of UCLan's work within the earlier `Choosing Health' publication, the Government's 2010 public health strategy reinforced the importance of universities as a setting for health — stating that "Healthy Schools, Healthy Further Education and Healthy Universities programmes will continue to be developed by their respective sectors, as voluntary programmes, collaborating where appropriate and exploring partnership working with business and voluntary bodies" [C]. The inclusion of Healthy Universities was clearly influenced by the work of Dooris and colleagues and represented a significant achievement in an era of `stripped down' government, offering continued legitimacy to the growing number of HEIs adopting this whole system model of working [Contact 2]. Dooris is also an expert adviser to the Welsh Government in the development of its own Healthy and Sustainable FE and HE Framework, which draws extensively on the work of Dooris and colleagues [1, 3, 4] [Contact 3].

Research by Dooris and Doherty [1, 3] has been recognised and cited by bodies such as Universities UK, National Union of Students and the Royal College of Psychiatrists — the latter stating in 2011 that "the `Healthy Universities' systemic and holistic approach is commended and should be adopted as widely as possible" [D].

Research by Baybutt and colleagues [McAllister et al, Stirling University) examining the benefits of adopting a whole system approach to regional tobacco control has strengthened the evidence base and thereby contributed to national-level policy debate [5].

c) Institutional and Population Level

Perhaps most significantly, the research has had far-reaching influence on institutional practice, impacting on population health and wellbeing — through the implementation of the Healthy Prisons model by establishments across the North West region [Contact 4; and through the adoption of the Healthy Universities approach by a growing number of HEIs within the UK and internationally [E; Contact 2].

The research on prison-based wellbeing (with a particular focus on horticultural and environmental projects) [6] has highlighted the reach of such work (3828 beneficiaries) and the value of such activity in transforming individual offenders' lives [Contacts 4-5]. Furthermore, it has demonstrated the importance of adopting a whole-system approach that addresses wellbeing, reoffending, citizenship and social justice agendas — thereby levering further Big Lottery and National Offender Management Service funding for Healthy Prison implementation and evaluation by Baybutt and Dooris within North West establishments, with current interest in wider roll-out into North West probation and other community settings and into prisons beyond the region [Contacts 4-5]. Evaluative research of offender health trainer services has led to wider roll-out within the North West and strengthened the case for further investment in the work.

Building directly on their research [1, 3], Dooris and Doherty (with Powell at MMU) were in 2009 awarded £200,000 from HEFCE for an implementation project Developing Leadership and Governance for Healthy Universities www.healthyuniversities.ac.uk. This enabled previous [1-3] and concurrent [4] research findings to inform developments — and specifically for: the UCLan- convened National Network to be formalised and expanded, with membership increasing from 47 HEIs and 10 other stakeholder organisations in 2008 to 73 HEIs and 22 other stakeholder organisations in 2013; a website and toolkit to be developed, facilitating the translation of research into practice through offering guidance packages, case studies and a self-review tool; and advocacy and leadership for Healthy Universities to be strengthened through a high-level Leadership Advisory Group jointly chaired by the Chief Executives of the Leadership Foundation for Higher Education and the Royal Society for Public Health [E; Contact 2]. The reach of this work is evidenced by the extensive use of the website (9,043 unique visitors from 125 countries since its launch in 2010); the request from the Welsh Assembly and HEIs outside of England for UCLan to widen the Network's remit from England to the UK [Contact 3]; increased demand for `associate' membership of the Network by HEIs in countries outside of the UK (e.g. Australia; Canada; Ireland; New Zealand); and requests for Dooris and Doherty to act as advisers and to speak at Healthy University events (e.g. Simon Fraser University, Canada; University of Sydney, Australia; University of Calgary, Qatar; University of Extremedura, Spain).

Sources to corroborate the impact

A. World Health Organization Healthy Settings Web Portal. www.who.int/healthy_settings/en

B. Health Service Executive (2011) The Health Promotion Strategic Framework. Dublin: HSE. [Section 4/Figure 3]

C. H.M. Government (2010) Healthy Lives, Healthy People. London: Department of Health.
www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public-health-in-england [p.34]

D. Royal College of Psychiatrists (2011) Mental Health of Students in Higher Education: College Report CR166. London: RCP. www.rcpsych.ac.uk/files/pdfversion/CR166.pdf
[Recommendation 9, p.14; pp.49-51]

E. Dooris, M. & Powell, S. (2012) Developing Leadership and Governance for Healthy Universities: Final Report to HEFCE. Preston: UCLan.
www.healthyuniversities.ac.uk/uploads/fck/HU%20Final%20Report%281%29.pdf

Contact 1: Marie Claude-Lamarre, Executive Director, International Union for Health Promotion and Education.

Contact 2: Prof. Richard Parish, Chief Executive, Royal Society for Public Health (to June 2013) — now Executive Director, Health Development Bureau.

Contact 3: Sue Bowker, Head of Life Course Branch — Health Improvement Division, Welsh Government.

Contact 4: Maggie Moody, Target: Wellbeing Portfolio Manager, Groundwork UK.

Contact 5: Alan Scott, Deputy Director of Custody — Public Sector Prisons North West, National Offender Management Service, Ministry of Justice.