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The impacts of COVID-19 on cities across the United Kingdom were significant and diverse, whilst ongoing climate-related, sustainability and social challenges were highlighted and sometimes amplified. Lessons from organizational and citizen experiences and their responses have the potential to improve local sustainability and resilience to global events, hence they must be examined. We report findings from a project conducted in Preston (UK) exploring how COVID-19 recovery might accelerate organization- and citizen-led action for the wellbeing of people, places and planet. The project used a settings approach to public health and combined qualitative research with conceptual development; the former involved online interviews and group dialogues with members of several local anchor institutions, whilst the latter examined synergy between community wealth building, Doughnut Economics and place-based climate action. We explore two themes 19 anchor institutions’ strategic priorities and plans; ‘building back better’ and its future sustainability implications. These revealed four cross-cutting aspects – wellbeing; tackling societal inequalities; collaborative working; and COVID-19 as a catalyst for transformative change. Informed by ‘Doughnut-Shaped Community Wealth Building’, organizations are encouraged to: embed commitment to equitable and inclusive climate action; consolidate the co-operative approach developed during the pandemic at strategic, operational and grassroots levels; take a nuanced approach to future work policies and practices; and work across anchor institutions to advocate collectively for supportive national-level policy to build a sustainable, wellbeing economy.

With the Institute of Health Promotion and Education turning 60, it is timely to reflect on health promotion’s journey. While health promotion can celebrate many advances, much remains to be done. This paper considers the enormous challenges we face and how we might move forward by working not only within, but beyond, the five action areas of the Ottawa Charter: engaging creatively with the opportunities offered by the changing contexts in which we operate, for example in relation to integrated care systems and place-based partnerships; learning from our experience of COVID-19 to ensure joined-up whole system responses that nurture the transformative change necessary to ‘build back better’ for a sustainable and healthy future; and advocating a new economic vision and model that rejects economic growth as an end in itself and refutes the assumption that such growth will automatically result in improved population and planetary health. Health promotion is inherently political. Reflecting on the UK’s current situation – with spiralling child, food and fuel poverty, flatlined/reduced life expectancy, increased inequalities, and the ongoing failure of government to take on powerful vested interests through legislative, regulatory and fiscal measures – we face a crisis. However, a crisis represents not only danger, but also a potential turning point. This should motivate the health promotion workforce to harness and channel its righteous anger; and give space for active hope that we – as citizens, professionals and members of families and communities – can envision, advocate and fight to secure the wellbeing of people, places and the planet.

This qualitative study examined the perceptions of potential wellbeing benefits of local green and blue spaces for adults aged over 50 years in a coastal town in North West England. At a population level, living close to green and blue spaces is associated with better mental and physical health, with the strength of the benefits being inversely related to the economic prosperity of an area. However, living in economically disadvantaged coastal communities may be associated with poorer health and wellbeing, particularly for older adults, despite the proximity to blue (and often green) space. Exploring this apparent paradox was the aim of the present study. Through semi-structured interviews with members of a community group, we gained insight into lived experiences of local green and blue spaces. The main themes we developed from analysis of the conversations were accessibility, amenities, social connections, quality of environment, and recuperation and escape. Our findings illustrate that participants valued natural spaces that were local and accessible, particularly when they felt connected to them, and were less likely to visit spaces that were further away and that were perceived as being less welcoming or accessible. This study provides insights into the experiences of adults aged over 50 living in coastal areas and suggests that policies and interventions aimed at promoting wellbeing in this demographic should consider the value of hyper-local green and blue spaces and their potential to promote connectedness to nature.

Introduction This report summarises research into the emergence and development of community hubs within Lancashire and South Cumbria (L&SC). The project has been funded by the University of Central Lancashire (UCLan) and was developed following discussions with the Partnerships Manager at Community Futures – the Community Council of Lancashire. It acknowledges a degree of confusion and overlap regarding hubs in the L&SC region, some led by the VCSFE and others by the statutory sector. It addresses differences in perceptions of the role and function of hubs and aims to give an overview of the emerging landscape, challenges, motivations and drivers for hub formation, as well as reflecting on public and VCFSE sector perspectives. Aims and Objectives Aims a) To characterise the emergence and development of community hubs in Lancashire and Cumbria, accounting for their diversity and the key challenges they are attempting to address. b) To inform the development of a joined-up, coherent and sustainable approach to establishing effective community hubs in L&SC. Objectives a) To examine the approaches to developing and resourcing community hubs within L&SC. b) To gain an overview of existing and proposed community hub-related developments within L&SC. c) To increase understanding of how these community hub-related developments are responding to community need, infrastructure and provision. d) To underpin a joined-up approach to working across sectors within L&SC and produce policy recommendations that can lead to better outcomes and less duplication. Methods The study followed a mixed-methods approach and ethical approval was secured from the relevant UCLan Ethics Committee. Three phases of data collection included: Desk-based research and mapping exercise. Semi-structured interviews with decision makers and project managers from public bodies. Small-group and individual interviews with participants from a sample of community hubs.

Background, Rationale and Community Hub Characterisation This report summarises research into the emergence and development of community hubs within Lancashire and South Cumbria (L&SC). The project has been funded by the University of Central Lancashire (UCLan) and was developed following discussions with the Partnerships Manager at Community Futures – the Community Council of Lancashire. The phrase ‘community hub’ has existed for a number of years and usually relates to a range of community initiatives, including community centres, community spaces, and many other projects that provide services to a community [1, 2]. Most of these initiatives have originated in the Voluntary, Community, Faith and Social Enterprise (VCFSE) sector. However, since the proliferation of community hubs during the COVID-19 pandemic, hubs operated by district-level local authorities have emerged in greater number. These are perceived to have been a successful response to the challenges posed by the pandemic, and to have reduced barriers to communication between organisations and led to an increase in partnership working [3]. In L&SC there are a couple of large programmes being developed by public bodies such as Lancashire County Council and the local NHS foundation trust that build on the theme of community hubs. The range of initiatives that the phrase ‘community hub’ can refer to has created some confusion amongst members of the VCFSE sector who are unsure how these programmes will affect them and what role, if any, they may be expected to fulfil within them. At times there is little agreement (and some tautology) over what constitutes either a ‘community’ or a ‘hub’ – ‘community’ indicating the constituents served by a hub, and ‘hub’ referring to the nature of the community initiative in question. This report begins by outlining the geographical parameters of the study in the context of the L&SC Integrated Care System (ICS) before considering definitional issues, drawing on insights fro

This document reports on the ‘Climate Resilience, Social Justice & COVID-19 Recovery in Preston’ project. Funded by the Place-Based Climate Action Network (PCAN) with additional support from the University of Central Lancashire (UCLan)’s Institute of Citizenship, Society & Change and Centre for Sustainable Transitions, this comprised a rapid literature review (supported by a webinar and workshop) and a qualitative research project. The project sought to explore how recovery from COVID-19 could create innovative opportunities for climate action and social justice, translating into practice the rhetoric of ‘build back better’ and serving as a springboard to accelerate action for a future that respects and prioritises the wellbeing of people, places and the planet.

This chapter provides a background to the settings-based approach to health promotion, examining the evolution of the approach and highlighting issues for further consideration. Adopting a largely chronological approach, it looks at the following: (i) international policy development as a context for healthy settings; (ii) the emergence and consolidation of the approach and its application in different contexts; and (iii) key emerging themes for critical reflection, debate and research.

This chapter introduce the theoretical basis and fundamentals of the settings-based approach, complementing Chap. 1, by tracing the evolution of thinking over time. While there have been multiple attempts to establish models, typologies and frameworks for the settings-based approach, a recurring theme has been the absence of a shared understanding of the theoretical foundations of the approach. This chapter summarizes key advances, presents an expanded conceptual framework that can be used to guide future policy and practice, considers how theory can be usefully translated into practice, and identifies key themes for critical reflection.

Health-promoting universities are a growing global movement and one of the important applications of setting-based health promotion. This chapter contextualizes and provides a brief overview of the development of health-promoting universities and then goes on to review and discuss key conceptual and theoretical considerations, emphasizing the importance of comprehensive whole institution and systemic approaches. It then moves on to look at the translation of theory into practice, presenting three contrasting examples from different regions of the world. It concludes by looking to the future in the context of the International Okanagan Charter for Health Promoting Universities and Colleges—outlining key opportunities and challenges, spotlighting the importance of whole-system working; the need to maximize leverage for transformative change through future-oriented and outward-focused engagement with civic and global challenges; a willingness to advocate and live counter-cultural values such as compassion and respect; and a commitment to positive-focused approaches that integrate salutogenesis and regenerative sustainability.

Given the importance that current food-related challenges pose to our society, the potential of local food initiatives to address sustainability has gained increased attention. Nevertheless, research has increasingly demonstrated that local food initiatives are limited in fulfilling their sustainability potential. This realisation has led many scholars to argue that the path towards food system transformation needs to be based on interconnected networks of these ‘alternative’ practices – what this paper terms local food systems. Nevertheless, as many local food initiatives rely on funding and volunteer work, their capacity to create infrastructures for integrated approaches is limited. In this context, influential players – those who can provide resources, such as local authorities – become key in the assemblage of local food systems. However, there is limited understanding of how the role of local authorities affects the internal dynamics of local food systems and potential outcomes. This study addresses this research gap by analysing two case studies (Preston, England and Vitoria-Gasteiz, Basque Country). Using urban political ecology (UPE) as a theoretical framework, this study offers original insight into the key governance elements affecting the direction of local food systems and thus the alignment of diverse local food initiatives, limiting their sustainability potential.

Background Measurement of UK food insecurity has historically been inconsistent, making it difficult to understand trends. This study contributes by reporting and analysing data from a national survey conducted in line with UN Food and Agriculture Organization (FAO) recommendations and standard methods, providing an internationally comparable pre-coronavirus disease 2019 (COVID-19) snapshot of food insecurity. Methods Data came from a nationally representative 2019 UK sample (N = 2000) surveyed by Ipsos-Mori. Prevalence of food insecurity was assessed using the UN FAO Food Insecurity Experience Scale. Logistic regression was used to model food insecurity in relation to geographic and socio-demographic variables. Results Severe food insecurity was reported by 3% of the sample, an increase of 66.7% over the last directly comparable UK analysis (Gallup World Poll data from 2016 to 2018). Indication of some degree of food insecurity was reported by 14.2% of the sample and tended to be higher amongst younger age groups, those on lower incomes, and home renters (as opposed to owners). No geographic variables were significantly associated with food insecurity prevalence. Conclusions The finding that prevalence of severe food insecurity was already increasing before the COVID-19 pandemic, across all areas of the UK, is cause for concern. Our results provide an important benchmark for assessing the impact of COVID-19 on food insecurity.

Purpose This paper reports on a research study examining opportunities for and characteristics of effective leadership for whole university approaches to health, well-being and sustainability. Design/methodology/approach A multi-method qualitative approach was used: semi-structured interviews and focus groups were conducted with vice chancellors (n = 12) and UK Healthy Universities Network members (n = 10) and online questionnaires were completed by non-UK network coordinators (n = 6) and non-UK health promoting university coordinators (n = 10), supplemented with two interviews. Findings A total of two overarching themes emerged: opportunities to secure and sustain effective senior-level leadership and characteristics of effective senior-level leadership. Sub-themes under “Opportunities” included aligning work with core business so that health and well-being becomes a strategic priority, harnessing the personal qualities and values of senior-level advocates and using charters and policy drivers as levers to engage and catalyse action. Sub-themes under “Characteristics” included commitment to whole university/whole system working; an understanding that health underpins core business and is a strategic priority; enabling effective coordination through appropriate resourcing; balancing top-down and distributed leadership models and complementing strategic leadership with cultural change. Originality/value This study is one of the first to explore leadership in relation to health promoting universities. Drawing on the findings, it presents a guide to developing and securing effective leadership for health promoting universities – of value to researchers, practitioners and policymakers worldwide.

While breastfeeding is known to improve health, economic and environmental outcomes, breastfeeding initiation and continuation rates are low in the UK. The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) aims to reverse declining rates of breastfeeding by shifting the culture of infant feeding care provision throughout hospital maternity settings. In the UK, the global BFHI has been adapted by Unicef UK reflecting a paradigm shift towards the experiences of women and families using maternity services. This research used a critical ethnographic approach to explore the influence of the national Unicef UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. Twenty-one staff and 26 service users were recruited and engaged in moderate-level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. Using Antonovsky’s Sense of Coherence construct, the findings discussed in this paper highlight how the BFI offers ‘informational’ (comprehensible), ‘practical’ (manageable) and ‘emotional’ (meaningful) support for both staff and service-users; strengthened by effective, local leadership and a team approach. This is juxtaposed against the tensions and demands of the busy hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balances relational and rational approaches for positive infant feeding care and experiences to flourish.

Focusing on the conceptualization of a whole university approach, this paper reports on an international qualitative study that explored vice-chancellors’ and network members’ understanding of and commitment to Health Promoting Universities, examined perspectives on leadership and investigated the Okanagan Charter’s potential to catalyse whole university leadership and change. A multi-method qualitative approach was used: semi-structured interviews and focus groups were conducted face-to-face with vice-chancellors (n=12) and Health Promoting University co-ordinators who were members of the UK Healthy Universities Network (n=8); telephone interviews were conducted with a mix of UK and non-UK Health Promoting University co-ordinators (n=5); and two online questionnaires were distributed to non-UK network co-ordinators (n=6) and non-UK Health Promoting University co-ordinators (n=10). Through thematic analysis, a number of key themes emerged that build a new conceptualisation of the whole university approach (see Fig. 1): building a broad understanding and framing of health; developing a supportive ethos and culture; embedding health into the university and joining up areas of work; focusing on the whole population; and facing challenges and seizing opportunities. The study elicited rich and wide-ranging views from multiple stakeholders from universities and networks across four continents, confirming Health Promoting Universities as a truly global movement. Looking ahead, there are clear opportunities and challenges. First, the media narrative of a student mental health ‘crisis’ has focused universities’ attention on ‘health’, but from a single issue ‘illness’ perspective. This risks detracting from the whole system Health Promoting Universities approach. Second, even with the Okanagan Charter inspiring individuals and universities, there are still major challenges in translating the rhetoric of whole system approaches into meaningful action within large, complex and