Promoting social change: the experience of Health Action Zones in England

When New Labour came to power in the UK in 1997 it brought with it a strong commitment to reducing inequality and social exclusion. One strand of its strategy involved a focus on area based initiatives to reduce the effects of persistent disadvantage. Health Action Zones (HAZs) were the first example of this type of intervention, and their focus on community based initiatives to tackle the wider social determinants of health inequalities excited great interest both nationally and internationally. This article draws on findings from the national evaluation of the initiative. It provides an overview of the HAZ experience, and explores why many of the great expectations associated with HAZs at their launch failed to materialise. It suggests that, despite their relatively limited impact, it is best to consider that they made a good start in difficult circumstances rather than that they failed. As a result there are some important lessons to be learned about the role of complex community based interventions in tackling seemingly intractable social problems for policy-makers, practitioners and evaluators. Social programs are complex undertakings. They are an amalgam of dreams and personalities, rooms and theories, paper clips and organisational structure, clients and activities, budgetss and photocopies, and great intentions. (Weiss, 1998: 48)