We often hear 'the system' is broken, but what do we mean by this? How can changing the way we think about, define, research, evidence, monitor, evaluate and resource 'the system' lead to meaningful change for deprived communities? How will this change benefit those who have first-hand experience of trauma, homelessness, poverty, unemployment, displacement, poor mental health or imprisonment? REALITIES takes a human-systems approach noting 'health and social care systems' (HSCS) are constructed mental representations of relationships existing in the world to promote health for people. Our Scottish consortium of 57 people has five established asset hubs in Clackmannanshire, Dundee, Easter Ross, Edinburgh and North Lanarkshire with strong relationships uniting conflicting ways of seeing the world. Through phase 2, we co-produced a systems-level model with deprived communities, policymakers, practitioners and researchers collecting and respecting different types of knowledge and alternative evidence-bases (from arts performances to nature walks; words to statistics) as equally important to understand complexities of unjust and avoidable health differences. Foundational funding evidenced REALITIES is able to transcend the challenge for our currently imagined HSCS. The medical model of disease shaping who and what is considered to be part of 'the health system' has brought benefits to human existence, though key actors within these place-based HSCS systems understand the limitations of this systems-framing for human flourishing. At present, they don't have a way to help reimagine them. REALITIES provides exploration and method for this reimagining. A model representing collective pathways producing creative routes for people to get the healthcare they need at the right time of their journeys by co-researching and co-creating with them the "what, whom, how, and why" - leading to successful connections between individuals with health and social needs and community-based opportunities for health and wellbeing improvement. We are a transdisciplinary collective of individuals with lived and felt experience of inequalities working alongside policymakers; local authorities; charities; artists; environmentalists and researchers from policy; health humanities; arts; psychology; human geography; environmental sociology; dentistry; medicine; statistics; economics; counselling; psychotherapy; management; medical anthropology; design and innovation. We will: understand what work is needed to enable places to reimagine and build 'systems' that create equitable health and wellbeing. explore and explain how links between creativity, relationships and nature create healthier and more resilient communities and environments for people in deprived areas. support creative, participatory processes, enabling communities to construct shared mental models (systems) using different ways of knowing (epistemologies) and perceiving reality (ontologies). combine different ways of knowing, enabling a more complete representation of bio-psycho-social-political factors which create 'health' and ways in which these are experienced by marginalised people. support communities to construct place-based versions of systems encompassing all aspects of health and wellbeing, and make purposeful changes in the nature of their relationships with each other and their environment. explore the usefulness of 'standard' Health Economic evaluation tools to assess Social Return of Investment, working with communities to re-conceptualise and re-define measures of 'value' and 'quality of life' in relation to human experience.

There is strong evidence that natural environments within urban areas, such as parks, woodlands, lakes and beaches, have positive impacts on health. These urban green and blue spaces (UGBS) could be huge assets for protecting and equalising health if they were available, accessible, valued and well-used, particularly by less advantaged groups. The problem is that they are not. This is largely because the many policies, organisations and communities involved in designing, creating, managing, promoting, maintaining and using UGBS are disconnected. Also, the voices of less advantaged communities that UGBS could be helping most are either not heard or not persuasive. Perhaps as a consequence, those communities are much less likely to benefit from these spaces. We know that the UGBS we have are not the UGBS we need to make the best possible contribution to better and more equal health. GroundsWell aims to change that. We propose a new partnership - researchers working together with communities and those who currently create and control UGBS, to plan, design and manage it better so that it benefits everyone, especially those who need it most. The main research will take place in three cities - Belfast, Edinburgh and Liverpool. These have sufficient similarities (such as large and diverse low-income communities) but also distinct features (such as geography and culture) making them, collectively, an ideal laboratory. Each city already has policies and programmes in place to improve UGBS, but there is much room for improvement. GroundsWell will take a systems approach. This means understanding the multiple and interconnecting components of policy-making, practice, perception and people which together affect the presence, location, character and use of UGBS. It also means working to transform the system so that the components function together. To do this, GroundsWell will mix co-development of new theoretical frameworks, novel data science including simulation, health economics and policy analysis, but at its heart will be community engagement and partnership. We will develop and use meaningful community engagement, co-production and citizen science to understand the system, identify how and where it is broken, and co-create solutions. We anticipate interventions aimed at how the UGBS system operates, and small-scale interventions around actual spaces and their use. Data play an important part in understanding systems. GroundsWell will develop an accessible, trustworthy and policy-relevant system to collate, collect, house and share data on UGBS across the three cities. These data will be used to help the whole Consortium understand the UGBS there, identify possible interventions, and then assess whether they work, for whom and why, creating feedback loops to help us continually monitor, learn and adapt what we do. Novel simulation approaches will also be used to suggest interventions, and in particular what could be effective beyond the three cities. Health economics will suggest what would be best value for money. An important part of putting actions and solutions in place is understanding if they work (or not). Evaluation of our actions and the Consortium as a whole will be undertaken in partnership with our communities, drawing on the new data system we establish, and enabling them to directly see whether and how the process has benefited them. In particular, we will assess and share our impacts on health inequalities. We are realistic about the likely scale of our impacts. Small actions within existing UGBS and local communities are unlikely to affect population level health and inequalities within our funded period. That is why we are going to focus on improving the UGBS system as a whole, laying foundations for long-term benefits. We know that the use and enjoyment of UGBS is something that adults pass on to their children. If GroundsWell can improve and equalise the role of UGBS, it will achieve a lasting impact.