The project will build on the findings of the Prescribe Heritage Highland (PHH) work, funded under Phase 1, which examined delivery challenges and conditions for scalability of a cultural and natural heritage intervention to promote rural mental health and well-being. The value of non-clinical interventions is increasingly recognised by health and social care service planners and professionals. Community-based services like exercise groups, outdoor activities, art therapies and peer support are being 'prescribed' to 'treat' mental health conditions, address sedentary lifestyles and reduce health inequalities. Although awareness is increasing about potential benefits, such interventions are not universally available or accessible, particularly to those from disadvantaged rural areas (Morton and Bradley, 2020). Although rural communities can be perceived as tight-knit and resilient, the extent of social isolation and deprivation can remain hidden. Rural deprivation is hard to measure using conventional tools such as the Scottish Index of Multiple Deprivation (SIMD) due to low population densities and rural data is scarce (RSE, 2023). However, a "rural premium" is evident, with living costs generally higher than in urban areas (RSE 2023). Rural areas provide unique challenges for service delivery, particularly at scale, due to the economic and logistical challenges in large geographical areas with dispersed populations. Drawing on PHH findings, the project will develop a replicable rural model for collaborative community working using a co-design approach. The collaboration's aim is to maximise the use of existing community assets (e.g. museums, archive centres, libraries and green spaces) and develop new ways of integrating them with mainstream healthcare in order to inform service commissioning, improve services, increase community resilience and reduce rural health inequalities. The collaborative model will be developed through local stakeholder groups comprising community members with lived experience, healthcare professionals and third sector organisations in six rural mainland and island communities. The groups will be supported by the research team, who have expertise in community engagement and co-production. The groups will share their learning to develop a toolkit for other rural regions experiencing similar logistical and health equity challenges. The toolkit will be of value to rural communities, service planners and policy makers. The project will add to evidence on co-production, community engagement, service design and the value of community assets as well as offer new insights for rural policy. The project will: establish a regional advisory group comprising people with lived experience and third sector representatives (encompassing heritage, health and rural poverty), NHS and Local Authorities. engage community researchers in asset mapping to identify key local resources, health needs and gaps in rural data establish and support community co-design groups to develop new ways to maximise the value of existing assets and facilities to address local needs based on data gathered 4. conduct a policy/literature reviews and data mapping 5. develop a replicable collaborative model by researching barriers and enablers from each member perspective and develop a toolkit for rural communities, service planners and policy makers 6. implement a clear communication, dissemination and impact strategy involving a range of creative and accessible outputs.

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.