Listening, co-creation and action: a neighbourhood approach to reduce health inequalities

Reducing health disparities requires more than generic health promotion strategies. In Rotterdam, the Healthy Neighbourhood Approach (HNA) was developed as a practical methodology to tailor action to local needs, combining resident engagement, behavioural science, co-creation and public health expertise. The HNA is a structured 6-phasemethod (listening, focus, activities, evaluation and maintenance), first piloted in November 2023 in three Rotterdam neighbourhoods and refined in two more in 2025/2026. Neighbourhoods were selected based on local health literacy data and opportunities for local collaboration. Residents were approached in familiar local settings to identify health priorities and related health determinants. Focus groups and co-creation sessions, guided by the COM-B behavioural framework, informed the design and implementation of a mix of activities. Evaluation and maintenance ensured long-term fit. After evaluation in five neighbourhoods, HNA was found to be feasible in different settings, reaching residents who are often missed by regular communication and service routes. Pilot results show residents reported improved access to reliable health information, feel supported by activities and show signs of increased health skills and knowledge, indicating improved health literacy.  Positive spillover effects were also observed, including stronger social connections in the neighbourhood, increased resident empowerment, and improved awareness of local health initiatives. The strength of the HNA lies in its practical translation of equity-oriented public health. Key conditions for success include sustained visibility to build trust, and connecting with local networks. Additionally, tailoring activities through co-creation and accessible communication contributed to successful implementation. The HNA showed value as its transferable 6-phasemethod proved applicable across neighbourhoods and health topics, such as health literacy and vaccination uptake.

Key messages

• A neighbourhood method that combines listening to residents, behavioural science, data and co-creation can make local public health action more equitable and practical.

• The 6-phase transferable design of Healthy Neighbourhood Approach can be applied to diverse neighbourhood settings and health topics, in international context.