In North Wales, some of the most deprived communities in the region face significant health disparities, with many families struggling to afford essentials such as food and heating. 

Recognising this challenge, Betsi Cadwaladr University Health Board launched the Inverse Care Law Programme to address local health inequalities. Inspired by the principle of the Inverse Care Law—where those most in need of healthcare are often the least likely to receive it—the programme focuses on addressing the systemic barriers that limit access to quality care in underserved areas. 

Understanding that health inequalities are deeply influenced by social, economic, and environmental factors beyond the remit of the NHS, the health board adopted a collaborative, whole-systems approach. It partnered with various organisations across North Wales to address the root causes of health disparities. 

The programme was piloted in three key clusters: Anglesey, Central and South Denbighshire, and North West Flintshire. These areas were selected to trial innovative approaches that could later inform a broader rollout. 

Urban Foresight was commissioned as the programme’s evaluation partner to assess its success in fostering collaborative approaches and improving health outcomes. Our role included evaluating both the effectiveness of partnership working and the programme’s emerging health impacts. 

To achieve this, we deployed Ripple Effect Mapping, a cutting-edge evaluation tool designed to capture the wide-reaching impacts of programmes. Ripple Effect Mapping not only evaluates outcomes but also highlights unintended ripple effects that can drive further positive change across communities. 

We conducted interactive workshops with over 40 stakeholders, creating individual ripple maps that visualised the impacts of the programme from various perspectives. These maps were then combined into a single, comprehensive map that presented a holistic view of the programme’s intended and unintended impacts over time. 

This approach provided a clear, visual representation of how the programme contributed to building partnerships, improving access to care, and addressing health disparities. The ripple maps proved invaluable in demonstrating the programme’s success while fostering a deeper understanding of its impact on individuals, communities, and organisations. 

Our evaluation showed that despite facing significant challenges, the Inverse Care Law programme has met, and in some cases exceeded, its goals of reducing health inequalities. As a result of these successes, Betsi Cadwaladr University Health Board is now rolling out the approach to the region’s remaining 11 clusters. 

To support this rollout, Urban Foresight created a blueprint for success, ensuring that future implementation benefits from the insights and lessons learned during the pilot phase. 

This project builds on Urban Foresight’s extensive experience in delivering impactful health and care evaluations. Past projects include the evaluation of Sunderland’s Better Mental Health Programme and social prescribing of active travel in deprived communities. 

To read the report click here.