Feeds:
Posts
Comments

Archive for the ‘local authorities’ Category

Addressing the social determinants of health: how do you eat an elephant?

Posted in Health Inequalities, Lifestyles, local authorities on March 27, 2018| Leave a Comment »

Natalie Lovell, one of the authors of What makes us healthy? An introduction to the social determinants of health, writes about distilling such a big topic into a quick guide

SOME people might think it’s a bit ambitious to attempt to produce a ‘quick guide’ to the social determinants of health – the social cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age. But, despite the vastness of the topic, we decided to give it a go.

The social determinants of health: what are the key messages?
Firstly, we should care about good health because it’s essential if individuals, society and the economy are to thrive. I recently read that “all members of a community are affected by the poor health status of its least healthy members”. Whether your cause is social justice or economic development, or you’re interested in social cohesion, good health is a relevant piece of the puzzle.

Secondly, health is about more than healthcare. When people are asked about health, their thought process often leads them straight to illness, medicine, and treatment of disease. But many of the drivers of health sit outside health and social care. As Michael Marmot puts it, “Why treat people and then send them back to the conditions that made them sick?”

Thirdly, as individuals, we have less control than we think. The factors that make us healthy sit largely outside individual control, and it is the conditions in which we find ourselves living that make us healthy or unhealthy – consider the greater density of fast food outlets in deprived areas in England. This is echoed in a recent report by Guy’s & St Thomas’ Charity about inner city childhood obesity, which found “it is in these areas in particular where people are bombarded with opportunities to eat high energy food and have less defence against ‘obesogenic’ city environments that promote unhealthy choices”.

Finally, collectively, we need to create the surroundings that give people the opportunity to be healthy. As set out in our quick guide, the evidence shows that many people and sectors have the levers to improve people’s health and reduce health inequalities (the differences in health outcomes that exist between groups in society). These include people sitting across government, the voluntary sector, the private sector, media, advertising and local communities. But if we don’t understand and act on this knowledge, we will never overcome our biggest health challenges.

What is already happening?
Many people can make a difference. It could be a charity that helps a group of people feel less lonely, an employer who decides to become a Living Wage employer, or a councillor who puts cyclists and pedestrians first when coming up with an action plan to tackle congestion. The list of those with the power to influence our daily lives for the better (often through structural changes), and therefore our health, is long.

We uncovered some great examples, particularly at local and regional level, of where, despite the odds stacked against them (such as severe budget cuts in local government), action is being taken that will improve people’s opportunities for healthy lives.

Read our quick guide, What makes us healthy? An introduction to the social determinants of health, to find out more about:

  • how local councils are using innovative inclusive economic growth techniques
  • how local councils are making the most of planning and transport policies to design and create healthy places
  • how charities and businesses can influence health
  • what approaches national governments are taking.

What’s the aspiration for this quick guide?
My hope is that this quick guide will make its way to those people across society who have the potential to influence people’s health, and that they might pick it up and think, “This is about me and the work I do.” Perhaps a public health expert will pass it on to a Director of Economic Development and Planning, who will pass it on to a business leader or employer they are working with, who might then be able to ask themselves important questions such as, “Did the last decision I make have an impact on people’s health?”

The quick guide sits within a broader programme of work at the Health Foundation. It offers a broad overview of the interconnectedness of virtually every aspect of people’s daily lives and their health – and therefore, the dizzying potential that exists for people across society to take action.

Order a free copy of the quick guide now. It will fit right into your pocket.

Oh, and the answer as to how you eat an elephant? Piece by piece.

Natalie Lovell is a Policy Analyst for the Health Foundation

Read Full Post »

Faculty of Public Health campaigns progress – Brexit and funding

Posted in austerity, Brexit, funding, local authorities, PH Spending on February 5, 2018| Leave a Comment »

By John Middleton, FPH President

John Middleton 2 web

I wanted to let you all know about the progress we’ve been making with our two flagship influencing projects and to ask you, our FPH members, for help.

You may recall that in June last year I let you know that we had decided to focus the efforts of our small, but perfectly formed, Policy and Campaigns Team on two vital public health priorities – Brexit and Public Health Funding.

This followed a significant policy consultation and prioritisation process with our members through the first half of 2017.

Before I tell you where we’ve got to with these two campaigns it might be helpful to remind you that these two issues aren’t the only two policy areas FPH is working on. We also have five policy committees and 30 (and growing) Special Interest Groups all developing and shaping policy and making the case for a very broad range of public health issues.

In terms of the Brexit and Public Health Funding projects, since June last year we’ve done a number of things in order to be ready to start campaigning at the beginning of 2018.

We’ve talked with a range of different public health stakeholders – including the Public Health Minister, Steve Brine MP – to find out where they thought we should focus our efforts within these two large policy areas. Through this consultation process we drew up ‘long lists’ of possible policy asks.

We’ve also created two campaign project groups, made up of staff and – for the first time – specialty registrars on placement at FPH. As well as giving us more capacity to deliver both campaigns, we’re keen that these projects provide an opportunity for our public health trainees to learn about, and play a vital part in, campaigning for policy change at a national level.

We’ve also created two Advisory Boards of senior FPH members – one for each campaign – to ensure we’re able to draw from the vast expertise we have on both these issues. I won’t embarrass the Board members by highlighting particular people but trust me when I say that both Boards are packed with very senior, experienced FPH folk.

The Advisory Boards met in November and December and shortlisted three policy asks for each campaign. I’m very pleased to announce they are:

For Brexit:

1. We are calling on the UK Government to introduce a ‘do no harm’ clause into the EU Withdrawal Bill – with the effect that the Government commits to ensure that the Bill’s powers are not used to reverse or amend regulations critical to the health of the population.

2. We are calling on the UK Government to ensure the UK’s future relationship with the European Centre for Disease Prevention and Control – we think it is vital that we can continue to work in close partnership with our European partners to tackle serious cross-border threats to health security, e.g. blood borne viruses, pandemic influenza, viral haemorrhagic fevers, and chemical and radiation incidents. In so doing, we will provide a model for the UK as it considers how to continue to play a significant role in other EU public health agencies.

3. We will be calling on the UK Government to ensure that the impact on the public’s health is a vital determinant in our post-Brexit trade agreements – we will develop with the public health community a set of evidence-based public health principles for negotiating ‘healthy’ trade agreements. We will call on the UK Government to adopt these principles as it negotiates our future trading arrangements.

For the Public Health Funding campaign:

1. We are calling on the UK Government to invest in a public health ‘transformation and innovation fund’ to support the upgrading of prevention and population health services in local authorities – FPH members are telling us that they have gone to heroic lengths to deliver more with less and less but they cannot make the ‘radical upgrade’ in prevention services asked of them without additional dedicated funding. This is needed to enable their teams to make the step change in the types of services they provide and how they provide them. We think this fund will need to be in the region of an extra £1bn per year but the exact figure will be determined during the policy development phase.

2. We are calling on national governments to conduct a review into NHS spending on public health and prevention – our aim is to ensure that the approximately £2 billion spent in England annually on prevention and public health services ‘in the NHS’ is spent appropriately and as effectively as possible. We’ll also be looking at what an increased funding settlement for prevention in the NHS might look like in order to help deliver the radical upgrade. As part of this we will be encouraging STPs to focus more on the prevention agenda.

3. We are calling on Public Health England, and other relevant national bodies, to develop an improved ‘dashboard’ for public health services – we want to ensure updated dashboards include what our members think are the key public health performance metrics and indicators. We hope this dashboard will enable the public health community to agree what a ‘good’ public health service looks like, where it is occurring, and to further encourage the sharing of best practice between different areas and sector-led improvement.

Over December and January both campaign project groups have been pulling together their campaign plans for the first year of what will be three-year long campaigns.

These plans have now been signed-off by our Advisory Boards and, as a consequence, I’m delighted to say that at the end of January the Brexit campaign took its first steps and started to make the case to Peers in the House of Lords for our ‘do no harm’ amendment.

It’s been incredibly exciting to be so closely involved in the journey FPH has been on over the past year to get us to this stage and there’s an awful lot of campaigning activity to follow in 2018 and beyond.

And that’s where you come in!

We’re looking to create informal networks of FPH members who are particularly interested in Brexit or Public Health Funding (or both) who we can involve in each campaign on a regular basis.

The kinds of things we’d be looking for you to help with are:

  • Asking for your views as we’re developing our policy thinking – i.e. acting as an informal sounding board as we’re testing our draft ideas and thinking, so that we can be confident that what we end up saying in public and to governments is closely informed by what our members think.
  • Helping us decide which campaign messaging works best – eg. which messages do you think are most inspiring? which messages are likely to play best with local and national decision-makers? which hashtag do you like most? We want to know what you think.
  • Championing our campaigns on social media – eg. retweeting and commenting positively about tweets FPH sends out and saying supportive things about our campaigns on other social media.
  • Speaking up at conferences and events you’re attending – to highlight the importance of these issues and our specific asks.
  • Responding to questionnaires and surveys we will be doing throughout the campaign.
  • Introducing us to your networks – if you play Canasta with Philip Hammond, table tennis with Jeremy Hunt, or go paint-balling with Jeremy Corbyn then please do let us know.

If you’d like to find out more, then please email our Policy and Campaigns Team via policy@fph.org.uk and tell us which campaign you’d like to get involved in.

Thank you so much in advance for your help and watch this space for future updates on both campaigns. We’ll be updating you very soon on our Brexit activities so far in the Lords.

 

Read Full Post »

2040 is too long to wait for air-quality improvements

Posted in Academic, air pollution, Chronic Disease, Climate change, Europe, Health Inequalities, Health Protection, local authorities, transport, Urban health on August 3, 2017| Leave a Comment »

By Dr Jennifer Mindell, Reader in Public Health, Research Department of Epidemiology and Public Health, University College London

The government is proposing to ban the sale of diesel and petrol vehicles from 2040, to address air pollution in the UK that regularly breaches health-based EU regulations.

There are three main ways to improve UK air quality: reducing emissions from vehicles; driving less; and dealing with other sources of air pollution. The government’s preferred approach seems to be ‘business as usual, but less pollution from existing travel patterns’. Yet, even with this route, they are not committing to a scrappage scheme for diesel. This would produce air-quality benefits in the short-term, instead of in the 2040s – or even the 2050s and 2060s, as some individuals and businesses keep their vehicles for a long time. A scrappage scheme needs to be available to all individuals and businesses, regardless of size, and needs to encompass vehicles of all ages. Although older vehicles are known to be very polluting, no-one really knows about new vehicles! This could be complemented by financial help for retrofitting, particularly for older buses and lorries, if replacement isn’t an option.

Drivers of diesel cars are understandably aggrieved. They were urged to buy diesel engines by previous governments and given financial incentives to do so, because of the lower CO2 emissions per km. The higher emissions of other pollutants were ignored. Those with newer vehicles have no idea what their car really emits, due to the scandalous behaviour of manufacturers. This is yet another parallel with the tobacco industry (1) which designed cigarettes to produce low tar and nicotine in the laboratory but not when used by actual smokers.

Chargeable clean-air zones (low or ultra-low emission zones) are, according to a technical report issued by the government earlier this year, the most effective mechanism, but we understand that the government’s strategy will restrict charging to the last, not the first, resort. This is one of the areas, along with improved infrastructure for transport options other than private car use, that local authorities can contribute to greatly, but they need adequate powers and adequate resources. As air pollution costs the country £20 billion annually (2), the proposed figure of £255million to local authorities is a drop in the ocean.

The government is apparently also going to urge local authorities to speed traffic flows, by amending traffic-light settings and removing speed humps. What is actually needed is more calming, not less, to support smoother driving. It is not speed humps but the marked acceleration and braking that many drivers do that increases pollution. Greater use and enforcement of, and adherence to, area-wide 20mph limits without traffic calming would be better still.

Lower speeds, which would also support more and more pleasant walking and cycling, bring me to the better approach. Instead of persuading (in the next two decades) or requiring (from 2040) people to replace their existing car with an electric car, the health gains would be far greater if people travelled by public transport, walked or cycled whenever possible. As well as reducing pollution and carbon emissions, this generally increases physical activity and can improve wellbeing and reduce obesity and its consequences.

Reductions in pollutant emissions can also be achieved by reducing the need to travel. If people who could do so worked at home once a week, that would reduce their commuting by 20%. Land-use planning that encourages mixed use can shorten journeys sufficiently to make non-car options more feasible, although this will take longer. But as the government proposal for banning sales of diesel and petrol cars is to start in 2040, they are talking longer term anyway.

The government also needs to acknowledge that, although mobile sources are the largest category of pollutants, they are not the only ones. Two major contributors are buildings, including both homes and businesses, and transboundary industrial pollution from mainland Europe. Ministerial engagement with European countries will be necessary to deal with the latter. Local authorities need to be given the powers to address the former.
Air pollution is a major contributor to health inequalities. Poorer people are more likely to be exposed to higher pollutant levels. They are also more susceptible to the harmful effects of pollutants as they are more likely to have circulatory diseases (particularly heart disease and strokes) and respiratory diseases, such as chronic bronchitis or emphysema (now called chronic obstructive pulmonary disease) or asthma. Improving air quality is an important factor in reducing health inequalities.

The other option that we trust the government won’t take is to move the goal posts when (or if?) the UK is no longer bound by EU legislation. That would really be a cynical approach to the population’s health.

************************************************************************************

1. Mindell J. Lessons from tobacco control for advocates of healthy transport. J Public Health Med. 2001; 23:91-7.

2. Royal College of Physicians, Royal College of Paediatrics and Child Health. Every breath we take: the lifelong impact of air pollution. London: RCP, 2016.

Read Full Post »

Getting the ammunition to the front line…

Posted in Academic, evidence, FPH Annual Conference, local authorities, research on June 14, 2017| Leave a Comment »

By Hannah Dorling, Helen Walters and Tara Lamont

How can alcohol licensing decisions impact upon alcohol-related crime and health issues? Does turning street lights out at midnight cause more accidents? How does a new bus service impact upon physical activity levels?

Front-line public health professionals need relevant evidence in formats that reach them and are digestible by them and those they work with. At this year’s FPH conference we are running a session on just this issue. The National Institute for Health Research (NIHR) spends £10m a year on its Public Health Research (PHR) programme and we are one of the main funders of public health research in the UK. We support research which may not be funded by others – from studies of impact of alcohol licensing to evaluation of urban motorways. NIHR also runs the Dissemination Centre whose specific role is to get research findings to the front line.

We want to fund research that evaluates public health interventions that happen outside the NHS – that will provide new knowledge on the benefits, costs, acceptability and wider impacts of interventions that impact on the health of the public and inequalities in health. We want this research to be multi-disciplinary and broad, covering a wide range of public health interventions. Funding comes from the Department of Health in all four UK countries. A key aim of the programme is to deliver information to allow practitioners and policy makers to improve services, rather than simply improving scientific knowledge. A challenge for the programme is finding the questions that most urgently need answering.

We also need to help decision-makers get hold of the evidence they need. Every day, about 75 new clinical trials and 11 new systematic reviews are published, many of which will be relevant to public health. The NIHR Dissemination Centre filters new knowledge and produces a wide range of publications. We want to know more about what kinds of evidence and formats work best for front line staff.

This is where we need you. This interactive conference session is aimed at front-line public health professionals (though academics are welcome!) who want to talk about how you use research in your daily work. Where do you find your research? What do you do with it? What would you like more of? Do you have challenges linking to the academic world? What questions would you like answered to help you in your work? Come along to our session and tell us what you think. We are keen to hear and to use your wisdom as we reflect on 10 years of public health research funding and make plans for the next 10 years.

In the meantime if you have an idea for research that needs doing please do contact us on phr@nihr.ac.uk or use the programme’s online mechanism for submitting suggestions.

Join the session at the FPH conference on Tuesday 20 June in Telford:
11:30 – 12:30: Public health need – filling the evidence gaps in local government
Location: Wenlock Suite 1&2
Presenters: Helen Walters, Consultant in Public Health Medicine / Consultant Advisor, NIHR NETSCC, University of Southampton
Tara Lamont, Deputy Director of the NIHR Dissemination Centre
Closing comments: John Middleton, President of the Faculty of Public Health

Read Full Post »

Local Healthwatch: fresh start or more of same problems?

Posted in Health Inequalities, local authorities, Localism, Public health in transition on July 26, 2012| Leave a Comment »

Does Local Healthwatch offer a fresh start for democratic accountability in healthcare, or more of the same structural problems that lead to tokenism and a lack of inability to have real influence? This was the question at the heart of the debate about democratic accountability at the 2012 FPH conference. The workshop was chaired by Professor Mark Gamsu of Leeds Metropolitan University, who specialises in tackling health inequality through strong citizens, local government and the voluntary sector.

Mark talked about how government policy often focuses on the ‘manual’, or process of delivery, rather than outcomes and impact. He – partly in jest – apologised for his part in the inclusion of Joint Strategic Needs Assessments as a duty in the Health and Social Care Act, because in his view it is only a tool – and tools should not be legislated for. It might have been better to have a duty requiring local strategies and commissioning to be based on local intelligence. There is also a tendency for all new governments to assume they are starting from a ‘year zero’ positionand therefore a danger that the achievements and experience of the present and past is not recognised and built on sufficiently.

Mark looked at the challenges and opportunities offered by Local Healthwatch, which launches in April 2013 and will take on the work of the Local Involvement Networks (LINks). Healthwatch and public health are potential allies. They share some characteristics, not least because they are both comparatively small and achieve much of their impact using evidence to influence change.

This led to lively discussion of what drives commissioners, and the kind of leadership that can be expected to make the new systems work effectively once they take effect in 2013.
This will have a direct effect on what Healthwatch can realistically achieve, given that its lack of statutory powers mean it could face the same problems of tokenism and inability to effect change that have affected LINks.

There a was both positive and negative experience among delegates, who included commissioners and current LINks members, about how likely it was that Healthwatch could have the necessary influence to hold local services to account. As one LINks member put it, very few people in his area had heard of the service, or knew what it did.

There is also a tendency for all new governments to assume they are starting from a ‘year zero’ position, so that new systems are required regardless of how well the existing ones are working or how much time and effort is put into reorganising systems.

Public health: from transition to transformation

Reorganising health systems is not always a good use of resources: Mark Gamsu

This led to lively discussion of what drives commissioners, and the kind of leadership that can be expected to make the new systems work effectively once they take effect in 2013.

This will have a direct effect on what Healthwatch can realistically achieve, given that its lack of statutory powers mean it could face the same problems of tokenism and inability to effect change that have affected LINks. There a was both positive and negative experience among delegates, who included commissioners and current LINks members, about how likely it was that Healthwatch could have the necessary influence to hold local services to account. As one LINks member put it, very few people in his area had heard of the service, or knew what it did.

Mark gave an example of how important it is that information reaches the people who need it. Sheffield Mental Health Citizens Advice Bureau gives advice to patients on mental health wards, helping to bring the outside world into an institutional setting.

Ultimately, Healthwatch’s success matters for public health professionals because without local accountability for health services, there is a risk that health inequalities will be increased. Healthwatch’s success will be measured in part by how complaints are heard and acted on. With the final report from the Staffordshire public enquiry due in October, there is still much to be learnt about how statutory bodies act on the information they receive.

Read Full Post »

Healthy Places and public health

Posted in Health and Social Care Bill, Health Inequalities, local authorities, Localism, Public health in transition on June 1, 2012| Leave a Comment »

by Daria Kuznetsova, researcher,  New Local Government Network (NLGN)

Local government is once again a major player in the health arena. With a new public health duty and a leading role to play in the new Health and Wellbeing Boards (HWBs), councils have an opportunity to generate much greater efficiency and effectiveness.

Moreover, as this is the first time clinicians, politicians and local government officers have come together, there is a once in a lifetime opportunity to rethink and redefine preventative health interventions to radically improve the health outcomes of the local population. In a recent research report, we began to map out how local government could take up the role of the ‘health improving council’ implied by the recent reforms.

The new arrangements will certainly create opportunities, and there are reasons for optimism: among those involved in the agenda, our research reveals a relatively high degree of confidence (3.85 out of 5) in HWBs. However, it is already evident that creating stronger relationships across an increasingly complex health and social care sector will not be without its challenges. Sixty six per cent of survey respondents said that organisational differences were the most significant factor which might limit the effectiveness of their HWB.

Organisational divisions and territorialism in decision-making and budget-setting will be particularly problematic, particularly where hard choices have to be made to divert limited resources from existing services to new priorities. To encourage honesty in these ‘difficult conversations’,  we recommend HWBs design ‘prenuptial agreements’ illustrating the commitment and contribution each board member is prepared to make to the board.

The effectiveness of HWBs will depend on their ability to engage with a wide variety of external stakeholders, which they can influence only indirectly. However as local government only has soft powers at their disposal, there is a danger of public health not being prioritised by other local agencies.

We propose legislating a “duty to cooperate” with HWBs, similar to that in the Localism Act 2011, for public bodies. We further propose the HWB chair should have a ‘call in’ power to local authority departments commissioning services (for example in relation to the use of CIL) to ensure local authority delivery takes the Joint Health and Wellbeing Strategy into account.

At the heart of the changes lies an opportunity for a new era of public involvement in health services and prevention. By engaging residents, particularly ‘hard to reach’ groups, HWBs will be able to design interventions that meet immediate needs but also reduce demand in the long term. To ensure public engagement is prioritised, we recommend that HWBS should publish an explicit strategy for public involvement in their work.

Our research found that budget pooling is seen as the most effective tool available to ensure effectiveness of HWBs.  However 94 per cent of respondents felt that central government has provided insufficient incentives for integrated working. If local authorities are to succeed in reducing demand for acute services, they will need to shift resources to prioritise preventative measures. We suggest government should create “Health and Wellbeing Deals” whereby HWBs bring forward plans for pooling in exchange for the removal of regulatory or legal barriers to pooling as well as potential top-up funding for pooled budgets from central government.

The reforms in public health offer a real opportunity to reshape public services and drive preventative healthcare into everything local authorities do. However without tougher power for HWBs, they risk becoming a talking shop. We therefore strongly urge the government to legislate for a small number of hard, statutory powers which could turbo charge the new boards and ensure the emergence of a new generation of health improving councils.

Read Full Post »