Public health post-2013 Contents

6Case study: Health in all policies

Summary

136.A major reason for transferring public health to local government was to enable health considerations to be taken into account across the full range of policy areas which impact on health—the ‘health in all policies’ agenda.

Local government is the right place for public health. Health is about more than medicine and wellbeing about far more than clinical input. In local government we can influence the wider determinants of health: housing, leisure, education, social services, environmental services, transport planning etc. The challenge now is to make sure we do this.

[Dr Andrew Howe, Director of Public Health, written evidence, PHP0103]

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137.As highlighted above, in some local authorities very good progress has been made, with modest positive impact on public health outcomes already being seen, but in others, less headway has been made.

“…it is clear already that there is a shift in the perception within councils of how health and wellbeing change can be effected. I am optimistic that we are seeing developing opportunities to influence future health through decisions on urban space, transport, housing and so on.”

[Eugene Milne, Director of Public Health, written evidence]

“I have worked in a locality where the CCG, the police and crime commissioner, and the local authority have different priorities and different five year plans with different objectives for exactly the same population. If leadership from those different elements can come together and work more strategically and we can mirror that on an operational basis, that will create some integration.”

[Drug and alcohol treatment service director, informal session]

“Within an acute trust, I see an enormous amount of variability. There are some areas where they have been motoring and doing fantastic things with the benefits of working within the local authority but there are others where progress has been really slow.

[Public health director, acute trust, informal session]

138.We visited Coventry City Council, which has been held up as an area where progress is already being made in embedding health across all policies. We were impressed by the variety of initiatives we saw and heard about there. These initiatives included interventions across the life course—ranging from an integrated programme for 0–5 year olds, through to improving young people’s mental health and wellbeing, supporting working age people, and redesigning Coventry as an age-friendly city. Some interventions were universal—including the drive to improve physical activity across the whole city—and others were targeted at specific populations—for example the MAMTA project aimed at supporting new parents in the south east Asian community. Further details of all the initiatives we visited can be found in Annex 2 of this report and with the written evidence submitted to the inquiry.76 Coventry also supplied information suggesting that they are already seeing some improvements in outcomes—both specific health outcomes (for example vaccination coverage) and also outcomes relating to the wider determinants of health—for example the number of young people in education, employment or training.77 The following infographic shows the initiatives we visited and heard about in Coventry, but is not an exhaustive list of all the work they are doing in this area.

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139.The recent announcement of a tax on the manufacturers of sugary soft drinks was hailed by many witnesses as a positive move at a national level, which will support action at a local level. However witnesses told us that despite public health now being embedded within local authorities, it was still harder than it should be to influence planning applications for the benefit of health:

When we are looking at licensing, we have a constant headache over the spread of availability of alcohol outlets in the city. We devote a lot of time to trying to support regulation in those areas. I would very much like us to have more formal public health input to some of the broader determinant decisions that at the

moment we really do not get in early enough for…. If you look at the way …road planning decisions are taken, the way in which benefits are monetised tends to neglect the utility of some groups. For example, a cycle journey tends to be considered of less economic value than a car journey and there is no utility attached to a journey by somebody who is retired. That seems to me to be very foolish.”

[Dr Eugene Milne, Director of Public Health, Newcastle City Council, Q121]

“It would be beneficial if health and wellbeing was seen as a material consideration in planning applications that the planning process is considered in its own right …it could make a real impact rather than us trying to fudge it with some of the other four licensing objectives that we have… They do not have to be onerous—there are some quick, mini-health impact assessments—but they need to be seen to be systematic, so not ad hoc just when you can persuade them to be undertaken.”

[Ros Jervis, Director of Public Health, Wolverhampton City Council, Q122]

Conclusions and recommendations

140.It is crucial that health considerations are taken into account in all areas of local government policy. Despite the increased potential for public health teams to influence other policy areas from their new position within local authorities, which we have heard is going very well in some areas, the current planning process continues to be a major impediment. We urge the Government to be bold, and make good on its commitment to health in all policies, by enshrining health as a material consideration in planning and licensing law.

76 Coventry City Council (PHP0136)

77 Coventry City Council (PHP0137)

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30 August 2016