Health, healthcare and the role of local gov

Yesterday, I had the privilege of speaking at the annual public health conference hosted by ADPH in partnership with the Local Government Association.

Over 1000 delegates registered for the event which included sessions on a wide range of topics, including how to get Britain working, tackling health inequity in childhood, neighbourhood health, devolution, public health intelligence, the role of health and wellbeing in economic success and more.

The conference came just a week after the ONS published the latest set of healthy life expectancy stats which revealed that the number of years we can expect to live in good health has gone down by around two years in the last few years.

What all this week’s conference sessions have had in common is a focus on the vital role local government has to play in improving health and wellbeing. While that shouldn’t really be a surprise given the core purpose of local government is to improve life for its local citizens, the way health can be framed can all too often lead people to think that health is just about the NHS.

The reality is that headlines are drawn to the immediately urgent life or death decisions which is why healthcare and treatment takes such a central stage. Sometimes, like during the pandemic, that is absolutely right, but in ‘peace time’ the public health workforce is ‘doing’ prevention all the time – it just doesn’t make the news!

In fact, only a very small proportion of our health – just 10-20% – is determined by access to traditional health services. The rest is shaped by economic, social and environmental conditions like our income and education, the housing we live in, the transport we use, and the air that we breathe – all things that local government helps to shape.

This framing of health has important policy implications. Healthcare is different to health and so to improve health, something the Government has made a clear and welcome commitment to doing, policies across all departments must change, not just those directly involving the NHS.

The public health workforce must also reframe its efforts. I, as a Director of Public Health, have a statutory duty to improve the health of population for my area (Sheffield) and that is not the same as a duty to reduce the demand on healthcare services.

This is an important distinction and has consequences for the economy as well as our individual health because while saving money in the NHS is absolutely necessary, improving health will boost the economy far more dramatically through the impact of increased productivity.

I have no doubt that the Government is committed to creating a fairer Britain where people can live healthier lives for longer. Progress has been made with child poverty, investment has been made in early years and work and health, legislation has been passed to improve housing and the game-changing Tobacco and Vapes Bill is making steady progress through the Commons.

There is more to do of course, but these changes are hugely welcome and give those of us working at a local level some of the structural change we need to really make a difference and support our day to day work. This work makes a real difference when it is done consistently over a long period of time, it just doesn’t make the headlines.

For example, in the work to reduce tobacco harm and cardiovascular disease, dogged determination and consistent ‘plugging away’ by local teams and front-line staff, backed by national population level policy, has been what has produced the dramatic reduction in numbers of people dying.

It is thanks to the tried and tested methods of public health work that life expectancy over the last 200 years has improved beyond recognition. The challenge we are now faced with though is making that longer life a healthier life – and there are a number of things stopping us.

Non-communicable diseases, including many cancers, heart and lung conditions, are responsible for a large majority of today’s long-term health conditions. We know that a lot of these illnesses are caused by exposure to, and consumption of, health-harming products like fast food, alcohol, and gambling, which in turn is driven by targeted marketing and concerted industry lobbying.

Moving forward, to tackle the growing numbers of people living with the consequences of this industry influence, we must even the playing field and ensure that on the one hand, accessing healthier alternatives is affordable and seen as an attractive option, and on the other, ensure that industry influence is removed from public health policy. That’s not to say DsPH are anti-business – far from it! We want our local economy and community to thrive, but we want a healthy economy – in every sense.

We also need to take into account the impact of wider issues like climate change, which is by far the biggest public health emergency we face, and we need to prepare for its impacts. AI meanwhile poses a range of risks and challenges and will undoubtedly bring about a huge transformation of the labour market, which will necessarily have consequences for our health and wellbeing. Another technological threat we need to mitigate against is that of social media – a thorny issue that brings both benefits and harms. Meanwhile, related but distinct is the threat of misinformation, something we must collectively tackle so that we can combat the harmful consequences of the spread of mistrust in well-evidenced effective public health measures.

In all of these risk factors, it is important to remember that while individual agency is important, it should not be the bedrock that policy is based on. Individual behaviour is not the reason we are seeing more people for example living with obesity.

Only by shaping our environment so that people are easily able to access all the things that are needed to be healthy, whether that be through restricting advertising, introducing age limits to harmful products, or increasing the number of clean air zones, will we be able to combat them properly.

Which is where local government plays its pivotal role. Of course, this needs to be backed by local level spending power and adequate resourcing of local teams – and not just public health teams. Environmental health, education, planning, early years, libraries, leisure – everyone and anyone has a role to play because only by working in partnership across government, and with businesses, communities and other agencies, will we ever be able to turn the dial, get those numbers down and make prevention a reality.