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Paper 5 - 24 September 1999 Meeting

Association of Hampshire and Isle of Wight Local Authorities

24th September 1999

Public Health - White Paper July 1999

Joint Report by HIOW Health Leads

RECOMMENDATION

It is recommended that the action points in paragraph 7 be agreed.

SUMMARY

The report describes the Public Health White Paper which is an action plan to tackle poor health, both in terms of health inequalities and the main killer diseases.

It highlights national priorities and illustrates local priorities for health authorities in the HIOW area.

It describes the implications for the Local Authorities in the HIOW area.

It proposes that planning mechanisms are clear and that links across agencies enhance the effectiveness of Local Authority input to the process.

1 Introduction

1.1 The White Paper Saving Lives: Our Healthier Nation was published on 6th July 1999 together with Reducing Health Inequalities: An Action Report. The government's overarching target is to save 30,000 lives every year. The government acknowledges the role of Local Authorities in the health agenda, recognising it is not only the responsibility of the NHS to ensure healthy communities

1.2 These two documents set out the Government's strategy for health for the next 10 years giving an important focus to the promotion of health and the prevention of ill-health. The twin aims of the strategy are to improve health and reduce inequalities.

2 The Health Context

2.1 The White Paper states that there have been major improvements in life expectancy. We now live longer healthier lives - 80 for women, and 75 for men. However, while people are living longer, it is also true that they are unhealthy for longer, suffering a significant number of years of disability and illness as people get older.

2.2 Health is profoundly unequal and health inequality runs throughout life from before birth into old age. There is a widening health gap and the poorer people are, the more likely they are to be ill and die younger. That is true for almost every health problem. These inequalities cover social class and ethnicity.

2.3 There are complex influences on health that work together. Underlying factors like poverty, unemployment, poor housing and environment as well as individual choices about lifestyle - smoking, physical activity, diet, alcohol and sexual health.

3 The Government Approach

3.1 A key element of this new approach is to develop a three way partnership between individuals, communities and Government.

Individuals need good information to look after and improve their health, as well as the services and local amenities to allow them to act on their decisions to improve their health. Liam Donaldson, Chief Medical Officer, has issued a list of "Ten Tips for Better Health", which are attached, for information as Appendix I

Communities can work in partnership with local organisations to develop better information, services and community-wide programmes.

Government needs to set the policy framework nationally so that conditions are right for improving health - this means combating social exclusion, supporting families, creating safer communities tackling the big problems of housing, education and welfare.

3.2 Cancer, coronary heart disease and stroke, accidents and mental illness have been identified as the four priority areas. The intention is to tackle the major causes of premature death and avoidable ill-health, setting new targets in each.

3.3 There will be wider action to address the root caused of ill health such as poverty and poor housing. Each partner agency is expected to recognise and act on their share of the responsibilities for health so that a climate is created where the healthy choice is an easy choice. An example of the role Local Authorities can play is attached as Appendix II.

3.4 It is intended to implement the strategy not by starting with a blank sheet of paper, but by building on the new duty of partnership between Health Authorities and Local Authorities. This will include Health Improvement Programmes, Health Action Zones, Healthy Living Centres and Primary Care Groups as well as Best Value, Community Plans and a new duty to be placed on local government to improve the social, economic and environmental well being of the local population

4 Making it work

4.1 A variety of measures are being introduced to support the new initiatives

A public health development fund of 96m over 3 years will support implementation of the White Paper in addition to 110m for smoking, 300m for Healthy Living Centres, 290m for HAZs and 54m into NHS Direct..

Education and training to ensure there is a skilled workforce to deliver the health strategy.

A new Health Development Agency will be established to raise the standard of the quality of public health function in England from 1st January 2000.

There will be public health observatories in each NHS Executive region closely linked to universities who will work with a range of statutory bodies to form a national network of knowledge, information and surveillance.

A clear national picture of health and health inequality is needed to underpin national targets and to track changes over time. This means better use of information currently available as well as ways of filling in the gaps in information to inform developments.

4.2 The success of these measures will be underpinned through the NHS performance assessment framework.

4.2.1 The assessment of progress will cover:-

targets themselves
improvements in the risk factors
movement in underlying factors which influence health and inequality
effectiveness of programmes

4.2.2 The monitoring mechanisms to be used will include:-

Health Improvement Programmes
Local Authority community plans
Best Value reviews
National Service Framework
Audit Commission

4.2.3 There will be a national three year review that will :-

measure changes to life expectancy, which currently stands at 80 for women and 75 for man consider the issue of while we may be living longer, it is also true that we are unhealthy for longer, suffering a significant number of years of disability and illness as we get older

measure reductions in health inequalities

5 Priorities for Health Improvement

5.1 The national priorities for health improvement are mentioned earlier in para 3.2 and these national priorities are relevant across all 4 Health Authorities in the area of HIOW. The targets are as follows:-

Target

Cancer

A reduction of at least 20% in the annual death rate of people under 75

Coronary Heart Disease and Stroke

A reduction of at least 40% in the annual death rate of people under 75

Accidents

A reduction of at least 20% in the annual death rate and a reduction of at least 10% in the rate of serious injury

Mental Health

A reduction in the death rate from suicide and undetermined injury by at least 20%

5.2 Additionally, local priorities have been developed within each health authority area and these priorities reflect specific issues of concern to local communities. While the area may not experience extremes in terms of poverty and deprivation, there are some clear concerns for the health of people across Hampshire and the Isle of Wight, Portsmouth and SE Hampshire Health Authority:-

Asthma
Perinatal mortality
Promoting independence
Cutting health inequalities

North & Mid Hampshire Health Authority:-

Mental health of young people
Healthy backs
Oral health
Reducing inequalities in health
Drug Action Team
Partnerships to promote community safety

Southampton & SW Hampshire Health Authority:-

Emergencies and waiting lists
Mental health and substance misuse
Older People
Primary care

Isle of Wight Health Authority:-

Children's health
Rapid diagnosis and treatment
Promoting independence
Social exclusion

6 Local Implications - early thoughts

6.1 A consultation exercise has taken place to seek the views of all the Local Authorities across HIOW. A response from almost 50% has been achieved and the key issues emerging are:-

a) The White Paper is broadly welcomed, and is seen as an opportunity for Local Authorities to develop a new role in the formulation of health strategy. It is felt to reflect the important role that Local Authorities have in the wider health issues of local communities.

b) It underscores some of the health activity already taking place across authorities.

c) There needs to be clear links between the various planning mechanisms, such as Health Improvement Programmes, Community Plans, Health for All and Healthy Cities Plans and Primary Care Groups.

d) It deserves a high profile within Local Authorities and affects all council departments.

e) It is an 'enabling' document with a focus on partnership working. However, the challenge is to make that a reality, with real and meaningful ownership by stakeholders, and not tokenistic gestures.

f) Such ownership is required to ensure effective delivery by those people working at a local level.

g) It recognises the significance of implementing Modernising Health and Social Services agendas and links these to the wider aims of improving the health of individuals and communities.

h) Implementation for all agencies will be complex and demanding and will require good communication between all authorities.

i) There is a welcome focus on inequalities and how they link to socio-economic and environmental concerns, as well as community safety.

j) Healthy Living Centres are happening across HIOW and are being led primarily by Local Authority multi-agency alliances and partnerships.

k) Issues around implementation are important, not least openness and as well as the different legal imperatives that exist between Local Authorities and the Health Authorities.

7 Recommendations

7.1 Local Authorities should welcome the White Paper which is seen as an opportunity to develop a new role in the formulation of health strategy and where local authorities are clearly identified as having a significant role.

7.2 The various planning mechanisms must have clear links to ensure gaps do not develop, nor that there is overlap and duplication of effort.

7.3 The complex issues on implementation should be reported back to the Association at a future date, once a clearer picture is established.

7.4 The Association considers this report and its recommendations alongside the report received on 4th June, entitled Health Improvement Programmes.

Copy recommendations from which are in appendix 3 for ease of reference.

APPENDIX 1

Ten Tips For Better Health

1. Don't smoke. If you can, stop. If you can't, cut down.

2. Follow a balanced diet with plenty of fruit and vegetables.

3. Keep physically active.

4. Manage stress by, for example, talking things through and making time to relax.

5. If you drink alcohol, do so in moderation.

6. Cover up in the sun, and protect children from sunburn.

7. Practise safe sex.

8. Take up cancer screening opportunities.

9. Be safe on the roads: follow the Highway Code.

10. Learn the First Aid ABC - airways, breathing, circulation.

APPENDIX II

A National Contract

on Cancer

Local Players and Community

can:

Government and National

Players can:

Social & Economic

Tackle social exclusion in the community to make it easier for people to make healthy decisions.

Work with deprived communities and with businesses to ensure a more varied and affordable choice of food (including fruit and vegetables)

End advertising and promotion of cigarettes.

Prohibit sale of cigarettes to youngsters and ensure enforcement.

Tackle joblessness, social exclusion ,low educational standards and other factors which make it harder to live a healthier life.

Economic

Through local employers, make smoke-free environments the norm, with adequate separate provision for smokers and availability of smoke extractors where possible.

Tackle radon in the home (e.g. through direct advice from local authorities to affected householders)

Encourage employers and others to provide a smoke-free environment for non-smokers.

Continue to press for international action to restore the ozone layer.

Personal behaviour

Encourage the development of healthy workplaces and healthy schools.

Target health information on groups and areas where people are at risk.

Develop healthy living centres.

Fund health education campaigns to provide reliable and objective information on the health risks of smoking, poor diet and too much sun.

Encourage research into ways to modify high risk behaviours (e.g. low consumption of fruit and vegetables)

Services

Provide effective help in stopping smoking to people who want to stop especially for disadvantaged groups.

Work with voluntary organisations to provide clear and consistent messages about early detection and uptake of screening.

Ensure smokers have access to high-quality smoking cessation services, particularly in health action zones.

Ensure that healthy schools work with pupils and parents to improve health.

APPENDIX 3

Health Improvement Programmes

Joint action agreed at the Association of Hampshire and Isle of Wight Local Authorities on 4 June 1999:

(1) Local Authorities should work to ensure the next HImPs reflect a public health, and long term ill-health prevention agenda (a 'social model' of health)

(2) Local Authorities should work towards synchronising their various objectives and towards HImPs reflecting strategic and local issues in a broadly based way. Over time this "synchronisation" should lead to real integration in the context of an increasing number of issues and actions.

(3) The timescale should be realistic to achieve widespread ownership and support.

(4) Local Authorities should link with PCGs to ensure Healthy Alliances objectives are reflected in PCG based HImPs.

(5) The Association should press for Councils to have an increased level of representation on Primary Care Groups to strengthen both operational and democratic/community links.

(6) Local Authorities should help the HImP processes relate more effectively to community links.

(7) The potential of, and support for, a cross-Health Authority/Local Authority forum in Hampshire and the Unitary Cities should be assessed. Pending that, the current Corporate Health Group should have strengthened District Council representation.

(8) Links between Hampshire and Isle of Wight health services should be reviewed if the Island's Health Authority were brought within a mainland Health Authority area.

(9) Participation in the reviews of Joint Planning processes should seek to ensure that all requisite plans can be developed and delivered. Those processes also need to take account of the contribution of Heath Alliances and Drug Action Teams and other related cross-cutting working.

Last update: 12/10/2000
Author: Nick Goulder, Policy Manager

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