Councils must demonstrate the benefits of tackling public health locally
Local areas need to look at long-term funding for public health, beyond today's ringfenced grants
Author: Heather Fearn, the Guardian |
The full study is more complex than the headline, and is timely: 2.7bn in government funding for public health is now in the hands of local authorities, and this week it was confirmed that this pot would be ringfenced for a third year.
The handing over of the baton hasn’t been entirely smooth. Central government left it almost disastrously late to confirm funding allocations for councils. There have been lengthy wrangles over who should sit on health and wellbeing boards (with various noses put out of joint), and the relationship between councils and clinical commissioning groups hasn’t been simple.
However, the optimism that councils display is not misplaced. Danny Dorling‘s forensic work as a socio-economic geographer tells us just how closely life chances ? including, most critically, health and life expectancy ? are linked to location.
In his short book, The 32 Stops, Dorling traces social indicators such as employment, health and average income across the length of London’s central line tube map. At the start of the journey from west to east, life expectancy falls by two months a minute as the train rattles from the wealthier suburbs of London through some of the poorest neighbourhoods. By the time the train has passed four stations, every second spent moving equates to a day off local residents’ lives.
Given these stark figures, councils are clearly best placed to tackle local health problems. To do this successfully, local government will need to think big; public health is far more complex than sexual health, obesity, alcohol and smoking.
Councils are already aware of this. They understand that health problems can be very localised, and that a local answer is required. Liverpool’s crackdown on the city’s sunbed obsession is a great example of this.
As Localis points out, councils should be looking at the wider determinants of good (or bad) public health, such as decent housing, education, transport and employment. Lambeth’s work to design healthy high streets and Lincolnshire’s efforts to grow local food for residents show how councillors and officers have grasped this lesson, too.
All this work, however, depends on funding. While the ringfence is still snapped shut, officers have the tools to make change happen. When it is released (and it will be released) the pressure of the “Barnet graph of doom”, the spiralling of social care costs as government grants retreat, risks seeing public health funding siphoned off elsewhere. The same has already happened with the supporting people pot.
As the Localis report argues: “It is crucial that local authorities maintain public confidence in the reforms by only spending public health funds on things that are demonstrably related to improving health outcomes for local people”
This is about more than public confidence. Committing to public health projects saves money. Success, however, requires councillors to stop playing cyclical politics for the long-term good of local communities. How many will have the confidence to do this?