On April 1st 2013 Local Authorities had returned to them after 39 years the responsibilities for Public Health.  This gives them an opportunity to take up the proposals of the Marmot Review.

This, we believe in Local Government terms, to have been one of the few beneficial developments within the Health and Social Care Act 2011. This will enable Local Authorities to co-ordinate the wider responsibilities that they have to the community and will also benefit in tackling the serious health inequalities that exist in many communities. This is both in areas that you expect from the statistics in the North, Midlands and London but also in areas of the wealthy South East.

In my own area of Aldershot, part of Rushmoor Borough Council which also covers affluent  Farnborough, there are three areas which are in the top 20% of deprivation  in the UK. This includes the ward I represent and have done for 37 years.

Whilst the responsibility for public health has returned to local government the additional moneys have not fully – as you would expect from this Government. Local authorities have been squeezed alarmingly in settlement terms since 2009/10 where the level has been reduced overall by about now cumulatively 33 1/3 %, through the Communities and Local Government Dept. (CLG). However CLG  has given us more responsibility.

The challenge is great, as it would be in any case, but in a time of austerity when poverty levels are increasing, benefits are being cut and food banks are now proliferating with ever increasing additions everywhere, including both towns in my Borough, the effect of that nations health also increases causing widespread effects on the community as a whole and in poorer challenged areas in particular. Investment in preventive diseases which save moneys lags.

Into the mix we have the results some three years ago of the Marmot Review into Health Inequalities in the UK which followed on from the World Health Organisation Report by Sir Michael Marmot’s Team and pre-empts the work he’s currently doing for the EU.

The Marmot Report of all the evidence, by the world’s leading expert in this field, showed the social gradient of deprivation was worsening for many but ironically the life expectation was rising. However the correlation between richer areas and poorer ones would suggest that the disparity was markedly also increasing as well.

The report Fair Society, Healthy Lives recommended action to tackle social inequalities so as to reduce health inequalities, based on the  “social determinants” approach to preventing ill health. Health is closely linked to socio –economic status.

The Marmot Team monitors the position in about 150 local authorities through its range of indicators which are:

  • Life expectancy at birth
  • Children reaching a good level of development at age five
  • Young people people not in employment, education or training (NEET)
  • Percentage of people in households receiving means tested benefits

This is added to by the index of social inequalities for each local authority.

Most will be familiar with the Health Observatory Reports which cover each local authority that for some local authorities are very challenging as to their results..

The Marmot Team also calculate what health inequalities cost the taxpayer in England:

  • Productivity losses of £31-33 billion every year
  • Lost taxes and higher welfare payments in the range of £20-32 billion per year
  • Additional health care costs well in excess of £5.5 billion per year.

Overall these figures, from 2012, could range between about £57 billion to £71 billion.

Now we have austerity.  In a report completed recently for BHA for Equality and Social Care their conclusions were petty stark.

For example on patient health there was the possibilities for deteriorating mental health due to work situation (stress), extra work loads, no work, struggling to make ends meet, benefits cuts, continual review cycles of appeals, depression and self medicating by drugs and alcohol.

Some 25% and rising of all activity areas within Clinical Commissioning Groups (CCGs) are due to mental health support needs by resources. Many do not associate the mental health issues of serving soldiers with this area, domestic violence in general and wider support needs but they are essential areas for consideration.

With regard to practice impacts there will be a changing workload, access by patient’s effects and staff morale.

In secondary and support services patient transport has already been affected by cutbacks, delays in discharge letters can result in significant potential serious prescription errors and workers are now struggling to do any structured addiction work.

There was also more pressure on rehabilitation services, occupational therapy and similar areas.

In the key area of social work and housing in many areas discharges from hospitals were resulting in bed blocking, respite care was being marginalised, vulnerable adults and children were being further marginalised despite serious concerns over their safety within increasing reliance on the voluntary sector.

So in all these pressured environments there has to be  a radical review of the balance between the Acute and Preventative Care Sectors. If between the CCGs and Local Authorities within their new remit there is a need to tackle some of the increasing key issues of say obesity, diabetes, sexual health issues, mental health and so on, then with money being tight there will have to be priorities.

However its the immediate issues which need to be tackled – the health reaction to the effect of austerity superimposed on the existing levels of health inequalities or else there will be a marked decline in the nation’s health.

In conclusion there needs to be an immediate robust response to the austerity issues which are now increasing prevalent.

  • There needs to be an indication of the economic outlook and the effects, as Marmot work indicates, on the wider determinants of education, jobs and skills,
  • There is the need for a robust discussion on the work which needs to be done on the key health issues of our time as indicated and, therefore, the balance between acute and preventative expenditure
  • The wider determinant’s that effect the health of the individuals and their communities such as planning and transport need to be factored into the decisions of all stakeholders’ particularly local authorities.
  • There must be an immediacy over the effects of Government Policy in its reaction to austerity and the effects on people in general, communities and those challenged especially through an impact analysis

 Sources

(1)   UCL Institute of Health Inequality background briefing

(2)   Tackling Health inequalities – Healthier Scotland the Journal SHA Scotland

(3)   Marmot Report 2010

(4)   RTPI Planning and Health Inequalities

(5)   TCPA Planning and Health Inequalities

(6)   BHA Report

Mike Roberts

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One Comment

  1. Brian Cox says:

    Mike, thanks for this. Really helpful.

    What I like about this is its scope over the longer term. Having done a little bit of work with Health and Wellbeing Boards and local systems in preparation for the transfer of responsibilities to Local Government I have been concerned that there has been too little focus on the broader determinatnts and impacts. Whilst this is understandable given the immediate issues people face it does risk compounding the misalignment of current actions with strategic outcomes. For instance how services and interventions aimed at tackling urgent health and inequalities priorities might compound feelings of powerless, self-worth, isolation, and so on in the longer term.

    How should we take this forward?

What do you think?

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