London councils are making their mark in their new role following the transfer of public health to local government last year, says Jeanelle de Gruchy
London, in common with many other urban and metropolitan areas, faces significant public health challenges.
‘The transfer of public health demonstrates that local authorities have the strategic leadership and technical skills to support major transformational change’
It has a highly mobile and diverse population: more than 300 languages are spoken in the capital; there are more than 50 diverse communities with populations of more than 10,000.
Some boroughs experience such high levels of population churn that almost a third of residents change every year.
And there are massive health inequalities. For example, it is a sad fact that there is a nine-year gap in life expectancy between men who live in deprived areas in the east of my borough of Haringey, compared with those in the west.
How to begin to tackle this?
Since the transfer of public health to local government last April, London boroughs have been joining up services within their organisations and with wider partners to improve the health and wellbeing of residents, and reduce health inequalities.
London councils has received many examples of such projects in response to a call for evidence of good practice.
Wandsworth is using its links with local children’s centres to promote smokefree homes. Central to the project are parent champions, people at the heart of their communities who encourage smokers to avoid lighting up at home and to become parent champions themselves.
This is community leadership in action and it exemplifies the public health ethos: to empower individuals to make healthy choices, and give communities the tools and resources to address their own health needs.
Local authorities are well positioned to improve the health and wellbeing of communities’
In Haringey, we’ve been working with Tottenham Hotspur Foundation, the charitable arm of the football club, on a Community Health Check programme. This focuses on men over the age of 40 and is helping to address health inequalities. Over the next three years, assisted by health champions recruited from the local community, this aims to health check 3,000 men.
The transfer of public health to local authorities has also led to a step change in thinking about the way services are delivered. Public health is fast becoming integrated into every aspect of London local government.
Newham has built on existing links between planning and public health to put healthy urban planning at the top of the agenda. For all major developments in Newham, there is now a requirement to undertake health impact assessments. Proposals that consider how to cut the impact of food takeaways, keep air clean, and promote walking and cycling will be supported.
The council has also used public health data to shape its core strategy, creating a food outlet map to identify areas with poor access to healthy food where interventions, such as encouraging allotments, community good growing projects or protecting the corner shop, might be useful.
In Croydon, data on alcohol-related harm, including figures on ambulance callouts, has been used to create four cumulative impact zones. These aim to halt the proliferation of off-licences where there are alcohol-related issues.
Croydon’s public health team is also working with the police, licensing colleagues and council members to introduce a voluntary scheme for the banning of cheap “super-strength” alcohol.
While these are all innovative examples of good practice in public health, councils know even more can be achieved by working together.
Boroughs quickly established the London Association of Directors of Public Health to support directors in their new leadership role within local government. This provides a platform to discuss issues, share learning and identify, where appropriate, a collective way forward.
Working in partnership with London councils, the association will roll out from next month a three-year London-wide HIV prevention programme to deliver key HIV prevention services to complement locally commissioned schemes.
The transfer of public health has not been without its teething problems. Challenges have included getting to grips with council procurement systems, and adapting to new ways of working for staff that have moved from the NHS.
Over the next few years, local government faces more change: the integration of health and adult social care, reforms under the Care Bill and the transfer of commissioning responsibilities for health visitors.
However, while concerns remain around the funding of these new responsibilities the transfer of public health demonstrates that local authorities have the strategic leadership and technical skills to support major transformational change.
We are well positioned to improve the health and wellbeing of communities.
Jeanelle de Gruchy is director of public health at Haringey Council and co-chair of the London Association of Directors of Public Health