Primary care trusts'cross-discipline approach could provide a vital impetus towards eradicating health inequalities, the UK Public Health Association conference heard. Barbara Millar reports

Published: 14/03/2002, Volume II2, No. 5796 Page 12 13

The choice was formidable: to attend a session on the health impact of a swimming pool closure in Glasgow or a workshop on tackling global inequality?

With 65 parallel sessions and workshops offering 177 individual presentations - whittled down from over 300 submissions - effective timetable management proved quite a task.

There were also a dozen main speeches, lunchtime events, evening discussions, poster displays and exhibitions, as well as a Scottish supper and ceilidh to fit into three days. The 10th annual UK Public Health Association conference, in Glasgow last week, was its biggest, with over 900 delegates. The theme was tackling health inequalities and building sustainable communities.

Public health minister Yvette Cooper opened proceedings by saying that this had been an important issue for the government since it commissioned Sir Donald Acheson's independent inquiry in 1997.

The government is pulling together a long-term agenda for health inequalities. Its consultation was wrapped up in November and had received over 600 written responses and contributions from more than 900 people attending regionally based workshops. Ms Cooper pledged that a long-term delivery plan would be published later this year, once the outcome of the crosscutting spending review on health inequalities has been agreed.

Meanwhile, an interim report on the consultation is due out around Easter, summarising the key messages from the consultation and indicating the main thrust of the delivery plan.

Revealing a few of the anticipated contents of the interim report, Ms Cooper said that there was a need to focus on the wider determinants of health - poverty, bad housing, unemployment, polluted environments - alongside the specific structures of the NHS and Department of Health.

'Action on health inequalities cannot be carried forward in isolation from action to reduce poverty and deprivation more generally, ' she said.Work on early years and child poverty was particularly important, as was a focus on the health inequalities of individuals from black and ethnicminority groups, older people, disabled people and people with a mental illness.

Any action needed to be sustainable, she added, not seen as an 'extra' to current policies and with departments, services and sectors working in partnership.

Ms Cooper believed the development of primary care trusts - with their new directors of public health - and local strategic partnerships would be important in addressing health inequalities at a local level and for 'joining up activity' between different services and sectors.

From April 2002, regional directors of public health and their teams would be based in each of the regional offices of government, she added.

'For the first time they will be uniquely positioned to work with other government departments in the regions to build a strong health component into regional programmes in areas such as transport, the environment and urban regeneration and well placed to work with regional development agencies to tackle the fundamental root causes of poor health and inequalities.'

The voluntary sector - with over 1,000 organisations working at the national level and donating over 20 million hours to the health service every year - has an important contribution to make in building sustainable communities, said Suzanne Tyler, senior fellow at Birmingham University's health services management centre.

Voluntary organisations must be equal stakeholders in any local initiative to tackle health inequalities, she insisted, and the NHS should cease to see the voluntary sector as a cheap provider. 'The voluntary sector has access to information and is free from political connotations.

'It is focused on users and potential users of services and provides expertise based in real experiences. It is one way statutory services can mobilise and engage communities.'

Cardiff University's school of sciences research director Professor Gareth Williams, and Professor Phil Hanlon, director of the Public Health Institute of Scotland, talked about delivering the public health agenda in their own nations.

Professor Williams said the 'extraordinary intensity of health and related socio-economic problems' in many parts of Wales, particularly in the post-industrial communities of the South Wales valleys, could result in a bleak, depopulated and disenfranchised future for the country.

But he was upbeat. 'There is a political opportunity in Wales to address the problems of poor housing, lack of employment, poor health facilities, poor retail food outlets and pollution in a new way, ' he enthused. 'It is time to take the words of politicians about social inclusion, supporting communities, citizenship and participation in policy and to make something of it, free from cynicism and scepticism.

'It is a new democracy now. We are not just talking about handing out benefits to the poor but about sharing wealth, power and opportunities.' Professor Hanlon waxed lyrical about 'a period of dawn and bright morning' in Scotland and said he was 'excited' about the possibilities that have been opened up since the Scottish Executive committed itself to social justice as its centrepiece.

The conference also heard from public health stalwart Margaret Hilson from the Canadian Public Health Association, a former president of the World Federation of Public Health Organisations.

After 30 years working in international development arenas, she said she regretted that the 1978 Alma Ata declaration had now lapsed, with nothing to replace it.

The declaration had been a defining statement of social justice, calling for health for all by the year 2000 and for primary healthcare services to be located within 10km of every family in every country, 'There have been major health gains since Alma Ata - the burden of ill health has been reduced, as has childhood mortality, and life expectancy has been increased, ' said Professor Hilson. 'But these gains are vulnerable. There is no assurance they will be permanent.'

With the demise of Alma Ata, there was no common world-wide strategy. 'We need to demand a new policy of the World Health Organisation, ' she said. 'You need a firm foundation on which to build a public health system. You cannot focus on immunisation, or tuberculosis, or HIV in isolation.

As soon as you stop the particular problem, without a proper foundation, the gains disappear.'

UKPHA chair Dr Geof Rayner and Dr Teri Knight, public health scientist with Birmingham University's health services management centre, wound up with the launch of a UK 'health and wellbeing challenge'. Dr Knight explained this would be a longterm initiative to involve the whole public health movement in 'refreshing and modernising' public health, with a far stronger environmental focus and a longer-term perspective on the health of communities.

Dr Rayner added: 'We need a UK-level public health strategy with fresh thinking outside government focus, covering all public policy. He called for written responses from delegates.'Tackling trends such as food and farming, for example, is well beyond the healthcare sector and involves local, national and European changes, as well as tremendous imagination. We need to build a national movement against the anti-health forces and also against the grain of existing public health policy.'