Published: 26/05/2005, Volume II5, No. 5957 Page 23

A multi-agency public health programme shows regionalism is not dead, say Nick Salfield and Lindsay Davies

The abolition of NHS regions does not mean regionalism is dead. In fact regional public health groups remain, addressing health and inequalities with new partners. While opportunities for improving health are huge, little of this work is known within the NHS.

The 2002 white paper Your Region, Your Choice paved the way for elected regional assemblies and strengthened partnership assemblies. It defined a role for the regional director of public health as health adviser to an elected regional assembly and the responsibility for setting out a longterm public health strategy.

In the East Midlands our regional partners highlight the great opportunities for health improvement through work at this level. Levels of health here are near to the national average and improving. However, there are wide health inequalities and much scope for improvement.

The agenda is driven by the East Midlands regional assembly strategy Investment for Health (I4H). It takes a holistic approach recognising the interdependence of the economy, social environment and health and the additional benefits to health gained from activities not necessarily health focused.

The strategy adds value to national policy and its local implementation. It provides a framework for local organisations and partnerships based on a regional health profile without prescribing local priorities or actions.

The challenge is to ensure I4H is a living approach. A range of organisations have been developing action plans with relevant stakeholders.

The East Midlands Development Agency is committed to sustainable economic development as a major factor in better health. It is strongly engaged with the corporate citizen and corporate wellness themes.

The inclusion of I4H in the Government Office for the East Midlands business plan sees teams working on regeneration, housing, planning, and transport considering health issues as integral to their work.

The regional assembly monitors and approves the I4H group work programme and is committed to future consideration of significant health issues led by the regional director of public health.

The partnership development of a web-based appraisal tool, including health inequalities impact assessment and environmental sustainability, was another success.

The development of the East Midlands public health brand 'EMPHasis' has been fundamental to strategy delivery. It encompasses a multi-agency public health network of 1,200 people with a newsletter, website, and e-bulletin, plus conferences and workshops.

Does engaging a new set of partners in the health improvement agenda result in tangible improvements? Baseline data produced in October 2002 and updated in March 2005 indicates:

An increase in life expectancy with the inequalities gap remaining largely unchanged or possibly increasing;

Under-18s pregnancy rates falling (faster than England) since 1997-99;

Coronary heart disease death rates falling with inequalities gap increasing;

Death rate from cancer falling with a slight increase in the inequalities gap;

Accident mortality rates falling, but still significantly higher than England, with no trend in the inequalities gap;

I4H is a long-term commitment to improving health and reducing health inequalities. It involves agencies, communities and individuals at regional and local level.

New regionalism is a growing force, and regional public health groups are providing a strong and influential presence at the regional level.

Dr Nick Salfield is deputy regional director of public health and Professor Lindsey Davies is regional director of public health for the East Midlands.