Matthew Cole On public health

Published: 08/01/2004, Volume II4, No. 5886 Page 29

What are the big public health issues at the moment? Four dominate the local picture: the Department of Health's Tackling Health Inequalities: a programme for action, the new general medical services GP contract, the public health agenda in the acute sector and, last but not least, health protection.

Some colleagues perceive the latter as the preserve of the Health Protection Agency. do not you believe it - any director of public health without a focus on health protection is a P45 waiting to happen.

How does a small public health directorate deliver such a huge agenda? It is all about relationships.Nowhere is this more crucial than implementing Tackling Health Inequalities.As a joint appointment, I have the leadership role for health inequalities.

This enables the directorate to develop a successful approach in building relationships between directorates in the local authority and primary care trust.

In practical terms, social and economic regeneration through the Thames Gateway is our main focus for tackling inequalities and sustained health improvement over the next 10 years. Barking and Dagenham PCT has been working with the borough council to tackle health inequalities since 2001. A health partnership group, which included senior managers from all five local authority directorates together with PCT and community representation, was established.

It recognised that health inequalities could only be addressed if each department appreciated:

evidence for the way health is determined by socio-economic factors;

the relevance of specific policies, action and progress;

where these need to be developed together with targets and indicators.

The public health directorate evaluated each local authority department's policies in relation to 1997's Acheson inquiry recommendations on public health. Each department had policies, targets, indicators and some evidence of success on the majority of relevant inquiry recommendations.However, the quality of responses also suggested there was limited capacity in most departments to produce standardised reports documenting progress.

Spurred on by the results, the group began setting health inequality targets for the borough. But with all the organisational change, the group did not get formal agreement for its inclusion in the local authority's performance-management framework.

The group has since been reconstituted, as part of the local strategic partnership. Part of its remit is to focus on tackling health inequalities and agree a local basket of indicators, which it will regularly monitor and report on annually.

As a preliminary, a letter was sent to all directorate heads requesting them to complete a template for each objective that is relevant to their department. The responses have been encouraging; however, it is also clear that co-ordination across the council and PCT remains variable.

The group intends to conduct a more rigorous evaluation of current activity against each of Tackling Health Inequalities'42 objectives by March 2004. The results can then be used to:

agree existing or develop some additional local targets;

develop a joint delivery plan for tackling health inequalities;

agree a monitoring and reporting framework;

agree a programme of health impact assessment and equity audit .

Matthew Cole is joint director of public health for Barking and Dagenham primary care trust and borough council