2 May 2017
In Victorian times local government used all their public health tools to prevent ill health caused mainly by severe poverty. They cleared the slums and built better quality housing, ensured the water supply was cleaned up and built parks, leisure centres and theatres to promote peoples’ wellbeing. In today’s world we face a different set of public health issues – yet the same approach and tools can still make a difference. The importance of ageing well, increased obesity leading to other health issues and growing mental ill health are leading to a modern day health crisis. Unitary and district councils have got to step up to the plate - and become more than the sum of their parts.
Since the creation of the NHS we have left health to the health service and local government have got on with other things. With their housing, environmental health and leisure roles local government has still been involved in preventative health, but it’s a bit piecemeal at best. Although it will undoubtedly be making a difference – if local government were to pull its tools together and use them strategically and holistically to achieve the one aim of promoting the wellbeing of its residents – just think of the huge impact it would have.
The environment in which we live has a massive impact on our overall health and wellbeing. Not surprisingly our most immediate environment, our home, has the biggest impact of all. Whether it is overcrowded, under occupied, full of hazards or unaffordable and causing debt - the home in which we live has a huge impact on us. The environment where our home is set, how close it is to open spaces, the air quality, local crime rates, the transport links to work, school and leisure activities also impacts on us – and then the community links and local economy can either affect us positively or negatively.
It is unitary and district councils that have the housing, planning, community safety role, environmental health, leisure, economic development and community links to change the environment in which we all live and work. They can either do that piecemeal with each of its functions following their own objectives which may or may not be the same as their colleagues objectives – or they can make the conscious decision to pull all their tools together and use them holistically and strategically to promote the wellbeing of their residents. If their new policy or action plan does not have a positive impact on the wellbeing of its residents – the council needs to ask itself why are they doing it.
It is not easy to come out of our specialist silos. One tool in tackling obesity can be to limit the amount of unhealthy fast food takeaways in particular locations. If planning can’t achieve this objective alone can it do it in partnership with licensing and/or environmental health? Local government too often works in their own specialisms and this has to change.
Ageing well and the out of hospital care system and can be tackled with housing and planning working together to increase supply of purpose built homes for older people, home adaptations and strong communities – such as dementia-friendly towns and villages that also happen to be child friendly and generally more people friendly.
Mental ill health has so many causes but there is no doubt that the environment in which we live has a huge impact. Over-crowding, loneliness and debt are causes of mental ill health that councils can tackle with their housing powers. Planning can make sure wellbeing is at the heart of the towns and villages it allows to emerge ensuring plenty of green spaces and places to exercise and no isolated units.
Economic development can ensure a thriving local economy with good jobs; and environmental health can tackle noise nuisance which can cause mental ill-health or indicate over sensitivity to noise which can be an early indicator of mental health issues. The council’s community safety teams work tirelessly to tackle domestic abuse and bullying which can all lead to future mental ill health. And obviously more leisure facilities can help cure a range of health issues.
The NHS is struggling to fix ill health. It needs its partners in local government to re-connect with its roots and make the promotion of wellbeing the central core of all its does. It is unitary and district councils that have most of the tools to achieve this, but they have to consciously become more than the sum of their parts. The NHS needs to understand in two-tier areas the power of district councils when it comes to preventative ill health and the promotion of wellbeing, and include them more in their discussions and formulation of future plans.
