Acting on wider Determinants: A DPH Perspective District Councils’ Network, LGA, 4 Sept 2013

Jim McManus, FFPH, CPsychol, Csci, AFBPsS, FRSPH, MCIEH

Director of Public Health, Hertfordshire

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Hertfordshire

• 1.1m People in 37 Settlements• 10 District/Borough/City Councils• 1 County Council• 2 NHS CCGs• 8 NHS Trusts• 1400+ vol orgs• Urban/Rural mix

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Systems thinking on wider determinantsGetting everyone on the same systems page

The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)

The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)

The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)

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Conceptualising the role ofLocal Government in wider determinants

Smoking 10%

Diet/Exercise 10%

Alcohol use 5%Poor sexual health

5%

Health Behaviours 30%

Education 10%

Employment 10%

Income 10%

Family/Social Support 5%Community Safety 5%

Socioeconomic Factors 40%

Access to care 10%

Quality of care 10%

Clinical Care 20%

Environmental Quality 5%

Built Environment 5%

Built Environment 10%

Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status

While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

Contributors to overall health outcomes

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40 years of science/policyon wider determinants

• From Rose to Black to Marmot....

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The Herts Policy Ethos

• Very apparent every council in Herts is already trying to mainstream public health across its business– Consider impact of all they do on health– Local focus with an eye to the Health and

Wellbeing Strategy– Develop a plan to deliver this

• Opportunity is to build on this

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Towards Shared Principles

• Public Health might have been designed on a unitary model but we will innovate and succeed in multi-tier areas

• The Local Govt Family is a major asset in public health Parishes/Towns – we need to do more Counties and Districts cannot do public health without

each other. • Three tier areas can do public health with style!

Strong science, strong political leadership, countywide approach, local focus & engagement

Just some examples of district led work....I could easily do four or more from every district.

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Parks

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Planning

• Obesity in core strategy• Planning approach to Obesity– Children– Adults

• Whole System Obesity Pilot for Herts• Sustainable Community Strategy and Core

Strategy has Health Ambitions

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People 50+

• 50+ Golf Discount Card

• Dance Opportunities

• Walking for health, fun and fitness

• The North Herts 50+ Forum

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Alcohol

• No More Project• Very Chaotic Users• Signposts and accompanies– Wholistic addressing of problems, food access,

housing, benefits, skils....• Reduces re-offending• Reduces A and E attendance

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Whole System Approach

• Health Partnerships (Every district)• Health Promotion Dedicated Staff Time/People• Each district has a Strategy• Just four Examples– Bereaved Men (E Herts)– Leisure Access (Welwyn Hatfield)– Young People and Mental Health (St Albans)– Older People, Long term conditions leisure/ decent homes

standard (Dacorum)

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Strategic Focus

• South Oxhey• Area of Significant Deprivation• Joint Working between two councils• Assessment of Need• Development of local strategy• Focus of whole council services• Asian Women Premature Mortality in Watford

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Better Together

• Public Health Board • Public Health Partnership Fund for every district

– Match funds community safety fund• Public Health Strategy (Herts wide and local)• Workforce Development, 400 people 2013-14 with RSPH

– Elected Members– Leisure Officers– Council staff– Third Sector

• Online MPH Public Health from2013, route to PH Practitioner being developed

• Exercise Referral Schemes

The Hertfordshire Public Health Board Members

Some of our partners

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The Future

• Countywide coverage, local focus• Complementary skills• Skilled, commited workforce– Public Health Career Structure for whole PH family

• Third Sector, Public Sector and Private Sector providers

• Healthy Workforce, Prosperous County• Children

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Herts Public Health Conference

• 4th December, 300 People• Stream for elected members• Stream for third/community sectors• Celebrating our Public Health Family

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Key Advice for a County DPH

• Acknowledge blessings, not problems• Fit your strategy to harness the culture• Count your assets... starting with elected

members• Enable networks of action, don’t establish

hierarchies of control (‘cos you won’t succeed)• Localism is a gift if you can make it happen• The 3 tier structure lends itself to public health

action on wider determinants

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Thank you!

Jim.mcmanus@hertfordshire.gov.uk

Public Health Service Pageshttp://www.hertsdirect.org/your-council/hcc/publichealth/

Health in Herts Portalhttp://www.hertsdirect.org/services/healthsoc/healthherts/