Relationships with Districts Scrutiny, December 19th 2013

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

Director of Public Health, Hertfordshire

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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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PH 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

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Arrangements

• Public Health Strategy• Support and Cross-referencing with District

Strategies• Multi Agency Public Health Board• Strategy developed with very close working• Joint Health Protection Committee

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The PH Offer to Districts

• Information and Analysis – locality profiles• Training – – RSPH accreditation– UKPHR practitioner route

• E Learning Platform • E Books and Journals www.hertsdirect.org/phelearn • Public Health Partnerships Fund (£100k)• PH Conference• Delivery Partnerships

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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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/