I set out in an earlier blog how disappointing the Public Health England strategy is and drew attention to the more relevant analysis and strategic framework provided by Due North. This analysis – freed from the hand of government and away from the clinical eye of the CMO is much more focussed on the multi-sectoral, social determinants agenda that local authorities work within.
The analysis of Due North is essentially a socio-economic one which builds on this to also make the case that economic inequity leads to alienation – the ‘Antonovsky argument’.
The report identifies four areas to focus on these are:
- Tackle poverty and economic inequality
- Promote healthy development in childhood
- Share power of resources and increase the influence of the public
- Strengthen the role of the public sector
I support this framework it makes a refreshing change from the usual lazy public health analysis that invariably defaults to “smoking is the biggest cause of health inequalities”.
The challenge faced by this report is that many of the actions it calls for are long term in nature and are ‘wicked issues’ in other words they are not just complex but addressing them requires a change in the balance of power.
I think that Due North tries to address this complexity by talking to 4 different agendas:
- National Government – in effect these are manifesto points
- Aspirational Actions for Local Players – calling for actions which are ethically correct but unlikely to be achieved systematically – across whole populations in the short to medium term.
- Practical Actions for local players – actions that local leaders can take that could in the short to medium term impact on whole populations.
- Process Actions – Capturing evidence at a local and national level to challenge and improve policy
As an example I will focus only on the actions on tackling poverty and economic inequality.
There are 17 actions here – however I think that they are mainly in the National Government or Aspirational Actions category as the pie chart below shows. My working out is here
I am not arguing against any of the recommendations but it is crucial that local authorities focus on what they can do to make a practical difference to people now.
Action 1 – Draw up health equity strategies that include measures to ameliorate and prevent poverty among residents in each agency’s patch
On the pie chart above this is the one action that I have put in the category of having the potential to have a population impact in the short/medium term, it is concerned with:
- supporting networks of credit unions and other community finance initiatives
- controlling pay day lenders
- debt counselling
- benefits advice
Although appearing first, this is only one action among many – but I think it is the most important, because local commissioners can make a real difference here through investing in the above provision systematically. It is therefore crucial that local health and wellbeing boards prioritise action to develop strategies that ensure that all of their most vulnerable populations have equitable access to these services. I find it surprising that most local authority areas still do not have clear, aspirational strategies on financial inclusion. Due North is a powerful powerful spur to resolving this.
There is a good body of evidence on population groups that must be targeted systematically for example:
People with Mental Health Problems – Royal College of Psychiatrists – Debt and Mental Health and Centre for Mental Health Welfare Advice for people who use mental health services
People with Disabilities – New Policy Institute (commissioned by JRF) Disability Long Term Conditions and Poverty
Local Authorities custodianship of public health is now at an important stage in its development. They can either look to Public Health England with its emphasis on clinical and behavioural change or they can consider rebalancing their public health budgets to ensure that they respond to the Due North challenge by investing in programmes that address financial inclusion for their most vulnerable populations.
What do you think?