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I asked for water and you brought gasoline – Health Inequalities, STPs and Public Health England


Public Health England have just produced a set of intelligence briefings on health inequalities for Sustainability and Transformation Plans.

The briefings achieve the seeming impossible of being technically right and so very wrong.

The problem

We know that:

The STP Challenge

STPs aim to do three things – improve service quality, address health inequality and save huge amounts of money – this is a big ask!

I think that history tells us that there always a drift to achieving savings and away from addressing inequality. So, we urgently need a strong, coherent framework that creates momentum for change and lays the foundation for sustainable action on inequality – step in Public Health England!

What PHE gave us

The data sets produced by Public Health England are meant to help us ensure a focus on this weakest element – health inequalities.

They show three things:

The problem is we know all of the above already – what the data sets do not do is help us create a platform for an evidence based dialogue that promotes the substantial system change that we need if we are to shift to stronger action on health inequalities.

Where PHE fails us

There are two areas where the briefings fail spectacularly.

Mental Illness does not exist

Frankly, I am staggered to be writing this – if you were to come to these briefings cold you would think that poor mental health does not exist in England. These briefings say nothing at all about mental illness!

Yet we know:

  • the relationship between health inequalities and poor mental health.
  • that health outcomes are far worse for people with mental health problems

Social Determinants are not relevant

The briefings say nothing about the social determinants of health

yet we know:

  • NHS England is promoting accountable care systems that seek to pull together holistic approaches to respond to need and some Multi-Speciality Community Partnerships are developing new service models with community anchor organisations.
  • There is a stated ambition for STPs to focus more on prevention
  • Addressing the social determinants of health – housing and employment insecurity, low levels of income are crucial to tackling health inequalities

What PHE should have done

What PHE should do

PHE should help bring the outside world and the lived experience of inequality into Sustainability and Transformation Plans.

PHE lacks the system change competence and freedom to challenge so it should commission an ongoing programme of thoughtful briefings that can be used by health inequality champions inside and outside the NHS to drive help drive local system change.

These briefings should be commissioned from two sources first – the members of the VCSE Health and Wellbeing Alliance (which they sponsor) and second leading independent organisations such as CLES, Centre for Welfare Reform, Money and Mental Health Policy Unit etc who have a track record of bringing sophisticated, independent challenge to existing local systems and the people who are trying to influence them. They should be asked to respond to the question “From the perspective of you and your stakeholders what action should STPs take to reduce health inequality?”

What do you think?

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