What every health and wellbeing board needs to know about environmental health services

Transcription

1 Public Health Series What every health and wellbeing board needs to know about environmental health services The first in a series of CIEH pamphlets about the new public health services in England. October 2011

2 Introduction In England, Health and Wellbeing Boards are part of the new arrangements for delivering public health services. The Marmot Review 1 demonstrates that in our modern society health inequalities have increased and as a result there are unacceptably wide disparities in health and wellbeing. As Marmot makes clear, we have to tackle the wider determinants of health and wellbeing and really get to the causes of the cause of ill health, including mental ill-health. To achieve this we need transformational change in the way we deliver public health services particularly preventive services if we are to redress this unfairness and reduce health inequalities. In England s new arrangements, local authorities have the lead role and responsibilities in making this change and their new Health and Wellbeing Boards are the means to co-ordinate the contributions of the local councils, NHS organisations and others. The aim is to achieve a step-change in performance and outcomes for measurable improvements in population health 2. In order to bring this about, it will be necessary to integrate the work going on in all these organisations in support of each of the three domains of public health health protection, health improvement and healthcare services. We also have to harness the skills, knowledge and tools of all parts of the public health workforce in carrying out this challenging work. The purpose of this pamphlet is to set out the contribution that the environmental health workforce already makes to delivering public health services and to illustrate the important role Environmental Health Practitioners (EHPs) will have in the future 3. 1 Fair Society, Healthy Lives, Marmot Review February 2010, 2 See Healthy People, Healthy Lives 3 See also The case for a prominent environmental health role in the new Public Health Service for England OCT_2010.pdf Public Health Series What every health and wellbeing board needs to know about environmental health services 2

3 Environmental Health Services Modern local government largely owes its origins to the public health movement which emerged in the 19th century and it still retains EHPs as its public health workforce. These EHPs already make a tremendous difference in communities all around England in the public health duties that they perform. They deliver services in relation to the air we breathe, the food and water we consume, the condition of the housing we occupy, the protection of the land that we build, walk and play on from contamination, the places where we work and our protection from diseases. It is going to be vital to continue this work and lock in the benefits of the work that they have already done. It is crucial to a full understanding of the importance of EHPs to public health to recognise that local authorities exercise a number of statutory powers, often led by EHPs, which represent significant public health interventions, including: Many EHPs working in local authorities regularly operate within the scope of these and other sources of legislation, carrying out their duties and exercising their powers for the good health and wellbeing of local communities. Following years of great structural change in local government, it is less common now for there to be a separate Environmental Health Department, but EHPs will be prominent in alternative structures such as Directorates responsible for community safety, public protection, housing and economic development, regulatory services and public health. However, EHPs do not work exclusively in local government, they are also to be found working in businesses (for example in food safety and workplace safety roles), in various parts of the NHS and the Health Protection Agency, in the not for profit sector, in academia and in private consultancies. Students who are studying to become EHPs and their training providers also gain important experience from working in all these settings. Under Health Protection Regulations, to restrict a person s movements and detain and cleanse their property; Under the Housing Health and Safety Rating System, to require improvements in housing conditions and prohibit the use of housing that is harmful to health; Under Official Controls for food safety, to ensure good hygiene and if necessary close down unsafe food outlets and prohibit individuals from working in food businesses; Under the Health and Safety at Work Act, to require safety measures and if necessary prohibit the use of dangerous equipment and close down unsafe workplaces; and Under the Environmental Protection Act, to prevent pollution and require the clean up of contaminated land. Public Health Series What every health and wellbeing board needs to know about environmental health services 3

4 The skills of Environmental Health Practitioners EHPs are already well-trained not just to fulfil their regulatory function but for a modern public health role too. The training to become an EHP is rigorous 4. The profession is graduate entry so a science-based degree in environmental health is required. Students are also required to demonstrate a minimum range of practical experience, which is tested by examination and interview before entry to the profession is permitted. Career-long learning remains a requirement through a scheme of compulsory Continuing Professional Development and many EHPs go on to obtain further degrees and membership of other professional bodies. As a result of the route which members of the profession must take to become EHPs, their skills include: Effective communication of information, which may be complex or sensitive, at a variety of levels; Science-based knowledge of environmental influences on health; Problem-solving ability involving a variety of tools; Working in partnerships as a matter of course; An holistic approach to overcoming challenges. All this is combined with a knowledge of the specialisms and localities in which they work. EHPs contribution to England s new public health services These skills, and the powers and duties which EHPs exercise are, and will continue to be, available to local authorities. But it is the role of Health & Wellbeing Boards to meld them together with the resources being transferred from the National Health Service and elsewhere to maximise their effect. This will be all the more challenging in parts of the country where there is still two-tier local government and where the new public health funding and powers will be given to Counties while the environmental health workforce remains employed by the districts. There is much more for EHPs to do in helping to achieve in England the Government s ambition, which we share, of improving health and wellbeing and reducing health inequalities in every community. Preparation of a Joint Strategic Needs Assessment 5 became a legal requirement in 2007 and before then preparation of a JSNA had been discretionary for local authorities. The Joint Strategic Needs Assessment will continue to be a legal requirement under the new arrangements and the information they contain will help to determine the health and wellbeing strategy for the local area. EHPs will be needed to contribute to identifying the research base, gathering evidence, engaging with local communities and identifying priorities for action. In many areas EHPs are already involved in these activities and are making important contributions. As the Health and Wellbeing Boards will be high-level, strategic bodies, they are unlikely to have seats for every organisation with an interest in public health, but the CIEH does advise Boards to consider the value of having a representative of environmental health on the Board. In addition, the Boards will rely on others to lead the work streams that will feed into the JSNA and the local health Public Health Series What every health and wellbeing board needs to know about environmental health services 4

5 and wellbeing strategy and EHPs are able to lead on those work streams within their areas of expertise, such as improving air quality, ensuring affordable warmth and dealing with contaminated land. Furthermore, EHPs working in local government are well placed to provide assistance and support to the Directors of Public Health and the Health and Wellbeing Boards, making the Business Case for specific public health interventions. This includes identifying local needs and matching them to the national Outcomes Framework, assessing the costs and benefits of options and providing a health impact assessment. In determining their local strategies, the Health and Wellbeing Boards may also give attention not just to what EHPs already do to contribute to meeting their priorities but also what more they are able to do given appropriate levels of resource. In this regard, Boards will expect that other stakeholders locally will support the priorities of the health and wellbeing strategy, including by building into their own budgets and schemes of work measures to help meet them. It should be remembered that EHPs have strong working relationships already with groups who will be significant partners for the local authority and local NHS organisations for example, employers, housing providers, police and fire and rescue services and not for profit groups active locally. Going the extra mile While expanding the role of local authorities, the Government s aim is also to emphasise that everyone has a responsibility for public health and that bringing about behaviour change will be an important means of achieving better public health outcomes 6. EHPs have long experience of working with individuals, businesses and communities to bring about behaviour change. This is especially so in their work in respect of health protection, health improvement and in securing businesses compliance with relevant legal requirements. The Government also has a policy of seeking voluntary Responsibility Deals with various business sectors and EHPs can help to achieve the aims of these through working with businesses locally to capture the anticipated health gains. This model suggests they may also be able to work with smaller businesses to develop relevant, local responsibility deals that fit with the priorities of Health and Wellbeing Boards health and wellbeing strategies. In summary The current public health reforms promise a new era of public health improvement but much depends on the success of Health & Wellbeing Boards for its achievement. Theirs will be the difficult job of co-ordinating and directing diverse workforces towards local priorities, acknowledging and maintaining what has been achieved already. The contribution of environmental health has been very significant in the past and local government s own public health experts have a significant role to play in the future. Contacts Nationally: David Kidney, Head of Policy CIEH, 15, Hatfields, London SE1 8DJ Tel: d.kidney@cieh.org Local contact: Name: Address: Tel: 6 See for example (1) (2) and (3) Public Health Series What every health and wellbeing board needs to know about environmental health services 5

6 The Scope of Environmental Health This diagram illustrates the scope of environmental health and supports our vision for the contribution of environmental health to public health which is: Environmental health practitioners, working with and alongside other public health professionals, will be key partners in local and national efforts to protect and improve the health and quality of the lives of individuals and communities, and to reduce health inequalities They will maintain a direct relationship with the general public, and apply their expertise in responding to the needs of individuals, while also tackling the wider determinants of the population s health by identifying, controlling and preventing risks They will play lead roles in local authority development, co-ordination and implementation of community health and well-being strategies through local health and wellbeing boards, and will also contribute to tackling public health issues at regional, national and international levels. Environmental Health 2012 A key partner in delivering the public health agenda published by the CIEH and the former Health Development Agency projects a future in which the practice of environmental health is based on a modern health development agenda, best practice and evidence of what works. Source: Burke, S., Gray, I., Paterson, K., and Meyrick, J. (2002), Environmental Health 2012 A Key Partner in Delivering the Public Health Agenda, Health Development Agency, London. Printed on Evolve Business, which is a 100% recycled paper certified by the Forest Stewardship Council (FSC). This document is also fully recyclable. Chartered Institute of Environmental Health Chadwick Court, 15 Hatfields, London SE1 8DJ Telephone info@cieh.org Web Registered charity no CIEH, 2011 EDU250