Care, Fairness & Housing Policy Development Panel 21 November 2005

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1 Agenda Item No: 6 Developing a Corporate Health & Well-being Strategy Head of Environmental Services Summary: This report proposes the development of a health & well-being strategy for the Council, which will set out a clear action plan for further improving health in the district. Conclusions: The Care, Fairness and Housing Policy Development Panel, assisted by an officer working group should play a lead role in developing the strategy. Recommendations: a) The views of Members of the Panel are requested on the key policy decisions set out in the document attached at Appendix 1 to this report; a) The Policy Development Panel take lead responsibility for developing a health strategy for the Council; b) An officer working group made up of representatives of all key service areas be formed to develop a strategy and action plan that identifies the potential contribution of all services to improving the health of residents; Cabinet member(s): Mr P Waltham Contact Officer, telephone number, and Ward(s) affected: All David Osborne Background 1.1. The Council has an important duty to maintain and, where possible, improve the health and well-being of the residents of South Norfolk, as required by the wellbeing powers contained in the Local Government Act While this is a relatively new statutory duty, it formalises a public health role which has existed since the nineteenth century, and which was one of the fundamental reasons for the creation of local authorities in their current form. The importance of this role is often not appreciated, but is the fundamental reason for many of the core

2 functions of the Council that are specifically provided to promote the social, economic and environmental well-being of the district This report outlines a proposal to develop a health strategy for the Council that recognises the various contributions of different services, co-ordinates activities and sets out a clear action plan to target resources at the specific health needs of the district. 2. What do we mean by Health? 2.1. There are many definitions of the term health. It is a broad concept, and quite distinct from healthcare, which is primarily the responsibility of the National Health Service. Health is about maintaining the general well-being of a person so they might achieve their own individual optimum performance. Healthcare is about dealing with ill health. One outcome of a health strategy should be to reduce the burden on NHS services For the purposes of this report health is defined using the widely accepted World Health Organisation definition: A state of complete physical, mental and social well-being and NOT merely the absence of disease or infirmity A person s state of health and well-being is determined by a wide range of social, economic and environmental factors. Some determinants such as age, gender and genetic makeup are fixed and there is little that can be done to change them. Other determinants however can be changed and include an individual s lifestyle and behaviours, social and community influences, living and working conditions and, beyond these, the broader macro-economic environment in which they live. While individual lifestyle factors are important, it is known that health and wellbeing are strongly affected by social and economic factors, which are beyond the control of the individual. This highlights the vital role of the Council The Council s role in health is clearly demonstrated by the widely recognised Social model of health (detailed in Appendix 1). This model describes the complex nature and interrelatedness of these determinants and demonstrates how a problem in one area of a person s life can have a knock on effect in many other areas. Only by understanding and acting on these underlying causes can the health of an individual be improved. 3. The State of Health in South Norfolk 3.1. In South Norfolk we are fortunate to generally enjoy good levels of health. However, recent work with the Southern Norfolk Primary Care Trust confirms that this is not true for all residents and some areas of health inequality do exist Compared with the national position we are fortunate not to have the large areas of deprivation experienced by some (often inner city) areas. However, small pockets of health inequality can be identified in South Norfolk, and like the national position, the magnitude of this inequality (the so called health gap ) is growing larger.

3 3.3. To those individuals affected, this problem is nonetheless as significant as to a person in a recognised area of deprivation. The challenge for all agencies therefore is to identify these pockets and the local factors giving rise to them The data has been given some initial consideration by the Council s Health Improvement Forum. It is now considered appropriate that the matter be considered by the Care, Fairness and Housing Policy Development Panel, as the lead committee on health policy matters, to consider a corporate strategy to address the key issues identified. 4. Proposal 4.1. The Council is well placed to take a lead role in improving the health of its residents, both as a community leader and as a provider of many of the key services necessary to address the underlying causes of poor health It is proposed that the Care, Fairness and Housing Policy Development Panel should take a lead role in developing a Health strategy for the Council. An officer working group, made up of officers representing all key service areas, would be formed to help the Panel with this work. The final strategy would then be presented to Cabinet for consideration and adoption The strategy would aim to give a clear vision of what the Council aims to achieve, how its own resources might be targeted and form a basis for developing future joint initiatives with partner organisations. Fundamentally, only by understanding what it wants to achieve can the Council be an effective partner and community leader As a starting point to the process, an initial discussion document is attached at Appendix 1, setting out the basis of any future strategy, highlighting the potential roles and responsibilities of the Council and posing a number of key questions to help identify the basis of its future proposals. The purpose of the document is to help identify the scope of the strategy. 5. Developing a Strategy 5.1. The document attached at Appendix 1 outlines the potential contribution of the Council to improving health in the district. Its content is intended to highlight some of the key issues and considerations, with questions posed at various points to highlight key policy decisions The views of members on these key issues will be invited during the meeting and will form the basis for developing the proposed strategy. 6. Resource Implications 6.1. The proposed health strategy and associated action plan will be developed and implemented using existing resources. However, in the event of any additional resource requirements being identified in the future, they will be raised as growth

4 items through the existing budgetary process for consideration on their particular merits at that time. 7. Project Plan 7.1. The following timescales are proposed for developing the strategy: Action Completion Date Establish an officer working group End of November 2005 Develop an initial draft action plan February 2006 Present draft strategy and action plan for consideration by Policy Development Panel Carry out consultation on draft strategy and action plan Present final strategy and action plan to Policy Development Panel for approval February 2006 May 2006 June 2006

5 7.2. Appendix 1 Developing a Corporate Health Strategy Introduction South Norfolk Council has always worked with communities and organisations to improve the health and well-being of its residents. However, it does not have a single, overarching document that describes its overall aims, the contributions of its different services and a detailed action plan setting out how it will go about improving health further. The Council is responsible for the social, environmental and economic well-being of the community and is able to have a direct influence on many of the determinants of health. By working with Southern Norfolk Primary Care Trust it has been possible to develop a clearer understanding of the health profile of the district and identify specific local health issues. This information will enable the development of action plans that will form a key part of the final strategy. The proposed health strategy will be developed around the Social model of health because it best describes the wide-ranging factors that influence health and are capable of being influenced by the actions of the Council. A successful health strategy will therefore have a bearing on many policies and actions across the Council. South Norfolk as a whole is a relatively healthy area and many residents enjoy a greater life expectancy than in other parts of the country. However, within the district there are pockets of health inequalities where individuals suffer reduced life expectancy and other related health problems. Therefore, the health strategy might have two fundamental aims: 1. To improve the health and well-being of the whole population of South Norfolk; and 2. To improve the health and well-being of those most in need by reducing health inequalities using a targeted approach. Policy Decision 1. Are the two aims broadly correct? What do we mean by health and well-being? There are many definitions of health, but the World Health Organisation (WHO) definition is widely recognised. This sees health as being: A state of complete physical, mental and social well-being and NOT merely the absence of disease and infirmity. A further definition states: Health is about enabling everyone to reach their maximum potential.

6 Similarly, the term well-being is also difficult to define. It refers to a person s sense of feeling safe and secure, free from stress and comfortable with their lives and environment. Policy Decision: 2. Should the definition of health and well-being used in the strategy include all aspects of social health as described by the WHO definition? What factors influence Health and Well-being? Health and well-being are created by a wide range of social, economic and environmental factors known as determinants. Some determinants such as age, gender, and genetic make-up are fixed and there is little that can be done to change them. Other determinants include individual lifestyles and behaviours, social and community influences, living and working conditions and, beyond these, the broader environment. While individual lifestyle factors are important, it is known that health and well-being are strongly affected by social and economic circumstances, which are beyond the control of individuals. Figure 1 describes the Social model of health (developed by Dahlgren and Whitehead) and demonstrates the complex nature and interrelatedness of the determinants of health and well-being. It highlights how a problem in one area can have a knock-on effect in many other areas. Policy Decision: 3. Should the Social Model of health form the basis of the strategy? A Corporate Approach to Health The Council has a long and distinguished history of working to maintain, and where possible, improve the health of its residents. It has a number of roles to play in the area of health improvement, including enforcement action, the promotion of healthy lifestyles and community development. The Dahlgren and Whitehead model (as shown in Figure 1) also helps to show the extent of the Council s role and that no one service area has exclusive responsibility for health. For example, the Council has a role in influencing individual lifestyle factors such as affordable opportunities for exercise, healthy food choices, smoking and alcohol and drug consumption. Similarly, the Council has a corporate role in strengthening and developing social and community networks through its community development work. The Council also has a major role in the improvement of living and working conditions, not only as a large employer but also through regulating health and safety in the workplace, the provision of housing services, access to local education, training and development opportunities, the provision of safe food and ensuring effective waste management. The other determinants of health relate to general socio-economic, cultural and environmental conditions and again the Council has a major role in economic development, provision of cultural activities and environmental management. In fact the only area in the model not directly under the control of the Council is the provision of healthcare services!

7 Figure 1

8 Policy Decision: 4. Should Health be a matter for all Services? The local context for the Health Strategy The Health Strategy is intended to highlight the main health issues affecting the whole district and to help identify the role that the South Norfolk Council can play to improve health through its own direct and indirect actions. The strategy is also intended to link with a number of other key documents to achieve greater co-ordination and a clear direction for future action. In particular, it will be a key element of South Norfolk Council s Corporate Plan and will update the social strand of its Agenda 21 strategy. As such it will set out a clear direction for the Council, identify priorities and provide a focus for future service planning and budget setting. The Corporate Plan already includes a commitment to produce a health strategy and recognises the need to work at two levels through its aims of: Making South Norfolk healthier and safe. Targeting services to those who need them most and ensuring that diversity is welcomed and equality of opportunity is available to all. It includes the following health-related priorities that will need to become central elements of the strategy: To work closely in partnership with health agencies to improve health and health care provision. To help residents and staff to take responsibility for their lifestyles and health, with good access to all healthcare requirements. To encourage walking and cycling through the provision of safe and convenient routes and pedestrian / car-free areas, which in turn, reduce the need for vehicle access in some areas and to improve safety, fitness and health among residents To develop initiatives to tackle health inequalities in South Norfolk, which are concerned with responding to the housing, poverty and access to educational needs of disadvantaged people, in order to improve their quality of life and life expectancy. To encourage user involvement in the provision of health and social care services. To encourage healthier lifestyles with the provision of leisure centres and activities. The Health strategy is intended to describe the Council s contribution to the work of other health-related strategies produced by other agencies. This recognises that the Council cannot tackle the health challenges facing the district on its own. Achieving the aims of the strategy will involve working in close partnership with other agencies, voluntary organisations, businesses and all sectors of the community. The strategy will

9 therefore seek to encourage closer working between organisations, greater awareness of health issues, partnership and participation. POLICY DECISIONS: 5. Should the health strategy be an over-arching document that co-ordinates and informs other documents describing the Council s role in improving health? 6. The aims of the strategy are to be achieved through partnership working and by raising awareness. Legal and national background to a health strategy The Health Act 1999 gives a duty to councils to work in partnership with Primary Care Trusts in the preparation and review of local health delivery plans. This legal requirement recognises the joint ability of local councils and the NHS to improve health. The common sense justification is that co-operation, co-ordination and communication improves the service to the public. The Local Government Act 2000 provides councils with new powers to promote wellbeing. Local authorities can make use of the power of well-being to achieve the promotion or improvement of any one or more of the following: the economic well-being of the area the social well-being of the area the environmental well-being of the area The Government s White Paper Choosing Health making healthy choices easier identifies seven national priority areas to be addressed by all agencies able to influence the health of residents. These are: tackling health inequalities reducing the number of people who smoke tackling obesity diet, nutrition and physical activity encouraging and supporting sensible drinking improving sexual health improving mental health and well-being accident prevention The White Paper encourages joined up action and sees an effective system for health delivered through close alignment between local community partners. Local authorities, it says, are public sector leaders for addressing health inequalities, protecting the health of their local communities and promoting health to their populations.

10 Policy Decision: 7. Should the Council take a lead role in promoting good health in the community? 8. Should the proposed health strategy adopt both local and national health improvement priorities? An overview of health in South Norfolk The health profile for South Norfolk indicates that generally the state of health in the district is good compared to many other areas. However, many premature deaths still occur and health inequalities are common. It is believed that the Council can play a valuable part in influencing this position for the better. About two thirds of all local deaths are caused by either circulatory disease (heart disease and strokes) or cancers. Circulatory disease is commoner and the levels differ little from the national averages. In the Southern Norfolk PCT area 38% of deaths are due to circulatory disease and 26% to cancers. However, circulatory disease, and to a lesser extent cancers, are predominantly diseases of older age. If the data is adjusted to show the proportion of years lost to life for individuals affected then a different picture emerges. Then South Norfolk has a greater than average problem with both cancers and accidents. When analysed at ward level it can be seen that the state of health varies across the district, with some pockets of quite severe health inequality or deprivation. For example, life expectancy is generally high in South Norfolk but there is a difference of over 10 years between the ward with the highest life expectancy (88.8 years) and the lowest (77.4 years). This difference must be of concern and its reason needs to be understood better. Similarly, death rates compare favourably with many parts of Norfolk, but local variations are found. One of the most commonly used measures of health inequality is the national Index of Multiple Deprivation. This compares every ward in England using six domains or indices; income, employment, education skills and training, housing and access to services. Using this tool it can be seen that levels of apparent deprivation in the district compare very favourably with many other areas of the country. However, it is still possible to identify a number of wards that compare less favourably than others. In addition to the Index of Multiple Deprivation there are many other statistics, which help identify areas of health inequality. These include information from the 2001 Census such as statistics on access to services, community well-being and the social environment, crime and safety, economic deprivation, skills and training, health and care, housing and work deprivation.. In summary, it can be concluded from all of this data that three of the highest health priorities at South Norfolk are: Heart disease Cancers Access to services

11 Other important health issues include accident prevention, mental health and the small pockets of deprivation scattered across the district. Policy Decision: 9. Should the health strategy focus on these priority areas? The Council s role in Improving Health The Council role in health improvement is clearly one of prevention rather than cure. The purpose of the health strategy will be to understand and interpret the available data on ill-health in the district and the underlying causes of preventable medical conditions. The role will therefore be one of addressing the underlying cause of ill-health as described in the social model of health highlighted earlier. This role has been acknowledged in the government publication Creating Healthier Communities: A Resource Pack for Local Partnerships. It suggests the following examples of actions which council services might take to improve health and well-being: Executive Ensuring that corporate plans effectively focus on the most deprived areas. Considering local corporate responsibilities for example recruiting where possible local people; ensuring employees have a healthy workplace. Elected Members Take an active role in scrutiny of health issues and other policies which impact on health, eg housing. Encourage interest and involvement of local people in health issues; act as advocate for their views and ideas Planning and Transport Consideration of health issues in Local Development Framework Guidance to developers Green travel plans Protection of open spaces and provision of allotments Health impact assessment on planning proposals Policies to reduce car usage Safe routes for pedestrians/cyclists Speed restrictions Secure cycle storage in towns Road infrastructure planning School transport Walking and buses Leisure Services Provision of sports and leisure facilities at discounted rates for the most disadvantaged Passport to Sport Play areas for children Working with PCTs and local GPs to develop exercise referral schemes Activate for Health scheme with Health Promotion Service to signpost patients to physical activity in local area Development of green gyms

12 Seniors exercise in communal settings such as community centres and residential homes Work with tenants and residents groups to implement exercise sessions at suitable venues with affordable cost Securing funding for specialist disabled exercise equipment in sports centres Strategic involvement with Active Sports, Sports Action Zone Encouraging community access to school facilities Health promotion training for leisure staff Promotion of local leisure facilities, sports clubs and therapies through local newspapers offering free/reduced price taster sessions as incentives. Housing and Environmental Health Food safety and healthy eating advice Investigation of nuisance Pest control Health and safety at work of offices, retailers, warehousing and similar premises Enforcement of private housing standards Air quality monitoring Contaminated land strategy Licensing of premises Working with Registered Social Landlords to provide advice to tenants Proactively signposting vulnerable people (especially older people and young families) to energy efficiency advice and grants Estate action plans covering topics such as healthy eating, and play areas Healthy Living Forums established Senior life skills project aimed at promoting healthy living issues Regular health information contained in Council newspaper Education and Information Regular health information contained in Council newspaper Education about diet and physical activity Role models Community education Using local media to convey health and regeneration messages Libraries: working with libraries to ensure healthy messages, access to information (including for those whose first language is not English, people with learning and physical disabilities) Children s Services Children s Trust arrangements, integrating the planning, commissioning and delivery of health services across education, social care and other partners Increasing physical activity and enhancing take-up of sporting opportunities Information and campaigns

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