When the London Metropolitan Board of Works authorised the construction of the Victoria Embankment, it wasn’t for the District Railway. London’s first local government was motivated to solve London’s greatest public health crisis of the day, cholera.
Thankfully cholera has been consigned to the past. But our city faces new challenges and grows increasingly unequal and unhealthy. Depending on where you live, and the life chances that you are afforded at birth, you can be expected to have a shorter life, spent with more years in ill health if you are one of the unlucky ones.
he return of public health powers to Local Government is a reminder of our purpose. Local authorities are seen by some as purely the vehicles to deliver public services that the market can’t, or other public bodies won’t.
Instead, we have the opportunity to refocus the existence of local government toward something more fundamental. We exist to help make people healthier and happier, in themselves, their families and their communities.
When Michael Marmot published his ground-breaking “Fair Society Healthy Lives”, he reminded us all that the underlying causes off ill-health are social and economic.
In his assessment, the best possible way of improving someone’s health, was effectively give them the economic tools to change their circumstances for the better, and that change had to take place at the earliest possible moment.
But these new public health powers arrive at town halls at the same time as greatly constrained and diminished budgets. Now no longer deemed ‘NHS’ spend, public health grants have been cut in successive years, and fairer funding for councils with greater need have still yet to be achieved.
These pressures are not just felt by Councils either. Far too often do we allow public funds to be sucked into providing ever greater supply of acute hospital services,
rather than investing in what will prevent the growing demand for health services.
Far too much time is spent in partnership working attempting to squeeze every last penny out of pooled budgets attempting to make patient flow in NHS and care settings more effective. Conversely by conservative estimates, there are tens of billions of pounds worth of savings to the NHS that can be made by tackling obesity, smoking, substance and alcohol abuse.
This review set out to answer a few, key questions.
Firstly, how do we ensure as a local authority that everything we do can achieve better health and happiness for our residents?
Secondly, how far can we go working with partners across the public and voluntary sector to join forces and ensure they are working towards the same goals as us?
Thirdly, what kinds of interventions can we develop to ensure that we tackle problems before they exist and unpreventable pressure building on strained public services?
What is no longer in doubt is the absolute necessity to make health and wellbeing the golden thread in all that we do. This requires us to demonstrate braveness of vision, and the willingness to grapple with the trickiest challenges of changing human behaviour, our own corporate culture, and going further to lead a collaboration of our partners.