10 years ago, the 2012 Health and Social Care Act recognised and strengthened the role of local government in improving health. The act returned public health teams to local government, from a long period away in the NHS, and increased the public health responsibilities of local government for their communities. A decade on, the vital role of local government as leaders for health has again been recognised by government in their 2022 Levelling Up White Paper.

Thriving communities are built on good health, but in the UK, there are stark differences. People in the poorest areas are dying years earlier than people in wealthier neighbourhoods. Inequalities exist between local authorities, and within every local authority in the UK.

As Jim McManus, President of the Association of Directors of Public Health, succinctly put in his recent MJ article, there are no quick fixes, and the causes of poor health and inequalities are ‘far more complex than simply individual responsibility’.

To create a healthy society, we need all the right building blocks in place, including stable jobs with good pay, quality housing and education, and green spaces. Across the wide breadth of their work, local government hold – or can work with others to influence – many of these building blocks.

The Health Foundation was proud to sponsor an MJ award recognising councils’ work to improve health. We saw excellent examples of how councils are embedding action to reduce health inequalities across all areas of their work. The winner, London Borough of Newham’s comprehensive ‘50 Steps to a Healthier Borough’, has as its first step, ‘Ensure we put health in all policies, using all our tools as partners of the Health and Wellbeing Board, to maximise the health of Newham’s population…placing health, wellbeing and happiness at the centre of our vision for residents.’

Newham recognises the need to make use of all the tools and levers they have across the local authority and are working together to improve health and wellbeing, in areas as diverse as young people’s mental health, air quality and housing.

To better understand how local government uses the breadth of their direct influence, and works with partners and communities, to improve health, the Health Foundation interviewed a wide range of local government leaders. From these conversations we have identified six key elements to building a whole-council approach to improving health:

1. Local leadership

  • Elected members, with passion and vision for improving health, champion causes, work across party lines and drive an agenda for the whole council.
  • Existing momentum is used, framing issues in ways to best engage elected members.

2. Whole council focus and strategy

  • All directors understand their contribution to improving health and that this is not the sole purview of the director of public health.
  • Public health acts as a strategic service within the council and is involved in shaping strategies, providing data and intelligence, designing evaluation criteria and defining outcomes from the outset of all key projects.

3. Key partnerships

  • Partnerships are built with others key to improving health, including local businesses, the voluntary and community sector, and local delivery partners, including health organisations.

4. Community collaboration

  • Communities are at the heart of all work to improve health. Solutions are co-designed to meet the needs of local people. 
  • Diverse voices are heard and there is consideration of the assets that different communities bring to maximise the effectiveness of collaboration.

5. Evidence-based communications to build support 

  • Partners, including local communities, are communicated with in ways that build understanding about the complex and systemic causes of ill health to build support from all sectors for their role in improving health.
  • Effective framing of communications is used, tailored for target audiences, to maximise the impact of evidence, data, and the need for action.

6. Evidence to inspire action

  • Accurate and timely data and intelligence are used to inform and inspire action.
  • National networks are maintained and developed, and resources and expertise from academic institutes are explored and accessed.

Action is also needed from central government to enable and support councils in improving health. Unsurprisingly, we heard calls for increased and sufficient investment to resource activity and workforce to tackle future challenges. Certainty about the security and sustainability of this funding is paramount. Complex problems with multifaceted causes require long-term planning and cannot be tackled effectively on constantly changing annual budgets.

A whole-government approach is needed at national level. Siloed national strategy, policy and funding can hinder the ability of local government to take cross-sector action locally. A coordinated national approach to improving health, beyond the Department of Health and Social Care, could create clear and coherent policies and funding streams and provide a framework for effective local action.

The challenges, now and in future, are substantial, complex and require true collaboration across systems and organisations. But the health gap can be closed, and the MJ award entries provide examples of innovative ways councils are working towards this goal.

Alexander Allen is Public Health Specialty Registrar at the Health Foundation.

Louise Marshall (@louisemarsha11) is Senior Public Health Fellow at the Health Foundation.

This piece was originally published in the MJ (p14–15) on 7 July 2022.

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