02 May 2024

The power of local authorities to promote and protect good health: guest blog from: The Association of Directors of Public Health (ADPH)

Greg Fell

Greg Fell, President of the ADPH and the Director of Public Health (DPH) for Sheffield writes about the role that local authorities have in protecting and promoting good health and the importance of a cross-government strategy to reduce health inequalities. When the IHA was formed, Directors of Public Health (DsPH), were in the eye of the storm leading the local response to Covid-19, despite not always being involved in national discussions or decisions.

Although just one part of the job, during the pandemic health protection naturally became the focus. As well as being a reassuring voice in local media, DsPH were involved in contact tracing, sourcing PPE, encouraging compliance with social distancing and lockdown, liaising with care homes and schools, encouraging vaccine take up and much, much more.

It quickly became clear that some communities were being hit harder than others, both in terms of fighting the virus and in relation to the financial, educational, and social consequences of lockdown. Where health inequalities already existed, they grew worse, and where they didn’t, they emerged, causing the gap to widen to such a degree that public health organisations stepped up their calls for action through the IHA.

Today, the campaign’s call for a cross-Government strategy to reduce health inequalities remains unmet and ever more urgent due to the devastating impact of the cost-of-living crisis.

ADPH echoes this call in our Manifesto for a Healthier Nation, urging the next Government to put health at the heart of all decisions, whether they be in relation to transport, education, planning, the environment, or anything else.

That is because every aspect of life, from the buildings we live, learn, and work in, to the shops and leisure facilities we can access, how we travel between them and what support we have within them, affects our health and wellbeing.

Currently, there is a huge disparity between what people can access depending on a range of factors including wealth, gender, and race. For example, nutritious food is three times more expensive than unhealthy options and far harder to come across, with the density of fast-food outlets far higher in more deprived areas. That limitation in choice means rates of diabetes, high blood pressure, cardiovascular disease and cancers are higher for those who can’t afford, or easily access, healthier options.

These social factors are then compounded by what we call the commercial determinants of health. This is when health-harming industries such as tobacco, alcohol, fossil fuels, gambling and manufacturers of unhealthy food, exert hidden influence through a range of tactics including marketing, advertising and lobbying, to increase our consumption of harmful products and practices.

With more than one in five people living in poverty and unable to afford the basics, the situation is worsening. To break the vicious cycle of deprivation and harm, we need to create environments which promote good health. Our members work in partnership on a local level to help make this happen. For example, many areas have introduced planning restrictions that ban new fast food outlets, some, including my own, have introduced advertising regulations to limit exposure to adverts for health-harming products. Some areas are working with local groups to promote active transport and facilitate access to green spaces.

However, local authority powers need to be strengthened, to enable them to better promote and protect good health because what is right for one area, isn’t for another. It all depends on who is most in need, where and why. That takes local knowledge which our members, alongside their teams and cross-sector partners, have, but it also needs national backing.

Improving everyone’s health is essential – not just for individuals and their families, not just to tackle the high rates of sickness in the workforce or alleviate pressure on health and social care services, but also to make us more resilient in preparation for the next time we find ourselves up against the pressures of a pandemic.

The Association of Directors of Public Health (ADPH) is the representative body for Directors of Public Health (DsPH) in the UK. It represents the professional views of all DsPH as the local leaders for the nation’s health. DsPH are responsible for the health and wellbeing of their local residents, and are tasked with protecting and promoting good health, and preventing illness and disease in their area. ADPH is a member of the Inequalities in Health Alliance (IHA), convened by the RCP, which is campaigning for a cross-government strategy to reduce health inequalities.