Addressing the social determinants of health is an important foundation for the health and wellbeing of our citizens. The fundamentals of life such as access to clean water and safe waste disposal; housing which provides enough space, clean air and efficient heating; education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all be assessed and developed as a holistic approach to public health.
Local and national democratically accountable governments need to hold these strategic responsibilities and be supported by public health officers at Chief Medical Officer level in national governments and District Directors of Public Health at local government level. These officials need to be professionally independent chief officers and be required to report annually on the health of their populations with reference to other populations and assessing health inequalities and their recommendations on priorities.
Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.
- The nation’s Chief Medical Officers (CMOs) will be required to report annually on the health of their populations to their governments. The UK CMOs will be required to submit an annual report directly to Parliament charting progress in UK comparative performance in terms of population health, health inputs, care processes and patient outcomes (both patient and clinician reported). Such a report will need to consider the UK health outcomes in an international context.
- Directors of Public Health within local authorities should be adequately resourced executive directors able to make recommendations which must be integral to decision-making by the council’s chief officers.
- Social care and other local authority provision and relevant services and proposed developments should be included in public health plans.
- All local authority policies and plans should be subject to an environmental and health impact assessment.
- All policies in government will be subject to an assessment of their impact on the public’s health.
- Strategies and plans for wellbeing should be agreed at local, sub-regional and regional level and should be used to guide decisions about service provision, major investments and reconfigurations.
- Infectious diseases require attention to high uptakes of vaccination and immunisation and the promotion of hand hygiene and the reduction in the use of antibiotics to help prevent the growth in antimicrobial resistance.
- The public health remit must include promoting health, protecting health as well as effective (evidence based) health and social care. All these three domains of practice require robust systems of appraisal of evidence, systematically collated knowledge and information.
ENVIRONMENT/CLIMATE CHANGE
- The NHS must maximise environmental sustainability and engage with the strategy that protects and improves health within environmental and social resources now and for future generations.
- Such sustainability strategies mean reducing carbon emissions, minimizing waste and pollution, building resilience to climate change and nurturing community strengths. See separate section on sustainability and planetary public health (in preparation with David Pencheon of the NHS Sustainability Unit).
AIR QUALITY
- We will take urgent steps to reduce the air pollution caused by road traffic, particularly by diesel engines.
- We will reconsider strengthening the regulation of vehicles, taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
- All this in the context of decreasing coal fired electricity generation and proportionately increasing the use of renewables.
FOOD AND DRINK
- We will remove the VAT exemption from sugar and raise tax on the simple sugar content of drinks and foods such as breakfast cereals.
- We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers by standardised information in the form of WHO recommended traffic lights and standard information wherever it is sold.
- We will ban the use of trans fats in food products and push for the ban to be extended internationally.
- We will introduce minimum unit pricing for alcohol and encourage lower alcohol products. We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol.
- The sale of tobacco and alcohol in supermarkets should be regulated so separate areas are identified to display and pay ensuring better supervision and differentiating alcohol and tobacco from a normal family shopping basket.
- Tax should be proportionate to alcohol strength
HOUSING
- We will introduce minimum standards for healthy housing construction to ensure sustainable housing quality and reduce the risk of adverse impacts such as fuel poverty through inefficient heating/insulation.
- Internal ventilation is also required to reduce the risk of house dust, fumes to ensure clean air.
- Housing should be located near green spaces and close to play ground amenities for children.
WORKFORCE
- In conjunction with a strengthened Health and Safety Commission, we will introduce measures to ensure that workers feel more in control of their own work. Workers and their trade unions should be represented on company boards?
- Occupational health will become a responsibility of the NHS to provide a national service with local generalist and more specialist regional resources.
- A healthy workplace must be the expectation and employers be held to account on best practice and minimum standards in line with health (both physical and mental) and safety legislation.
DRUGS AND TOBACCO
- The taxation system will make healthier products like fresh fruit and vegetables more affordable while making less healthy processed food products better regulated and relatively more expensive.
- We will progressively raise tobacco tax and the age below which it is unlawful to supply tobacco to young people.
- Personal, social and health education (PSHE) will be compulsory in schools appropriate to the age of the child and directed to inform and empower children to look after themselves.
- We will bring forward proposals to reform the law on misuse of drugs to minimise risk which will include alcohol, tobacco and other drugs.
TRANSPORT/ SPORT.
- The Active Travel (Wales) Act 2013 will be extended to England so every local authority will be required to publish details of expenditure on transport measures divided between walking, cycling, public transport and motor vehicles.
- We will rebalance the transport budget so that 10% is spent consistently over the length of the parliament on the needs of pedestrians and cyclists
- We will remove VAT from bicycles and encourage cycle to work and other workplace incentives.
- We will progressively ensure access for all to affordable public transport
- Physical activity should be encouraged in schools with whole school activities, travel to school schemes as well as specialist sports teaching.
- All local authorities must introduce 20mph speed limits on all residential roads so this speed becomes the urban road norm.
- Transport policies need to be strengthened so that city centres are largely free of private cars with access ensured by efficient public transport, cycle and pedestrian access.
- Overall transport policies should be biased towards walking and cycling, bus and trains and vehicles that are increasingly electric or other low carbon fuels.
- We recommend that transport policy should accept a hierarchy of walking >cycling >public transport, to include good provisions for disabled people
- Air transport needs to be increasingly regulated and air fuel tax applied. We must actively encourage more use of continental trains as an alternative to short haul flights.
CHILDREN
- We will ensure children have received high quality PSHE through their school years so they are aware of gender and sexual and interpersonal relationships, understand the distortions of on line pornography and be empowered to say no.
- We will ensure contraception and sexual health clinics are easily accessible to reduce the risk of sexually transmitted diseases and unwanted pregnancy
- More investment in the training and employment of midwives and Health Visitorss to ensure that sufficient support from midwives and health visitors is available for women and babies, especially solo parents and young mothers,
- We will increase benefit rates for pregnant women so that they can afford a healthy diet and suitable accommodation.
- Every school must have a named school nurse and a school counsellor, for which more funding will be required
- Children’s mental health services need to be improved and made adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.
- We will ensure that there is parity of treatment in health and social care services in respect of both youth and age.
- Services must be improved in transition from child to teenager and teenager to adult
HEALTH INEQUALITIES
- Improving health requires addressing the social determinants of poor health based on the principle that there is a role for an interventionist state, for redistribution of wealth and power, and a role not just in planning and commissioning but in delivery.
- Labour’s long-term goal is to break the link between a person’s social class, their social situation and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this.
- We recognize the importance of the early years (pregnancy and first 5 years of life) and there should be workplace benefits to enable generous maternity and paternity leave, state nursery provision and safeguarding along the lines of Scandinavian countries.
- The establishment of an Office of Health Equity to promote and monitor the application of the Fair Society, Healthy Lives policies of giving every child the best start in life; enable all children, young people and adults to maximize their capabilities and have control over their lives; create fair employment and good work for all; ensure a healthy standard of living for all; create and develop healthy and sustainable places and communities and strengthen the role and impact of ill health prevention.
- Health impact assessment of all government policy will be used to reduce inequalities in income and wealth and those caused by trade, foreign and defense policy
THE IMPORTANCE OF COMMUNITIES
- NHS agencies and providers will ensure that every locality has a thriving third sector largely funded by grants rather than contracts.
- NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so.
- Health agencies will play an active part in deploying community development to improve health protection through community empowerment, help tackle health inequalities and encourage responsive statutory agencies.
This document is one of a series developed by the SHA that underpin our recommendations for the Labour Party Manifesto. Each has been developed with contributions from many experts and curated by Brian Fisher through an SHA Policy Commission. They remain in draft and have not been approved by SHA Central Council. They offer an opportunity to explore policy in more detail through debate. They are timely as the NHS is such a key part of the election.