What can Councillors do about health?

Public Health

A video of this presentation is available

The Health and Well-Being Board A forum for discussion and asking questions

  • Ask about population health, and wider determinants of health – implications
  • Health priorities and commissioning
  • Check -good measurements of need and service, ask for profiles of health
  • Communication with other depts of the council


  • Joint Strategic Needs Assessment,
  • Health and Well-Being Strategy (every 3 years)

Joint Strategic Needs Assessment is online, available to everyone and updated

Information-  is it fit for purpose?

Obtain and share Public Health Information data in your Local Authority –analyse it -produce local, timely evidence, discuss

health profiles, maps, time trends, wider determinants and comparative data across Local Authorities, Counties, Regions and across England for best commissioning, to improve health and reduce inequalities

Health is everyone’s business – towards Healthier Lifestyles

  • Local Government Association Peer Challenge

  • Prevention agenda
  • Social Prescribing
  • Learn from other Local Authorities
  • Enable communities to be healthy
  • Scrutinise Public Health Intelligence in times of austerity- priorities

Key Health Areas:

  • Stop smoking
  • Reduce obesity,
  • Increase exercise,
  • Sensible drinking,
  • Improve sexual health,
  • Improve mental health (Child and Adolescent Mental Health Services)

Public Health Intelligence is  the key to reducing Health inequalities  & Inequity – get involved !

Health in all Policies

What are our health priorities for the next year?

Look at  the evidence:

Childhood obesity
Childhood obesity
Preventable Premature Cancer
Preventable Premature Cancer

How does your area compare with other similar places?

Health and Social Care + wider determinants of health

  • Health Scrutiny Committee
  • Public health, Prevention and Performance
  • Adult Social Care
  • Children’s Services
  • Environment + Planning +Transport
  • Housing (community infrastructure)
  • Education & Libraries
  • Community Safety and waste management

Public Health Intelligence & the Marmot report

Tools to investigate

Robust  statistical methods to give  evidence to change local health policy

  • Health Needs Assessment (JSNA) ;
  • Health Equity Audit;.
  • Time trends, Comparisons
  • Priorities;
  • Cost-effectiveness;


  • Inequality – the difference in the distribution of a health measure (by person or place)-univariate measure
  • Inequity – an inequality in the distribution of health intervention in relation to health need that is considered unfair -bivariate

Inequity :  those with most need get the lowest level of service- the undesirable “inverse care law” (this case even worse than negative linear relationship)

inverse care law

Equity : high need is matched by high service provision- the desirable situation


Health Equity Audit  cycle

Audit cycle

Health Equity audit: Smoking among   St Albans PCT males

St. Albans had the lowest overall Standardized mortality ratio in the region and was considered a “healthy, rich  PCT”.  But this figure and the high quit rate of  68% disguised the inequity of uptake of smoking cessation services between wards within the PCT. The negative gradient of regression line (although low r) indicates poor wards with high Smoking Attributable Mortality (SAM) have  low or zero smoking cessation uptake.”.. Ie inverse care law. The stop smoking services then got moved to be located in low and zero SAM wards ( into church halls and a pharmacy – not GP centres) – and the gradient was reversed over the next 3 years – and gradually SAM reduced In Sopwell ward smoking attributable mortality was high and smoking cessation uptake is recorded as zero.

The quit rate in itself is not enough.  We can use data for more accountability locally to improve health.

Health Equity Audit in St.Albans: Male smoking cessation uptake v .smoking attributable mortality  for all males age 35 years and over between 1998 and 2002   

Quit Rate= 68% (2002-3)


Measure the Smoking cessation uptake  and Quit Rate by ward.  

We should use % Uptake from high Smoking Attributable Mortality areas as targets rather than quit rate alone, to measure service success.

Communicate health needs with other depts of council- eg transport, housing

Share Health  Intelligence

Integration and Partnership working with other directors,and depts in the local authority,  CCGs, Voluntary sector Hospitals , Community Trusts  and other Local Authorities

Collaborations to save costs- win, win!

Eg cycling, walking bus, – exercise, lower carbon footprint, reduce obesity- etc… but safety?  are cycle lanes in place… argue the  business case- to save costs later.,

Listening,  and Participating in  Communication

Asking questions

Politics, Elections in May 2018  can push  key health message priorities through the Health and Well-Being Board.

  • Understanding wider determinants of health Councillors next May -money going to  poorer health places and people
  • Money spent appropriately on evidence based interventions
  • Understanding, listening and speaking the same language as the community with poor health to be reached

Childhood  and Adult Obesity

Local Authorities need to know their wards  of most need

  • Joint responsibility health, education, transport, sport, green spaces, fast food outlets, shops.
  • Data – Information –Public Health Intelligence –communication-partnership – intervention- monitor data, (PHI) record evidence of improvement (or not)-
  • Evidence of what works .
  • Schools approach for children?


Measuring a child

Summary of Findings since 2006 :  Children’s body mass index in Barking and Dagenham Age 5 and 11 with

School nurses from Barking and Dagenham Collecting data for the National Child Measurement Programme

Childhood Obesity in Year 6:

Prevalence of obesity

Change in rates of obesity

Councillors can improve health by knowing the needs in their own patch, using Public Health Intelligence,  asking key questions &  becoming health champions in every dept of the council, Health in all policies, and with partner organisations!