Agenda item

Directors of Public Health (DsPH) have a statutory requirement to produce public health reports. These reports are the DsPH’s professional statement about the health of the local community.

To coincide with the 10^th anniversary of the Marmot Report, ‘Fair Society, Healthy Lives’, Medway’s 2019-20 Annual Public Health Report focuses on health inequalities that persist within the unitary authority boundary. The report sets out:

·       Key information relating to the causes of health inequalities

·       Ways in which the Council is working with key stakeholders to act to address the key health inequality determinates

·       Recommendations for future actions to address the root causes of health inequalities in Medway

·       The manner in which the COVID-19 pandemic has impacted vulnerable groups in Medway and the Council’s initial response to support its residents.

Following the Health and Wellbeing Board on 16 February 2021, this report will be presented to the Health and Adult Social Care Overview and Scrutiny Committee on 11 March 2021 and Cabinet on 30 March 2021.

Discussion:

The Health and Wellbeing Board considered a report which presented the latest annual report from the Director of Public Health entitled ‘Health Inequality in Medway.’

The Board raised several comments and questions, which included:

Impact of COVID-19 – it was acknowledged that COVID-19 would have had an impact on health inequalities nationally and in Medway. The efforts of staff across health and social care was commended, particularly as the additional requirements had been met by the existing workforce. It was noted that many services had continued throughout the pandemic, adapting to different ways of delivery. 

Further guidance and training on health inequalities – in response to a request, the Director of Public Health undertook to hold a training event on health inequalities.

Interventions – a comment was made that interventions needed to be cost effective and provide an opportunity for individuals to improve their own life chances with support. Indeed, it was noted that at a time when all public sector budgets were under severe pressure, existing resources needed to be used more effectively to maximise beneficial outcomes. This could be achieved with careful planning and coordination. A few examples of recent successes were outlined including details of how a regeneration scheme had increased local employment.

It was acknowledged that action needed to be proportional, so that all Medway residents experienced the same quality of opportunity. The importance of giving children the best start in life was also recognised.

Target audience – reflecting on the intended aims of some Council led events, it was commented that it was important that there was equitable access so that all residents were able to gain benefit.

Place shaping – in the context of establishing new communities in Medway, concern was expressed in relation to GP access, particularly in Hoo where the Council was undertaking a significant regeneration programme. In response, the Director of Public health explained the importance of place shaping and referred Board Members to figure 9 of the Annual Public Health Report set out at Appendix 1 to the report (The Dahlgren-Whitehead model) which showed all the elements which could impact on an individual’s wellbeing. Access to appropriate care services was one key element.

The importance of addressing the wider determinants of health was highlighted for example housing, education, and employment. Reference was made to the differential in life expectancy between Cuxton and Halling (85.7 years), and Chatham Central (77.3 years) which had increased over the last six years. It was considered that now was a good opportunity to reflect on the current state and work collectively as a system to make improvements. Whilst recognising the importance of these wider determinants, a comment was made that a Healthy Living Centre in Chatham Central would be welcomed.

In response, the Accountable Officer for the Kent and Medway CCG explained there was a clear role for healthcare provision, particularly primary care. He added that it was important to ensure the right workforce was in place, not just GPs. He referred to models elsewhere in Kent, in communities with similar levels of deprivation, that had successfully remodelled the workforce mix to provide primary care services.

Complexity of the issue – it was said that health inequalities were a complex issue. In some areas progress was demonstrably good, for example the achievements of the stop smoking service, but it was recognised there were challenges which would need to be worked on over many years to come. A comment was made that the problems were recognised but solutions that really work were needed and it was suggested that establishing a task force may be beneficial. It was said that the recommendations of the Annual Report were strong and would help achieve progress.

The Director of Public Health concluded by explaining that it was important that it was understood that there was no single fix, it was important to look at the broader issues that would interplay to create the right environment for the population. It was important to achieve equitable outcomes for all by proportionately addressing needs of specific communities. Progress had been made in several areas, but more needed to be done.

Decision:

The Health and Wellbeing Board noted the Annual Public Health Report set out at Appendix 1 to the report, including its findings and recommendations and congratulated the Director of Public Health for the work he was doing on this issue.