Taking bigger leaps of faith over improving the health of communities

06 February 2013

As local government prepares to take up responsibility for public health, Nick Forbes, leader of Newcastle City Council, sets out how the new boards can tackle an unforgivable scale of health inequality

From April, councils like mine have a unique chance to help their citizens live happier, healthier lives.

We, and the organisations working for us, will be on the frontline, fighting the health improvement battle, listening to local people and encouraging bottom-up, grassroots approaches to everything from smoking to obesity.

Newcastle is relishing the public health challenge, we've hit the ground running, despite the current financial climate, and in Newcastle the scale of the challenge is huge.

Since I became leader, Newcastle City Council has been asking how it can make its communities healthier and happier.

What can we, as a council and as individual citizens, actually do to consign our city's shocking health inequalities to the past?

How do we make our staff incorporate health and wellbeing in their every day work, so it becomes part of their professional currency?

These aren't new questions, pushed to the front of our mind by April's impending deadline.

They are questions we've been asking for some time. You can't afford not to think about health and wellbeing in a new way when you live in a city where average lifespan differs from ward-to-ward by as much as 12 years.

We realised early on that the council did not have all the answers to what can be deep-rooted social attitudes and cultures.

We recognised that the broader the partnership we could create, the more chance it would succeed. That's why we set up a wellbeing and health partnership, a forerunner to our statutory wellbeing for life board.

We embraced Marmot (Fair Society Healthy Lives) and its principles; we looked at health and wellbeing in its broadest terms. After all, people told us that everything from graffiti to bus routes affected how they felt about their lives.

That's why our original partnership included not just the usual suspects from the NHS or health groups, but also people from the voluntary and community sectors as well as council departments that are outside the traditional health arena.

It was partly that inclusive approach that helped us achieve designated healthy city status within the World Health Organisation's healthy city network.

Partnerships have been part and parcel of the way we do public health and join up health and social care since the 1990s.

So it is easy to think that their latest iteration – statutory health and wellbeing boards – are just another shift to allow business as usual to carry on. But let's face it, if we do what we've always done, then we'll continue to have health inequalities at an unforgivable scale.

In Newcastle we've decided to use the latest change as an opportunity to think differently and build on our established track record of working together.

Consistently this broader work tells us we need to take action to improve the conditions in which people are born, grow up, live their lives and grow old – achieving this isn't just about the world of service provision, integration or clinical pathways – it is using all the resources of our partners to improve the local economy, create great places and great communities.

It involves using spatial planning, development control, regulation and engaging civil society in working with us to improve wellbeing and health. It also involves lobbying for national changes such as standard packaging on cigarettes and minimum unit price.

In other words, it is taking seriously our responsibilities to create the society that will give everyone fair access to the right to health.

This doesn't come easy. We have to take bigger leaps of faith and recognise that we won't always measure results in the short-term, but these challenges are exactly the reason we need to start this job now.

So our health and wellbeing board has a wider membership than the statutory requirements and we've spent our shadow year thinking beyond the provision of services and challenging each other to think creatively about taking action on the social determinants of health.

I'd like to see this approach create new jobs to decrease unemployment and give our young people the aspiration to achieve at school.

I'd like to see a wide uptake of our living wage which the council has committed to pay its staff believing that it is actually an economic and social investment.

And I'd like to see communities fulfilling the potential they have to take action to improve their own wellbeing and health. Using their own assets, their buildings, their knowledge, their networks, to improve their own home. I want a bottom-up approach.

This isn't only a matter of fairness and the kind of society we'd like to live in, it is also one of the only ways cities like Newcastle can manage in the face of decreased resources.

The challenge ahead is huge, but I'm confident we've hit the ground running and that the new era of public health under local authority control will lead to happier and healthier communities.

This article first appeared in Public Servant magazine