The Obesity Health Alliance is hosting a series of expert blogs in support of the launch of their Local Government Position Statement. Third, we hear from Darrell Gale, spokesperson for the Association of Directors of Public Health on Healthy Places and Director of Public Health for East Sussex, on why we should make preventing ill health & reducing health inequalities a primary purpose of National Planning Guidance.
Directors of Public Health (DsPH) are responsible for the health and wellbeing of their local populations. In England, we discharge our responsibilities from within local authorities, while in other parts of the UK, we are part of the NHS. However, regardless of our reporting lines or funding streams, we always strive to work in partnership with all local authority (LA) departments, as well as local businesses and voluntary organisations, to promote and improve our residents’ health.
Inevitably, there will always be a degree of illness and disease that we are unable to prevent. However, nearly 89% of deaths in England are attributable to non-communicable disease – largely avoidable conditions including many cancers, respiratory, heart and liver disease, and mental health disorders. Moreover, these conditions, which are often a result of obesity and caused by health-harming products like alcohol, and unhealthy food and drink, disproportionately affect people living in the most deprived areas, and often for many years before eventually claiming their lives.
Consumption of these harmful products is often thought of being the result ‘personal choice’. The reality is though that people don’t have freedom to choose. Instead, they are forced by circumstances to buy cheaper, less healthy food and drink, bombarded by clever advertising and marketing campaigns, and unable to access active transport, open spaces, or affordable leisure options.
Only by tackling the issue at a population level can we hope to address this inequity. To even the playing field, public health teams are increasingly looking to local levers, including planning, licensing, system leadership and procurement procedures, to create healthier environments where people have better access to the things we need to be able to live healthier lives for longer.
Barking and Dagenham for example, has introduced a £1000 levy on new hot food takeaways, while Newcastle City Council is among a growing number of authorities to use planning levers to restrict the opening of hot food takeaways. In Bristol, street traders have to hold a Bristol Eating Better Award as a condition of their license, and in Swindon, the council have recently passed a Healthy Food Advertising Policy. The policy aims to restrict advertising of products high in fat, sugar and salt across council owned advertising spaces that are often targeted at people living in areas of deprivation, who are more likely to experience health inequalities.
Public Health teams, in partnership with other LA departments and local providers and organisations, also encourage businesses and outlets to promote healthier eating. For example, in County Durham, where nearly 40% of children leaving primary school and 75% of adults are overweight, food businesses are offered training to support delivery of more healthy options on their menus. The Healthy Options Takeaways (HOT) Masterclass includes taste tests and information on how to offer more healthy options at low or no cost to the business, such as swapping mayonnaise for low fat yoghurt and taking away saltshakers from the counters. Six weeks after the pilot training scheme, not only had businesses taking part stuck to their promises but some had made further improvements like only stocking sugar free drinks and offering free fruit to children each time they visit.
As a result of local initiatives like these, the tide is definitely turning and ADPH is currently involved in three projects focussing on improving the environments we live and work in. The first, funded by The Health Foundation, aims to develop long-term, collaborative relationships between planning and public health professionals in local areas. The Health Foundation are also funding our work to support local public health teams to better understand commercial sector influences. Meanwhile, a major new research project, funded by UK Research and Innovation will identify, implement and evaluate population-level interventions – like using planning law – that are most likely to tackle the negative impact of industry influence and improve health, wellbeing, and equity. The project will also explore and address the barriers to implementing these interventions.
Throughout all our work, we strive to improve practice by sharing expertise and knowledge, making resources that have been developed and used in one area available to DsPH and their teams across the country, so that no one area is having to come up with the solution. Instead, they can use resources, like Sustain’s Healthier Food Advertising Toolkit, and the CDOH Essentials toolkit, to use local levers to create tailored solutions for their area.
A lot can be achieved by working in this way locally, but there are some things that need national backing to be truly effective. For example, local advertising bans which can only be enforced on council owned property and services like those in place in Sheffield, while helpful, will not completely stop people from seeing adverts for junk food. Similarly, localised campaigns to promote reformulation in take aways won’t stop the availability of unhealthier versions. Equally, funding for behaviour change campaigns may support a small number of people but won’t help to make the structural changes to the food environment that are needed to reverse the increasing numbers of people suffering from largely avoidable illnesses caused by consumption of unhealthy products.
The Government’s consultation on reforming the National Planning Policy Framework, promises to “consider ways in which the planning system can do more to support the [creation] of healthy communities”.
As part of our response to the consultation, ADPH will be stressing the role that neighbourhood design has in facilitating access to a healthy diet, physical activity levels, travel patterns, social connectivity and mental and physical health outcomes. We will also make the case for DsPH and their teams to have greater say in the planning process by being a statutory consultee so that collaboration is not reliant on goodwill but is instead a requirement that will ensure that implications for health are always considered in local planning and decision making.
Ultimately though, as well as national action on those elements we can’t implement locally, we need a strong national framework that supports LAs to use the powers that are available to them to promote public health. By taking this type of whole system approach, DsPH and their teams will be much better equipped to address soaring obesity rates, alongside a wide range of other public health concerns, and support the entire population to live healthier lives for longer – not just those with the means to access healthier options. Not only will such action reduce health inequalities and reduce pressure on local health and social care services, but it will also serve to boost the economy through increased workforce productivity – an undeniable win win!