The 2010-2015 UK Parliament has made many changes affecting local government in the first half of its term, but one notable (and positive!) change of 2013 went fairly unremarked other than by those affected. In the major re-structure of the National Health Service, it was not only GP practices which had to take on more responsibility. All public health functions have now transferred to Local Authorities.
Public health functions include vaccinations and the commissioning of community health services such as maternity and post-natal care. Also included are all the preventative health interventions including education and campaigns on topics such as sexual health, tobacco, alcohol, obesity and physical activity. Considering the nature of such health prevention measures, the synergy between public health functions and other local government services is manifold.
For example, social services have often had as much or more interaction with those at most risk of sexually transmitted diseases as primary care trust staff. Environmental health officers and licensing teams control the locations where alcohol and tobacco are sold, inspect food hygiene and deal with many other topics that have been the focus of years of public health campaigns. Waste collection and drainage has an important role in preventing the spread of diseases that afflict other nations with less developed infrastructure. Local Authority Planners have been at the forefront of finding new ways to tackle childhood obesity by limiting fast food outlets near schools. And transport and highways officers manage the quality of public space to make the roads safer and encourage active travel (e.g. walking and cycling). There are therefore clear benefits to public health professionals working within the same organisations as all these service deliverers.
There are also many benefits to those of us delivering these services. Public health colleagues are on hand to remind us of the interplay between lifestyle choice and quality of life, and that the purpose of all the work we are doing is to improve the wellbeing of the citizens we serve. Too often in departments such as transport, planning and licensing, statutory duties and service plan targets focus on economic and environmental concerns, allowing officers to overlook the individuals who are involved. Public health in comparison is all about improving health outcomes for individuals, particularly those known to be at risk. Social objectives are re-prioritised and more likely to be incorporated into transport, planning and climate change strategies.
The new public health teams in local authorities also have substantial information about the needs of different sectors of the population. This information can help other services appraise projects and target interventions where they will have the most impact. Such information can also support the evaluation of completed projects, supplementing the traditionally outputs-based reporting with a longer-term view of outcomes. Finally, the information and knowledge public health teams have about the communities they serve can help others in Local Authorities get to know their customers better and understand what motivates them.
Indeed, the incorporation of public health functions into local government is full of opportunities for all involved and reinforces what local government is designed to do. It is more of a return to the first principles of local governance than an introduction of a new service to deliver. After all, local government was originally formed to deal with public health issues like poor sanitation, facilities for the vulnerable, and the safe and healthy management of public spaces such as roads and parks. One could say that public health is the purpose of local government. In which case, 2013 saw Local Authorities recover their raison d’etre. Perhaps 2014 will see them make it their own.