The government's consultation on the green paper Our Healthier Nation has been vaunted as a 'listening exercise'.
So it was unfortunate that when public health minister Tessa Jowell spoke to the Association for Public Health's annual conference in Lancaster last week, she appeared not in person but on a live video link from Richmond House. Technical gremlins meant that at first delegates could either listen to her and not be heard themselves or question her but not hear her replies.
But once audible and able to take questions, Ms Jowell said that when the white paper is published in the autumn there will be 'a number of areas' in which she expects it to be different from the green paper, 'and not just in emphasis', she added, stressing the importance of the consultation process.
Rita Stringfellow, chair of the Local Government Association's social affairs and health committee and leader of North Tyneside council, also pointed out that the green paper 'recognises that the strength and effectiveness of partnership in driving local action is key to determining success'. Local government's 'pivotal role' in the health of local populations was recognised in the green paper in a way that it had not been for many years, she added.
Effort going on in local government included auditing health and regeneration projects, improving older people's take-up of income support and work with the Food Alliance to improve people's access to healthy food at a reasonable price. This all underpinned local government's role in tackling health inequalities, Cllr Stringfellow said.
Its contribution to the government's wider agenda included its role in education action zones, employment action zones and the commitment to regeneration, as well as work on healthy schools, workplaces and neighbourhoods. This would have 'a significant cumulative effect' on the health of local communities, she said.
But much needed to be done to maintain relationships with local people, she stressed. 'Local people must feel all agencies are working together to meet their needs and to respond to locally set and agreed priorities.' Too many previous health campaigns had sought universal solutions to local problems. 'Local government, together with its partners, can deliver these local solutions and the green paper gives us the flexibility and scope.'
Robert Hughes, president of the Society of Local Authority Chief Executives, believed that tackling the public health agenda was 'one of the most important things many of us will do in our career'.
He urged local government and the NHS to work together. 'We need our friends in the NHS and they need us.'
With the first 10 health action zones set to roll, Tim Sands from the NHS Executive's HAZ policy team told delegates what was looked for in the bids:
vision, a real sense of the longer term, evidence of genuine partnerships, and assessment of service development priorities and health needs priorities.
Most of the 41 bids received were based on the core local authority/health authority partnership, but 'a broadening and a deepening of stakeholders' involvement' was sought, said Mr Sands. The bids had largely been policy handed down for consultation and had been developed without much involvement from front-line staff and the public.
The second wave of HAZs would follow quickly 'as soon as we have digested the lessons', Mr Sands promised. A HAZ information website was also likely.
Lionel Joyce, chief executive of Newcastle City Health trust, asked whether delegates believed the NHS had a part to play in urban regeneration. 'If wealth equals health the answer has to be yes, ' he said. He explained that when his trust put£1.5m into building a GP centre in a deprived part of Newcastle it had attracted a supermarket and a betting shop chain to the same area, creating more than 50 jobs.
'We had a real, if small, impact on the wealth of the area, ' he claimed. 'It is in the overwhelming interest of the NHS to attract jobs to deprived areas. It affects the general level of employment and health dramatically and immediately.'
Everybody needs good neighbours. . .
The notion of 'social capital' was in vogue, with much rhetoric about its use in tackling public health inequalities, according to Pamela Gillies, professor of public health at Nottingham University and research director of the Health Education Authority.
She said social capital was 'social trust in others and social services, organisations and institutions'. It worked best in egalitarian societies with horizontal, rather than hierarchical networks for exchanging information, ideas and practical help.
Networks could be formal, such as school or church or leisure activities, or informal, such as childcare among neighbours and friends.
Studies in the US and Italy have linked social capital with fewer infant deaths and longer life, said Professor Gillies. Work in Glasgow had also shown that in friendly neighbourhoods with lots of community organisations and a positive social life people showed more interest in health.
Research by the London School of Economics and the HEA in Luton had also suggested that high levels of social capital in neighbourhoods made other public health initives more likely to be effective, she added, although this needed more investigation.
She concluded that social capital was worth developing as a theory which could explain some of the ways health inequalities could be reduced.
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