A case study

The conditions in which we live, work and age have a profound influence on our health and on health inequalities. That’s why we’ve been taking a Health in all Policies approach as the Public Health team at Tonbridge and Malling Borough Council.

What is a Health in all Policies approach?

Housing, education, leisure and the environment are just some of the factors influencing health, but each is usually the responsibility of a different local authority department and health isn’t always an obvious priority for them.

That’s where Health in All Policies comes in1. We work collaboratively with departments across the local authority to encourage them to take health considerations into account when making decisions, for example encouraging them to think about the potential benefits and risks to health when considering a new policy.

The challenges: 

Major challenges have been a lack of funding and resources, as budgets have diminished year on year; the time required to build and sustain working relationships across the local authority; and more recently, the impact of COVID-19. 

An example of resource constraints has been sourcing cost effective venues at the heart of the community to deliver our weight loss programmes. Due to competing needs/budgets this hasn’t been easy and at times has resulted in unsuitable venues being used, resulting in poor uptake.

Developing and sustaining collaborative relationships has also sometimes been a challenge.

Successes:

Working with district councils: This has been one of our most successful partnerships, delivering and implementing the One You Kent service2. We currently work with Sevenoaks, Maidstone, Tunbridge Wells and Dartford district councils. This has provided greater local collaboration on service design and delivery. For example, a resident who lives in Tonbridge but works in Tunbridge Wells can access the support of their One You Lifestyle Advisor closer to work, helping to reduce barriers to public health. Partnering with other district councils has also provided the opportunity to reach more people within the community, working together at community-based events.

Intersectional collaboration: The Health Operational Steering Group was set up to initiate conversations and share our ideas with other areas/departments not usually associated with health issues, such as leisure, planning, licensing and housing. The plan is to make health everyone’s business. Before the pandemic we had started to make progress, such as providing making every contact count training for all reception staff at the council offices, linking with leisure services and setting up events such as children’s centre buggy walks and walk a park run events, promotion of the One You healthy lifestyle services to all housing tenants and providing NHS Health Checks for all taxi drivers, working with the licensing department.

We hope that once things return to normal, we will be able to rebuild this collaboration, especially now that health inequalities have been brought to the forefront again following the pandemic.

Working with GP Practices, Leisure Centres and community venues

We have worked hard to engage with local GP practices, leisure centres and community venues to enable free use of their facilities for our weight loss programmes - attending GP advisory groups and having one to one discussion with leisure centres and community venues, to highlight the benefits of partnership. This took time to achieve but as a result, just before we entered the first lockdown, we had been providing weight loss programmes at three different venues. Unfortunately, due to the pandemic our weight loss groups stopped almost overnight, leaving clients initially unsupported. Since then, we have worked extremely hard to provide online weight loss programmes and one to one support, resulting in four successful online programmes for over sixty overweight/obese residents, 42% of whom have lost weight. As a team we are very much looking forward to resuming face to face programmes. The success of the online programmes will hopefully enable us to offer both options to our residents and reach a larger target audience.

Conclusions

Already before the pandemic improvements in life expectancy had started to stall for the first time in many years, leading to growing recognition of the significance of maintaining people’s health and reducing health inequalities. Now more than ever we know this cannot be achieved by the health system alone. Health needs to be everyone’s business. A health in all policies approach can help make this a reality.

Sally Leach

 

This article was first published on the Royal Society for Public Health website.

 

References 

1. Health in all policies: a manual for local government Local Government Association (2016) https://local.gov.uk/health-all-policies-manual-local-government 

2. One You Kent Service https://www.kentcht.nhs.uk/service/one-you-kent/