It’s coming up to three years since Directors of Public Health and their local public health teams moved formally into local authorities.
Both before and after this transition, much progress has been made towards developing creative ways of improving public health and reducing health inequalities. Many local authorities were already active on a number of areas of sustainability or environmental improvement such as reducing waste, improving air quality, maximising energy efficiency, sustainable social care and protecting green belt or playing fields.
However, considerable challenges remain in linking these actions to improving public health at the local level.
One challenge is the increasing pressures on local government budgets (and those of its partners). Another is the difficulty in balancing activities to serve the needs of current populations alongside measures that might be vital to future generations. This can make sustainability, or environmental protection, look like an expense that can be postponed until the hard times are over.
There are two reasons why, in my view, this is not a sensible approach.
One is a negative argument; the hard times may not be over soon. Difficult choices will continue to be made both for today and for the future.
Fortunately the other argument is more positive. Many of the actions we need to take to enhance our environment (and help achieve a sustainable economy) are also good for public health and good for the health of those alive today as well as future generations. This is set out with extraordinary clarity by the second Lancet Commission on Climate Change and Health which describes its central finding as ‘tackling climate change could be the greatest global health opportunity of the 21st Century’.
Finally, as outlined in the opening sentence of PHE’s narrative on sustainability, ‘the health and wellbeing of the public, now and in the future, depends on us living within limits and developing all sustainable assets - environmentally, economically and socially’. The narrative was agreed by the Sustainability and Climate Change Programme Board in October 2015; it is intended to inform and engage PHE leadership and staff but also to be relevant and understandable to partners and the public.
So the questions are how to take forward sustainability in a time of austerity and what would help local government to grasp this challenge? There are no simple answers to this but several key steps are probably required.
- One is to secure a degree of understanding and commitment from local populations on some of the key measures, which will both protect the environment and improve public health, and which can be taken at local level.
- Another is a better set of mechanisms for firstly estimating, and secondly capturing, the wide range of benefits that would result from sustainability initiatives; such a ‘return on investment tool’ would help both in selecting priorities for local action and in auditing that the expected outcomes had been achieved.
- Finally, local councils need to feel they are not being asked to do this all on their own.
In relation to securing understanding and commitment, there are a number of ways that PHE may be able to help. We have a set of robust evidence reviews and publications which we are planning to place in a repository, initially for access by public health professionals. We realise that shorter and more accessible material will be needed for public engagement, possibly tailored to the different measures on sustainability which are under consideration locally.
Also on the evidence base, the Sustainable Development Unit (SDU), jointly supported by NHSE and PHE, has recently launched a Local Implementation Toolkit. This toolkit has four areas for action and 12 themes, covering issues such as housing, travel, food, jobs, natural environment and green space among others. This allows local authorities to identify and share good practice on sustainability.
In addition PHE has already begun work to help local authorities identify best buys for public health including the Spending and Outcomes Tool and further work on capturing return on investment.
The final challenge of joining local to national work on sustainability is one that PHE’s new Sustainability and Climate Change Programme Board will be addressing through its Implementation and Communications work-stream. In support of this the SDU and PHE will be facilitating a master-class organised by the Association of Directors of Public Health, hopefully early in 2016.. PHE is also contributing to a Sustainability and Health Special Interest Group recently established by the Faculty of Public Health. We hope from this to ensure the main priorities for sustainable practice at local level are shared with and supported by national partners and fed into national plans to protect and improve public health.
This work is particularly timely as this as the 2015 Paris Climate Conference, also known as COP 21 (the COP stands for Conference Of Parties and this is the 21st such conference), has just taken place. I am pleased to say that PHE formally endorsed the WHO call for action on Climate Change and health in advance of this conference . If we needed a reminder this makes clear that improving sustainability is not just a local challenge but a national and, indeed an international one as well.