Agenda item

The Council received a presentation by the Interim Director of Public Health, Stephen Horsley, concerning the Director of Public Health Annual Report 2015, entitled Transforming Public Health.

The Annual Report provided a profile of health and wellbeing in Sheffield and reviewed how Sheffield compared to other core cities and the rest of England. It identified areas for improvement. Examples were provided of how Council resources as a whole were being used to achieve the City’s aspiration of improving health and wellbeing in Sheffield to be amongst the best in England. The report described a number of priorities for action during the next 12 months and made a further three recommendations to improve the health of the local population.

National indicators produced by Public Health England were used to provide a detailed picture of how long people live and how healthy they were in comparison with other core cities and the England average.

Life expectancy was improving and the gender gap was narrowing. For women, average life expectancy at birth (2011-13) was 82.4 years and for men it was 78.8 years. However, life expectancy in Sheffield fell short of the England average of 83.1 and 79.4 years respectively but it was amongst the best of the major cities in England. Inequality in life expectancy between the most and least deprived (women and men) remained unchanged in the last ten years.

The presentation looked at the wider determinants of health, which were social-economic factors which influenced health and which included poverty, employment, environment, housing and crime and safety. Improvement was required in areas including child poverty, school readiness, pupil absence, 16 to18 year olds not in education, employment or training, violent crime and fuel poverty.

The presentation outlined areas of health improvement or healthy lifestyle choices and mental wellbeing including teenage conceptions, where the City had seen a sustained reduction in the rate of conceptions in girls aged under 18 years, although it remained higher than the national average.

In relation to health protection, the incidence of Tuberculosis in Sheffield had increased and was higher than the England average. Sheffield was seeking to develop a Tuberculosis screening programme.

The rate of premature mortality from cancer at 159.9 per 100,000 population in 2011-13 was significantly higher than the national average of 144.4 per 100,000. Approximately 58% of those deaths were considered to be preventable, either by changes in lifestyle or screening programmes and early detection and treatment.

A number of public health programmes and initiatives were identified, which it was believed had the potential to transform health and wellbeing in Sheffield and for which there was evidence that a local authority can have a major impact on the population’s health. Detailed priorities for action were provided within the following broad areas:  

-        More children ready for learning and life

-        Improved mental and emotional wellbeing

-        Better housing conditions

-        Tackling the underlying causes of health inequalities

-        Helping people who face barriers to get a job

-        Maintaining a healthy weight throughout life

Stephen Horsley concluded by setting out the following three recommendations:

-        The Health and Wellbeing Board should establish a local baseline measure of wellbeing for the City and use this to track change over time and variation across the different communities in Sheffield

-        The Council should provide products which assist residents to reduce the cost of their home energy and the amount they use 

-        The Health and Wellbeing Board should ensure schools in Sheffield give all children the opportunity to participate in appropriate exercise. 

Members of the Council asked questions and commented upon issues raised by the Director of Public Health’s Annual Report and presentation.

Question

Is there evidence that what was being done in relation to obesity was working and do we need to be doing more or implementing other initiatives; and how might physical activity be built into people’s lives.

Answer

There was evidence to suggest that some programmes relating to reducing obesity worked effectively, but this was not the case for all existing programmes. The public health review, which was being undertaken at present, would give consideration to alternative initiatives or programmes. There was evidence that sufficient exercise at age 45 to 60 may result in increased mobility later in life at age 60 to 70 and also improved people’s quality of life.

Question

There was pressure on people to eat the wrong type of foods, but also pressure to be thin, which might have a negative effect on a person’s self -image and mental wellbeing and it could be that someone of a certain weight was healthy at that weight.   

Answer

Attention should also be given to people who were underweight.  There were a number of health conditions associated with being obese or overweight, including diabetes and obesity was a significant problem in the adult and child population. Nearly 60% of the adult population were overweight or obese. People needed to be supported to live healthy lifestyles or lose weight.

Question

In relation to obesity, was enough being done to influence national policy and what more could be done to provide people with advice on foods which were bad for them? Reference was made to the idea of a tax on sugar.

Answer

It was the responsibility of the public sector to influence others and many things associated with healthier lifestyles were not necessarily expensive. For instance, it cost less to stop smoking and to eat less or consume less alcohol. Some forms of exercise could also be free. It was possible to build upon work already being done in communities and alternative approaches would also be considered.

Question

How much Public Health funding is spent on prevention and what level of shift in the allocation of such spend would be desirable?

Answer

The public health budget had moved from the former Primary Care Trusts to local authorities and this included a number of treatment elements, such as sexual health. The budget was divided approximately equally between prevention and treatment. Ideally, a greater proportion would be spent on prevention. However, the Council also used other components of its budget in ways which supported health and wellbeing and contributed to prevention, such as the City’s parks and swimming facilities. There was a need to look at preventative work to ascertain that it was effective.

Question

What might the Council do to influence national government to change legislation in relation to things such as the obesogenic environment and other policy levers that can really help people to change behaviours relating to diet and smoking, for example.

Answer

Legislative change was required as regards the prevalence of smoking. There might be reluctance to apply a tax to foods containing sugar and there were also commercial pressures to consider. Directors of Public Health and Public Health England were in a position to engage government to bring about support for change and there were also things which could be done locally.

Question

What was the extent of confidence that the Community Wellbeing Programme and others were supporting the most vulnerable people, for example older people; and in relation to GP Practice Champions, was this proving successful?

Answer

Work had been done in Sheffield communities and GPs attended community meetings and there might be an extension of such practice. However, it was not certain that all vulnerable people were being supported at a neighbourhood level. There was also evidence that the act of volunteering was good for people’s health and wellbeing and it was desirable to increase volunteering activity in communities. GPs wished to have more Health Champions. The Community Wellbeing Programme was a good base, upon which to build and local Councillors also had an important role to play in local areas as community leaders. 

Question

With regards young people’s mental health, which was affected by factors including economic austerity and poverty, how might young people be encouraged to participate in community development and actively engage in volunteering?

Answer

The Council was working on a project jointly with the Department of Work and Pensions to help people and especially those who were long term unemployed, into work and such activity could be resourced and built into community programmes.

Question

Despite reductions in some areas, inequalities in health were not really changing. How will the outcomes of programmes and initiatives be measured to make sure these were effective and were having impact and can there be greater precision in relation to measuring and targeting?

Answer

There had been targeting of activity, for example, stop smoking programmes had been targeted at manual workers and pregnant women. There was also a significant counter effort to encourage people to smoke. Particular wards in the City had also been targeted in relation to smoking cessation. However, the City had not been as successful in reducing health inequalities as people may have liked and there was a similar national trend. There was a need to examine in what ways the public health budget linked to other areas of the Council’s work.

Question

Was there evidence of the effects of poverty and inequality on early life and related implications of the welfare reforms and would it be possible to produce a half-yearly progress report on the action plan?

Answer

Reductions in the available resources affected all aspects of the Council’s work and the effects of budget cuts would need to be monitored. Progress reports on actions would be provided to Members. There was useful information at ward level in relation to smoking, obesity and alcohol and further information could be provided for Members, who could play a vital role in their respective wards.

Question

Was there evidence about the amount of time children and young people spend on computer games at the expense of physical activity and the relationship this may have with weight and health. The cost of some gym memberships was also high, whilst it was acknowledged that Activity Sheffield was doing a very good job.

Answer

The increased use of computers or similar devices and the effect on physical activity was something which could be examined.

Question

Average life expectancy continued to follow the national trend of increase. How might improvements continue? The number of children walking to school was low, and was something which might be investigated.

Answer

The public health review was in progress and this would look at whether resources were being used in the best way possible. It was important that the Council and the Clinical Commissioning Group develop a joint strategy in order to tackle issues together. The Clinical Commissioning Group wished to review how it interacted with the City Council. It was necessary to concentrate on a smaller number of initiatives to improve people’s health and wellbeing. There were actions that the Council might take which would help improve health and wellbeing by introducing bylaws, encouraging walking to school and reducing parking around schools and in other areas such as licensing.

Question

Some school based programmes such as sports coaches had ceased in recent years. In terms of changing lifestyle choices and behaviours, there could be a greater emphasis on children and young people, especially in terms of exercise in the school curriculum and this could be followed through by Ofsted. There were still marked inequalities between areas of the City.

Answer

There were contrasts in health and wellbeing between different areas of Sheffield. Much had been done in relation to giving children a better start. There was evidence of successful outcomes if certain actions were taken with regard to children at an early age and the Council would need to examine whether resources should be used to support children earlier in their lives.

Question

What was happening in relation to young people’s mental and emotional health and what was the effect of government cuts? There were particular issues regarding the health of people in black and minority ethnic communities.

Answer

Particular strategic areas would be examined, but together with the circumstances for the whole City. The Council tried to make sure that children had access to services for their health and more could be done specifically regarding mental health and emotional wellbeing. 

The Lord Mayor, on behalf of the Council, thanked Stephen Horsley for presenting his report and for answering Members’ questions.