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Agenda item

Director of Public Health Report for Sheffield (2016)

To receive a presentation by Greg Fell, Director of Public Health, on his annual report for 2016 on the health of the people of Sheffield.


A background report is attached. A copy of the Director’s Annual Report is also attached for Members of the Council, and an electronic version of the Annual Report has been published with this agenda.



RESOLVED: On the motion of the Lord Mayor (Councillor Denise Fox)  and seconded by Councillor Peter Rippon, that, in accordance with Council Procedure Rule 9.1, the order of business as published on the Council Summons be altered and Agenda Item 9 – Director of Public Health Report for Sheffield (2016) be taken as the next item of business.




The Council received a presentation by Greg Fell, the Director of Public Health, concerning the Director of Public Health Annual Report 2016: A Matter of Life and Healthy Life. The Annual Report examined how improvements in health and wellbeing and reductions in health inequalities could be maximised by capturing the impact of work across the whole Council and its partners.




In his presentation, Greg Fell outlined trends relating to population, health and causes of illness and mortality and the factors contributing to health. The presentation also covered prevention and the importance of the best start for children in their early years. He outlined factors which would create the environment to enable people to live well, including active travel, self-care, employment and planning and development of neighbourhoods. He also considered ageing and chronic conditions and presented some challenges to change the way people thought about health and wellbeing.




Mr Fell outlined four key recommendations, made in the Annual Report, as follows:-




1.          The Health and Wellbeing Board should take forward a series of learning events / appreciative enquiry on different approaches to health and wellbeing to explore what optimising “health and wellbeing” could look like in a number of key policy areas.



2.          The Council and other stakeholders, as part of Public Sector Reform, should consider a healthy population and minimising health inequalities as a core infrastructure investment for a prosperous economy.



3.          The Council and the Clinical Commissioning Group (CCG) should explore the development of a ‘Heart of Sheffield’ structural model to coordinate and shape a policy approach to improving living well options (such as increasing physical activity and reducing smoking) in the City.


4.          The Council and the CCG should develop a joint neighbourhood delivery system with a broad model of primary care as the main delivery mechanism for services.




Members of the Council asked questions and commented upon issues raised by the Director of Public Health’s Annual Report and presentation and these, together with the responses to them, are summarised below:




In relation to the continuing problem of health inequalities, Members were informed that Sheffield was not unique in that health inequalities were a persistent issue and the situation was not improving. This was clearly not acceptable, and the Sheffield Health and Wellbeing Board was taking a new approach to health inequalities. 




Responding to a comment about the availability of public health data, there was a considerable amount of such data available on the Council’s website and this could also be presented for a particular ward or neighbourhood.




In connection with a question about the engagement with the City’s Walking Forum, Greg Fell said that he would like to discuss further the involvement of public health and the Council.




A question was asked about the contribution of mental ill health and premature death and Mr Fell responded that there was a well established evidence base concerning the positive effect of prevention in relation to health. With regard to austerity, mental health and suicide rates, the numbers relating to suicide were relatively small and the main reasons for premature death were cardiovascular diseases and cancer. However, there was a link between mental health and life expectancy and often, the physical health of people with mental health conditions was neglected.




In relation to a question about the debate concerning the impact of migration on health and health services, people that came to the UK tended to be younger and healthier, although that was not always the case.




In response to a question concerning the use of data and individual case studies, Mr Fell stated that both the use of data and case study material were important and data alone could not explain why something was occurring. In connection with a further question relating to knowledge and education regarding life choices in helping to improve health and quality of life, it was considered that, in school, children and young people were quite well informed about health. Children and adults had choices in the environment in which they lived and that environment might also affect those choices. There was a focus on children in early years and helping children to make the best start in life.




A comment was made about the importance of personal confidence and the impact of better engagement and of neighbourhoods working collectively to help bring about improvement and change.  Responding to this point, Greg Fell said that there was a vibrant voluntary sector in Sheffield. There was also a question of how best to access social capital to bring about change and this was something which required further consideration.




It was stated that Sheffield had a significant potential because of its physical assets including proximity to the Peak District and work in relation to the Outdoor City. A question was put as to how effective criteria might be established which allowed an assessment of creative investment and likely health outcomes. Mr Fell stated that as regards creative investment in health and the effect of physical assets such as parks and woodlands and the potential return on investment for the population’s health, one might look, for example, at issues including air quality and the potential for physical activity including walking. It was not immediately clear how this could be incorporated into routine use and decision making.




A question was asked concerning the relationship between an ageing population and increasing care costs and preventive approaches, including children walking to school. In response to the latter, Members were informed that the Council funded a range of activity relating to children walking to school. As regards the issue of an ageing population, it was clear that increasing costs of health and social care related to proximity to death and particularly the final 18 months of a person’s life. That was true whether somebody was 55 or 95 years of age. It was about how poorly that person was and not how old they were and some health conditions were preventable.




In relation to obesity and the prevalence of diabetes, obesity in children had levelled off, but it had not improved. Diabetes was an important health condition to consider in connection with future costs. Much was due to lifestyle choices, some of which were within people’s control and others were not.




There was potential with the development of the Housing Plus service, to collect data relating to the health of the population and it was most important to consider what was happening in a community and which might impact on the population’s health. There were things that could be done locally to encourage people to use their local park, for example, and voluntary groups had a significant potential role in encouraging involvement and participation and in supporting people.




Responding to a number of points, Mr Fell stated the private sector was not generally well engaged in the health debate at this point in time and this needed to be looked at. In relation to social capital and community resilience, it was clearly important, but it was not known how exactly it might be measured.




In responding to a question concerning the determining factors relating to the gap in life expectancy between different areas of the City, Mr Fell explained that when people became more affluent, then tended to move to a more affluent area of the City. In the long term, the factors which would address the gap in life expectancy were housing, primary education and primary care, by which he included community services and General Practice. More immediately and in the short term, actions might include GPs identifying diseases such as cancer at an early stage.




In relation to the consideration of public health in decision making, evidence was important and the implications for public health could be taken into account in connection with matters which were both big and small. There were times when the Council had to consider budget cuts which led to difficult decisions. However, this could include or lead to a decision to invest in something which improved health. Public health had to be considered as part of the totality of available resources and expenditure, be that in primary schools, parks or cycle lanes.




RESOLVED: That this Council notes the information contained in the Director of Public Health’s report, expresses support for the four recommendations outlined in the report for improving the health of the local population, and thanks him for his presentation.





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