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Agenda item

Director of Public Health Report for Sheffield 2014

To receive a presentation by Dr. Jeremy Wight, Director of Public Health, on his annual report for 2014 on the health of the people of Sheffield.


A background report is attached.  Electronic versions of the Director’s Annual Report and a Summary Report have been published with this agenda, and a copy of the Summary Report will be provided to all Members of the Council prior to the meeting.



The Director of Public Health, Dr Jeremy Wight, presented the Director of Public Health Annual Report for Sheffield 2014 ‘Climate Change and Health’. Dr Wight outlined health indicators for 2009-10 and 2010-12 in Sheffield and the comparative data for England, including in relation to life expectancy, early deaths from heart disease, strokes and cancer, infant deaths and injuries and deaths caused by road traffic accidents. He also illustrated inequality in life expectancy for women and men.




The report focussed upon climate change as the biggest public health challenge of the twenty-first century which could potentially threaten all of the core determinants of a healthy life such as clean water supplies, adequate, healthy food supplies, shelter and norms of social behaviour in a civilised society. Climatic changes caused by the emission of greenhouse gases could lead to an increase in global temperatures of 2 degrees Celsius by 2050. The potential effects of hotter drier summers and milder and wetter winters on public health were outlined, which included heat related deaths, winter deaths from severe cold, psychological effects of flooding and disruption of food supplies, amongst others. The impact would be greatest on the most vulnerable people.




In responding to climate change, the report asserted that adaptation was required to manage the unavoidable; and mitigation to avoid the unmanageable. Actions which helped to adapt or mitigate in relation to climate change might also have health benefits. Such actions were to insulate homes, plan for extreme weather, reduce meat consumption and active, not motorised, transport.




Recommendations were proposed in response to following issues:




-        Active Travel


-        Reduce Meat Consumption


-        Warmer Homes


-        Strengthen the Local Economy


-        Develop a Low Carbon Health and Social Care Economy


-        Prepare for Extreme Weather Events


-        Design Healthy Urban Spaces and Places




Members of the Council asked questions and raised issues in relation to the Director of Public Health’s Annual Report, a summary of which is outlined below:-








Global warming was the subject of some contradictory evidence and was an issue which received national and international attention. In Sheffield, there were particular local concerns about people’s health and the effect on health of deprivation in areas such as Firth Park, which was the second most deprived ward in the City. Conditions were considered to be worsening as a result of Government policy. Mental health was also of concern. Whilst the Report’s recommendations addressed a reduction in meat consumption, in reality, there were days on which some people did not eat a meal.




Whilst the conclusions contained in the report might be agreed with, there were some areas of disagreement. Globalisation, according to the report, had a tendency to lead to increased inequalities. Contrary to this assertion, globalisation might be said to lift people out of poverty through the ability to trade. The focus of the report on climate change meant that a wider view had been taken of public health, when it may have been better to take a narrower one.




It was important to identify the link between climate change and health and solutions to issues relating to climate change could also contribute to better health. There was a recommendation to increase the number of 20mph zones, although an objective should be to move to 20mph zones throughout Sheffield. Whilst the recommendation concerning food concentrated on the NHS, it was also important to make the City more self-sufficient in locally grown food, which was less expensive.








Dr Wight responded that he agreed that macro policy and reductions in welfare would have a potentially adverse effect on the health of those people who were affected. However, whilst the Annual Report could have focussed upon that issue, it was something on which the Reports had focussed in previous years. Whilst the Director of Public Health was in a privileged position to write with a degree of independence, it was also necessary to say something different and challenging. It was accepted that many people’s circumstances were not beneficial to good health. It was also the Council’s responsibility to look forward to an environment that it wished to leave for people in the future. 




A broad view was taken on the wider social causes of ill health. The recommendation concerning 20mph zones could be further refined and he accepted that the greater number of 20mph zones there where, the better. Greater self-sufficiency in relation to food production might mean that peoples’ gardens, allotments and local farms were better utilised and people were encouraged to purchase locally produced food.








Some people did not have the luxury of reducing their consumption of meat or growing their own food. The City should look at what could be done to help people who used food banks and increase the amount of fruit and vegetables that people ate.




Whilst it was agreed that climate change was an important subject, the Annual Report might have provided comment on what was happening in Sheffield, including progress concerning existing strategies, for example smoking cessation programmes, the increase of liver disease and the teenage pregnancy strategy.




Some policy and environmental issues were not necessarily in the gift of the Council and given the limited resources available, consideration should be given to where the Council should focus effort in terms of improving public health.








Dr Wight stated that some of the public health grant had been used to give advice to people who were using food banks. The City’s food strategy included an aim of increasing the production and uptake of fresh food. A written update on public health programmes would be provided separately to Members of the Council.




Dr Wight said that one consequence of climate change was the acidification of the sea and the effect on fish. Increased levels of carbon dioxide in the atmosphere had a detrimental effect on fish stocks. In relation to obesity, this was the result of physical inactivity and poor diet. Obesity resulted in between 500 and 800 deaths each year. He stated that it was part of a Director of Public Health’s role to identify future public health problems and whilst climate change might not kill people now, if no action was taken, the prospects for the future were bleak.








There was gap in life expectancy between the area of Wincobank and Dore and Totley, which had not decreased. Public health issues included child mortality, mental health, teenage pregnancy and drug abuse and research had shown that some of these problems were being made worse by government policy. Older people were affected by poor mental health and children had been affected by the closure of Surestart provision. A unified approach was required to address the gap and the transfer of public health to the Council was expected to bring about change.




Air pollution was significant issue affecting people’s health. A question was asked as the extent to which air pollution resulted from the railways.




The report referred to an estimated 580 deaths a year, which could be prevented if diets complied with national nutritional guidelines. Food banks were a relatively recent thing and in one area, young people were attending youth provision which also provided something for them to eat.








Dr Wight stated that he agreed that the health inequalities which existed were a disgrace and reflected people’s life opportunities and consequent lifestyles. There were a number of previous Annual Reports which had focussed upon those inequalities. A Health Inequalities Action Plan had been produced by the Health and Wellbeing Board and was being implemented.  He said that he would look at the issue of the proportion of air pollution which was due to the railways.




The occurrence of food poverty and need for food banks was of great concern and an indictment of society. Everything would be done to address the issue of food poverty and the Council had implemented advice services for people using foodbanks. 








The Council’s focus was to address the health inequalities in the City. However, people may lose sight of issues relating to climate change as they did not appear to be as immediate and it was also important that this was also brought to people’s attention. The Council might consider what it could ask the Government to do in relation to climate change and also consider how to inform people and change behaviours.




Whilst the general thrust of the report might be accepted, there could have been more attention given to Sheffield. The reliability of some data in report may be open to argument. For example, the assertion that only 25 per cent of adults in Sheffield eat five more portions of fruit or vegetables a day. In hospital, people were offered a variety of food to encourage them to eat. Targets should be produced for the recommendations in the report and thought should be given as to how the progress of the recommendations could be monitored.   




A question was asked as to whether the recommendation about integrating adaptation principles into the local planning framework includes transport planning, including walking and cycling?








Dr Wight stated that the Government should make more efforts to securing international agreement to reductions in carbon emissions. People could be informed and educated to help make changes and it was important for them to understand the rationale for change. This could be supplemented with legislation or environmental changes that helped to bring about behavioural change.




The transport system could be engineered so that public transport takes priority over private transport and walking and cycling take priority over both.




The assertion that 25 percent of adults obtained 5 portions of fruit and vegetables per day was based on self-reported figures and there was a tendency for people to overstate what was perceived to be a “good” answer. However, the same method was used throughout the country, so the results could be compared. There was no reason why hospitals could not decide to have a meat-free day each week.




Recommendations from previous annual reports had accumulated over time and an audit of them could be done. A report back on previous year’s recommendations was made in each subsequent annual report. 








Questions were asked as follows: Where was life expectancy improving? Would it have been possible to produce a report on climate change and health jointly with other Directors of Public Health?




There was a connection between prevention and public health, for example improving the standard of housing to bring about health improvement.




The Council was working with cycling groups to help encourage cycling activity. The Council also had a responsibility to promote journeys by bus, tram and train and investment in such transport infrastructure needed to be balanced with other modes of transport including cycling. Many people were not necessarily able to cycle. Public transport was also vital in providing access to employment. People also walked between different modes of transport, of which London was a good example. Air quality was a particular concern. A multi-modal approach had been adopted to shift journeys away from the car. Action could also be taken in relation to the economy and low carbon sector. Nuclear energy was carbon free and the engineering industry in the City might contribute to that sector.   




There were financial implications within some of the proposed recommendations and these might mean that resources would need to be diverted from another service or area of expenditure.








Dr Wight stated that life expectancy was increasing across the City but the gap between certain geographical areas was not reducing. He confirmed that he would have liked to have produced a report jointly with other Directors of Public Health.




He agreed that public transport use should be encouraged both in respect of being more active and in improving the economy and confirmed that by ‘motorised transport’ was meant private motorised transport.




With regard to nuclear power, continuing to rely on fossil fuels was environmentally dangerous and a mix was required of methods of energy generation. There were though clearly different opinions in relation to nuclear energy.




The report was about climate change and health, which was a subject, the impact of which we would all experience and therefore had a wide audience. It was the most disadvantaged who would potentially suffer most as a consequence of climate change. The recommendations had not been explicitly costed. However, it would not necessarily cost hospitals more to implement a meat-free day each week. It was accepted that some of the recommendations would have financial implications.








It was considered that the recommendations would benefit from SMART (to mean Specific, Measurable, Assignable, Realistic and Time –related) targets. A question was asked as to how the recommendation “Sheffield People Should” might be measured.




The report highlighted an important challenge which the world faces but it was important to know how this would affect the people of Sheffield. The recession, budget cuts and cost of living were all factors which had affected people. 23 per cent of children in Sheffield were living in poverty, compared to a national average of 18 per cent. The Institute of Fiscal Studies had predicted that, by 2020, some 33 percent of children would be living in poverty. Safeguarding was something that the Council undertook for the future of the City’s children. Poverty affected parenting, housing, food and aspects of a child’s cognitive development. Poverty and unemployment were the biggest challenges to the City and the Director of Public Health Annual Report was a potential source of evidence by which the Council could focus its strategy. 




Questions were asked as to whether the priorities from the last year’s Annual Report were completed and if funding would be directed to address them; and whether it was considered that climate change was the biggest public health challenge in Sheffield at this time.




Were there aspects of recommendations from previous reports of the Director of Public Health and those relating to climate change and health which could be interwoven? There was, for example, a link between the amount of money that people had to spend on fresh fruit and vegetables and reductions in their income, employment and poverty. A question was asked as to the challenges and threats arising from the devolution of decision making to a City Region.








Dr Wight acknowledged that the recommendations as set out in the report were not compliant with the SMART approach. They were broad recommendations and did not comprise an action plan. He commented that holding the people of Sheffield to account was challenging.




He agreed that the best start in life for children was very important and work had been carried out in this area in preparation for the bid to the Lottery Fund. Everything possible had to be done to give children the best start in life but it was also our duty to seek to ensure that the environment they will live in as adults was conducive to a civilised society.




The priorities which had been set out in the previous year’s Annual Report still remained. Climate change was the most important public health issue “of this century” and not the immediate ‘here and now’. It was the definitive public health issue of this century. Nonetheless, poverty remains a fundamental public health problem.




Dr Wight said that if powers were devolved to a City Region level, they could be used to help structure the economy and get people out of poverty. At the same time, powers which might become available could improve resilience to climate change.








Some recommendations related to problems which the Council was already seeking to address, such as 20mph zones, fuel poverty and flooding. A report on the impact of the Government’s welfare reforms could be something that should be sent to Government.




There was a high incidence of diabetes amongst Asian people and this had not improved over time and been the subject of a study in Sharrow but was also true in other areas. This was of particular concern because diabetes may lead to other illness including a heart attack or stroke.




The recently established Green Commission for Sheffield was considering issues which were also outlined in the Director of Public Health Annual Report.




A question was asked as to the priority being given to the problem of young people becoming addicted to ‘legal highs’ which might harm young people and their family relationships.








Dr Wight responded that the impact of welfare reforms upon the health of those affected was negative and the Faculty of Public Health had collectively expressed such a view. He confirmed that he would also seek to ensure that the Government was aware of the adverse impact on health of its programme of welfare reform.




He said that people who were more physically active could reduce the risk of diabetes. There was also a more specific community wellbeing programme in Sharrow which was designed to work with particular communities, including people in the Asian community, and develop links with other programmes.




Dr Wight stated that legal highs were the subject of a public health programme and there was a team in the Council’s Children, Young People and Families portfolio which commissioned services to deal with substance misuse which was looking at the problem of legal highs, whereas other public health issues such as smoking, physical inactivity and poor air quality cause many hundreds of deaths per year, so it needed to be treated proportionately.








From a global perspective, climate change was potentially the biggest issue facing the world’s poor but health inequalities was the issue of immediate concern in Sheffield. Whilst there were a number of recommendations with which one might agree and upon which the Council was already taking action, the recommendation concerning the implementation of a meat-free day each week was problematic. This had been attempted in Brighton, for example, and it had not been successful. There was also concern in relation to the cost of the proposals within the recommendations.




There were some recommendations in the 2013 Report which were not included in the 2014 report, including those relating to tobacco, obesity and diabetes.




There was the question of what the Council was able to achieve and the immediate issues it faced relating to health included whether people had enough to eat. Legal highs were of concern to parents and Members received casework relating to that issue.  








Dr Wight responded that he accepted that much work had been done on some of the issues which his report had highlighted. There were, for instance, less winter deaths in Sheffield than in other cities due to the effective insulation of homes. In relation to the recommendation concerning eating less meat, he said that he would like to think that Sheffield would go about such a change in the right way, by setting an objective, consultation and talking with those people who were likely to be affected. Whilst the recommendations were not costed in the Report, there would be a further step in the process to do that. Some would be at no cost or bring about a cost saving. There may not be a need to stop doing something else in order to afford to fund the activity in the recommendations. It was a choice to write about climate change and public health, which was an opportunity to put a different perspective on public health.








Climate change was a serious issue and it was disappointing that the driving force behind change had been missed, which was that an individual’s life circumstances impacted upon their capacity to change. People’s needs were to be warm, fed and safe. The problem of health inequalities might have been more clearly linked to climate change. Inequalities might serve to prevent people from taking an active part in helping to solve climate change.




A report had been published, which was entitled Due North and which examined health equity in the north. The Health and Wellbeing Board had considered issues highlighted within that report and there was a corresponding action plan.




Climate change was an important issue, especially for the future health of the population and it was hoped that a report would be made concerning the progress on the recommendations.








Dr Wight stated that people’s immediate concerns would determine how they behaved. There were links between climate change and health and practical things that could be done to help with regard to both. He commented that he had submitted the Due North Report to the Health and Wellbeing Board. He hoped that the recommendations could be taken forward. 




The Lord Mayor, on behalf of the Council, thanked Dr Wight for presenting the Director of Public Health Annual Report to Council.


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