1. Relationships with Districts Scrutiny, December 19 th 2013 Jim McManus, FFPH, CPsychol, Csci, AFBPsS, FRSPH, MCIEH Director of Public Health, Hertfordshire

2. Public Health Prevent  Promote  Protect

3. Public Health Prevent  Promote  Protect Systems thinking on wider determinants Getting everyone on the same systems page The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!) The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences) The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)

4. Public Health Prevent  Promote  Protect Conceptualising the role of Local Government in wider determinants Smoking 10% Diet/Exercise 10% Alcohol use 5% Poor sexual health 5% Health Behaviours 30% Education 10% Employment 10% Income 10% Family/Social Support 5% Community Safety 5% Socioeconomic Factors 40% Access to care 10% Quality of care 10% Clinical Care 20% Environmental Quality 5% Built Environment 5% Built Environment 10% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective. Contributors to overall health outcomes

5. Public Health Prevent  Promote  Protect PH Policy Ethos Very apparent every council in Herts is already trying to mainstream public health across its business – Consider impact of all they do on health – Local focus with an eye to the Health and Wellbeing Strategy – Develop a plan to deliver this Opportunity is to build on this

6. Public Health Prevent  Promote  Protect Towards Shared Principles Public Health might have been designed on a unitary model but we will innovate and succeed in multi-tier areas The Local Govt Family is a major asset in public health  Parishes/Towns – we need to do more  Counties and Districts cannot do public health without each other. Three tier areas can do public health with style!  Strong science, strong political leadership,  countywide approach, local focus & engagement

7. Public Health Prevent  Promote  Protect Arrangements Public Health Strategy Support and Cross-referencing with District Strategies Multi Agency Public Health Board Strategy developed with very close working Joint Health Protection Committee

8. Public Health Prevent  Promote  Protect The PH Offer to Districts Information and Analysis – locality profiles Training – – RSPH accreditation – UKPHR practitioner route E Learning Platform E Books and Journals www.hertsdirect.org/phelearnwww.hertsdirect.org/phelearn Public Health Partnerships Fund (£100k) PH Conference Delivery Partnerships

9. Just some examples of district led work....I could easily do four or more from every district.

10. Public Health Prevent  Promote  Protect Parks

11. Public Health Prevent  Promote  Protect Planning Obesity in core strategy Planning approach to Obesity – Children – Adults Whole System Obesity Pilot for Herts Sustainable Community Strategy and Core Strategy has Health Ambitions

12. Public Health Prevent  Promote  Protect People 50+ 50+ Golf Discount Card Dance Opportunities Walking for health, fun and fitness The North Herts 50+ Forum

13. Public Health Prevent  Promote  Protect Alcohol No More Project Very Chaotic Users Signposts and accompanies – Wholistic addressing of problems, food access, housing, benefits, skils.... Reduces re-offending Reduces A and E attendance

14. Public Health Prevent  Promote  Protect Whole System Approach Health Partnerships (Every district) Health Promotion Dedicated Staff Time/People Each district has a Strategy Just four Examples – Bereaved Men (E Herts) – Leisure Access (Welwyn Hatfield) – Young People and Mental Health (St Albans) – Older People, Long term conditions leisure/ decent homes standard (Dacorum)

15. Public Health Prevent  Promote  Protect Strategic Focus South Oxhey Area of Significant Deprivation Joint Working between two councils Assessment of Need Development of local strategy Focus of whole council services Asian Women Premature Mortality in Watford

16. Public Health Prevent  Promote  Protect Thank you! Jim.mcmanus@hertfordshire.gov.uk Public Health Service Pages http://www.hertsdirect.org/your-council/hcc/publichealth/ Health in Herts Portal http://www.hertsdirect.org/services/healthsoc/healthherts/