Embedding Health & Health Equity across Local Government : The Hertfordshire experience Cllr Teresa Heritage Executive Member, Public Health and Localism Jim McManus Director of Public Health, LGA / ADPH Public Health Conference 11 February 2015

Three tier area 1 County, 10 Districts/Boroughs, 130 Parishes 1.2m people, 37 settlements Cannot do Public Health without Districts Public Health Strategy embeds corporate ambitions for HCC and ambitions shared across Hertfordshire Partners Public Health Facing Three ways –Programme of support to NHS, Districts and to County Depts –PH and Localism Portfolio

Unhealthy Housing Morbidity and mortality : High morbidity and mortality rates are observed where housing conditions are substandard. Psychosocial effects : The sense of isolation felt by persons living in the upper floors of high buildings is now well known to have harmful effects. In three tier areas, one of the biggest common challenges is Planning, because of distribution of functions

Real patchwork of issues across the County, each of the 10 Districts/Boroughs has a local approach

As much a planning and sustainability challenge as a health challenge for Public Health

Some early wins Health and Place Agenda – dedicated PH staff person A Public Health commissioned programme in EVERY district and EVERY HCC Dept HCC and one District piloting “Mainstreaming Public Health” approaches Core Strategies – 2 adopted public health so far Scrutiny of PH 2013, Further Scrutiny 2015 IP Scrutiny – Health in all Portfolios

Big Challenges Having enough houses of the right standard Massive pressures for more homes Sustainability and environment issues –Health and Wellbeing Board adopting as new priority Existing private rented and owner occupier stock poorer than social rented/LA stock, Varies by area Transport strategy

Housing A district function but also many RSLs Districts are the leaders, not County PH supporting role –Public Health Partnership Fund –JSNA, District and Locality Health profiles, Tartan Rug –Community Safety – dedicated public health input (1.5wte staff) –Air quality plan –Planning and health with TCPA

Example - Watford Street Improvement pilot The intention is to invest in around 80 households on a key gateway road take a holistic approach to resolving the issues that these residents face and their environment. example of partnership working. Links with health, the community navigator, landlords, relevant 3rd sector and statutory agencies multi-disciplinary team. holistically tackle housing issues, issues of deprivation and persistent health inequalities.

Examples East Herts – mainstreaming public health through scrutiny of all functions by council Dacorum – targeting physical activity and access North Herts – scoped BRE housing costs calculator for all County Keep Warm Stay Well – big programme, multi agency, targetting most vulnerable

What we have done since arriving in Local Government: 1.Public Health Strategy adopted Nov 13 with clear priority commitments on tobacco 2.One of the HWBB 9 Priorities 3.Hertfordshire Tobacco Control Policy approved by Cabinet (based on LGA declaration but goes further) Nov 13 4.Established PH board – advocates of Tobacco Control and route to sharing best practice and advocacy 5.Collaborating with national agencies on harm reduction and e cigarettes in tobacco control

Elements of a Strategy Housing Quality and affordability The Lives people leadThe Environment and amenities Decency standards Thermal efficiency Fuel Poverty Financial Exclusion Issues for social care and health care supported by housing (independence, falls prevention, telecare) Quality of Education Life skills Self-Efficacy Accessibility Social Isolation Social Inclusion Green Clean Safe Environmental cues for healthy living This is about doing Housing in a public health supporting way, NOT making housing staff health workers

Further Resources Evidence briefing and primary care document and training resources ch/devgroups/whocc/healthhousing_papers/ ch/devgroups/whocc/healthhousing_papers/ AN ODD ONE - health.php health.php ousing_and_health.aspxhttp:// ousing_and_health.aspx TCPA resources on planning and health

thank you