Developing Healthy Economic Policies: Experiences of Public Health Leaders in NW England Darryl Quantz Faculty of Public Health Conference 2017 darryl.quantz@nhs.net

Research Question What are the experiences and practices of public health decision makers regarding their role in economic policy decision making within local authorities?

Context: Reorganisation Health and Social Care Act Shift of public health to local authorities Public Health England

Context: Income Inequalities UK Average Full Time Pay (2016) Source: The Equality Trust

Context: Economic Development GDP measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile. Robert F. Kennedy, 1968

Participants Directors of Public Health from across the NW 9 Key Informant Interviews Cumbria and Lancashire (n=3) Cheshire and Merseyside (n=3) Greater Manchester (n=3) Transcription/Analysis

Economic Indicators “So I’d say that really – and it’s probably much more so since we’ve sat within the Council – all of those economic factors have become really important to us in sort of understanding where Public Health can make the biggest impact and how it needs to have a voice in all of these arenas.” (DB) Employment Types of Jobs Wages Educational Attainment Poverty Not in Employment, Education and Training Income Inequalities

Promoting Healthy Business “So there’s lots of things I can now influence within the Council… simple things like if we’ve got an empty premises....we try and support a business that fits in with our values and our ethos and that is about promoting health as well, so it’s not just about making money out of that empty premises but it’s about responsible income and not giving in to a payday loan company or a betting company or an off licence”. (JS)

Promoting Healthy Business “So it’s difficult to always argue on the basis of ‘You shouldn’t have this here and you shouldn’t have that there’ because you’ve got other kind of things about what money’s coming into the city to manage the whole of the city”. (RW) “And that causes some tension as well where the purposes and function of Public Health is to restrain and hold back unbridled economic development where it might have risk to the population, and to make the Council consider wider processes”(BL).

Employment/Local Economy “It’s about making sure we create that economic democracy within [our local authority], so that we create jobs and we create jobs for local people and we keep that money locally.” (DB) “I’ve got members of my team who do quite a lot about worklessness so mostly what I’m doing is supporting their work on tackling the worklessness agenda. And some of that has been about making sure that public health services are helping people into work in one way or another”. (HN)

Quality of Work “The evidence seems to be that generally, on average, having a job is better for you than having no job. But having a job that is low control, low skill, low pay, low flexibility…all that sort of stuff, isn’t any better for you than having no job on average. So we’ve got to be looking to bring in quality work”. (RW) “Of course the biggest risk about developments is the people you most want to benefit from them actually don’t. All they end up doing is cleaning and serving coffee, while other people come into the town to enjoy the facilities. That’s the worst possible outcome.” (EP)

Advocacy/PH Intelligence “The market economy generates the wealth which is spent in the non-market economy and so therefore social policy has to be secondary to economic policy because it’s economic policy that pays for it. And that’s the traditional way of thinking in this country. Actually it’s nonsense.” (RW) “When you look at it from a more broad public health perspective, you have to start challenging the entire discourse about economic growth.” (EP) Living Wage Initiatives Early Years Challenging the narrative Partnerships Sustainability Data

Opportunities and Challenges Local Government “…..being based within local authority means that you have a much better chance and more engagement around the wider determinants of health so already, yes we have moved more upstream just by moving out of the NHS and into local authority.” (PW)

Recommendations Strengthen and articulate the public health mandate for work on economic determinants at the Faculty of Public Health, regional public health associations and Public Health England. Identify inter-sectoral partnership opportunities with environmental movements and groups promoting alternative approaches to economic growth and measurement. Initiate case studies of existing public health activities on economic issues. Create an evidence base for public health practice on economic determinants.

What does a health promoting economy look like? Healthy economic policies are those that use the resources generated from economic development to invest in raising the living standards of low-income groups and in public systems for health, education, and other essentials such as food security. Whitehead M. Health should never be merely a means to an economic end. The Lancet, 2008, 371:1155-1156