6. The Experience of Health Having Energy Being loved, loving Being in control Fit, fitting in Stress-free Outdoors, nature Friends, family Giving/receiving, sharing Having Energy Being loved, loving Being in control Fit, fitting in Stress-free Outdoors, nature Friends, family Giving/receiving, sharing Meaning in life Able to do things I enjoy Peak Physical shape Happiness Creativity Spiritual contentment Wholeness Playfulness Belonging Meaning in life Able to do things I enjoy Peak Physical shape Happiness Creativity Spiritual contentment Wholeness Playfulness Belonging

7. Model of Health Connectedness Community Meaning, Purpose Control, living conditions Vitality, Energy Doing things one enjoys Good Social Relations Physical MentalSocial HEALTH Adapted from work by LaBonte, R

8. Obesity / Food / Physical Activity / Active Travel: Tobacco Control / Smoking: Mental Health / Wellbeing / Suicide: Alcohol: Accidents: Fuel Poverty: Water: Air: Obesity / Food / Physical Activity / Active Travel: Tobacco Control / Smoking: Mental Health / Wellbeing / Suicide: Alcohol: Accidents: Fuel Poverty: Water: Air:

9. ‘What is wrong with‘Why are you unhealthy ?’ ‘What is stopping you from being healthy ?’   Smoking  Poor diet  Lack of fitness  Drug and alcohol misuse  Poor coping skills  Lack of lifeskills  Powerlessness Isolation Pollution Stress Hazardous living conditions you ?’  Heart Disease  Cancer  HIV / AIDS  Diabetes  Obesity  Mental Health  Hypertension Medical ApproachBehavioural Approach Socioenvironmental

10. Inequalities in Health ‘ … even if we cure or prevent all leading causes of premature death (including improving all those health behaviours that contribute to these diseases) … a new set of diseases will arise to kill or disable the poor years earlier than the rich’ LaBonte, Prof. R (1997) Health Visitor Journal, Vol. 70, No.2 p. 64

11. “The fundamental relation between spatial patterns of social deprivation and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.” The Ghost of Christmas Past, Dorling et al, BMJ, 2000, 321: 1547-1551

12. Health as a concept needs constantly to be contrasted with a medical reductionist model which emphasises fragmentation, towards a model of health as integral to and as a result of social justice. Adams and Armstrong 1996

13. Are we really thinking about health All Age All Cause Mortality

14. Are we asking the right questions? The world is in a mess, and much of this mess is of our own making Events such as the financial crisis and climate change are not quirks of the marketplace or quirks of nature. They are markers of massive failure in international systems that govern the way nations and their populations interact. The contagion of our mistakes shows no mercy: WHO Director General: Dr Margaret Chan

15. The burden of collective action The pollution of air gives utility We do not individually or collectively discount the cost and impact Tragedy of the commons

16. Life satisfaction has run approximately flat through time in Great Britain” Blanchflower and Oswald 2004 Journal of Public Economics 88 (2004) 1359 – 1386

17. Model of Healthy Communities Viable Adequately Prosperous Sustainable Convivial Equitable Livable Community Economy Environment HEALTH Adapted from work by Hancock, T

18. Hancock’s Sustainability Duties Duty to other species – the health of humans cannot be purchased at the expense of the health of other species and the ecosystem Duty to future generations – the health of present generations cannot be purchased at the expense of that of future generations

19. Hancock’s Equity Duties Duty to the disadvantaged – the health of the advantaged cannot be purchased at the expense of the health of the disadvantaged Duty to other places – the health of my community cannot be purchased at the expense of that of other communities

21. Public Health Outcomes Framework – Air Pollution: Inclusion of this indicator in the PHOF will enable DsPH to prioritise action on air quality

23. Public Health Outcomes Framework – Air Pollution: Inclusion of this indicator in the PHOF will enable DsPH to prioritise action on air quality – “Attitudes count, not numbers, and control is rooted not in hierarchy but in values and beliefs” Hunter, 2003

24. Contact Stephen Turnbull Assistant DPH NHS BARNSLEY / BARNSLEY MBC Stephenturnbull@barnsley.gov.uk 01226 787412