“People don’t make choices on health behaviour in isolation,” said Greg Fell, Sheffield’s director of public health.
“The environment, social norms, advertising, and economic and social issues all influence behaviour. The NHS should take every opportunity to encourage people to lose weight, eat healthily, move more and stop smoking.
“This should be through interactions between clinicians and patients but also through setting the right kind of environment. A good example of this is the Health and Social Care Trust, which has recently gone completely smoke-free on site. It’s been a tough journey with many hurdles, however, early signs suggest significant numbers of staff and users want to stop. In my view, the fact that someone might smoke or is overweight should have no bearing on the services offered to them beyond encouragement to change.”
Since public health became the responsibility of Sheffield Council in 2013, efforts have been made to bring the department’s initiatives in line with the authority’s wider aims – such as cutting inequality in all its forms.
“There isn’t a single thing that will solve the conundrum of a healthier population and a significantly narrowed gap between best and worst,” said Mr Fell.
“Improvement requires activity on many fronts simultaneously. A couple of key areas I would increase our efforts on would be helping people stop smoking and stop them starting. We know about five children a day start smoking in Sheffield.
There isn’t a single thing that will solve the conundrum of a healthier population and a significantly narrowed gap between best and worst
“I’d also spend time on initiatives to reduce sugar consumption and encouraging us all to move more. The strategy we have for activity – Move More – is excellent, now we need to enact it. This requires the whole population to sweat a little more.
“On other fronts, addressing inequalities in childhood educational and other outcomes is perhaps the single most important investment we can make for the wellbeing of future generations. The inequality in educational attainment sets inequality in life chances and all poor outcomes that come from this.”
Mr Fell is cautiously supportive of Government health targets, but said the country ‘already has’ a seven-day NHS.
“Some of the targets are realistic, some are less so. One of the points of targets is that they spur activity in a certain direction. This can be good, but sometimes it may have consequences we didn’t anticipate.
“We already have a seven-day health service. We always have. It is true that elective care is not as available over the weekend as during the week. If we want seven-day elective care we should be prepared to fund the NHS to pay for this or if no further finding is available work out what services to cut.”
Mr Fell said that, in Sheffield, he would like to see ‘sustained action’ in five key areas to tackle inequality, beginning with a ‘continued commitment to a community development-based approach to health and wellbeing’.
“I don’t underestimate the difficulty of this in an era of shrinking resources, and I have no doubt that our approach isn’t perfect, but his is something we can hopefully build on and reflect the strengths which communities have.”
Investment in primary care and GP services – ‘especially in the most disadvantaged parts of the city’ – is also required, he said, ‘in particular a focus on targeted cardiovascular risk management and an approach to healthy lifestyles as part of treatment and prevention’.
“I would like to see a continued commitment to the principle of implementing effort and change where greatest need is identified. This is about focusing our approaches where need is highest.”
Efforts needed to be concentrated on the link between employment and health, ‘finding new ways to help people get back into work, and stay healthy at work,’ he said.
“When we are looking at the issue of healthy lifestyles we need to focus on the environment and make the healthy choice the easiest and default choice.
“There aren’t easy or simple answers, and equally these five issues aren’t the only answer to the difficult issue of health inequalities – but these were the issues Sheffield’s Health and Wellbeing Board agreed to focus on first.”
Mr Fell’s other priorities for 2017 include improving the city’s air quality, and boosting people’s mental wellbeing. But he said the biggest challenge facing his department was ‘maintaining a focus on preventative activity, and prioritising investments in activities that don’t have a right-here-and- now benefit but have a payoff in the future’.
“As budgets for local government and the NHS, and many other agencies, get tighter there is a danger that we revert to statutory requirements alone and revert to our own organisational trenches. That is problematic.
“Prevention in a health and wellbeing sense is not a statutory requirement, also the health inequalities challenges this city faces will not be solved if organisations act in an insular way.
“The other, linked, challenge is that the outcomes achieved in terms of health and wellbeing are not considered as part of the balance sheet in the same way finances are.
“This is understandable but if outcomes were visible, countable and able to be measured in financial terms as well as health and wellbeing terms it would change the way we think about return on our investments.”