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The business case for public health

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Local authorities regained responsibility for public health as part of the health and social care reforms introduced last April.

Dedicated funding has helped to raise the profile of public health, but it is crucial that councils also maximise their influence over the many wider factors that determine the health of local communities.

Local environment, housing, transport, employment and day-to-day social interaction all play a part in health improvement. These are bread and butter issues for local government, and there is significant scope for councils to improve the health of their populations through the full spread of their work – not just in health and social care.

When I and colleagues at the King’s Fund began to assemble a set of practical resources to support local authorities with their responsibilities, one thing that became clear was the sheer volume of different actions available to them.

Some measures can be disarmingly simple and often build on the success of existing local or national initiatives.

For example, we show how councils can foster more active and safer travel  – thereby improving health – by promoting the Department for Transport’s ‘Cycle to Work’ scheme and by learning lessons from the successful ‘Cycling Demonstration Towns’ and ‘Cycling City and Towns’ programmes.

We also sought to learn from authorities that have led the way in response to challenging local circumstances.

In 2008, Blackburn with Darwen BC became the first authority in the country to make all of its leisure centres and swimming pools free to users, under a scheme set up in partnership with the local NHS.

Blackburn with Darwen has continued to build innovative partnerships across teams.

A theme that emerged as we compiled the resources was the compelling business case for putting public health at the top of the local government agenda.

In straitened times, it is encouraging to know that measures that improve the health and wellbeing of local communities can also provide an excellent return on investment.

Often this means tweaking what local authorities are already doing, with health benefits coming at little or no extra cost.

Again, these include actions in areas where the trail is well established. For example, a review for Kensington & Chelsea RBC showed £620 of potential benefits for every £100 invested in air quality measures, such as ensuring that new buildings are air quality neutral, and encouraging the expansion of car club schemes.

Crucially, the savings are shown not just in the NHS but in the demand for investment in services elsewhere in the local authority.

Councils know better than most that health improvement is not just about care provided in the NHS.

The hope is that councils can use the return of these responsibilities to lead the battle once again in improving population health and reducing health inequalities.

David Buck, senior fellow for public health and inequalities, the King’s Fund

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