Title: ABUHB
Director of Public Health Annual Report 2022
Paper sponsor:
Dr Sarah Aitken, Executive Director of Public
Health and Strategic Partnerships, ABUHB
Paper author:
Stuart Bourne, Consultant in Public Health, ABUHB
Date: 15th December 2022
1. Introduction
1.0 This paper has been
written to provide Gwent Public Service Board members with a summary of the Director of
Public Health Annual Report 2022. It has
been written as a cover paper for the main report included in the Public
Service Board papers at Appendix A.
2. Background
2.0 This year’s report is centred on the theme of inequity and fairness, and
the importance of acting on the social determinants of health. In taking this approach, the report is
structured around the eight Marmot principles originally developed by Professor
Sir Michael Marmot and the Institute of Health Equity in 20101. These eight principles have already been
presented to Gwent Public Service Board on a number of occasions and will be
familiar to members.
The eight Marmot principles 1. Give every child the best start in life; 2. Enable all children, young people and adults to maximise their capabilities
and have control over their lives; 3. Create fair employment and good work for all; 4. Ensure a healthy standard of living for all; 5. Create and develop healthy and sustainable places and communities; 6. Strengthen the role and impact of ill-health prevention; 7. Tackle racism, discrimination and their outcomes; 8. Pursue environmental sustainability and health equity together. |
2.1 The Marmot principles are central to this
year’s report for two reasons; firstly, the aim is to provide members of Gwent
Public Services Board with practical suggestions as to how to respond to the
eight principles, and secondly, it provides the Director of Public Health with
an opportunity to reflect on progress three years on from the 2019 Annual
Report ‘Building a Healthier Gwent’2.
3. Assessment
3.0 The opening to this year’s report
re-states the ambition set out in the 2019 annual report to ensure: “In 2030
the places where we live, work, learn and play make it easier for people in our
communities to live healthy, fulfilled lives”.
Three years on, this remains the ambition, framed through the lens of
the eight Marmot principles. The
following summarises the key messages in each chapter.
3.1 Chapter 1 acknowledges that achieving
this ambition has in many ways got harder.
The COVID-19 pandemic has acted to exacerbate and magnify health
inequalities, an effect that will endure in communities experiencing the
poorest health outcomes into the future.
Alongside this, the economic situation in the UK is about to make life
harder for many individuals and communities, and to limit the ability of public
services to intervene. Whether measured
by differentials in healthy life expectancy, childhood obesity or consumer
spending, the present position makes tackling inequity both more difficult but
also more urgent.
3.2 Chapter 2 explains
the Marmot principles, as well some other important concepts such as
proportionate universalism and the social determinants of health. For an NHS Wales audience, this chapter also
includes a framework for how the NHS can respond to the social determinants of
health. Developed by the Health Foundation, this contains four quadrants
through which NHS organisations can think about how they should address the
social determinants of health. Each of
these quadrants is explored further in chapter 2.
3.3 Chapters 3 – 10 of the
report concentrate on each of the Marmot Principles in turn. In each chapter, the importance of each
principle is discussed, examples of what organisations in Gwent can do are
highlighted, and a case study is included to illustrate work that is already
taking place. Taken in turn, these
chapters recommend the following:
3.4 Chapter 3 (Give
every child the best start in life) makes the case that collective action
from all public service partners needs to focus on ensuring a consistent
universal offer of support to all families throughout the early years AND a
focus on enhanced support for families with a low income to ensure that they
don’t get left behind. In this context,
the importance of addressing adverse childhood experiences is highlighted, as
well as the importance of the Healthy Child Wales Programme and the Early Years
Integration Transformation Programme.
3.5 Chapter 4 (Enable all children, young people and adults to
maximise their capabilities and have control over their lives) suggests a starting point is sharing good
practice about what each organisation in Gwent is doing in respect of
recruitment. Commitments set out in the Aneurin Bevan University Health Board People
Plan 2022–20253 are put forward as examples of good practice. This includes, supporting widening
access for school leavers and the unemployed into work, designing workforce
plans that ensure an inclusive workforce and trialling new selection methods in
place of traditional interviews to encourage applications from all parts of the
population.
·
Area and place-making;
· Job creation and attracting fair work employers;
· Encouraging and incentivising fair work practice;
· Supporting pathways to access to that work;
· Being exemplars as good employers and anchor
institutions;
· Implementation of the Socio-Economic Duty.
3.7 Gwent
Public Services Board can set the direction by incorporating fair work into the
Gwent Well-being Plan, with partners translating that collective commitment
into action by their own organisations. Regional Economic Frameworks and Implementation
of City and Growth Deals, supported by Regional Skills Partnerships are also recognised
as having an important role in embedding fair work approaches.
·
Purchasing goods
and services from local businesses and organisations;
·
Opening buildings and spaces to support local
communities and staff;
·
Widening access to
quality work, including reviewing whether current ‘difficult to recruit’
vacancies can be converted into wider opportunities such as apprenticeships and
placements, to provide local employment;
·
Ensuring that
services across Gwent remain accessible financially and physically to
service-users, e.g., cost of travelling to an appointment; time of appointment to
avoid having to take unpaid absence from work;
3.12 Chapter 10 (Pursue environmental sustainability and health
equity together) recognises the draft steps set out in the draft Gwent Public Services Board Well-being
Plan to protect and improve the natural environment. In consulting on the Well-being Plan, Gwent Public
Services Board are recommending the following steps:
·
Reducing the environmental impact of
production and consumption.
· Declaring a nature emergency in Gwent;
· Responding to the climate emergency and protecting and
preparing communities for the risk associated with climate change;
· Exploring and promoting community energy projects;
· Transforming food transport and energy in Gwent;
·
Recognising biodiversity as an asset,
addressing the root causes of biodiversity loss and better managing the
pressures on natural environments.
3.13 Chapter
11 provides a summary of the report’s key points and
reflections from the departing Director of Public Health. A full copy of the report is available at:
https://abuhb.nhs.wales/healthcare-services/staying-well-and-healthy/building-a-fairer-gwent/
4. Recommendations
4.0 Gwent Public Services Board
is asked to DISCUSS and NOTE the main points in the Director of
Public Health Annual Report 2022.
References
1. Michael Marmot, Peter Goldblatt,
Jessica Allen, et al. Institute of Health Equity (2010), Fair Society,
Healthy Lives (The Marmot Review) [Online]. Accessed on 16/09/22. Available
at: https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
2. Dr Sarah Aitken (2019), Director of Public
Health Annual Report 2019: Building a Healthier Gwent [Online], Aneurin
Bevan Gwent Public Health Team. Accessed on 16/09/22. Available at: https://abuhb.nhs.wales/healthcare-services/staying-well-and-healthy/building-a-healthier-gwent/further-information/
3. Aneurin
Bevan University Health Board (2022) People Plan 2022–2025-Putting People
First. Aneurin Bevan University Health Board [Online]. Accessed 21/09/22.
Available at: https://nhswales365.sharepoint.com/sites/ABB_Pulse/SitePages/People-Plan-
2022-25---Putting-People-First.aspx