Agenda item

This is a Joint item with members of the People Scrutiny Commission who have also been invited to attend. A report of the Director of Public Health (Becky Pollard) is attached.

There will also be a presentation for this item.

Becky Pollard (Director of Public Health) gave a presentation on the above issue and made the following points:

(1)        It was important to assess how to keep the population healthy so that resources could be directed in the appropriate way

(2)        The following areas were important – healthy life expectancy, the impacts and influences on the population in terms of health, the costs and benefits of means for keeping them healthy and which areas to target

(3)        Current death mortality rates indicated a wide variation between different wards. There was a gap for healthy life expectancy between different wards (16 years between the highest and the lowest). There was some variation between sexes – whilst Clifton Ward showed the longest life expectancy in terms of men and women, the lowest life expectancy for men was in Lawrence Hill whilst for women it was in Southville;

(4)        In terms of quality of life, Clifton, Cotham and Redland showed the highest quality of life;

(5)        The average national life expectancy was 78 for men and 83 for women – in some wards, the life expectancy was under 75;

(6)        There were an estimated 1,111 early deaths each year in Bristol (including 439 cancer deaths, 230 Cardio Vascular-related deaths, 100 Respiratory Deaths, 45 Liver-Related deaths;

(7)        It was estimated that 61% of cancer deaths and 61% of Cardio-Vascular related deaths were preventable, that nearly half of all respiratory-related deaths and nearly all liver-related deaths were preventable;

(8)        The following factors were identified as being a high risk for premature death – diabetes, obesity, cancer and heart disease. Other risk factors included dietary factors, smoking, high body mass, index and drug abuse;

(9)        Data showed that 40% of health was due to socio-economic factors, a third was due to health behaviours and 20% was due to clinical care;

(10)      The 4:4:48  Prevention model in San Diego determined whether or not to invest in public resources;

(11)      The current percentage of those with risk factors were as follows – 19% of smoking, 57% due to dietary factors (ie obese/overweight), 28% due to alcohol, 39% due to physical activity and 47% due to people not eating the recommended daily fruit and vegetables intake. There had been great success in reducing the number of people smoking but more work was required in other areas;

(12)      The estimated costs of treatment for each health risk were as follows: Alcohol £21 Billion, Smoking £111 Billion, Unhealthy Diet £17 Billion, Lack of Exercise £6.5 Billion – cost effective campaigns through Public Health were an important mechanism for tackling this problem. Other campaigns included the successful Stoptober  and the smoke-free zone at Millenium Square;

(13)      Measures to tackle these problems included healthy procurement in schools, creation of cycle paths, green spaces and areas for spatial planning;

(14)      Whilst lifestyle choices remained an important factor, socio-economic reasons were the biggest factor for health risks. Issues such as mental health, well being and self esteem were important;

(15)      There was a need to work with children and families to deliver against the evidence;

(16)      Officers made 5 recommendations arising from the report as set out on Page 17 of the Agenda papers.

The following points were made by Councillors and by officers responding to these points:

(17)      The issue of Planning Policy in respect of the approval of takeaways and fast food outlets, particularly near schools, was an important issue. Whilst the current policy that no new fast food outlet should be built within 400 metres of a school was rigorously enforced, it was noted that there had been some outlets that had been built fractionally further away than this. In addition, the rules could not apply retrospectively to existing takeaway outlets;

(18)      Rules concerning off licences were enforced through the Licensing regime. However, whilst representations could be made in respect of the CIA (Cumulative Impact Area) for any licensing application, this did not apply to matters relating to Well Being and Health under Licensing rules. However, other mechanisms were available, such as Local Neighbourhood Plans;

(19)      In respect of procurement and catering, it was noted that this was a major strand of the Healthy Weight Strategy. Action: Becky Pollard to provide an update report on this issue for a future meeting.

(20)      In respect of Active Travel, it was noted that walking and cycling were major elements of this. However, the 2016/17 financial year had started with a zero budget for these areas, unlike Transport and Highways. Officers could draw on funding from other budgets and could use volunteers as appropriate. A budget was available for Physical Activity for Active Travel. In addition, work was being carried out with colleagues in the Place Directorate. However, it was acknowledged that further investment may be required in this area;

(21)      In respect of Air Quality, it was noted that this was not a visible part of the needs assessment. Officers acknowledged Councillors’ concerns and noted that there were an estimated 200 deaths a year in Bristol due to air quality. It was noted that Public Health was not a statutory consultee for Planning Applications. Action: Becky Pollard to investigate if there is any mechanism for future concerns from Public Health about air quality in respect of Planning Applications being put forward;

(22)      The Bristol Walking Alliance has been talking to a number of Neighbourhood Partnerships about issues relating to health. The University of Bristol were carrying out work with Somali women in Easton and Lawrence Hill, particularly in respect of takeaways. It might be useful for officers to link with the University on this issue;

(23)      A more detailed analysis was required to assess what is working and what isn’t ie obesity. In respect of Change 4 Life, there needed to be an assessment of its impact on schools since the issue of obesity did not seem to be being tackled. Officers confirmed that the Government had recently published an Obesity Strategy. There remained a great deal of work to carry out in schools as it was disappointing in some areas. It had been acknowledged in the Strategy that a more family-oriented approach was required to tackle obesity and physical activity. Officers pointed out that Sugar Smart would be launched in 2017 (similar to the scheme operating in Brighton) and that a Healthy Weight Strategy was being discussed in October 2017 at the Health and Well Being Board;

(24)      It was noted that smoking was an area which was the highest preventable risk factor and yet the return for the reduction was low. There need to be an effective cost/benefit analysis in this area. Officers referred to the Sustainable Transport Plan in which consideration of many of the healthy benefits (ie smoking, alcohol, diabetes, prevention, healthy living) were embedded). However, no mechanism was yet in place to track funds – one possible approach to address this could be through the use of Joint Funding arrangements or to develop a Strategic case for pooled budgets;

(25)      Value for Money was an important factor in this issue, particularly the ability to deliver at every level (ie from the supra-national to Neighbourhood Partnership level). It was important that effective co-ordination was taking place to ensure that local funding was returning into the system. Officers were working with Public Health England which operated at a regional and national level.

(26)      In addition, a major education campaign could be required to ensure delivery of the Council’s health ambitions in schools. Officers pointed out that there was no longer direct contact with many schools as many operated their own arrangements in this area. However, Bristol had in place the  Mayor’s Award for healthy schools – a meeting would be taking place shortly with Head Teachers and Governors at which this issue could be raised;

(27)      Schools could invite families for particular events as a means of educating and helping them in this area. The current arrangements made through Life Education Classes were a bit “hit and miss” at the moment;

(28)      If the current healthy life expectancy gap of 16 years which existed between wards could be reduced, this would have also help to significantly reduce costs in the service;

(29)      The will be a greater  focus in the future on diabetes prevention.

Resolved that:

1.         The Director of Public Health should work through Bristol Health and Wellbeing Board and other stakeholders to implement the 4:4:48 prevention model.  This model addressed the 4 modifiable unhealthy lifestyle behaviours (smoking and tobacco, alcohol misuse, poor diet and lack of physical activity) that lead to the 4 main diseases (cancer, cardiovascular disease, respiratory disease and liver disease) which contribute towards around 48% of all early deaths in Bristol. 

2.         work is carried out to put “Health In All Policies” into practice with a wide range of partners to make health everyone’s business.

3.         The Health and Wellbeing Board oversees an audit of current prevention and early intervention programmes against the evidence based interventions set out in this report and identifies any gaps.

4.         The Bristol Children and Families Partnership Board seeks to strengthen cost effective public health programmes aimed at children and their families to give them a better and healthier start in life (specifically targeting those who experience the greatest disadvantage).

5.         Bristol City Council’s Public Health Team coordinates the roll out of a ‘Making Every Contact Count’ training programme for multidisciplinary front line staff to improve health and wellbeing.

6.         The Director of Public Health works with the emerging Mayor’s City Office, other city partnerships, the Bristol, North Somerset and South Gloucestershire Sustainability Transformation Plan and the West of England devolution deal to find ways to strengthen and consolidate public health effort.

7. the actions set out in Bullet Points (19) and (21) of the Minute Preamble (above) are carried out.

ACTION: Becky Pollard