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Ten ways for councils to tackle health inequality

During the Labour Government between 1997 and 2010 health inequality widened. The life expectancy gap between rich and poor increased by 7% for men and 14% for women. The good news is that life expectancy increased for everyone, but it was much faster for the rich than the poor.

Around £4 billion a year has been spent on public health (of which £2.5 billion a year will now be given to councils). But it has been largely wasted. Lots of generalised nanny state messages about giving up smoking, losing weight, using condoms, etc. An army of people going round with clipboards and balloons engaging with people and monitoring their ethnic group. Another army inputting data.  Lots of stakeholders, projects, strategies, advisory assessments, cessation co-ordinators, pathways. All top-sliced, front-loaded, fast-tracked, and multi-disciplinary.

Nothing very tangible achieved.

As mentioned, average life expectancy has increased - from 74 for men and 79 for women to 78 and 82 respectively. But this is largely because we have got richer. It's thanks to all those thrusting wealth creating capitalists. The worthy public health bureaucrats appear to have been an irrelevance if the widening gap between rich and poor is anything to go by.

So what should councils be doing to improve public health - including for the poor who were left behind by Labour? Not all involve spending money and in any event there are restrictions on what the £2.5 billion may be spent on - there is ring fencing and there are statutory requirements. It would be better if councils were judged on the outcome rather than face interference with how they spend the money.

Anyway this would be my list:

1. Reduce the number of children in care by increasing the adoption rate. Looked After Children have dramatically worse health outcomes. They are seven times more likely to abuse drugs. More than four times as likely to commit suicide when they are adults. A third of care leavers end up on the streets. Over half of them suffer depression. Councils failing to place children for adoption is an important factor in increasing health inequality.

2. Ensure more residents are able to speak English. Studies from the US (as well as common sense) indicate that low proficiency in English has adverse public health outcomes.  Councils could promote English tuition as a priority for voluntary sector grants. These could include providing Saturday School reading classes for adults and children. A requirement to non-English speakers to attend classes could be made conditional for Council Tax support and housing waiting list applications.

3. Promote economic growth. Local authorities can reduce unemployment by cutting business rates and reducing planning delays for new business. The life expectancy for men in Kensington and Chelsea is 85.1 years while in Glasgow it is 71.6 years. The differences between the poorest and richest wards are much greater. The best way to improved the health of the poor is to help them become rich.

4. Cycling. The spreading of the Boris Bikes cycle hire scheme further across London is great news for public health. It should be copied in other cities and more done to promote it as a cheaper way to travel than buses or the tube.

5. Breakfast clubs. Schools could offer free breakfast to children (possibly to all to avoid stigma). This improves education as well as health.  Councils should make a grant from their public health budget to schools that provide this.

6. Competitive sport in schools. Schools that hold sports days and interschool competitions could be given funding. There could be prize money provided.

7. Flu jabs. Boots and some of the big supermarkets offer flu jabs for around £10 and these only takes a couple of minutes. There have been various studies about the effectiveness of the vaccine. Some estimate that it makes you 50% less likely to get flu - a more recent one said 62%. It also reduces the severity of the flu. I have already suggested that councils providing free flu jabs to their staff would be cost effective in terms of reducing sickness absence. They should also consider offering free flu jabs for others. Each year 20% of us catch the flu and 1% of us have to treated in hospital for it.

8. Drug rehabilitation.This is expensive - much more expensive than the ineffective "advice" usually offered to drug addicts under existing public health schemes with their "drop ins." But could not the costs of a proper rehab programme be split with the police? Oliver Letwin suggested that those arrested and found to be drug addicts be offered the choice of residential rehab or imprisonment.

9. Fewer tower blocks. I wrote about this recently without focusing on the health aspect. Children have less exercise. There is greater mental illness. Greater suicide. The condensation and mould that characterises even recently built tower blocks is damaging to health.

10. Better playgrounds. Paddling pools. Skate boarding ramps. Outdoor ping pong tables. Making exercise enjoyable is so much better than all the priggish nagging. It's not quite so bad for the rich if the local playground is scuzzy. At least they can spend money on dancing classes and karate lessons for their children and take them off on Mark Warner holidays.


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