“Determinants of health – if only local government took it seriously”

“Determinants of health – if only local government took it seriously”

I had to double take (!)

“If only the local government took the social determinants of health as seriously as we do and engaged on it”

This is a paraphrased quote from a senior manager I’ve heard more than once over the years.

As I say…..even I stopped emailing, had a double take and had to correct this one!

It was a mighty interesting, off the cuff and insightful comment about how different sectors ‘see things’.

I’ve briefly touched on a little of this in a previous blog
Here I go into more detail
In this particular meeting meeting we did agree that it was the NHS that should engage with local govt on said social determinants (which are basically the services and policy agendas that local (& national) government spends your taxpayers pound on – agendas like poverty, employment, economic development, housing policy, parks and leisure, schools and education of your kids etc.

We then had an interesting discussion on this.

My basic point was that:
1. The NHS generally does health care (mostly quite well though a spectacular failiute to prevent at any scale),
2. local govt spends spectacularly large amounts of your money on the above aforementioned areas (and many others), but often NOT with a primary goal of “health”. A happy bi product of having a job or a good education is healthier population etc….but “health” isn’t the primary objective ….but….does that matter?

Local government will always do these things, well till someone tells it not to. These things matter to health, but also to lots of other outcome areas.
Yes of course we can get better by getting better connectivity between say the ‘health care’ and the ’employment’ system with the objective of enabling those who are unable to work on account of poor health to get back into the labour market. This will obviously be good for their health and will also be good for the economy. Double winner. Sorting this requires the putting together of very different cultures and contexts and operating models of “employment services” and “health services” but together we get more health than separately for the same sum of cash….this is obviously a good thing in the context of public service reform.

Could say the same on transport, housing, education, our approach to economic development, the list is endless.

There are some deeply entrenched cultural issues. I’m sorry to say that many NHS types think all local government is basically “social workers” and that phemonomia cuts both ways. Both ‘sides’ are wildly diverse institutions with a massive diversity of roles and contexts. Understanding this is important.

This sort of stuff is being flushed out by the STP currently, but it’s not new….

the basic point about health in all policy approach is the health IS in lots of policies and service areas …..just not explicitly recognised as an objective .

For dorks(like me) that want to read more – There isn’t a single document that (I know of at least) adequately describes this area – read Marmot & Aecheson from the late 80s report for social determinant stuff – (though it’s fair to say these were mostly about inequalities in health outcomes and the things that determine those, rather than social determinants per se)
Also read the Lalonde report – Canada 1970s
wanless 2004 for the approach to “lifestyles” and the like, and more latterly Saving Gotham – describes how it was done in New York.



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