People’s Board June 2018
St Helens People and Place: Maximizing Opportunities for Good Health and Wellbeing
1.
PURPOSE OF THE REPORT This paper outlines the joint work already being completed by People’s and Place and provides recommendations to develop further integrated work to improve health and wellbeing in the borough. The People's Board are asked to approve the recommendations in section 5.
2.
JUSTIFICATION FOR THE DECISION
2.1
Traditionally we have looked to the health and social care sector to tackle ill health and improve our health and wellbeing. However, we know that the health of individuals and populations are also heavily influenced by social, economic and environmental factors, which are referred to as the wider determinants of health. This opens up many opportunities to improve health and wellbeing working across other local authority functions and with wider partners. The diagram below illustrates the key determinants of health which are interconnected and all have an important part to play in our health and wellbeing.
2.2
Key Determinants:
2.2.1
Socioeconomic Status: There is a clear link between socioeconomic status and an individual’s health. Lower socioeconomic status and poorer income is linked to reduced life expectancy and poorer health and wellbeing.
2.2.2
Economic factors: Being in work is generally good for our physical and mental health (good work) and having access to high quality education is key in enabling individuals to maximize their potential and take full advantage of opportunities which in turn can determine future employment status and income.
2.2.3
Physical Environment: The environment in which we live and work can have a significant effect on our quality of life and health. Poor quality housing poor housing conditions, including cold and damp, falls hazards, homelessness, overcrowding and the quality of the neighbourhood can have a negative effect on health and wellbeing and can be a contributory factor to many preventable health problems and injuries including respiratory illness and hypothermia and mental health problems. Having access to green spaces has been shown to improve mental health. Good access to amenities is essential for good health and wellbeing.
2.2.4
Social Environment: Our social environment can affect the health and lifestyle choices we make from how much exercise we take to the food that we eat. In addition, support from family, friends and the local community through our social networks is important for good mental wellbeing and increasing resilience. (Source: Kings Fund). It is now acknowledged that health behaviours are not just influenced by personal attributes but also features of the broader physical, social and cultural environment. Recent research completed in Scotland (McDonald et al 2018) found that there were both greater numbers and clusters of ‘environment bad’ outlets (alcohol, fast food, tobacco and gambling outlets) within more deprived areas, increasing the opportunity to access potentially health damaging and/or addictive goods or services.
2.3
To have an effect on the wider borough objectives highlighted below People’s and Place need to continue to work together to maximize our impact. This paper highlights some of the work already undertaken and recommends opportunities for future developments
Sustainable Health and Social Care System Raising Aspiration and Ambition Growing the economy Being Connected
3.
FACTS SUPPORTING THE DECISION
3.1
HEALTH AND WELLBEING PRIORITIES
There are 3 particular aspects of health and wellbeing that are having a significant negative impact on our local population and remain key public health priorities for work going forward.
3.1.1
Alcohol In 2015/16 over 19,000 people were admitted to hospital for an alcohol related issue. Significantly, up to 84% of dependent drinkers in St Helens aren’t in treatment and therefore don’t acknowledge or realise they have an issue. The Merseyside Lifestyle Survey 2012/13 found that 19% of those surveyed drink alcohol 4 – 7 times per week. Alcohol harm to young people in St. Helens remains significant. Latest data showed St. Helens had the 6th highest rate in the North West of alcohol-specific admissions to hospital, higher than all neighbouring authorities. In St Helens there is an abundance of pubs, bars, clubs, shops (small, large, alcohol specific) from which our population can easily access cheap alcohol. In terms of the recreational & social options across the borough, there is a significant lack of dry options, in particular within the town centre.
3.1.2
Obesity 27% of reception age children and 38% of year 6 children, respectively, living in St Helens are classed as having excess weight. 71% of adults have excess weight and local rates for obesity admissions (1,212 per 100k) and obesity related prescriptions (17 per 1,000) are higher than national averages (995 per 100k and 8 per 1,000 respectively). Conversely there is a large number of hot food takeaways that sell calorie dense foods for low cost, and these are often located (often in rows of hot food shops) within areas of deprivation. Albeit improved, the infrastructure for active travel could do more to positively encourage people to take part.
3.1.3
Mental health and wellbeing Typically levels of depression and people reporting living with a long term mental health problem in St Helens is higher than the national averages. St. Helens has a high rate of admissions due to mental health problems, the second highest in Merseyside and above both North West and England averages. St.Helens ranks as the 36th most deprived of 326 Local Authorities in England, with 4 areas in the borough being in the 1% most deprived nationally. These areas are in the Town Centre, Parr and Sutton. There are higher rates of children living in poverty and also higher rates of fuel poverty in St Helens compared to nationally. The percentage of economically active people in St.Helens who are in employment (70.2%) has increased over the last year but remains considerably less than the regional (72.4%) and national averages (74.6%). In-work poverty is increasing which has a detrimental effect on the health & wellbeing of the population, in St Helens and the country as whole. 31% of St. Helens residents earn below the Living Wage Foundation living wage (currently £8.25 per hour, 2016), compared to 23% of people nationally. There is evidence of a sharp rise in the numbers of working people having to go to food banks.
3.2
Future Opportunities for the Borough St Helens is currently going through a period of significant change. The Council is preparing a new Local Plan which seeks to increase economic growth and increase jobs through the allocation of significant additional employment land for development (306 hectares in total). This growth is set out in the December 2016 Local Plan Preferred Options, which proposes the Borough’s housing target be set at 570 a year to accommodate this growth. The Council has recently approved two planning applications for large scale employment development at Florida Farm North, Haydock (1,452,600 sqft scheme) and Land North of Penny Lane, Haydock (498,639 sqft scheme). As well as this, the Council has purchased a major shopping centre in the town centre and has recently consulted on plans for a culture-led regeneration of the town centre, which will complement the economic and housing growth for the Borough. A balance has to be achieved if we are to make improvements to the borough, but in doing so we need to ensure that we do not adversely impact on the health and wellbeing of residents, making positive changes for the better.
3.3
Current Initiatives/Work Since Public Health responsibilities transferred to the local authority, planning officers and other colleagues across the council have engaged and some positive work has taken place to date such as:
3.3.1
Hot Food Takeaway Supplementary Planning Document (SPD) Adopted in June 2011 by St Helens council, this planning document provides additional guidance to assess and determine planning applications in relation to hot food takeaways with the aim of minimising adverse health impacts. A key consideration of the guidance is the proximity of hot food takeaways to local schools. Currently there are 139 hot food takeaway establishments in St Helens, a reduction of 22 since adoption of the supplementary planning guidance. In the past 7 years, 4 appeals where made and dismissed for takeaways in St Helen's for a number of reasons, one of which was being within 400m of a school. 2 of these where near Rainhill St Ann's Primary School, 1 was near Sutton Oak Primary school and 1 near Cowley High School/College. 5 requests to change an existing venue use to hot food takeaway establishments where refused and not appealed. 2 of these where again near Rainhill St Ann's Primary School, 1 application near Eccleston Mere Primary School and St Julie's Primary School, 1 near Sutton Oak Primary School and 1 near St Peter and St Paul Primary School. It is evident that the Supplementary Planning Document has achieved its purpose of limiting the uptake of hot food takeaways in close proximity to schools by being able to dismiss applications and further support the dismissal when an appeal is made.
3.3.2
Chip Fryer Award The scheme was introduced in 2013 to recognise the best practice of local chip shops to produce a healthier chip. To achieve the award businesses must meet a range of criteria and adopt certain cooking and preparation processes that result in a
healthier chip containing up to 40% less saturated fat. Approximately 20 chip shops per year have received the award. Once a reward is issued it is reviewed on an annual basis and an annual award ceremony held. 3.3.3
Healthier Options St Helens This is an initiative working with Indian, Chinese and Pizza venue in the borough to reduce the amount of salt or fat in their dishes. Each business is given its own individual target to achieve based on current levels of salt and fat and are supported to reduce it. An annual award ceremony is held in conjunction with the chip fryer award.
3.3.4
Childminder Healthy Eating Award In 2015 the Childminder Healthy Eating award was developed based on the schools and nurseries healthy food awards (Tasty Tuck / St.Helens Healthy Early Years award) that had been in existence for some time. Childminder’s are issued with a box of tricks which includes, health promotion information, plastic knives to encourage children to cook with the childminders and Oaty Bear mascot– which the childminders are encouraged to send home with the children taking healthy eating messages to their families. There are 65 childminders currently registered to have the award. The award is reviewed every two years.
3.3.5
Placement of Outdoor Gyms Research by the University of Essex (Environmental Science and Technology, May 2010) showed that exercising outdoors boosts people’s physical and mental health more than going to indoor gyms, even in winter. Furthermore the evidence supporting an active lifestyle and being active outdoors is significant. A proposal for Outdoor Gyms was considered and included in the Healthy Weight Strategy, ‘Healthy Balance 2014 – 2017’. The Strategy was received at Health and Wellbeing Board on 11th September 2014 and subsequently 6 parks where identified as being suitable sites for Outdoor Gyms, and installation took place in 2015. In general, the outdoor gyms have received positive feedback from members of the public, leisure services, the Ranger Service and Local councillors.
3.3.6
Input into St Helens Council Infrastructure Delivery Plan Planning colleagues have liaised with Public Health and the CCG for views on how infrastructure intentions for the next 15 years could impact on local delivery of health services. By sharing infrastructure maps and combining these with maps of health provision (General Practices etc) this enabled discussions around the implications of a potentially increasing population within certain wards across the borough and the changing offer of health services. Continued liaison between Health & Planning going forward will be of mutual benefit.
3.3.7
Active and Sustainable Travel A number of measures have been introduced in St Helens to improve active travel and use of sustainable transport. This includes the introduction of cycling training in schools and at cycling hubs, and the introduction of an Active Travel Coordinator to
encourage and increase active travel amongst the local population. Specifically the Coordinator has been working with workplaces and job seekers to encourage and increase active travel amongst these groups. Pelican and zebra crossings have been upgraded to improve road safety and encourage walking and cycling. Transport Planning & Public Health have worked jointly to enable a local group of volunteers to establish an independent co-op called Pedal Power who deliver bike rides and projects to address inequalities for example recycling of bikes from the various Cycle Hubs across the borough. The council is working with the Merseyside Quality Bus Network to improve the frequency of buses, reduce journey times and make bus travel convenient, accessible and attractive for passengers. The council has implemented a SCOOT system to reduce congestion at peak times through optimisation of traffic signals. In addition 20mph zones have been introduced and electric vehicle charging points have been placed at four locations in the borough. 3.3.8
Workplace Health and Wellbeing Charter A Business Liaison Officer within the Economic & Development Team has been commissioned by Public Health to provide a bridge between local businesses and health services. The officer has been in post for the last year targeting a range of local business (small, medium and large) to understand their business and health needs and to provide support towards achieving a Workplace Health Charter. 30 workplaces have so far signed up to the charter and are working to improve their standards with respect to health and wellbeing. Registrations to the scheme are currently on hold till spring 2018 while Public Health England are reviewing the charter.
3.3.9
Suicide reduction-Visible Signs and Structural Interventions A priority area of the national suicide prevention strategy is reducing access to the means of suicide, which is one of the most effective ways to prevent suicide. Public Health are working with Merseyside Police, Highways England and St Helens Engineers Department to introduce visible signs (Samaritans 24 hour number in the form of signs on fences and stencils on the pavement) and structural interventions at high risk locations for suicide. These include road and motorway bridges, multi-story car parks and public open spaces. These high risk locations will be monitored against suicide reductions and number of emergency service call-outs to verify their effectiveness.
4
Liverpool City Region Work In addition to local projects, there is currently work being completed at a Liverpool City Region level: A task and finish group is being established to focus on air quality There is work to produce standards for Alcohol Licencing Policy Statements across the City Region and campaigns such as ‘Drink Less, Enjoy More’ which have been run between licencing, the Police and Public Health across the Region. Further powers may be introduced for the Region as part of devolution part 2, the Directors of Public Health are debating the inclusion of Public Health as a 5th Licencing Objective and Minimum Unit Pricing.
5
There is work being completed to develop an age friendly charter for the City Region. St. Helens have already approved an Accessibility Charter. A motion is being put forward to Government by Local Authorities to tackle obesity. The motion calls upon Government to give healthy weight a greater priority by Implementing all of the Food Revolution actions (inspiring real, meaningful, positive change in the way children access, consume and understand food), tackling food poverty and having a fairer and greater obesity focus of the use of sugar levy funding including allocation to Local Authorities rather than to individual schools
RECOMMENDATIONS
Continued joint working between People and Place, in particular with the planning department will ensure that the built and natural environment promotes health and wellbeing. It is recommended that the existing good work continues between People and Place and a joint work programme is developed to maximise future opportunities for integrated working and improvement of health and wellbeing. Recommended areas for inclusion in future work plans include: Public Health input to Planning –Development of a local ‘Planning-for-health’ tool to ensure the health and wellbeing implications of major planning applications and the city centre regeneration are taken into account consistently to maximise health opportunities and minimise negative impacts as far as possible. Work in partnership to explore the introduction of novel place based design to encourage healthier behaviours. Licensing and Health – Mapping of establishments including licensed premises, hot food takeaways and gambling establishments to identify hot spots to focus future work. Developing a local licensing and health policy framework for planning, including the creation of a Supplementary Planning Document covering alcohol and gambling establishments in addition to hot food takeaways. Promotion of Active Travel and Sustainable Transport- Consider new opportunities for active and sustainable travel throughout the borough, improving access to these services. Development of policies for engaging with commercial organisations with a potential to impact on health and wellbeing. For example establishing a local policy position on E-Cigarettes. Liverpool City Region to continue to work across the City Region to explore opportunities to maximize health in place based programmes as highlighted in section 4. An action plan included in the appendices outlines actions for 2018/19 6
RISKS ASSOCIATED WITH THE PROPOSED DECISION
None any future decisions made as a result of the recommended way forward will be assessed individually 7
OTHER IMPLICATIONS
Issue
Implications
Legal Financial Anti-Poverty Effects on existing Policy Effects on other Activities Human Rights Equalities Asset Management Health
8
None All development will be assessed in relation to financial impacts Will support anti poverty All development in line with national guidance None None All priorities will address areas of equalities as appropriate None Will improve the Health and Wellbeing in the priority areas identified
APPENDICES  Appendix A: Action Plan 2018/19  Appendix B: Guidance and Key Frameworks
LEAD OFFICER FOR THIS REPORT Susan Forster Director of Public Health St.Helens Council Tel: 01744 673232 Email: susanforster@sthelens.gov.uk BACKGROUND PAPERS -The following list of documents was used to complete this report and they are available from the Contact Officer named above: See Appendix A
Appendix A: Action Plan 2018/19 Work Area Public Health input to Planning
Action Appropriate planning applications to be sent to Public Health for comment and any comments to be included within the Environmental health statutory response.
Responsible Officer Diane Bolton-Maggs/Matt DaviesPublic Health
Timeframe On-going
Melanie Hale- Planning
Following this pilot a local ‘Planning-for-health’ tool will be developed if common themes are found to be emerging from planning applications Explore the introduction of novel place based design to encourage healthier behaviours.
Licensing and Health
Promotion of Active Travel and Sustainable Transport Development of policies for engaging with commercial organisations with a potential to impact on health and wellbeing
Public health to input into the Local Plan. Creation of a ‘lifestyles’ Supplementary Planning Guidance to include alcohol and gambling establishments modelled on the hot food takeaway SPD that is now included in general planning guidance Re-development of school transport plans to promote sustainable journeys to school Identify key areas for concern and development of policy statements, commencing with an ecigarettes policy
Diane Bolton-Maggs-Public Health Melanie Hale & Jonathan Clarke,Planning
March 2019
Diane Bolton-Maggs-Public Health Place officer TBC Diane Bolton-Maggs-Public Health Michelle Loughlin-Public Health Place Officer TBC
March 2019 On-going
Appendix B: Guidance and Key Frameworks The way we plan and design our built environment can have and has had a significant impact on our population’s health and wellbeing. The link between planning and health has long been established and our built and natural environments are major determinants of our health. The Department for Communities and Local Government developed guidance in 2014 (last updated in 2017) which details how local authority planners should work alongside the Director of Public Health, CCG’s and NHS England. This guidance sets out how a Healthy Community can be achieved and how planning can help to create healthier food environments too. https://www.gov.uk/guidance/health-and-wellbeing#history Health is also detailed throughout the 2012 National Planning Policy Framework with particular reference within the core planning principles (paragraph 17), policies on transport (chapter 4), high quality homes (chapter 6), good design (chapter 7), climate change (chapter 10) and natural environment (chapter 11). Paragraph 7 is also worth particular attention, as it states that there are ‘three dimensions to sustainable development: economic, social and environmental’ and that ‘these dimensions give rise to the need for the planning system to perform a number of roles’ with links to health mainly captured under ‘a social role’: ‘a social role – supporting strong, vibrant and healthy communities, by providing the supply of housing required to meet the needs of present and future generations; and by creating a high quality built environment, with accessible local services that reflect the community’s needs and support its health, social and cultural well-being’
https://www.gov.uk/guidance/national-planning-policy-framework/8-promoting-healthycommunities This framework encourages local planning authorities to engage relevant health organisations to ensure improvements in health and wellbeing and consideration of health infrastructure is included in local planning strategies. In respect of health and healthcare infrastructure, planners should consider how: 1. development proposals can support strong, vibrant and healthy communities and
help create healthy living environments which should, where possible, include making physical activity easy to do and create places and spaces to meet to support community engagement and social capital; 2. the local plan promotes health, social and cultural wellbeing and supports the
reduction of health inequalities; 3. the local plan considers the local health and wellbeing strategy and other relevant
health improvement strategies in the area; 4. the healthcare infrastructure implications of any relevant proposed local development
have been considered; 5. opportunities for healthy lifestyles have been considered (e.g. planning for an
environment that supports people of all ages in making healthy choices, helps to promote active travel and physical activity, and promotes access to healthier food, high quality open spaces, green infrastructure and opportunities for play, sport and recreation);
6. potential pollution and other environmental hazards, which might lead to an adverse
impact on human health, are accounted for in the consideration of new development proposals; and 7. access to the whole community by all sections of the community, whether able-
bodied or disabled, has been promoted.
Transport and active travel
Natural environment
Food environment
Built Environment
Economic impacts
Why is planning for health and wellbeing so important? The table below summarises, in brief, some benefits that can be achieved. 1. Good place-making adds between 5% & 50% to the commercial value of residential developments 2. Benefits to the NHS pf reducing health hand safety hazards in housing can be significant (in Wales alone its >£67m) 3. If every household in England were provided with equitable access to good quality green space, savings of £2.1bn per year could be achieved in health costs 4. Savings to the NHS from a modal shift to walking and cycling would be more than £17bn over a period of 20 years 1. Mixed land use, higher population densities and highly connected street layouts are associated with a greater likelihood of walking, of between 25% - 100% 2.
Investments in more walking-friendly neighbourhoods are good value for money. Evaluations of the cost-benefit impact of a number of walking-friendly neighbourhood projects showed positive ratios of value for money 1. Takeaway exposure was found to be associated with a higher consumption of fast food, and with BMIs up to 1.21 higher than for those less exposed 2. Takeaways are predominantly located in areas with lower socio-economic status 3. Less than 30mins of allotment gardening can result in improvements in self-esteem and mood through reductions in tension and depression. 1. Studies have shown elderly men who have an increase of available green space within 440 metres of home are significantly more active 2. Mental health patients reported reduced levels of rumination after a 90min nature walk, compared with no improvements in patients walking in an urban environment 3. Potential value of urban green spaces’ role (recreational importance) in improving physical and mental health has been estimated to be equivalent to £2.1bn in reduced health treatment costs 1. Public transport infrastructure can result in increases in active commuting travel trips, reductions in trips made entirely by car and increases in weekly cycling commuting time 2. Mortality rates are 30% lower for cycle commuters than for commuters using passive transport
The Local Government Association produced a briefing in 2017 for Directors of Public Health, describing what local authorities can do to improve air quality in their local area. https://www.local.gov.uk/sites/default/files/documents/6.3091_DEFRA_AirQualityGuide_9we b_0.pdf A resource has been developed by Public Health England containing evidence on public health and spatial planning issues to inform the design of places from a health improvement perspective. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/625568/Spatia l_planning_for_health_an_evidence_resource.pdf
NICE have a series of local government briefings on improving the wider determinants of health
Town Centre Improvement Commission Draft.pdf