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Maintaining our momentum: Essays on four years of public health

Public health made the formal transfer to local government in April 2013, and in the last four years great strides have been made to tackle the wider social and economic determinants of poor health. This publication was commissioned by the Local Government Association (LGA) to capture the thoughts of those working hard to make the new system work with contributions from councillors, directors of public health, providers, commissioners, academics and other key decision makers.

Some of the articles are deliberately challenging and provocative; some of them present a picture of what is already happening in local government to tackle the social determinants of health; some of them look to what more local authorities could do in the future, either with additional powers or by using their existing powers and remit.

Good public health, drawing imaginatively on all of local government’s functions, can make a real, large-scale difference to promoting the independence of people with long-term chronic conditions, to preventing ill health and therefore to reducing pressures on the NHS, as well as to its primary goals of improving people’s lives and wellbeing and reducing health inequalities.

Good practice from individual councils shows just what potential there is for public health, if properly resourced, to make inroads into improving health and wellbeing. Public health teams, working with a ‘health in all policies’ approach across councils, are tackling persistent problems like adult and childhood obesity, mental illness, alcohol abuse, sexually transmitted infections and the health impact of isolation and loneliness in old age, as well as addressing some of the serious health inequalities that still exist within and between communities.

Already, we see DsPH beginning to build on their understanding of the impact of most local government functions on the social determinants of health.

However, the context for all the excellent work is the relentless reduction in the resources available for public health work. Councils and their public health teams have put a brave face on the compromises they have had to make, working with the local NHS and voluntary sector, sharing public health initiatives and sometimes even public health teams across councils, reorganising in an attempt to achieve more with less.