The way in which Public Health is organised and delivered in Sheffield is soon going to change significantly. As part of the wider changes to the management of the National Health Service, the Government has decided to restore responsibility for Public Health to local authorities. This means that 39 years after it was transferred to the NHS – in 1974 – public health will again primarily be the responsibility of Sheffield City Council from April 2013.
In many ways, this is taking public health back to its roots, because it was in the big metropolitan authorities of the Victorian era that public health started1. There is a clear rationale, in that local authorities arguably have a greater influence over the things that make populations healthy, or not, than do health services.
Employment, housing, air quality, the availability of opportunities to be physically active and to eat good food – all are more directly influenced by local authorities than by the NHS. We have, of course, always recognised this, and in recent years the public health team has increasingly been working across both the NHS and the Council. The challenge we now face is to build on that, and ensure that when Public Health is back in the local authority, we are able to influence every aspect of what the Council does, turning the whole organisation into a public health organisation.
However at the same time we must not downplay the big contribution that health services do make to the health of the population. Public health has a vital role to play in the commissioning and management – in its broadest sense – of health services. When resources are tight – as they are now more than ever – then public health skills are more than ever needed to ensure that the best value for money is obtained from health budgets. So we will work hard to build strong links with colleagues in the developing Clinical Commissioning Group, and to maintain public health input into the management of health services in Sheffield.
In this report, we have taken a look back and a look forwards for public health in the City. We have looked back to 1974, when it was last the responsibility of the Council, and noted the big improvements in health since then. We summarise the work being done by the public health team at the moment. And we then go on to identify opportunities and challenges for public health for the future.
In general, the health of the people of Sheffield, when measured by simple mortality rates or life expectancy, is better than it ever has been. Death rates from the major diseases continue to fall steadily, as shown in Figure 1. Life expectancy for men has improved again since the last reporting period though for the first time for some years it has not for women. As a result the inequality in life expectancy between the sexes has reduced from 4 years in the three-year period 2006-8 to 3.7 years in 2007-9.
Figure 1: Headline Health Indicators for Sheffield and England
|Male life expectancy at birth (years)||77.5||77.8||78.3|
|Female life expectancy at birth (years)||81.5||81.5||82.3|
|Early deaths from heart disease and strokes per 100,000 population||79.6||74.8||70.5|
|Early deaths from cancer per 100,000 population||121.1||120.8||112.1|
|Infant deaths per 1,000 live births||5.77||5.38||4.71|
|Road traffic injuries and deaths per 100,000 population||47.6||43.0||48.1|
Source: Association of Public Health Observatories – Health Profiles for Sheffield (2010 & 2011)
The improvement in men’s health is clearly very much to be welcomed as this follows big efforts being made to address the causes of premature male mortality in our healthy communities programme. It is also particularly good to see that the latest analysis of inequality in life expectancy across the City (shown in Figures 12a and 12b of this report) shows a narrowing of the gap for men.
The less good picture for women is, however, a cause for concern. Not only has the improvement in life expectancy stalled, but the inequality in female life expectancy across the City is now widening. This may well be the consequence of women increasingly adopting lifestyles more traditionally associated with men, such as smoking and drinking alcohol to excess. We will undertake further analysis of this widening in inequality in women in order to enable us to best address the causes.
There are, of course, other significant public health problems in the City that do not show up in mortality statistics, which simply reflect length of life and cause of death. There is a huge burden of diseases that do not cause death, or else cause ill health and disability for many years before someone dies. Psychiatric diseases and mental ill health are prime examples, but there are many chronic physical diseases that also cause much morbidity. Unfortunately we know, both from local data, such as the ‘Sheffield Health and Illness Prevalence’ surveys2, as well as from elsewhere, that inequality in morbidity across the City is every bit as great as inequality in mortality.
The persistence of health inequalities in the City underscores the need to continue with the implementation of the City’s Health Inequalities Action Plan ‘Fairer Sheffield, Healthy Lives’3. However it also points up the need to address the wider socio-economic inequality in the City, which is the underlying cause of health inequalities. The Public Health team remains absolutely committed to doing all we can to improve health and reduce inequality in Sheffield, and I am confident that we will continue to do that whilst negotiating a successful transition to a new base in Sheffield City Council.
I hope you enjoy reading the report.
Dr Jeremy Wight
Director of Public Health
Sheffield City Council and NHS Sheffield
1. “SHEFFIELD.- Dr. Francis Griffiths has been elected, by the Town Council of Sheffield, Medical Officer of Health for the Borough for a period of three years, at a salary of £600 per annum. There were in all thirty-five candidates.” British Medical Journal April 26th 1873.
2. Sheffield Health and Illness Prevalence Survey (2002) http://www.sheffield.nhs.uk/healthdata/resources/shaips2.pdf
3. Fairer Sheffield Healthy Lives (2010) http://www.sheffield.nhs.uk/healthdata/resources/hiap2010.pdf