Introduction
1.1.1
Public Health Wales welcomes the opportunity to provide evidence on
poverty reduction in the context of the Well-being of Future
Generations (Wales) (WFG) Act 2015 and Public Services Boards. As a
national agency, we have focussed our response on poverty reduction
in its widest sense, including examples of where Public Health
Wales’ work can support Public Services Boards in their
efforts to alleviate poverty in Wales.
1.2
Poverty
and the impact on public health
1.2.1
It is
well documented that the broader social determinants of health play
a much bigger role in shaping health outcomes than healthcare
itself, and addressing the causes of poverty calls for both
targeted and universal actions across the social gradient.
Action to tackle poverty should therefore feature throughout a
range of commitments at a national and local level such as
employment programmes, quality housing and access to quality
childcare.
1.2.2
Welsh
Government had the following key objectives set out in its national
action plan for tackling poverty (1):
o
To
prevent poverty, especially through investment in giving
children the best possible start in life. From conception through
to early adulthood, the aim is to reduce inequality at the earliest
possible stage and break the link between socio-economic
disadvantage, educational under achievement and the impaired life
chances that flow from these;
o
Recognising that the best route out of poverty is through
employment, to help people to improve their skills and enhance
the relevance of their qualifications. This also involves
removing other barriers to employment – from practical
barriers such as the accessibility of transport and buildings to
less tangible barriers such as poverty of aspiration - helping
people to move on to and up the employment ladder;
o
at the same time, supporting action to mitigate the impact of
poverty – recognising that for more and more
people, even being in work will not guarantee that they can escape
poverty.
1.2.3
Action
in these areas must be taken forward in ways which are mutually
reinforcing; good quality, affordable childcare should help
children to reach important developmental milestones: at the same
time it will create employment for some and remove a barrier to
employment for others. Early targeted action to prevent young
people from falling out of education, training or employment should
benefit them directly but should also benefit the next generation.
Advice which helps people deal with debt, or get on-line, should be
a basis for enabling them to manage their finances sustainably and
use new skills to increase their engagement in work and society.
Credit Unions and Time banking can make an important contribution
to integrated place based approaches to tackling poverty as can
Social Enterprise Development. Gambling regulation improvement
especially of fixed odds betting terminals and licencing is needed
to avoid clustering of outlets in areas of deprivation. Research on
the psychology of Scarcity (2)
has
shown that poverty affects cognitive processing and decision making
adversely in individuals with no previous mental health
problems.
1.3
What
is the potential role for the NHS in contributing to tackling
poverty?
1.3.1
In the
CMO report ‘Rebalancing Healthcare; working in partnership
to reduce social inequity’ (3)
the
NHS is highlighted as well positioned to facilitate and empower
efforts to work closely with communities and other public
sector bodies to directly influence the social, environmental and
economic factors which underpin the social gradient and tackle the
social determinants of health and well being. Specific
recommendations in the report include the provision of upstream
effective interventions throughout the life course, with a
particular focus on the early years (including the First 1000 Days,
Adverse Childhood Experiences, active lifestyle and healthy
aging).
1.3.2
The
report identified how NHS organisations including Public Health
Wales and Health Boards should ensure that health protection
interventions are delivered consistently across the social gradient
(vaccination, cancer screening, smoking cessation) and how
collaboration at primary care cluster level for example, can be
used to identify the health and well-being needs of local
communities and used to work co-productively with communities to
plan, manage and provide services that improve health
outcomes and tackle the inverse care law. Local Public Health teams
working with Health Board Executive Directors of Public Health are
involved in tackling health inequities in partnership with other
health professionals and sectors. Examples include involvement in
Valleys Taskforce and Cwm Taf and ABUHB Inverse Care Law
work.
1.3.3
Patient outcomes
depend not just on the clinical care and treatment offered to
people but on the wider aspects of a person’s life- whether
they work; what job they have, their living conditions and
finances; their family life. These factors should be of
interest to every professional seeking to maximise the impact of
their work as clinical outcomes are likely to be improved by
attention to these pressures. Primary Mental Health Care teams and
CAMHS services provide essential support to GPs in disadvantaged
areas, and some innovations such as GP Support Officers in Merthyr
Primary Care cluster have seen benefits to community members with
emotional support needs.
Befriending
schemes for the elderly have been utilised to good effect in
particular for older people living in poverty.
1.3.4
Finally, the NHS
is the largest employer in Wales. The NHS can be exemplar by
providing employment opportunities and by promoting good employee
health and well-being, reducing sickness rates and leading the way
on pay equality and providing good-quality and stimulating
work.
1.4
Actions
taken by Public Health Wales to progress implementation of the WFG
Act and support for Public Services Boards
1.4.1
Public
Health Wales takes a positive view of placing sustainable
development on a statutory footing through the WFG Act and as a new
potential opportunity to change the landscape for future
generations.
1.4.2
Public
Health Wales is a partner in Cymru Well Wales, a collaborative
undertaking involving different sectors. It was set up address
challenges such as persistent health inequities and the financially
unsustainable health and social-care system, with a focus on the
broader determinants of health. Three priority areas of work have
been identified: the first 1000 days, ACEs, and
employability.
1.4.3
Public
Health Wales have taken this opportunity presented by the new
legislation to invest in a Health and Sustainability Hub to help
both the organisation and the wider NHS system respond to the WFG
Act in order to maximise opportunities for improving health and
well-being and reduce inequity.
1.4.4
Whilst
Public Health Wales and the Hub do not provide support to the
Public Services Boards (PSBs) on an individual basis, the Hub
provides support to the public health community in its various
roles on PSBs with the following aims:
o
Bring together Public Health colleagues from across Wales who are
supporting the PSBs through a PSB Support Network, to share
information about work underway in different PSB areas;
o
Ascertain the level and type of support which the Hub can provide
to Network members.
1.4.5
The
Hub in Public Health Wales has delivered workshops for the PSB
Support Network covering themes like the use of evidence and
leadership qualities for working with PSBs, with up-dates from the
Office of the Future Generations Commissioner, Wales Audit Office
and senior leaders in Public Health.
1.4.6
As
part of the support the Hub is offering to PSBs and the Office of
the Future Generations Commissioner, the Hub team have reviewed the
PSB Well-being assessments to examine the approach taken to long
term thinking and planning for future generations. When
published, we anticipate that this report will be useful for policy
makers, public bodies and PSBs by identifying themes such as
austerity, trends in wealth and welfare, poverty, household savings
and consumption trends as playing a significant part in a more
equal Wales for the future.
1.4.7
The
Hub participates in the PSB Co-ordinator Network, which is
co-ordinated by Welsh Government and which (explain role on
Network). To date, the Hub Team have attended meetings to
raise awareness of work streams and to seek PSB
co-ordinators’ advice on the type and nature of support
required for well-being plans. Co-ordinators identified the need
for short, tailored, visual information on topics such as how the
environment impacts on health and well-being; the Hub team is now
taking forward.
1.4.8
The
Hub has also used the PSB Co-ordinators’ e-bulletin to alert
co-ordinators to useful reports like:
o
‘Making
a difference: investing in sustainable health and well-being for
the people of Wales’ highlights the need to combine
‘investment in prevention’ with steps to address the
economic, social and environmental determinants of health, framed
by the principles of the WFG Act and prudent health
care.
o
Adverse
Childhood Experiences research - a series of publications linking
adverse childhood experiences (traumatic experiences that occur
before the age of 18) with health-harming and antisocial
behaviours, mental well-being and chronic diseases and health
service use.
These resources
can be used by public bodies and public Services boards to identify
evidence-based action to help inform their response to the
Act.
1.4.9
Public
Health Wales is taking a proactive response to the recommendations
contained within The Future Generations Commissioner report,
‘Well-being in Wales: Planning today for a better
tomorrow’, on the learning from the local well-being
assessments of each PSB. The Health and Sustainability Hub is
in the process of identifying approachesfor a public
health system response to the Commissioner’s
recommendations– with ideas for actions and opportunities to
support PSBs at a national and local level.
1.4.10
Public
Health Wales has long advocated Health Impact Assessment as a tool
to support sustainable development; helping to ensure that both the
short and long term impacts of policies, plans and projects are
taken into consideration. The Wales Health Impact Assessment
Support Unit, which is part of Public Health Wales, is dedicated to
helping policy makers and practitioners develop and implement HIA
in Wales. Since the introduction of the WFG Act the Unit has been
supporting and development the role of well-being impact
assessments in demonstrating that the public bodies and public
services boards (among others) take the well-being goals into
consideration.
1.4.11
Finally, Public
Health Wales and the Health and Sustainability Hub are working on a
new tool which will help to embed sustainable development and new
ways of working. The intention is to pilot the tool in
several settings including with statutory partners on the Public
Services Board. The results (both positive and negative) will
be used to refine and develop thinking around embedding sustainable
development across public services.
1.5
References
1. Welsh
Government. Tackling poverty action plan: 2012-2016. Cardiff: Welsh
Government; 2012.
2. Mani A,
Mullainathan S, Shafir E, Zhao J. Poverty Impedes Cognitive
Function. Science. [Online] 2013;341(6149): 976–980.
Available from: doi:10.1126/science.1238041 [Accessed: 5th December
2017]
3. Welsh
Government. Rebalancing healthcare: Working in partnership to
reduce social inequity: Chief Medical Officer for Wales Annual
Report 2015-16. [Online] Welsh Government. Report number: WG28727,
2016. Available from:
http://gov.wales/docs/dhss/publications/161110cmoreport16en.pdf
[Accessed: 12th May 2017]