Feature

Looking back on the LA story

What lessons for the future can local authorities learn from their experience of health
promotion, asks Martin King

As local councils come under further financial constraint, ideological attack and even the threat of extinction, there are questions about the future role of health promotion in local authorities. Somewhat ironic in a world filled with rhetoric about ‘healthy alliances’ and working together to meet targets, and somewhat depressing after the optimism and flurry of activity around ‘Health for All’ in the late 1980s.

These questions are being addressed comprehensively in Tameside, east of Manchester.

Tameside metropolitan borough council successfully bid against other authorities in 1990 to host a three-year project funded by the Health Education Authority to examine the potential role of local authorities in health promotion, with a particular emphasis on training.

In recent years health promotion has been seen primarily as falling into the domain of health authorities, with all HAs having health promotion units as part of their preventive services. But the late 1980s saw the rise of the international Health For All movement which looked at health in a broader social context, the rise of the environmental movement, a series of food scares, mainstream discussion of the importance of issues around poverty, equal opportunities, and disability - all a matter of concern for the statutory sector. The threat of HIV and AIDS as a public health issue required inter-sectoral working. All of this gave rise to what has been called the ‘rediscovery’ of public health or the new public health.

With the realisation that the new public health required a comprehensive policy came the realisation that the local authority had an important role to play in health promotion.

As a provider of services which impinge on the lives of all its residents, it is well placed to improve the health status and quality of life of those residents, both through the policy decisions of members and the practice of officers. Housing, environmental pollution control, employment and investment decisions, food control, the provision of social services, refuse disposal and education services are just some LA functions which have become part of the public health agenda.

During the same period, the Health Education Authority had been developing links with LAs, mainly through environmental health departments. An HEA survey of LA health promotion activities in 1989 showed that health promotion was developing in a very ad hoc way and that those involved often did not have access to the growing body of theory and practical knowledge from HAs or LAs where major investment had been made in health promotion projects, such as Sheffield and Oxford.

Councils often just changed the titles of existing staff. There was confusion about what they should be doing - the work of many councils’ health promotion workers often just imitated that of their HA counterparts.

The realisation that the council has a key health promotion role was not immediately obvious to many. The need for a pilot project to explore the potential for health promotion specific to LAs and to examine training and professional development needs was established. The rationale behind establishing an initiative in one LA was that various methods of addressing the project’s overall brief would be tested and the results disseminated to other authorities. There was also a large networking element built into the project design so that it would link nationally with other LAs, HEA projects and with national training bodies such as the LGMB and IHEO.

A project officer was appointed in December 1990. The task of establishing health promotion as a corporate issue began with an ‘audit’ of health-related activity and the production of a policy statement and action plan.

The project then developed into a series of initiatives, including piloting and developing of a training package on health promotion to help staff recognise and develop their health promotion role in their day-to-day work.

A training pack based on this work was launched in July this year and is now available to other LAs.

A joint project with the HA looking at health needs on a large housing estate in Tameside and how council services can meet these is ongoing. One result is funding for a new local worker.

The project officer has also been involved in initiating a ‘healthy alliance’ between statutory, voluntary and private sector agencies to produce a joint health promotion strategy for the whole district which aims to co-ordinate activity and produce shared values, goals and concrete initiatives.

Another key feature of the project has been a national networking role both with established national networks and individual staff in other authorities. What seems to emerge is that a variety of innovative projects, alliances and developmental work is going on around health promotion in LAs but that it is despite the system - not because of it.

As councils impose cuts, areas seen as peripheral - like health promotion - go to the wall. It is the all too familiar story of short-term savings versus long-term change and achievement.

Don’t look back! The future of local authority health promotion is the title of Tameside’s end of project conference. It hopes to offer other authorities a chance to benefit from its lessons and achievements and will provide a forum for those working on health promotion in LAs to discuss ideas and strategies for the future.

The end of project dissemination conference for the Tameside project - Don’t look back! The future of local authority health promotion - will take place on Thursday 4 November 1993 at the Village Hotel, Tameside. Details from Professional Briefings, 120 Wilton Road, London, SW1V 1JZ Tel: 071-233 8322 Fax 071-233 7779.

Details of the local authority training pack are available from Martin King, Chief Executive’s Department, Tameside MBC, Council Offices, Wellington Road, Ashton-under-Lyne, OL6 6DL