Health in a Healthy City

The Annual Report of the Director of Public Health 2005 and Brighton and Hove City Health Development Plan

CONTENTS

Page Contents i Foreword and Contributors ii Executive Summary 1 Chapter 1 Introduction by Tom Scanlon, Acting Director of Public Health 3 Chapter 2 Policy Context 7 2.1 National Policy 8 2.2 International Context 9 2.3 Local Policies and Local Implementation of National Policy 9 Chapter 3 Tackling the Causes of Ill Health 13 3.1 The Determinants of Health 14 3.2 Lifestyle 15 3.3 Poverty 25 3.4 Health and Healthcare 28 3.5 Education and Life-Long Learning 32 3.6 Transport 35 3.7 City Planning 38 3.8 Housing 41 3.9 Crime 44 3.10 Economic Development 47 3.11 Environment 52 3.12 2020 Community Strategy Performance Targets 56 Chapter 4 Involving Local Communities 59 Chapter 5 Healthy City Partnership 63 Chapter 6 Conclusions and Delivery Plan 69 Glossary of Abbreviations 78 References 79

i FOREWORD

Foreword Recent years have seen greater ties and co-operation between the many partners in Brighton and Hove who contribute to health improvement and to the reduction of inequalities in health. In July 2004, this progress was formally recognised by the World Health Organisation (WHO) with the award of Healthy City status. Designation as a WHO Healthy City requires the production of a City Health Development Plan (CHDP). This year, therefore, the Director of Public Health’s Annual Report 2005 serves also as a City Health Development Plan. The production of the Report and CHDP presented further opportunities to develop the ties and close relationships required of the partners who hold a remit for improving public health. This year’s Report is the second that has been produced jointly between the Primary Care Trust (PCT) and the City Council and reflects an increasingly common agenda between the two organisations. I would like to thank all those who have played their part in putting this Report and Development Plan together; colleagues at the PCT and the City Council, as well as colleagues in the business, community and voluntary sectors. I would like to thank the individuals who took overall responsibility for co-ordinating specific contributions: Bernadette Alves, Kate Benson, Chris Dorling, Henriette Hardiman, Carmel Mullaney, Sarah Nicholls, Sunanda Ray, Peter Wilkinson and Becky Woodiwiss. In particular, I would like to thank Terry Blair-Stevens, Claire Turner and Martina Pickin. Terry, as well as writing a substantial part of the Report and Plan, led on its production, while Claire and Martina took on additional responsibilities in writing and editing to ensure that it was produced on time; all three of them with characteristic dedication, professionalism and good humour. I am confident that the Report and Plan will provide the framework required for delivering the Healthy City agenda and that it will be seen as a credit to all those involved who dedicate themselves to this end. Thank you all.

Contributors Bernadette Alves Chris Dorling Lydie Lawrence Andy Renaut Kate Benson Angie Emerson Scott Marshall Tom Scanlon Terry Blair-Stevens Rob Fraser Paul Martin Andy Staniford Gwendolyn Brandon Deborah Georgiou Chris Minter Matthew Thomas Gavin Bryce Henriette Hardiman Carmel Mullaney Liz Tucker Elizabeth Cameron Sarah Hardman Simon Newell Claire Turner Martin Campbell Doreen Harrison Sarah Nicholls Affy Wajid Kerry Clarke Nick Hibberd Caron Patmore Andrew Wilson Ruth Condon Louise Hulton Martina Pickin Chris Wilson Rachel Conway Paul Jarvis Hilary Powlson Peter Wilkinson Thurstan Crockett Jackie Johnson Sunanda Ray Becky Woodiwiss Gillian Cunliffe Carol King Julia Reddaway

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN ii

EXECUTIVE SUMMARY

Executive Summary Although there have been major improvements with recommendations as to how performance in health and life expectancy over time, the might be improved. Chapter 3 comprises experience of ill-health, disability and premature contributions on lifestyle, poverty, health and mortality is highly unequal between gender, healthcare, education, transport, city planning, ethnic group and socio-economic group. housing, crime, the economy and employment, Poverty, low wages and occupational stress, and the environment. The lifestyle section unemployment, poor housing, environmental within Chapter 3 includes a summary delivery pollution, poor education, limited access plan for the Public Health White Paper. The to transport and shops, crime and disorder, chapter concludes with a summary of progress and a lack of recreational facilities all impact against 2020 Community Strategy targets. on people’s health. Chapter 4 outlines the progress that has been Improving health and tackling health inequalities made in addressing community involvement on is a priority for the present Government. a number of fronts through neighbourhood A comprehensive cross-government programme renewal, New Deal for Communities (eb4U), of national policies and targets has been Healthy City status, the Local Area Agreement developed to address this, and targets and and with specific groups such as older people standards for local action have been set. and children. A local Health Inequalities Strategy, A Strategy The process for monitoring progress as a to Reduce Health Inequalities in Brighton & Healthy City is summarised in Chapter 5. Hove, outlines the local response to these The Report finishes with a concluding chapter inequalities (Scanlon, 2005). which includes a programme for delivering This Annual Report of the Director of Public the City Health Development Plan. This Health for Brighton and Hove 2005 is the delivery plan describes the key partnership second joint Primary Care Trust (PCT) and City arrangements for coordinating healthy city Council public health report. First and foremost, development, strategic objectives, actions, the Report serves as a City Health Development milestones and the resources necessary to Plan as part of the city’s commitments as a deliver the recommendations from this Report. WHO Healthy City. The Report also includes The worst health problems in the city will proposed actions to address the Public Health not be overcome unless the root causes of White Paper Choosing Health: making healthier ill health and inequalities in health are tackled. choices easier, and it summarises the progress There is a need, therefore, for targeting that has been made against the 2020 measures across employment, education, Community Strategy. housing, transport, the environment, the Following the introduction, Chapter 2 economy, crime and safety all of which have summarises the policy context for the Report an impact on health. This agenda can only in the light of the city’s designation as a WHO be addressed by building strong partnerships Healthy City. Chapter 3, which forms the bulk that include communities. Healthy City status of the Report, considers the wider determinants offers Brighton and Hove a unique opportunity, of health in a systematic way, outlining the and a vehicle for statutory and non-statutory evidence for their contribution to health and organisations and the community to come health inequalities, relevant national and local together and unite in making Brighton and policies, how Brighton and Hove has performed Hove a much healthier place for everyone. against targets or standards and concluding

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 1 2 CHAPTER ONE INTRODUCTION BY TOM SCANLON, ACTING DIRECTOR OF PUBLIC HEALTH CHAPTER 1 INTRODUCTION

Introduction Good health is the result of much more than knowledge, skills and experience can help plan medical care. Living and working conditions and develop services. Community participation determine people’s health. This includes the requires a genuine commitment to openness, physical, social and economic environment as flexibility and accountability. well as the quality and accessibility of health The vision for Brighton and Hove as a Healthy and social care services. People are healthier City is outlined in the Healthy City Partnership’s still when they live in nurturing environments Declaration on Health 2004. The people of and are involved in the life of their community. Brighton and Hove have the right to expect This Annual Report of the Director of Public Health the best possible health and quality of life for serves this year also as a City Health Development themselves and generations to come. Everyone Plan (CHDP). This CHDP has been put together needs to take responsibility and work together as a requirement of membership of the WHO to achieve this. This means getting involved Healthy Cities Project. This accolade awarded to individually to influence policy and decisions, Brighton and Hove in July 2004 is an and taking personal responsibility for acknowledgement of the high standard of strategic behaviours and lifestyles. Most importantly, planning, partnership and political commitment it means working collectively to combine skills for health improvement across the city. and resources to assist those who face the biggest challenges in achieving good health. The Report shows how health is influenced by the conditions in which the residents of Brighton The Healthy City Partnership is the group that and Hove live and presents an overview of the leads the Healthy City Work Programme. The success or failure of much of the work that is Partnership directs the actions required for currently being carried out locally to improve improving the health of everyone within the health and tackle its broader determinants. city. It brings together representatives from the The Report makes recommendations for City Council, neighbourhoods, the community actions that would further improve health and voluntary sector, health, business and the and reduce health inequalities. It concludes academic sector. The Healthy City Partnership’s with a framework for action across a variety goal is to improve health for everyone and to of partnerships to ensure that city planning is reduce health inequalities within the City. The influenced by, and influences in a positive way, Partnership’s objectives reflect how this will be the health of local people. achieved, and it will: The Report is aimed in particular at those • provide leadership and vision; who are best placed to take action to improve • co-ordinate action between partners across health and reduce health inequalities within all sectors; the city. This includes people who are policy and decision-makers, service developers and • influence policy and decision-making; providers across all sectors within the city. • communicate with and involve local However, health is everyone’s business so the communities; and Report is accessible to all through the web and public libraries and a shorter version will • support the health needs of vulnerable be available on request for the general public. and socially excluded groups. Everyone should be able to participate in Organisations need to be accountable to the decisions that affect health whether as people they serve. Within the Healthy City individuals or members of a group or Partnership, organisations take collective community. People often feel excluded from responsibility for the delivery of agreed actions decision-making processes. It needs to be easy to improve health and reduce inequalities. for the public to get involved, so that their

4 CHAPTER 1 INTRODUCTION

The partnership reports to a Local Strategic Partnership and Public Service Board. It is evident from involvement in the WHO Healthy City Programme that Brighton and Hove faces similar public health, social, economic and environmental challenges to other cities in Europe. The Healthy City Partnership is committed to learning from the experience of other Phase IV Healthy Cities and sharing challenges and successes. To achieve long lasting improvements to health there needs to be a commitment to sustainable development. Sustainable development, as defined by the WHO, means that action taken today should not jeopardise the health and well-being of future generations (WHO, 1997). People born in Brighton in Hove in 2003 can now expect to live on average four years longer than people born 20 years ago. However, the ‘health gap’ between rich and poor in Brighton and Hove remains. The worst health problems in the city will not be overcome unless the root causes of this inequality are tackled. There is a need therefore, for measures across employment, education, housing, transport, the environment, the economy, crime and safety all of which have an impact on health. There is also a need to challenge discrimination and social injustice and to make services as accessible and customer focused as possible. If this Report and CHDP is successful, residents can expect to see health considerations being taken into account in a much wider range of planning and policy decisions within the city. In the long term they can also expect to see improved health in the population for themselves and for future generations.

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 5 CHAPTER 1 INTRODUCTION

6 CHAPTER TWO POLICY CONTEXT

2.1 National Policy 8 2.2 International Context 9 2.3 Local Policies and Local Implementation of National Policy 9 CHAPTER 2 POLICY CONTEXT

Policy Context Improving health and tackling health inequalities 3. Working in partnership. People recognise is a priority for the present Government. that everyone needs to work together to A comprehensive cross-government programme help people to be healthy; in particular local of national policies and targets has been government, the NHS, the voluntary sector, developed to address this and targets and business and the media. standards for local action have been set. Choosing Health outlines the roles of the NHS, Details of these are summarised in the local central and local government and the voluntary Health Inequalities Strategy (Scanlon, 2005). and commercial sectors in delivering this crucial Several other national strategies have an agenda. The White Paper identifies six priorities impact on health including those relating with related actions: to crime, education, housing, poverty, the environment, city planning and transport. 1. Reducing the number of people These are considered as part of Chapter 3. who smoke: • a ban on smoking in enclosed public places 2.1 National policy and workplaces, with licensed exemptions - Key national strategies and reports addressing in place by 2008; health inequalities include: • picture warnings on cigarette packets; • Independent Inquiry into Inequalities in Health (Acheson, 1998) • further restrictions on tobacco advertising; • Saving Lives: Our Healthier Nation (DH, 1999a) • action against tobacco smuggling; • The NHS Plan (DH, 2000) • action on shops selling cigarettes to children; and • Cross-Cutting Review on Health Inequalities • improved NHS smoking cessation services. (DH, 2002) 2. Reducing obesity and improving diet • Tackling Health Inequalities: a programme of and nutrition: action (DH, 2003) • by mid-2005, a simple code indicating fat, sugar and salt content in processed foods • The Wanless Report: Securing Good Health will require work with supermarkets to for the Whole Population (Wanless, 2002) encourage its wide adoption; • The Health and Social Care Standards and • work with food industry to reduce portion Planning Framework: National Standards, sizes and to cut fat, sugar and salt content; Local Action (DH, 2004a) • Office of Communication (OFCOM) to examine Much of the above policy development has food advertising aimed at children with a been brought together in the White Paper on view to voluntary restrictions on junk food Public Health, Choosing Health: making healthier adverts, legislation to be considered in 2007 choices easier, (DH, 2004b). The White Paper is if voluntary approach proves ineffective; underpinned by three key principles: • schools to take a ‘whole school’ approach 1. Informed choice for all. People want to to diet and nutrition: healthier meals and make their own choices about their health free fruit to be mandatory, pupils given but require information and support to help opportunities to learn about diet, nutrition, them make the right choices. food safety, preparation and cooking, and 2. Personalisation of support. People want the active promotion of healthy food and support to enable them to be healthy, but drinks as part of a balanced diet; and this support needs to meet their personal • independent task force to examine the best requirements. ways to prevent and treat obesity.

8 CHAPTER 2 POLICY CONTEXT

3. Increasing exercise television, offering clear information on health • more than £1bn investment in physical choices. This will replace NHS Direct. NHS education and school sport, more sports health trainers will provide advice to individuals academies and more protection for school on improving their lifestyle, with advice, playing fields; and support and motivation on developing a personal health guide. • children to be encouraged to walk or cycle to school and adults to ‘get active’ at work. 2.2 International context The WHO Phase IV priorities are Health Impact 4. Improving sexual behaviour Assessment (HIA), Healthy Urban Planning and • new national campaign aimed at those most Healthy Ageing. Local experience and expertise at risk of unplanned pregnancies or STIs; of HIA within Brighton and Hove is increasing • improvement and investment in GUM clinics with HIAs having been undertaken on the City to bring waiting times down to 48 hours by Council’s staff transport policy, the city’s draft 2008; and Local Plan, on Waste Management and extending smoke-free environments. HIAs will also be • speeding up adoption of national chlamydia undertaken on the Local Redevelopment screening programme. Framework and new Local Transport Plan. HIA 5. Encouraging and supporting training for Public Health Practitioners and City sensible drinking Planners is being arranged. • work with Portman Group and industry to Healthy Urban Planning is a relatively new tackle binge-drinking and draw up a concept for the city. Health criteria and a voluntary social responsibility scheme for screening tools and checklists are in alcohol retailers and producers; development for use in regular planning • alcohol manufacturers to include messages assessments. It is proposed that one or two on products to promote sensible drinking; projects, annually, will be identified for comprehensive HIA and to include the Healthy • OFCOM to strengthen rules covering City manager in the Local Development broadcast advertising of alcohol; and Framework Partnership. • better services for tackling alcohol problems There are already strong integrated planning at an early stage. approaches within the city that support Healthy 6. Improving mental health Ageing. The Older People’s Health Promotion • action to tackle inequalities experienced by Mapping Exercise was undertaken as part of people from black and ethnic minority the Healthy City approach (see below). The communities in accessing mental health involvement of older people in the Healthy City care services; programme is being strengthened. • using Sure Start to put measures in place by 2.3 Local policies and local implementation 2005 to give children and young people the of national policy best start in life, protecting them against The 2020 Community Strategy identified the mental health problems in later life; and top community planning priorities for the city. These priorities reflect local needs and • new guidelines to be published by 2005 on aspirations and are agreed by all partners from managing mild to moderate mental ill health the public sector, local authority, business, in the workplace. community and voluntary sectors. Information to support people in making ‘A Healthy City’ is one of eight priorities chosen healthier choices will be provided by the launch by residents for the city’s 2020 Community of Health Direct, a comprehensive new service Strategy. All eight priorities - a healthy, available by telephone, internet and digital enterprising, safer, inclusive, affordable,

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 9 CHAPTER 2 POLICY CONTEXT

attractive, mobile and customer-focused city spaces through waste minimisation, have the potential to establish better conditions improving the quality of parks and green for health within the city. The priorities are spaces, and achieving better inter-related: action in one area will have an communication with service users so that effect on the others. the services can be more responsive to user requirements. Local Area Agreements (LAA) are currently being piloted nationally as part of the (3) To increase the capacity of local communities Government’s strategy for delivering public so that people are empowered to services more effectively at a local level. participate in local decision-making and are Brighton and Hove is one of the pilot areas. able to influence service delivery. LAAs are based on agreements between the (4) To create more sustainable communities Council, Government office and local partners through improvements in housing and about the delivery of national targets. These employment opportunities. agreements reflect local priorities, reinforce local partnership working and bring together (5) To improve awareness and encourage the various sources of funding to best address local use of sustainable transport choices. priorities. LAAs can strengthen Local Strategic The Children and Young People block reinforces Partnerships and help to raise the importance the integrated approach to children’s services of health inequalities and health improvement and will accelerate progress on a number of within local community planning. The initial key issues. These include early intervention LAA was based on three blocks: and prevention, Children and Young People • Safer and Stronger Communities in priority groups and those living in disadvantaged neighbourhoods, support • Children and Young People for families and carers, budget alignment, • Healthier Communities and Older People and the integration of commissioning and management. In Brighton and Hove a children’s A fourth block, Economic Development and asset mapping survey was carried out in 2004 Enterprise, will be added in the future. to identify gaps in information and where The Safer and Stronger Communities block services should be placed to improve outcomes. covers many of the key issues raised by Proposals in the Children and Young People communities in Brighton and Hove. In 2003- block are organised under the five Every Child 2004, a general survey undertaken by the City Matters (ECM) outcomes (DfEST, 2003) and the Council reported that the two most important shared priorities of the Children’s Trust Strategy issues for local people were cleaner streets and (CTS) (BHCC, 2005a) which flow from them. reducing levels of crime. A Single Community There is a substantial interrelationship between Programme will support community involvement activities and indicators across the five outcomes. in the Local Strategic Partnership, Community Strategy and Neighbourhood Renewal Strategy. (1) Stay Safe (ECM): fewer Children and This block also includes action on unemployment, Young People suffering harm and neglect housing, transport and waste. and more Children and Young People safeguarded from risks and diverted from The Safer and Stronger Communities block’s offending behaviour. All parents and carers five key strategic outcomes are: able to access support which builds on (1) To reduce crime and reassure the public, their existing skills and understands the by reducing the fear of crime and anti- diversity of family life in order to strengthen social behaviour, and reducing the harm their confidence, resilience and caused by illegal drugs. effectiveness (CTS). (2) To have cleaner, safer and greener public (2) Be Healthy (ECM): more Children and

10 CHAPTER 2 POLICY CONTEXT

Young People enjoying the best possible targets set in the National Service Framework physical and mental health, healthy for Older People. However, there is a need to lifestyles, and sustainable well-being (CTS). increase local understanding of older people’s health beliefs and what empowers them to (3) Enjoy and Achieve (4) Achieve Economic maintain their health and independence. Well Being and (5) Make a Positive Contribution are all outcomes from ECM. As part of the Healthier Communities and These share the same CTS priority of more Older People block, action to reduce smoking Children and Young People getting the most is essential to creating healthy lifestyles. out of life, fulfilling their individual potential, The local smoking cessation service has had whatever that might be and developing considerable success at an individual level, appropriate skills for adulthood, active in particular in reducing health inequalities. citizenship, and economic well being (CTS). At a local policy level following the completion of an integrated impact assessment and The Healthier Communities and Older People “The Big Smoke Debate” (a public survey of block of the LAA brings together the aspirations local opinion on the extension of smoke-free of the Public Health White Paper and the city’s environments) the City Council introduced a status as a Healthy City in a model for improving Smoke Free Charter and adopted the Charter the health of older people. The Brighton and in all of its premises. Other actions to improve Hove LAA supports healthy ageing for older healthy lifestyles include strategies relating people through better integration of services to diet and nutrition, physical activity and at a neighbourhood level and an increased weight management. focus on prevention, health promotion and support for independent living. This work will The city is also consulting on and assessing the be piloted in two neighbourhoods and where implications of the new Adult Social Care new approaches prove to be successful these Green Paper. This national strategy presents a will be extended across the city. new approach to support the care of vulnerable adults with an emphasis on increasing The LAA Healthier Communities and Older independence, choice and well-being and a People block’s five key strategic outcomes are: sustainable shift towards prevention of ill-health (1) To improve health for older people through and postponement of dependency. the prevention and early identification of The Area Investment Framework (AIF) maps key causes of morbidity: infections, falls, the spending plans of key public, private and chronic obstructive pulmonary disease and voluntary sector organisations against agreed heart failure. economic development and regeneration priorities (2) To improved the health of the population over the next 3-5 years. The AIF has the potential with increased life expectancy and reduced to target funding more effectively. The aim is health inequalities through the promotion for improved joint investment planning between of healthy lifestyles. a range of organisations to better address local priorities such as: housing; learning and skills; (3) To improve the quality of life for carers health and transport. The AIF was developed and the people they care for. before the introduction of LAAs and is likely (4) To adopt a more flexible and ‘needs led’ to be incorporated into the latter. service provision for older people. A local Health Inequalities Strategy has been (5) To improve housing for older people. produced which describes the extent of local health inequalities across the city and specifies Following an Older People’s Health Promotion local targets and an action plan to address Mapping Exercise, a Healthy Living Guide was them (Scanlon, 2005). The strategy has been produced to provide practical information on agreed within the Healthy City Partnership and health and decision-making on meeting the

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 11 CHAPTER 2 POLICY CONTEXT

will be presented to the Local Strategic with recent strategies including Every Child Partnership in the autumn for formal Matters and the National Service Framework endorsement. for Children and Young People. A Children’s Trust has been established in Brighton and The aim of the Brighton and Hove Hove whose aim is to secure the integrated Neighbourhood Renewal Strategy is to narrow delivery of children’s and young people’s the gap between the most deprived services. As part of the children’s strategy five neighbourhoods and the rest of the city (BHCC, children’s centres are being developed across 2005b). The strategy identified twenty-seven the city. Each will provide early education and priority neighbourhoods. Of these, nine childcare, family support and home visiting, neighbourhoods and the eb4U area (part of the health services including health visitors and New Deal for Communities initiative) were midwives and have links with Job Centre Plus, identified as the most deprived. The nine the Children’s Information Service and other neighbourhoods received funding to develop advice services. The first centres will be in the and implement Neighbourhood Action Plans. City Centre, Hollingdean, North Portslade, The strategy focuses on community Moulsecoomb and Whitehawk and will have a participation, community safety, education and clear role in reducing health inequalities. family support, employment and housing. The “Best care, best place” consultation in Sustainable development is necessary to place at the time of writing sets out proposals promote the health and well-being of people for the future development of hospital services living and working in cities. The Brighton and within the city and local area over the next ten Hove Sustainability Strategy (BHSC, 2002) years. In planning future hospital services the outlines actions and targets to improve well- consultation also considers alternatives to being and quality of life for everyone, now and hospital admission. for generations to come, by meeting social and environmental as well as economic needs. It is a time of great change and great There are twelve key objectives action plans opportunity. It is also potentially a time of (updated for 2004/06) which cover: confusion with a wealth of national and local policies and strategies. It is essential that the • access to basic elements of life common threads that unite various initiatives • air quality, culture, recreation, tourism are recognised and that the city’s efforts are and leisure properly co-ordinated. With increasing national and local emphasis on partnership working to • economy and work promote health and tackle the broader • education and training determinants of health, the city is ideally situated to take full advantage of its WHO • community safety Healthy City status and use this as the platform • housing for addressing health and health inequalities within Brighton and Hove. • land use • natural environment • transport • waste Children’s Trusts are being developed nationally by local authorities working with local health organisations and other key stakeholders. The Trusts will identify the services needed to improve children’s health and wellbeing in line

12 CHAPTER THREE TACKLING THE CAUSES OF ILL HEALTH

3.1 The Determinants of Health 14 3.2 Lifestyle 15 3.3 Poverty 25 3.4 Health and Healthcare 28 3.5 Education and Life-Long Learning 32 3.6 Transport 35 3.7 City Planning 38 3.8 Housing 41 3.9 Crime 44 3.10 Economic Development 47 3.11 Environment 52 3.12 2020 Community Strategy Performance Targets 56 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

Tackling the Causes of Ill Health This model of health puts individuals at the centre, with age, sex and hereditary factors ‘Poverty, low wages, and occupational stress, that influence their health potential. Individual unemployment, poor housing, environmental lifestyles represent the personal behaviour and pollution, poor education, limited access to way of life adopted by those individuals. These transport and shops, crime and disorder, and are then embedded in social and community a lack of recreational facilities all have had an networks and in living and working conditions, impact on people’s health’ (Acheson, 1998) which in turn relate to a wider cultural and socio-economic environment. 3.1 The determinants of health The 2004 Public Health White Paper, Choosing Although there have been major improvements Health: making healthier choices easier, in health and life expectancy over time, the recognises that tackling the factors that lead experience of ill-health, disability and premature to health inequalities, many of which lie mortality is highly unequal between socio- outside the remit of the healthcare service, economic groups, ethnic groups and gender can only be achieved through joined-up action (DH, 2004b). The 1998 report Independent (DH, 2004b). The priorities of many government Inquiry into Inequalities in Health (Acheson, departments will directly contribute to the 1998) illustrated that although health care objective set by the Department of Health services have improved, in some cases health to ‘improve the health of the population’. inequalities have widened since the 1970s. Within the context of the Public Health White This has further fuelled the move away from Paper, WHO Healthy City status, and the 2020 a biomedical definition of health, defined Community Strategy, this chapter considers in relation to illness, towards a more social how the determinants of health are being definition. The social model recognises that tackled to improve the health of the population, health is the product of factors that affect the and decrease health inequalities. The chapter lives of individuals and communities in different considers each layer of the determinants of ways and through different pathways. health as illustrated in Figure 3.1.1: Figure 3.1.1 illustrates how an individual’s • individual lifestyle factors; health is affected by layers of influence (Dahlgren and Whitehead, 1991) • social and community influences: poverty, education and healthcare; Figure 3.1.1 Main determinants of health • living and working conditions: housing, ltural and e c, cu nvi mi ron transport and city planning; and no rkin m co d wo g con en e an di ta io g tio l c in n c • general socio-economic, cultural and o iv ommunity s o s L d c in n l n flu d environmental conditions: economy, crime a a e i r l n t e a lifesty i i al le c o n c u f e and the environment. a n e o id c s S iv to s G d r n s I Further action on these broader determinants of health will make Brighton and Hove a healthier place for everyone.

Age, sex & hereditary factors

Source: Taken from Dahlgren G, and Whitehead M, Policies and strategies to promote social equity in health (1991).

14

CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

3.2 Lifestyle economic status with poorer people being Introduction disproportionately affected. The Brighton and Hove Annual Report of the Smoking is the main cause of preventable Director of Public Health for 2004 focused on illness and premature death; it is a major cause inequalities in health and the impact of lifestyles of cancer, heart disease and chronic obstructive on the health of the local population. In lung disease. Diet plays a fundamental role in November 2004, the Government produced the development of coronary heart disease in its White Paper on Public Health Choosing terms of fat content, salt, and fruit and Health: Making Healthier Choices Easier. This vegetable intake. For children, a healthy diet sets out the Government’s proposals for making has been linked with improved concentration, healthier choices easier through the provision better behaviour and, as a result, better of practical help to adopt healthier lifestyles. educational attainment. The White Paper highlighted six key areas: Physical activity reduces mortality from • tackling health inequalities; cardiovascular disease and coronary heart • reducing the number of people who smoke; disease in particular. It is also important in controlling diabetes, regulating weight and • tackling obesity; reduces the risks of osteoporosis and colon • improving sexual health; cancer. Overweight and obesity are associated with increased risk of diabetes and coronary • improving mental health and well-being; and heart disease. Childhood obesity predicts both • reducing harm and encouraging sensible adolescent and adult obesity. drinking. Sexually transmitted infections (STI) and HIV In March 2005 the Government published a rates continue to rise. Chlamydia can result in Delivery Plan for the White Paper, outlining the pelvic inflammatory disease and infertility affects ‘quick wins’: relatively easy actions that could as many as 1 in 10 young people. Teenage result in improvements to health in a relatively mothers and their babies are more likely to short period of time. This section sets out the suffer poor health outcomes (DH, 2004b). Primary Care Trust (PCT) and City Council Mental health, which is more than an absence action plan with regard to the Government’s of mental illness, appears to be central to all proposals for making healthier choices easier. health and well-being. It influences how people Lifestyles and health improvement think and feel about themselves and others, Despite overall economic, social and healthcare and how they interpret events. It affects an improvements, the gap in health between individual’s capacity to learn, communicate, those at the top and bottom ends of the social and form and sustain relationships. It influences scale remains large and in some areas continues people’s ability to cope with change and to widen. Some parts of the country have the manage life events. It affects physical health same life expectancy as the national average in terms of lifestyle choices and recovery from for the 1950s. The reasons for differences in physical ill health. There are many different health are in many cases avoidable and unjust - factors that influence an individual’s mental a consequence of differences in opportunity, health: the environment in which they live, access to services, and material resources, as their social circumstances, their personality well as differences in the lifestyle choices of and their life experiences. Everyone has mental individuals. Unfortunately, the circumstances health needs, whether they have a diagnosis are often inherited from generation to of mental illness or not. Mental well-being, like generation (DH, 2003). Smoking, diet, sexual physical health, is a resource that needs to be health and teenage pregnancy, alcohol and promoted and protected. substance misuse are all related to socio- Substance misuse is associated with mental and

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 15

CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

physical ill health and with many social problems Action Plan (Draft, 2004) highlights best including relationship and family breakdown, practice in Brighton and Hove and how further suicide, accidents, violence and crime. Additionally, progress can be made. Evidence in support of alcohol misuse can cause liver disease and active living is presented with recommendations certain forms of cancers and is responsible for for future action. A final strategy is soon to over 150,000 hospital admissions per year be launched. (NTA, 2005). It is estimated that around four Brighton and Hove Sport Strategy (Consultation million people use illicit drugs each year and Draft, 2005) aims to promote sport within the City that 8.2 million people drink in a way that particularly amongst people not currently taking causes harm (Home Office, 2002; NTA, 2005). part in physical activity. It will link with the National and local strategic context Active Living Strategy’s focus on healthy living. The national delivery plan for Choosing Health Brighton and Hove Weight Management highlights action over the six key areas. In Strategy and Action Plan is currently being addition the Government highlights action to developed. It will focus on the prevention, help Children and Young People to lead healthy management and treatment of obesity. It will lives, and to promote healthy and active lives link with Spade to Spoon, the Active Living for older people. Strategy and the Sports Strategy. One of the WHO Healthy City core themes Brighton and Hove Teenage Pregnancy Action is healthy aging with a linked emphasis on Plan (2004-2005) outlines the actions for promoting physical activity and active living. achieving the national targets of reducing A number of local strategies have been, or teenage conceptions, and reducing the risk of are being, developed which address lifestyle social exclusion by improving access to issues. These relate to the priorities outlined education, employment and training, and in Choosing Health and are summarised below: provision of appropriate support and The Smoking Cessation Three Year Action Plan accommodation for young parents. (2003-2006) describes the action planned to Brighton and Hove Gay Men’s HIV Prevention achieve the target of 4,379 people setting a quit Strategy (Draft, 2005) aims to reduce the date and quitting at four weeks by March 2006. incidence of HIV transmission between men in The plan, set in the context of wider tobacco Brighton and Hove. It is based on the national control issues, targets young people, pregnant Make it Count Framework and forms part of a women and their families, people living in areas Sexual Health and HIV Strategy building on the of deprivation, and manual workers. first gay men’s strategy published in 2000. Brighton and Hove Food Partnership’s Spade Brighton and Hove HIV and Sexual Health to Spoon Strategy & Action Plan (Draft, 2005) Commissioning Strategy is currently being examines the whole food system within developed. It seeks to maximise the potential of Brighton and Hove, bringing together all the clinical, social care and health promotion various elements including food production, services to reduce HIV and STI transmission and access to food, waste management and the promote the sexual health of the local local food economy. It builds on the food population. It also focuses on how best to mapping work documented in The Brighton configure services to ensure the needs of those and Hove Foodshed: Mapping the local food living with HIV are met. system (2003) and includes a clear focus on access to healthy affordable food. The Action Brighton and Hove Mental Health Promotion Plan covers a three-year period from 2005-2007; Strategy (2004) addresses Standard One of the a public consultation is in progress and is due Mental Health National Service Framework for completion in September 2005. (NSF), ‘mental health promotion’, which states that health and social services should: promote Brighton and Hove Active Living Strategy &

16

CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

mental health for all, working with individuals the Communities Against Drugs programme, and communities; combat stigma and now part of the Building Safer Communities discrimination against individuals and groups Fund. The plan is aimed at stakeholders and with mental health problems, and promote professionals in the substance misuse field their social inclusion. and in other areas where substance misuse is an issue. It links with the 2020 Community Brighton and Hove Suicide Prevention Strategy Strategy priority of ‘a safer city’ and The (2004-2006) is intended to build on previous Community Safety and Crime Reduction work locally and to provide a coherent Strategy (2002-2005). approach to suicide prevention. The strategy aims to support the achievement of the target The Alcohol Gaps Analysis Action Plan (March set in the White Paper Saving Lives: Our 2005) examines the services available and Healthier Nation, and reinforced in the NSF for action needed to tackle alcohol problems in Mental Health to reduce the death rate from Brighton & Hove in the context of the national suicide and undetermined injury by at least a Alcohol Harm Reduction Strategy for England. fifth by the year 2010. It focuses on the gaps in service as a basis for writing the local alcohol strategy, which forms There are two national strategies that deal part of the Community Safety, Crime Reduction with alcohol and substance misuse: the up- and Drugs Strategy (2005-2008). dated Drug Strategy (2002) and the Alcohol Harm Reduction Strategy for England (DH, Progress and performance 2004c). The Brighton and Hove Drug & Alcohol Inequalities Action Team (DAAT) co-ordinates local action The PCT and the City Council have now jointly on national priorities through four separate published a local Health Inequalities Strategy action plans: the Adult Drug Treatment Plan (Scanlon, 2005). This Strategy has been to the (2005-2006); the Young People’s Plan (2005-2006); Healthy City Partnership and will go to the the Communities Plan (2004-2006), and the Local Strategic Partnership for endorsement in Alcohol Gaps Analysis Action Plan (2005). These autumn 2005. The Strategy details a number of strategies focus on prevention, harm minimisation, health inequality targets for the city. Monitoring treatment and community safety and are of these will be through the Local Strategic implemented by a wide range of local agencies. Partnership and Public Service Board. The Adult Drug Treatment Plan (2005-2006) Smoking focuses on getting more people into treatment In Brighton and Hove over the past 10 years, and hence reducing the resultant harms caused smoking prevalence has fallen from 27% to by illicit drugs such as heroin and crack cocaine. 20% although smoking is increasingly a Other priorities include improving communicable deprivation issue and in some more deprived disease control measures and improving parts of Brighton it is as high as 50% (CHSS, support for problematic drug-using parents. 2003). Nationally, 22% of the adult population currently smoke. A survey of Brighton and Hove The Young People’s Plan (2005-2006) focuses school children aged 14 years conducted in on drugs education and prevention. It monitors 2004 showed that 15% of boys and 23% of the number of schools achieving the healthy girls smoked during the last seven days and school standard around substance misuse and children from more deprived backgrounds were alcohol, as well as tracking action against more likely to smoke by a factor of four targeted prevention strategies such as the (Balding, 2004). number of young people receiving early interventions and treatment. Nationally set smoking cessation targets are currently being met for Brighton and Hove with The Drug and Alcohol Communities Plan 4,379 people setting a quit date and quitting at (2004-2006) is the delivery plan for the DAAT four weeks by March 2006. The target to community agenda. It details investments of

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 17 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

reduce adult smoking rates to 21% or less by smoking policy of any work or public place. 2010, with a reduction in prevalence among Diet and exercise routine manual groups to 26% or less, is Of those residents who responded to the 2003 currently on track. lifestyle survey, 55% did not eat the Choosing Health outlines the staged approach recommended five portions of fruit and the Government proposes for introducing vegetables a day (see Map 3.2.1) and just 15% smoke-free places: by the end of 2006, all of residents took the recommended amount of government departments and the NHS will exercise of 30 minutes five days a week. be smoke-free; by the end of 2007, all enclosed From the responses from the local health survey public places and workplaces, other than licensed in 2003 it was estimated that eight percent of premises (and those specifically exempted), will, the local population was underweight, 44% subject to legislation, be smoke free; by the normal weight, 32% overweight, 7% obese, end of 2008 arrangements for licensed 3% grossly obese (6% of those who returned premises will be in place. the survey did not reply to the questions on A recent integrated impact assessment height and weight) (CHSS, 2003).

Map 3.2.1 Percentage of people eating less than the recommended 5 portions of fruit and vegetables per day in Brighton & Hove

% <5 portions 46.7 - 49.5 49.6 - 52.0 52.1 - 56.8

Patcham 56.9 - 63.0 HollingburyHollingbury Withdean & Stanmer 63.1 - 67.4 North Portslade

HangletonHangleton & Knoll

Stanford MoulsecoombMoulsecoomb & Bevendean Preston Park 1 Hanover WoodWoodingdeaningdean GoldsmidGoldsmid & Elm Grove Wish 2 6 3 4 East BrighBrightonton 5 Queen's Park 1. South PorPortsladetslade 2. WWestbourneestbourne 3. Central HHoveove Rottingdean CCoastaloastal 4. BrunswBrunswick&ick& AdAdelaideelaide 5. RegencyRegency 6. St. Peter'sPeter's & NorthNorth Laine

Source: Brighton and Hove City Primary Care Trust (Health Counts, 2003). involving the Tobacco Control Alliance resulted The PCT is working towards the Gameplan - in the formation of the Smoke Free City, a Sports England Strategy (Strategy Unit, 2002) Charter for Brighton and Hove (2005). This target of getting 75% of people achieving 30 Charter may be adopted by any organisation in minutes exercise per day five times a week by Brighton and Hove with responsibility for the 2010. A recently launched Active for Life

18

CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

website publicises all the physical activity Sexual health and teenage pregnancy opportunities in the city as well as the funding In Brighton and Hove attendance at the and training available to activity providers. A sexually transmitted disease clinic has increased pilot exercise referral scheme for patients with with regard to every sexually transmitted diabetes will commence in September 2005 disease monitored, apart from herpes infection, and run until March 2006. This will be based over the past five years (Figure 3.2.1). Annual in primary care and be supported by the PCT’s figures for first presentation of asymptomatic Health Promotion team. HIV infection have doubled to over 100 during this time. The number of people presenting A national target to halt the year-on-year rise with chlamydia infection and related non- in obesity among children under 11 by 2010 specific infections (NSI) is particularly high. has been set in the broader context of tackling obesity in the population as a whole. A PCT The rate of gonorrhoea infection in Brighton and weight management strategy is in development, Hove has also been increasing, but is predicted and a new weight management post has being to reduce slowly between 2005 and 2008. established, to help people to manage their Plans are being developed to ensure that the weight and reduce obesity. Additional funding GUM target of 100% of patients being offered has been provided to the school nursing service a GUM appointment within 48 hours by 2008 to assist in the monitoring of obesity levels is met. The PCT is required to submit plans to locally. A campaign focusing on childhood

Figure 3.2.1 Initial contacts of patients with STDs at GUM services in Brighton & Hove

2100

1800

1500

1200

900 Number 600

300

0 2000 2001 2002 2003 2004 Year Syphilis Warts Herpes Chlamydia Gonorrhoea NSI

Source: Brighton and Hove City Primary Care Trust (2005). obesity is to be launched in the autumn of show an integrated approach to sexual health 2005. In addition, the strategies relating to diet services and overall care pathways. This will be and exercise described above will all contribute reflected in the HIV and Sexual Health Strategy. towards this target. The PCT is also involved in the third wave of

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 19 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

the national chlamydia screening programme, misleading as the population of 15-17 year old together with three neighbouring PCTs. It has females is very low in this ward, 39 according committed funding to provide an additional to the 2001 census (ONS, 2004). It is the inner 13,000 tests per year in Brighton and Hove. eastern wards of Hangleton & Knoll, Hollingbury & Stanmer, Moulsecoomb & Bevendean, Hanover Around a quarter of GP practices in Brighton & Elm Grove, East Brighton and Queen’s Park and Hove have signed up for a local enhanced where there are high rates of teenage conception service for sexual health. This focuses and larger numbers of females aged 15-17. specifically on young people and provides them with a comprehensive risk assessment An evaluation of the local young person’s and individually tailored advice and treatment. contraception and sexual health services is currently in progress and will report in autumn Teenage pregnancy continues to be a challenge 2005. This will inform future service provision for Brighton and Hove. Teenage conception which is particularly important in view of rates as a whole are not falling at the same rate forthcoming mainstreaming of teenage as national rates and the national target of a pregnancy funding. 50% reduction by 2010 may not be reached. However, the reduction in the rate for those Mental health under-16 years is greater than the national A city-wide mental health promotion and social average. The proportion of terminations exclusion strategy group is to be established, performed at nine weeks or under also exceeds the remit of which will be linked to the mental the national average. health and social exclusion policy (SEU, 2004). As many of the factors that influence mental Map 3.2.2 shows teenage conception rates health lie outside the remit of health and social 2000-2002 as highest in the electoral ward of care, effective mental health promotion Central Hove. However, this may be somewhat

Map 3.2.2 Teenage conception rate per 1000 population in 2000-02 in Brighton and Hove

Conception rate per 1000 females aged 15-17 11 - 23 24 - 37 38 - 50 Patcham Hollingbury 51 - 92 Withdean & Stanmer North 93 - 145 Portslade

Hangleton & Knoll

Stanford Moulsecoomb & Bevendean Preston Park 1 Hanover Woodingdean Goldsmid & Elm Grove Wish 2 6 3 4 East Brighton 5 Queen's Park 1. South Portslade 2. Westbourne 3. Central Hove Rottingdean Coastal 4. Brunswick& Adelaide 5. Regency 6. St. Peter's & North Laine

Source: Brighton and Hove City Primary Care Trust (ONS).

20

CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

depends on the expertise, resources and in the past 10 years. There are no accurate partnerships across all sectors and disciplines. historical figures for binge drinking so trend It is relevant to the implementation of a wide data is not available. However, the Health and range of policy initiatives including social Lifestyle Survey (CHSS, 2003) suggested that inclusion, neighbourhood renewal, community binge drinking constitutes a significant problem strategies and health at work (DH, 2001a). in Brighton and Hove. Map 3.2.3 shows where residents who report binge drinking are most The national target relating to mental health likely to live in Brighton and Hove. is to reduce the mortality from suicide and undetermined injury by 20% by 2010. The An alcohol strategy group has recently been suicide rate for Brighton and Hove has long established in order to implement the findings been higher than the national rate, and of the Alcohol Gaps Analysis Action Plan. A despite much local partnership work, addressed harm minimisation campaign to reduce the through the suicide prevention working group, harm caused by alcohol misuse in young people this target is unlikely to be met. is being planned, and a drugs and alcohol website for young people is being developed. The Brighton and Hove Suicide Prevention A community detox nurse is to be appointed Strategy (2004) builds on previous local work shortly to enable the launch of a local and provides a coherent approach to suicide enhanced service for alcohol. prevention. The South East Development Centre of the National Institute for Mental Health in Drug use England has provided funding to Brighton and A range of illicit drugs is available and used Hove for two initiatives. The Assist Programme, in Brighton & Hove. Heroin and crack cocaine which is co-ordinated across Surrey and Sussex misuse are of greatest concern because of the by Lewes MIND, trains lay people how to impact these have on individual and public respond to someone who is talking about health, and the resulting harm to victims of suicide. And, in response to the high rates of acquisitive crime. Amphetamines, cannabis mental health problems identified in the local and ecstasy are used recreationally and Count Me In Survey (2000), funding has been problematically by a sizeable number of people. given to Brighton and Hove MIND to work with Prevalence information on the numbers of lesbian, gay, bisexual and transgender problem drug users is very limited, because of communities around suicide prevention. the illicit nature and stigma of drug use. The Mental Health National Service Framework Research by Imperial College during 2001-2002 stresses that the achievement of this target is suggests that there are approximately 2,300 dependent on all the others targets relating to injecting misusers in the city, a higher rate than mental health promotion and treatment and Liverpool and parts of Inner London, and care services. indicates that a substantial number of heroin misusers are not presenting for treatment Alcohol use (Brighton and Hove DAAT, 2005). Over the past 10 years alcohol consumption above recommended levels in Brighton and Hove There are four key components to tackling has increased from 16% to 27% in adult men substance misuse: reducing the amount of and from 8% to 17% in women. Ten percent drugs on the streets; education and information of 14-year-old boys and 5% of 14-year-old girls provision; reducing drug-related crime, taking in Brighton and Hove report that they drank 15 a particularly strong stance against Class ‘A’ or more units of alcohol in the past week and drugs, such as heroin and cocaine; reducing 18% of children report that they have tried the demand for drugs by providing treatment cannabis in the past month (Balding, 2004). for drug users. Several local strategies (referred The proportion of adult residents drinking more to above) address these components through than 50 units per week has more than doubled nationally and locally set targets; the work of

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 21 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

Map 3.2.3 Percentage of residents reporting binge drinking in previous 7 days in Brighton & Hove

% Binge drinkers 1.7 - 5.1 5.2 - 9.2 9.3 - 11.9

Patcham 12.0 - 15.1 HollingburyHollingbury Withdean & Stanmer 15.2 - 18.8 North Portslade

HangletonHangleton & Knoll

Stanford MoulsecoombMoulsecoomb & Bevendean Preston Park 1 Hanover WoodWoodingdeaningdean GoldsmidGoldsmid & Elm Grove Wish 2 6 3 4 East BrighBrightonton 5 Queen's Park 1. South PorPortsladetslade 2. WWestbourneestbourne 3. Central HHoveove Rottingdean CCoastaloastal 4. BrunswBrunswick&ick& AdAdelaideelaide 5. RegencyRegency 6. St. Peter'sPeter's & NorthNorth Laine

Source: Brighton and Hove City Primary Care Trust (Health Counts, 2003).

Note: The definition of binge drinking used for this map is someone who, on average, drinks more than nine units of alcohol at a time, and who drank 10+ units in the seven days prior to completing the questionnaire. which is co-ordinated by the Drug and Alcohol that in addition to the implementation of the Action Team (DAAT). There is innovative work strategies discussed above: being conducted through eb4U in east Brighton. 1. A Tobacco Control Strategy incorporating a The recently recruited DAAT Neighbourhood smoking cessation plan for 2007-2010 is Liaison Officer has begun work with organisations produced. already working in the Tarner area of the city. 2. An action plan to increase provision of The work has identified many drug and smoking cessation support to staff and alcohol-related problems and the process of patients in mental health hospitals and day engaging better with local residents to identify centres is developed. and develop solutions has begun. 3. The proposed exercise referral pilot for Next steps and recommendations diabetics is evaluated. The PCT and City Council have been active in addressing the key areas highlighted in the 4. Mental health promotion support is Public Health White Paper even before it was increased, particularly in the workplace. published. A number of strategic plans document 5. An alcohol harm minimisation campaign a coordinated local response. This has been in aimed at young people is conducted. recognition of the considerable public health problems that affect the city: persistent health inequalities; poor diet; low levels of exercise; obesity; teenage pregnancy; sexually transmitted disease; deaths from suicide; alcohol and substance misuse. It is therefore recommended

22 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH . es. ral. efer ch 2006 ticular eatment educing oach to food by oup tr n the local food , with a par gets. d and to assist in r ovide both gr eas of deprivation. established. ess against tar vices to pr eas. om deprived communities. ogr ess and will be completed by Mar tnership for endorsement in autumn 2005. eased risk of HIV and STI transmission ogr d the wider consultation o eastfeeding within the city oups and ar f & patients in mental health hospitals day centr war e in pr eement (LAA) - see Chapter 2. t schools in taking a whole school appr d to monitor pr . omote br omoters to give brief smoking cessation advice and r eness, knowledge and skills amongst people with a hood Renewal Ar t to staf vice to meet the NSF standar get. ea Agr t disease ar vice Boar educe inequalities in Brighton and Hove (2005) outlines the oups in various settings to be ral pathway y hear mediate smoking cessation ser efer onar ovides GPs and those with incr oject in Neighbour ess against the tar ease the level of awar y Plan for Brighton and Hove ogr east feeding advisor to pr weight and obese people, especially those fr ee blocks of the Local Ar ofessionals and other health pr tnership and Public Ser egnant mothers, people in manual social gr ovision of smoking cessation suppor ’ - A Deliver get over gets for the city and on-going actions to tackle them. omotion Scheme pr ogramme to incr educing inequalities. omoting sexual health. easing the capacity of school nursing ser ease the pr geting of pr eight management strategy has been drafted and soon to appoint a weight post. raining pr raining to health pr ar ole in pr A school food worker is to be appointed suppor Local action The joint PCT/City Council Strategy to r inequality tar Joint Inequalities Strategy to be taken the Local Strategic Par Local Strategic Par Implementing the thr Equity audits for cancer and cor (BHCPCT Inequalities Strategy). Expansion of the specialist and inter and individual counselling. T Development of a whole-systems r T Incr W Pilot facilitated weight management gr These will tar implementing the national Food in Schools package. This will work with Healthy Scheme locally Established a food development worker post to take for strategy and action plan. Incr obesity and monitoring pr Conducting a local childhood obesity campaign focusing on schools and their communities. Commencing Active for Life Pr Appointed a full-time br focus on r T r Condom Pr ove outine outine eas with the lowest life oader strategy to impr evalence among r gets th and the population as a whole t of a br oups and the population as a whole en less than one year) between r Choosing Health: making healthier choices easier -on-year rise in obesity among ee NHS by end of 2006 educe by at least 10% the gap in infant educe by at least 10%, the gap between oups to 26% or less eduction in pr oader strategy to tackle obesity in the en under 11 years by 2010 in the context oving sexual health tality (childr ackling health inequalities ackling obesity able 3.2.1 ‘ expectancy at bir Reduce adult smoking to 21% or less by 2010, with a r By 2010, r mor and manual gr By 2010, r the fifth of local authority ar manual gr A Smoke fr childr of a br population as a whole Reduce the under 18 conception rate by 50% by 2010 as par Halt the year sexual health T Priorities and tar T Reducing the number of people who smoke T Impr

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 23 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH s en’ editation ee school y to vices (2005), oduction will be signed oblems and iSH teaching vice. ces to use as d has been ovision esour e settings including A&E. ough the pr ms caused by alcohol. om, SW oss the countr ust Strategy r vice pr s T omotion and implementation eas. eas acr vices thr en’ t ar tnership boar ection. d), including all ‘high fr usts. The work of the Childr ough the development of r . s T Childr e Star en’ onments in Brighton and Hove was esponse to the har e able to identify alcohol pr egnancy ser d. The , and chapters 4 5. e and other healthcar esence locally y car ee envir ovide strategic dir ound mental health ser ofessionals ar omotion of the locally enhanced GP ser tnership Boar eatment using the national audit of alcohol ser iSH (So what is sexual health?) cd:r vice extended school during 2004-2007. Funding is to be e pr oject involving 17 schools. In 2004 additional money was ust Par vice listings and posters, thr r e in the first wave of Childr ee supply of condoms, lubricant and other r ther development. ventions in primar tners in planning a local r s T oolkit, SW f to ensur evention. en’ mation about sensible drinking to the public. t fur y par g.uk). omotion with work ar e being encouraged to work together on the pr e staf ectories, ser omotion. .swish.or fectiveness of alcohol tr omotion post to focus on workplace mental health. . vice dir d by the Childr e for Alcohol (2005) and the pr dinate and steer developments pr December 2006. eening and brief inter war opriately eness of healthcar ust: Brighton and Hove wer r s T ces such as the Sexual Health T en’ e sexual health issues have a high, positive media pr ded to Falmer School establish a full ser vene appr ticularly CAMHS) and suicide pr easing access and ef orking with other local statutor oposed to co-or f in September 2005 - see education section this chapter omoting the availability of sexual health, HIV and teenage pr oviding clear and accessible infor ust is taken for r o establish a health pr esour T Childr Incr (young people/gay men specifically) a fr tools for sexual health pr Pr pack and website (www Ensur T Linking positive mental health pr (par Much work impacting on mental health taking place in NRF and Sur Pr Raising awar inter Commencing scr the Models of Car W Healthy Schools: All agencies ar of the Healthy Schools Scheme. The aim is for half all Local Authority to achieve Silver Accr with Healthy Schools (i.e. Level 3 of the National Standar meals’ schools by Extended Schools: In 2003 Brighton and Hove was selected as one of 25 ar awar made available this year to suppor Extended schools work is to be linked healthy work; a joint par pr of An integrated impact assessment on extending smoke fr implement the Extended School Pathfinder Pr and distribution of ser r ove mined oader strategy to impr om suicide and om suicide and undeter y by at least 20% in 2010 tality fr tality fr en and young people lead t of a br m and encouraging mined injur oving mental health and wellbeing y by at least 20% 2010. omoting personal health Reduce the under 18 conception rate by 50% by 2010 as par Reduce the mor undeter Impr Reducing har sensible drinking Helping childr healthy lives Pr sexual health Reduce the mor injur

24 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

y 3.3 Poverty

oups. ‘Babies born to poorer families are more likely to be born prematurely, are at greater risk of oups including ee work and infant mortality and have a greater likelihood of poverty, impaired development and

omoters with chronic disease in later life. This sets up an

y school and its feeder inter-generational cycle of health inequalities.’ opean Social Fund, which (DH, 2002). y secondar .

e in favour of smoke-fr Introduction ter ough the Eur Poverty and material disadvantage in all its ents, black and minority ethnic gr forms has a significant effect on health e that ever ee Char t to clients. inequalities. Addressing poverty is fundamental to reducing health inequalities. Tackling childhood

. disadvantage is particularly important because ed to ensur , is to be conducted in autumn 2005. r childhood experience and circumstances lay the foundations for later life (ODPM, 2005). This espondents said they wer section describes the links between poverty and oduced a Smoke Fr ound obesity ning disabilities, lone par health and the evidence for the impact of ovides workers and volunteers all health pr poverty on health. It outlines in brief the vice has occur Brighton and Hove is a city-wide initiative between the public, voluntar

ded £6 million EQUAL funding thr national and local policy framework and reports on the extent to which progress has been made ovide behaviour change suppor oblems, lear against local targets. EQUAL . ce; this includes HIA training for City Planners, needs assessment oximately 80% of r Poverty and health outcomes People with the worst health outcomes and lowest life expectancy tend to live in the most deprived areas. In the UK there is a clear relationship between deaths from all causes ting Behaviour Change course pr

y schools has a qualified school nurse. and the level of deprivation or poverty. The largest differences are seen for ischaemic heart Funding has been obtained by the local public health practitioner network to assist in development of the public health workfor conducted in 2004. Appr public places and the City Council has intr A childhood obesity campaign, funded by the PCT Suppor training to enable them pr A workplace post focusing on mental health is to be established. Brighton and Hove has been awar had to be matched locally people with mental health pr public health practitioners and training ar Investment in the school nursing ser and private sectors which aims to widen access employment training for disadvantaged gr primar disease and lung cancer (Uren & Fitzpatrick, 2001). Life expectancy shows a stepwise increase with increasing socio-economic class. Poor health results not only from absolute poverty but also from relative poverty (DH, 2002). The 2004 White Paper Choosing Health highlighted the link between poverty and risk factors for poor health. For example the rate

ce of obesity in women in routine occupations is double that of professionals. Poverty is inextricably linked to the other determinants of health such as poor education and housing, inadequate transport infrastructures, high crime and low employment (ODPM, 2005). These factors impact upon each other as well as the health of individuals (NRU, 2005). Investing in the workfor

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 25 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

National and local strategic context The Government’s anti-poverty strategy Within Brighton and Hove, 27 areas have been Opportunity for all - tackling poverty and social identified as deprived. There are now 10 priority exclusion listed a number of key initiatives to Neighbourhood Renewal Areas including address poverty (DSS, 1999). East Brighton (eb4U) (Map 3.3.1) (CST, 2005). • Sure Start, Connexions, New Deal The 2020 Community Partnership leads the implementation of community planning and • Health Action, Education Action and neighbourhood renewal strategies. Employment Zones A City Health Inequalities Strategy, produced • More NHS investment as one of the recommendations of the 2004 • Action to tackle fuel poverty Annual Report of the Director of Public Health (Winter Fuel payments) has been presented to the Brighton and Hove City Health Partnership and will go to the Local • Child Tax Credit and Working Tax Credit Strategic Partnership for approval in 2005. Other relevant national policies include the The Brighton and Hove and Adur Area Investment National Minimum Wage, the Neighbourhood Framework (AIF) has identified narrowing the Renewal Fund, Pension Credit (guarantees a gap between deprived neighbourhoods and the certain income to over 60s) and the Child Trust rest of the AIF area, including support for Fund Savings Initiative. community engagement in regeneration, as a key investment priority (BH&A-AIF, 2003).

Map 3.3.1 Neighbourhood renewal areas in Brighton & Hove

Hollingbury Hollingdean Coldean Bates North Moulsecoomb Neighbourhood East & South Renewal Areas Moulsecoomb Bevendean Priority Neighbourhoods eb4U Neighbourhoods Other Identified Neighbourhoods

Ward Boundary Hangleton North Portslade

St.Peters Laburnum South & Moyne Woodingdean Portslade Knoll

Brunswick Regency Clarendon Whitehawk Portland Road & Manor Farm Poets Corner Bristol Estate Queen's Park and Craven Vale Saunders Park Meadowview St. James Street & Kemptown Tarner (South Hanover) Kingswood & Milner

Source: Brighton and Hove PCT 2005.

26 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH

In Brighton and Hove the most deprived areas adults (19.7%; 95% CIs 19.1-19.7). Only are also those with lower levels of social capital, Southampton, Thanet and Hastings (highest at more fear of crime and worse educational 24.0%) have higher figures: the lowest figure performance (Scanlon, 2004). These features being in Hart local authority (4.7%). result in higher unemployment and if unchecked, Progress and performance the intergenerational cycle of poverty and The 2004 Annual Report of the Director of health inequalities. There are more people living Public Health and the subsequent Health with limiting long-term illness in the most Inequalities Strategy, which was published in deprived areas of Brighton and Hove. Map 3.3.2 2005, both highlight the need to embed health shows deprivation across the city as demonstrated inequalities into the work of the City Council

Map 3.3.2 Index of deprivation score by super output area, in Brighton & Hove

Overall index of deprivation score 6 - 19 20 - 32

Patcham 33 - 46 Hollingbury Withdean & Stanmer 47 - 65 North Portslade

Hangleton & Knoll

Stanford Moulsecoomb & Bevendean Preston Park 1 Hanover Woodingdean Goldsmid & Elm Grove Wish 2 6 3 4 East Brighton 5 Queen's Park 1. South Portslade 2. Westbourne 3. Central Hove Rottingdean Coastal 4. Brunswick& Adelaide 5. Regency 6. St. Peter's & North Laine

Source: Brighton and Hove City Primary Care Trust (ONS, 2001). Note: A higher score means higher deprivation. by the Index of Multiple Deprivation. and PCT. A secondary care commissioning initiative to reduce health inequalities has A local lifestyle survey in 2003 found that the already started. prevalence of both smoking and drinking alcohol above recommended limits was higher The City Council Benefits Team, Income and in more deprived areas of the city. Residents Payments Team, and Social Justice Team run from more deprived areas were also more likely several initiatives which promote benefit to be admitted to hospital due to mental illness take-up including working jointly with housing or to die from coronary heart disease than those benefits and voluntary organisations. living in more affluent areas (Scanlon, 2004). The Adult Social Care team is working Among the sixty-seven local authorities in the alongside the Department of Work and South East region, Brighton and Hove has the Pensions in a nationally led initiative to help fourth highest percentage of dependent older people take up entitlements. children living in households with no working

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Work to co-ordinate a benefit uptake strategy older people lived with their families, there is is being led by the City Council. It involves an increasing trend for older people to be living voluntary, statutory and commercial sectors. on their own. According to the 2001 Census, A draft action plan has been prepared but 30% of households in England and Wales are funding has yet to be finalised. now one-person households, up from 26% in 1991. Nearly half of these households are The Community Legal Service Partnership one-pensioner only households. (CLSP) is a partnership between the voluntary, commercial and statutory sectors. It has This section outlines the national and local produced an action plan for 2005-2006 with policy framework and reports on the extent named lead agencies for recommendations that to which progress has been made against aim to improve access to legal and advice services local targets. It also shows how chronic that tackle social exclusion. Agencies involved diseases contribute substantially to the need in implementing the action plan include the for healthcare in Brighton and Hove and how Citizens Advice Bureau, YMCA, Brighton chronic illness can be prevented through Housing Trust, and Age Concern (CLSP, 2005). lifestyle interventions at younger ages and screening for early signs of illness. Progress against 2020 Community Strategy targets which impact on poverty has been Chronic disease and health improvement steady. These are further discussed in other Six out of ten adults live with a chronic condition sections of this Report. and eight out of ten GP consultations relate to a chronic condition. Patients with a chronic Next Steps and recommendations disease or complications use over 60% of A number of key strategies are already in place hospital bed days, and two thirds of patients with regard to addressing poverty. admitted as medical emergencies have an The following recommendations are made: exacerbation of a chronic condition or have chronic disease. People with more than one 1. Statutory organisations should continue to condition require more health care: 15% of work with partners (business, voluntary and people with three or more problems account users) in tackling the wider determinants of for almost 30% of inpatient days. health that impact on poverty. There is evidence that self-management, 2. The benefits take-up strategy should be education, and more input from primary and vigorously implemented to maximise income community care for people with chronic thus reducing poverty in vulnerable groups. conditions can have positive clinical effects and 3. The local Health Inequalities Strategy produced improve quality of life (SySx PCT Alliance, 2004). following the recommendations of the 2004 Providing more care for chronic conditions in Annual Public Health Report should be primary care and the community can also endorsed by the Local Strategic Partnership. reduce emergency admissions at the hospital. National and local strategic context The Public Health White Paper Choosing Health 3.4 Health and Healthcare prioritised for action: smoking, alcohol, diet, Introduction exercise, obesity, sensible drinking, sexual health Improved healthcare interventions and and mental health. All of these have implications treatments mean that people born in Brighton in preventing chronic diseases. The Lifestyle and Hove in 2003 can expect to live on average section in this Report considers these in more four years longer than people born 20 years detail. An important part of the prevention of ago. The challenge to health services is to chronic disease is screening. For example, women ensure that the increase in life expectancy leads aged 25 to 64 years are routinely screened for to an extension of healthy active lives rather signs of cancer of the cervix, women aged 50 than of years of illness. Whereas, in the past

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to 69 years are invited for breast cancer screening Phase IV Healthy City. Healthy ageing is a core and people at risk of osteoporosis are invited Healthy City theme and seeks to address the for bone density scanning. needs of older people related to health and social care and quality of life with special The Department of Health has developed emphasis on active and independent living, National Service Frameworks (NSFs) for improving creating supportive environments and ensuring specific areas of care. These identify key access to sensitive and appropriate services. interventions, set standards and targets for Empowerment and participation of older people progress within agreed time-scales and provide in planning services through partnerships with measures to raise quality and decrease local government and voluntary agencies is a variations in care. The NSF for coronary heart key component. An Older People’s Profile is disease lists 12 standards for improved being produced to provide quantitative and prevention, diagnosis and treatment, and goals qualitative information on the health and the to secure fair access to high quality services. living circumstances of older people. This will The diabetes NSF is similar. There are also NSFs inform the development of future strategies for renal disease, cancer, long-term conditions, and services for older people. older people and children. Local governments contribute significantly to The National Institute for Health and Clinical promoting health through their responsibility Excellence (NICE) is responsible for providing for the environment, housing and social national guidance on the promotion of good services. They also bring together locally based health and the prevention and treatment of agencies, citizens’ groups, and community ill health (NICE, 2005). For example, guidelines organisations with locally elected on the management of chronic obstructive representatives. Alliances between local pulmonary disease (COPD), rheumatoid government and public health can stimulate arthritis, and surgical interventions in heart efforts (DH, 2005a) to address the social, disease have contributed to the development economic and environmental determinants of ill of care pathways for various chronic diseases. health. In Brighton and Hove, city planners are Locally these are monitored through Clinical reviewing the design of the urban environment Reference Groups. to enable active living in older people, as active The Brighton and Hove Chronic Disease people stay healthier for longer. In consultation Management Strategy (BHCPCT, 2005) has been with older people’s groups, planners are developed in line with the aims and objectives considering accessibility through improved of the Transforming Chronic Care Programme pavements and walkways and better transport. (SySx PCT Alliance, 2005). The strategy aims for Progress and performance more integrated and consistent care, more National targets have been set to improve health effective use of resources, a broader range of outcomes for older people with long-term care choices and an improved quality of conditions (DH, 2001b). experience for people with chronic conditions. The five chronic conditions prioritised are • Reduce emergency bed days by 5% by 2008 diabetes, heart failure, respiratory diseases through improved care in primary and including asthma, dementia and stroke. community settings. Partnerships, in particular with people living with • Reduce delayed discharges to a minimum long-term conditions, need to be placed at the level by March 2006. centre of multidisciplinary groups that look at services for long-term conditions such as diabetes, Brighton and Hove City PCT has set its targets coronary heart disease, strokes, chronic to achieve a 5% reduction in overall emergency obstructive airways disease, and dementia. admissions in 2005-2006; 10% in 2006-2007; and 15% by March 2008 with an implementation Brighton and Hove is now a designated WHO plan on how to achieve this. Some progress has

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been made in the management and care of Primary Care people with chronic disease. The new general practice contract has established better systems for monitoring and Diabetes caring for people with chronic disease. Table Diabetes is a leading cause of blindness and 3.4.2 shows the current state of monitoring disability in Britain. Currently, 53% of people of patients with coronary heart disease (CHD), diagnosed with diabetes in Brighton and Hove diabetes, strokes and COPD. have been screened for damage to their eyes (retinopathy). The diabetes NSF has screening Chronic disease management groups targets of a minimum of 80% of people with In Brighton and Hove, multidisciplinary Clinical diabetes for the early detection of retinopathy Reference Groups for Rheumatology, by 2006 and 100% of those at risk of retinopathy Neurology, Gynaecology and Dermatology by end 2007. The retinopathy screening service diseases meet regularly to review progress is being expanded to an extra screening site as against agreed care pathways. Similarly, Diabetes well as investment in equipment in order that and CHD Local Implementation Groups for the these targets are met. NSFs meet regularly with and monitor progress across primary and secondary care. City-wide Respiratory infections audits that measure performance against CHD Older people are at a greater risk of the severe NSF standards have been carried out annually complications of minor respiratory infection since 2002. Achievement is generally high, and because they often have underlying diseases, has improved greatly since the early CHD NSF which reduce resistance to infection. The audits. For instance the proportion of people immune response may also be less effective in with CHD in whom blood pressure is elderly persons. People at risk of developing maintained under 150/90 has increased from complications following influenza infection are 46.2% in 2003 to 71.6% in 2004, and the offered vaccination every year through general percentage of patients whose cholesterol is practice surgeries in preparation for winter controlled below 5 mmol/L has increased from months. Table 3.4.1 shows flu vaccine coverage 28.9% to 49.8% from 2003 to 2004. in Brighton and Hove City for identified risk groups. Vaccination is also recommended for Public involvement anyone aged 65 years or more, and for people Brighton and Hove City PCT has organised living in residential and nursing homes. In several successful courses as part of the ‘Living Brighton and Hove vaccine coverage was 67% Well’ Expert Patient Programme run for and rather than the national target of 70% mainly by people with long-term chronic health because of vaccine supply problems. The PCT conditions. The courses encourage healthy has recruited a flu vaccine co-ordinator to help living and empower delegates to gain more increase coverage. control over their condition by learning from

Table 3.4.1 Patients with ‘at risk’ conditions with a record of influenza immunisation (September 04 - March 05) Brighton & Hove

Condition Coverage Asthma (patients aged 16 years and over) 58.35% Coronary Heart Disease 82.10% Chronic Obstructive Pulmonary Disease 82.23% Diabetes 81.25% Stroke and Transient Ischaemic Attacks 78.63% Average influenza immunisation for all at risk conditions 76.51% Source: Quality and Outcomes Framework, Brighton & Hove City PCT end of year figures 2004/05. Note: The percentage value is calculated using only eligible patients.

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Table 3.4.2 Patients whose general practice notes contain a record of review in the previous 15 months, Brighton & Hove Indicator CHD DM STROKE COPD Blood pressure checked 93.16 91.48 91.97 NA Latest blood pressure reading (measured in the past 15 months) is 150/90 or less (CHD & stroke) or 145/85 (diabetes) or less 80.67 70.06 78.79 NA Total cholesterol checked 81.58 86.65 73.9 NA Total cholesterol (measured in the last 15 months) is 5mmol/L or less 69.02 73.22 61.48 NA Smoking status recorded (in the past 15 months), except those who have never smoked where smoking status need be recorded only once 92.12 92.54 89.86 91.2 Source: Quality and Outcomes Framework, Brighton & Hove City PCT end of year figures 2004/05. Note: The percentage value is calculated using only eligible patients. peers with the same or similar conditions. to give patients more choice and control, offer Since July 2004, 112 people have been integrated networks for high quality specialist through 14 courses. Four more courses are care, and ensure that all NHS services contribute planned in 2005 with more to follow in 2006. to health promotion, protection and improvement. The Patient Advice and Liaison Service provide Services are being developed as part of the a free information and support service Chronic Disease Management Programme with responding to hundreds of calls and letters a focus on “good case management”. Innovative per year. There are regular consultations on ways of keeping older people fit and healthy significant changes to NHS services including and out of hospital are being explored. Most two in 2005 that involved hundreds of people prefer to return to their own home soon respondents. PCT and general practice patient after treatment and in Brighton and Hove over surveys are undertaken each year. The Citizen’s 60% of all operations are now carried out as Panel is a joint City Council, NHS and Police day case surgery. GPs, dentists, nurses and initiative with up to 2,500 members of the public therapists are being encouraged to develop who regularly respond to questionnaires or additional expertise in areas such as older attend focus groups. There is close collaboration people’s services and minor surgery to bring with three local, independent Patient and Public more diagnostic tests and minor procedures Involvement Forums which each have approximately to primary care. 10 volunteer members of the public scrutinising It is recommended that: the NHS and seeking the public’s views. 1. The PCT develops a profile of the health In spite of all the above, there remain difficulties and living circumstances of older people. in recruiting meaningful involvement of users, carers and patients in the development of 2. There are increased patient and user perspectives services for people with chronic conditions. in health service and care pathway planning. Next steps and recommendations 3. There is greater support for independence, In line with the NHS Improvement Plan (DH, well-being and choice for vulnerable people 2000) new service models are being developed as close to their homes as possible.

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4. The shift in focus to greater prevention of ill which in turn influence income, housing and health through lifestyle changes and screening other material resources. Poor skills and low for early signs of chronic diseases continues. levels of qualifications contribute to poor health, poverty, social exclusion and crime. In the UK, university graduates earnings are 59% 3.5 Education & Life-Long Learning higher than people with secondary education Introduction only (OECD, 2004). Women earn less on The importance education has in preparing average than men whatever their level of children for life beyond the attainment of education although this disadvantage is academic qualifications is well established especially marked at lower levels of education (Acheson, 1998). Education provides children (OECD, 2004). Among those who suffer with the practical, social and emotional skills to redundancy, retraining, acquiring new skills and achieve a full and healthy life and participate re-employment are more likely among those fully in society. To achieve this, education has to with educational qualifications and with family be delivered in an environment and culture that and social networks (Blane, 1999). is safe, healthy, and conducive to learning. This National and local strategic context section describes the links between education Every Child Matters: Change for Children is and health. It examines the evidence base for about radical change in the whole system of the impact of education on health, outlines in children’s services to improve short and long- brief the national and local policy framework term outcomes (DfEST, 2004). The Children Act and reports on the extent to which progress (2004) underpins this providing the framework has been made against national and local for developing more effective and accessible education targets. services focused around the needs of children, Education and health improvement young people and families. Economic and social inequalities are important The Healthy Schools Programme is a key factors in the success or failure of education. Government strategy contributing to tackling Children from disadvantaged backgrounds tend health inequalities. The National Healthy School to do less well at school than children from Standard provides a model of partnership working affluent backgrounds. Children from between the health service, external agencies disadvantaged backgrounds are likely to gain and schools. The programme addresses key fewer qualifications, make less healthy life health themes encouraging healthy eating, and choices and have poorer chances in reducing childhood obesity, pregnancy and employment (Acheson, 1998; Blane, 1999). drug use by using a “whole school” approach. Educational attainment is associated with The programme aims to ensure that half of all health-related habits such as smoking, exercise schools are ‘healthy schools’ by 2006, targeting and dietary choice as well as with mental areas of disadvantage first. health (Blane, 1999). The Food in Schools Programme encourages Education in the under fives enhances greater access to healthier choices in schools development and health and achievement in and links with the healthy eating component of later life. Adult learning also has positive effects the National Healthy Schools Standard. Another on health outcomes such as giving up smoking key initiative is the Extended Schools Programme. and taking more exercise. Adult learning An extended school is one that provides a range contributes to changes in attitudes and of activities and services often beyond the behaviours that promote social capital and social school day, to help meet the needs of children, cohesion (Feinstein, 2002; Feinstein et al, 2003). families and the wider community. Benefits Education has a pivotal role in influencing include higher levels of pupil achievement and inequalities in health (Acheson, 1998). increased motivation and self-esteem. Educational qualifications predict job prospects,

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Government targets on qualifications are for attendance for primary and secondary 60 per cent of all pupils to achieve five or more schools. Attendance is increasing in schools, GCSEs at grades A-C by 2008 (DfEST, 2002). with East Brighton schools reaching the In order to narrow the inequalities gap, in all local target set for 2010 (92%) in 2004. schools at least 30 per cent of pupils should 2. Narrowing attainment gaps and achieve five GCSE passes by 2008. Education is tackling underachievement. one of the three priority areas within the 2020 The “Excellence Cluster” has been working Community Strategy for Brighton and Hove. with schools in East Brighton to raise Progress against the targets of this strategy is standards (BHCC, 2005c). Strategic use of summarised at the end of this chapter. the Neighbourhood Renewal Fund (NRF) Progress and performance includes the provision of a consultant to Among the nineteen local education authorities schools focussing on low achievement in in the South East, Brighton has the third highest literacy and numeracy and provision of average proportion (17.5%) of primary school other support to schools in managing their age children eligible for free school meals national literacy and numeracy strategies. (DfEST, 2005). Only the Isle of Wight and Brighton and Hove has a higher five GCSE Southampton Local Education Authorities have A-C pass rate of 49.5% compared with the higher average figures. This average figure, average of NRF areas in the South East of however, for Brighton and Hove reflects a very 44.5%. However the city is below the wide range of primary school children (1.3% national average of 53.7%. Another indicator to 46%) who are eligible for free school meals. is the percentage of 15 year-olds gaining at With regard to secondary schools in the South least one GCSE grade A-G, which is viewed East, Brighton and Hove has the second highest as a measure of social inclusion. This figure average proportion (16.1%) of pupils eligible currently stands at 96.2% for Brighton and for free school meals (DfEST, 2005). Only Hove compared with a national average of Southampton Local Education Authority has a 95.9% (DfEST, 2005). higher average figure. This average figure for 3. Reducing permanent exclusions from Brighton and Hove reflects a range from 11.5% school via links with vocational courses to 41.9% of secondary school children eligible and other schools and colleges. for free school meals. The creation of an adapted curriculum, Key areas, drawn from the 2020 Community engaging in vocational training one day per Strategy, the Education Delivery Plan and the week has significantly improved attendance. Area Investment Framework, and the progress This year’s target for reducing permanent that has been made are detailed below: exclusions from school may not be met as there had been 15 exclusions by December 1. Increasing primary school attendance 2004. However, the majority of exclusions rates through the community schools take place in the summer term. programme and extended schools programme. 4. Increasing the number of people in There has been a successful targeted pilot deprived neighbourhoods taking up project in the 25 schools with the lowest family learning opportunities. attendance rates to increase attendance This is to tackle low educational achievement (BHCC, 2005c). The end results for 56 in specific geographical areas by assisting primary and 10 secondary schools are schools to become more involved in family encouraging with overall attendance rates learning. Family programmes raise the of 94.3% in primary schools and 91.8% for literacy, language and numeracy skills of secondary schools. These results narrowly parents to improve parents’ ability to help miss local targets of 94.5% and 92% their children.

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5. Reducing the number of adults who more challenging target is for all 29 schools lack basic skills such as literacy. identified as having a high proportion of The 2020 Community Strategy target is to children eligible for free school meals to improve the literacy and numeracy of adults achieve silver status by April 2006. Currently by 10%. According to the Learning Skills 16 out of the 29 schools concerned have Council, 1,366 places on numeracy, language achieved the silver award. The NRF has and literacy courses were available last year. enhanced the provision of the extended school programme in Brighton and Hove. 6. Increasing the provision of community For example the extended school at Falmer based learning opportunities. offers vocational courses to pupils from There is an outreach programme which other schools and colleges. delivers a range of neighbourhood-based courses to people who might not usually Next steps and recommendations engage with college adult learning courses. In response to Every Child Matters the new Courses identified by communities as being Children’s Trust Partnership is developing a relevant to their own needs for life skills city-wide strategy for children’s services, bringing include: first aid; healthy eating; health and together education, health services and social safety; and computing. care to secure better outcomes for Children and Young People in Brighton and Hove. 7. Developing specific training projects The first stage will be services for every family to assist workless people into work. with children under the age of five and the The EQUAL project is an initiative that aims development of children’s centres. At children’s to widen access to employment and centres there will be: combined early education training for those groups who face barriers and childcare for children aged 0-4 years; parenting for a variety of reasons. Examples of people and family support; health advice; and support who may access training through the for additional needs such as help for those with project include: black and minority ethnic English as an additional language. people; people over the age of fifty; people with disabilities and people with mental There is already an established strategic health needs. approach to education in Brighton and Hove. Co-ordination of social care, education and 8. Increasing the number of affordable health services across all sectors will be steered childcare places and the number of people by the Children’s Trust and outlined in the obtaining childcare qualifications. Children’s Trust Strategy (BHCC, 2005a). There The number of officially recognised is strong momentum within the city to improve childcare places for pre-school children in the standard of food in schools through the Brighton and Hove is 2,868 (DfEST, 2005). Food in Schools Programme. This needs to 9. Developing sector/skills specific training materialise in improved food for children in framework for example construction schools. There are opportunities to support with key partners. achievement of shared health objectives The EQUAL project encourages employers through stronger working relationships to develop innovative methods of between the Extended Schools and Healthy recruitment as well as funding information Schools Programme and the Healthy City sessions and supported placements. Programme. Consideration should be given to monitoring performance on these shared 10. Linking the work of the Healthy School objectives through the Healthy City Partnership. Scheme with the Extended School Strategy and improving this partnership. The Healthy School Scheme is likely to meet its target of half of all schools achieving silver award by December 2006. A further

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3.6 Transport Introduction The main function of transport is to enable access found that the busier the traffic on a street to goods, services and to other people. Some the more fragmented the social networks forms of transport, such as cycling and walking, (Appleyard and Lintel, 1972). Environmental promote health directly by increasing physical modification and redesign reduces traffic activity. Transport also promotes health indirectly speed and noise pollution as well as providing a better environment for play and other

Figure 3.6.1 Environmental and Overallhealth IofD effects Score community based street-level activities. The of transport introduction of 20 mph zones is associated with, on average, a 61% drop in pedestrian

Air pollution casualties and a 67% drop in child pedestrian and Physical inactivity Injuries cyclist casualties (Webster and Mackie, 1996). Fear of crime can hinder many people accessing services, particularly after dark, as it prevents Climate change them walking, cycling or using public transport (SEU, 2003, DfT 2005). However, the benefits

Psychosocial Nature and of cycling and walking have been shown to effects landscape effects Noise outweigh any risks. A report on transport and social exclusion (SEU, 2003) found that: two out of five jobseekers Source: WHO Regional Office for Europe (2005). say lack of transport is a barrier to getting a job; and nearly half of 16-18-year-old students through the achievement and maintenance say they find their transport costs hard to meet. of social networks. In addition, transport Each year an estimated 1.4 million people miss, may damage health directly, most notably turn down, or choose not to seek medical help by accidental injury, noise and air pollution. because of transport problems. 16% of people And a lack of transport may damage health without cars find access to supermarkets difficult, by denying people access to goods, services compared with 6% of people with cars. and to other people (Acheson, 1998). This section In Great Britain transport produces 70% of all describes the links between transport and carbon monoxide emissions, 48% of all nitrogen health. It examines the evidence base for the oxide emissions and 22% of particulates (DfT impact of transport on health, outlines in brief 2002a). The Committee on the Medical Effects national and local transport policy and reports of Air Pollutants has estimated that there are 8,100 on the extent to which progress has been made premature deaths every year as a result of exposure against national and local transport targets. to particulates and 3,500 premature deaths a year Transport and health outcomes due to exposure to sulphur dioxide (DH, 1998). In 2003, 3,508 people were killed on British Transport produces road noise, engine noise, roads, a further 33,707 were seriously injured, and other noise, such as slamming doors or and 253,392 slightly injured. Over 4,000 loud car stereos. Noise related to transport has children were killed or seriously injured (DfT, been shown to interfere with sleep patterns, 2004). These figures are likely to underestimate concentration and children’s performance at school the total burden of injury and therefore of the (Morton, 1999; Rutter, 2003; WHO, 2004). use of NHS services (Davis et al., 2005). Transport links can make or break social networks. Busy roads may disrupt networks and sever communities. A San Francisco study

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There are significant inequalities with regard to Whilst it is difficult to assign economic costs to transport and health (Acheson, 1998): the specific elements of transport’s impacts on health, Table 3.6.1 indicates the scale of the • ownership/access to a car is highly related to problem to society and to the NHS social class: 62% of the poorest groups do (Davis et al., 2005). not have a car, compared with 7% of those in the richest groups; National and local strategic context The Transport Act 2000 requires local • children in social class V are five times more authorities to produce a Local Transport Plan likely than those in social class I to die as (LTP) every five years. The LTP can provide local pedestrians (Grayling et al., 2002);

Table 3.6.1 Economic costs of the impact of transport on health Area Economic Evaluation Source Hospital and ambulance costs Cost £560 million DfT (2002b) of injury accidents (Great Britain) Physical inactivity Cost £8.2 Billion DH (2004d) (England) Reductions in PM10, sulphur dioxide Net benefit £1.69-£1,295 million DH (1999) and ozone (Great Britain) Implementation of 110 ’20 mph zones’ Cost £4 million IPPR (2002) in Kingston upon Hull Benefits £40 million Source: Davis et al., (2005) Making the Case: improving health through transport, HDA.

• for children and men aged 20-64 years, authorities with access to significant levels of mortality rates for motor vehicle traffic accidents government capital funds to invest in transport are higher in lower socio-economic groups; infrastructure. The first full LTP covers the period 2001/02-2006/07. The second round of • exposure to air pollution tends to be greater LTPs is currently in progress and will cover the for people experiencing disadvantage; years 2006/07-2010/11. • access to healthcare, shops, work and leisure The LTP should support and help deliver is more difficult for those in low-income national, regional and local objectives and households; and therefore is linked to a number of other plans • those in lower socio-economic groups are and strategies. These include the Government’s less likely to engage in physical activity as 10-Year Plan (2000), the Regional Transport a form of recreation. Strategy (2003), the Local Plan (2005) and the Sustainable Transport Strategy for Brighton and Awareness is increasing of the health benefits Hove (2000). It will also complement the that would arise from developing a transport Community Strategy (2003), the Sustainability system that promotes walking and cycling. The Strategy (2002), Tourism Strategy (2004) and National Forum for Coronary Heart Disease Active Living Strategy (Draft 2004). Prevention has described physical activity as today’s best buy in public health and walking as Within the second LTP there will also be central to any strategy to increase physical transport-based strategies, including walking activity (Sharp et al., 1995). Thirty minutes of and cycling, school travel, an Air Quality Action walking or cycling on most days of the week, Plan, an Accessibility Strategy and a Rights of even if carried out in 10-15 minute episodes, Way Improvement Plan. provides health benefits (DH, 2004d). This can The many overlapping themes within these easily be achieved, in two trips per day, by mean that partnership working is a very cycling or walking.

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important element of transport planning. The The Local Transport Plans and Annual Progress PCT and City Council are planning a Health Reports describe local performance against each Impact Assessment of the new Local Transport target in detail and are available from the City Plan in order to promote the positive, and reduce Council’s website (www.brighton-hove.gov.uk). the negative, impact of transport on health. Next steps and recommendations Progress and performance The Brighton and Hove LTP (2006/07 - The performance of local authorities in delivering 2010/11) will demonstrate how the City their LTP objectives is monitored each year and Council intends to tackle congestion, improve assessed by the government. The results are road safety, improve air quality and improve published in an Annual Progress Report (BHCC, accessibility. It will also address quality of life 2005d). The level of performance influences the measures such as: quality of public spaces and amount of funding available year on year. Over streetscapes; community safety, personal £35 million has been secured for Brighton and security and crime; neighbourhood renewal and Hove since 2000 to invest in and maintain the regeneration; noise pollution; climate change city’s transport infrastructure. and greenhouse gases and the increasing use of more sustainable forms of transport. Whilst The Local Transport Plan includes both it is generally for local authorities to determine national (core) and local targets, against which outcomes are most important locally, the which performance is assessed annually. Department for Transport expects all authorities Some progress has been good (BHCC, 2005e) to monitor and set targets for most of the current although a lack of data (related to changes in Best Value Performance Indicators and a few national guidance on data collection) has other mandatory key indicators. meant that some targets cannot be assessed; in some cases this relates to targets which in The following recommendations are made: previous years had been on track. 1. The PCT and City Council should fulfil their There are nine national transport targets: commitment to conduct a Health Impact Assessment on the Provisional Brighton 1-3: condition of the roads and Hove Local Transport Plan. 4: increasing the number of bus 2. The PCT and City Council should provide passenger journeys education, training opportunities and tools 5: user satisfaction with bus services for transport planners to understand and take into consideration the links between 6: number of cycle trips across the city transport and health. 7-8: number of children and people as a whole, 3. The PCT and City Council should ensure killed or seriously injured on roads in the city accessibility planning that contributes both 9: percentage of rural households within to health improvement and to treatment 800m of an hourly bus service and care facilities. Data are available to measure four targets 4, 7, 4. The PCT and City Council should work to 8 and 9. Currently targets 7, 8 and 9 are on track. increase community awareness of the impacts of traffic and travel on health. There are 32 local targets relating to road safety, tackling congestion, air quality, and maintenance of roads and footways. Data are available to report on 25 of them in 2004/05, 18 of which are on track.

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3.7 City Planning Introduction This section considers the links between urban healthy ageing and active living through development and health. As a WHO Healthy improved urban planning and design. City, Brighton and Hove is committed to The Local Plan, the current strategy for the implementing the principles and approaches control of development and use of land in of healthy urban planning. This means adopting Brighton and Hove, includes consideration of and implementing the principles of inter-sectoral wider sustainability objectives such as: tackling co-operation, community involvement, equity social exclusion; improving community safety and political support in the planning process. and supporting economic regeneration. All Healthy urban planning is about planning for development proposals are assessed for compliance people. with the Local Plan. The plan is however largely City planning and health outcomes limited to land use allocation and the physical Urban spatial and transport planning significantly infrastructure of the city. At the time of writing, influence the determinants of health (Duhl & the Local Plan is due to be adopted in August Sanchez, 1999). Many public health initiatives 2005 for the following three years. have sought to change the behaviour of A new planning system, the Local Development individuals and small groups. Attempts to Framework (LDF) will replace the Local Plan change personal behaviour however are often in 2007. The City Council will move to the new unsuccessful without changes in social, planning system and the LDF will have a greater economic and environmental conditions focus on health and social well-being in urban (Lawlor, 2003 and McCarthy, 1999a). The planning. The LDF will help deliver the urban connection between public health initiatives planning objectives of the 2020 Community and urban planning has been severed over time, Strategy. It will include specific health objectives at some cost to people’s health, especially in and place sustainability and community terms of healthy exercise and road safety. Healthy involvement at the heart of planning. Sustainability Urban Planning seeks to address this by: appraisals are in fact now undertaken for all • focusing urban planners on human health, major developments in the city. well-being and quality of life; The Local Plan and LDF will consider access to • making health objectives central to the sustainable modes of transport. Both will seek decision making process; to reduce car use in the city: car-free housing and minimal car parking standards will be • addressing ‘health’ as a core element of encouraged. The LTP will support access to sustainable development; and new employment developments. For further • improving the quality of the built information see the transport section in this environment in the context of the quality chapter. The LDF will also link new housing of life of individuals and communities. developments to open spaces (to encourage access to green spaces and exercise) and The strategic context inexpensive sources of fresh food (to address The WHO Healthy Cities programme focuses on concerns about urban food deserts). The LDF three core themes for Phase IV (2003-2007); will further include consideration of employment Health Impact Assessment (HIA); Healthy opportunities, particularly those that offer Ageing and Healthy Urban Planning (HUP). potential for higher paid employment. It will There is in additional a focus on Physical seek to secure improvements in the urban Activity. As a designated Healthy City, Brighton environment such that the quality of life for and Hove is expected to work on all three, core residents and visitors is enhanced. The LDP themes and the additional focus. This includes will make explicit links between the urban exploring how HUP and HIA can strengthen development and health improvement.

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The 2020 Community Strategy sets out an of land built on previously developed land; overarching strategy for achieving social, • significant effects indicators - drawn economic and environmental well-being. from sustainability appraisals. There are eight key objectives within it, including: an enterprising city; an affordable city and an In addition, there are Best Value Performance attractive city. Strong links will be made Indicators relating to the production process for between the LDF and the 2020 Community the LDF (Table 3.7.1). The production schedule Strategy through common time-frames and for the LDF is outlined in the Local joint revisions. This will also help ensure community Development Schedule (LDS). and stakeholder involvement in the LDF. The LDF will comprise Local Development There are a number of strategies that have Documents (LDDs) (see Local Development been produced by the City Council that have a Scheme, BHCC, 2005f). Health impact will be

Table 3.7.1 Best Value Performance Review Indicators for the development of the LDF BVPI Status BV200a - did the local planning authority submit LDS submitted on 4th January 2005 and was revised the LDS by March 28th 2005 and thereafter in April before milestones took effect. maintain a 3 - year rolling programme? BV200b - has the local planning authority met the Ongoing - subject to reporting on ongoing milestones which the current LDS sets out? programme management. BV200c - did the local planning authority publish Ongoing - pilot version completed and started on an annual monitoring report by December 2004? producing AMR based on current guidance. Source: Brighton & Hove City Council, 2005. spatial focus. These include the economic, explicitly considered in the preparation of all of transport, housing, community safety, tourism these key documents. The main types of LDD are: and cultural strategies. In addition, public sector • Development Plan Documents (DPDs) - partners including the PCT, Learning and Skills these form the statutory development plan Council, Sussex Police and providers of physical setting out the vision, strategy and policies infrastructure, have produced related strategies. for the area. These will include site allocations, It is essential that these areas are effectively proposal maps and area action plans. ‘joined up’ to achieve successful urban planning. • Statement of Community Involvement Progress and performance (SCI) - this sets out the policy for engaging There are performance targets for city planning the community on the different types of LDD although the majority of these focus on the as well as major planning applications. processing of planning applications. Related targets for transport, housing and waste • Supplementary Planning Documents management are addressed in other sections in (SPDs) - these provide guidance on how this chapter. As the LDF develops the City policies in the Local Plan and replacement Council will develop and monitor local DPDs will be implemented. performance indicators in an Annual Other key components of the LDF include: Monitoring Report (AMR).These will include: • Sustainability Appraisal Document - • contextual indicators - from the 2020 this sets out the methods for undertaking Community Strategy, including healthy city sustainability appraisals and strategic performance indicators; environmental assessment on other LDDs. • core output indicators - such as the amount Consideration will be given to how health

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impact is integrated into these other forms will also consult with colleagues in the Health of assessment. Protection Agency and seek expert advice regarding the potential environmental and health • Annual Monitoring Report - this report impacts for residents in the Hollingdean area. will be published every December and give monitoring information on the LDF for the A biodiversity action plan for the whole city is previous financial year. being drafted. The biodiversity action plan for schools is complete and will provide for a wider Although the LDF represents a new approach, range of habitats to be created in school grounds. already some change in urban planning can be A ‘Greenways’ plan is incorporated into the seen. The new library development was Local Plan identifying green corridors, which informed by a Sustainability Appraisal. The will become sustainable transport corridors for resultant building achieved a very high energy cycle/pedestrian routes whilst also allowing efficiency and water conservation standard wildlife to link between the city’s green spaces. (see Figure 3.7.1). The WHO has reviewed the city’s progress in Figure 3.7.1 Brighton Library taking forward the Phase IV healthy urban planning objectives, through analysis of Annual Reporting Templates. Brighton and Hove has been praised for the high quality of its healthy urban planning application, its high levels of activity and the excellent overall progress. “Brighton and Hove is very well organized having secured agreement to train all city planners in Health Impact Assessment and to incorporate healthy urban planning principles and approaches into new statutory Local Planning framework.” (WHO Region for Europe, 2005). Next steps and recommendations Healthy City awareness training has already begun with city planners. The PCT and City Council will provide training in Health Impact Assessment (HIA) for city planners. The training aims to make more explicit the connections The Waste Local Plan sets out proposals for the between urban planning and the consequent treatment and disposal of waste in East Sussex impact upon the health of people living and and Brighton and Hove City. The plan has working in the city. This will help reconnect completed its consultation phase following planning to its historical roots in providing a comments from the planning inspectors and healthy place to live and work. will be put forward for formal adoption by The following recommendations are made: the Council. The City Council is considering a planning application for a Waste Transfer 1. Apply Healthy City principles and a Healthy Station and Materials Recovery Facility for Urban Planning approach to Local part of the city’s Hollingdean Depot site. The Development Framework policy documents. Environmental Health & Licensing Team are 2. Undertake a Health Impact Assessment assessing the impact of noise, dust, smells, on all Local Development Framework air quality and contaminated land issues arising policy documents. from the proposed development and will report to the Council’s Planning Committee. The PCT 3. Support education and development of city

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planners in Healthy Urban Planning and Homes Standard. A decent home meets the Health Impact Assessment. current statutory minimum standard for housing, is in a reasonable state of repair, has reasonably 4. Explore ways in which HUP and HIA can modern facilities and services and provides a strengthen the development of healthy reasonable degree of thermal comfort. ageing and active living through urban planning and design. Housing is one of the Government’s Neighbourhood Renewal Strategy priorities. (SEU, 2001) The effects of road traffic impact 3.8 Housing disproportionately on deprived areas and Introduction individuals through pedestrian accidents, One of the fundamental conditions and air pollution, noise and the effect on local resources for health identified in the then communities of roads cutting through residential groundbreaking Ottawa Charter for Health areas (SEU, 2003). The risk of burglary varies Promotion in 1986 was shelter. Good housing between households: those with lone parents, contributes to maintaining people’s health and without security measures, where the head of wellbeing. Poor housing or the lack of a home household is aged 16-24 years, or where makes people’s health worse. This section people have lived for less than a year, are more considers the evidence linking housing and likely to be burgled (Dodd et al., 2004). health, describes the actions already taken to improve both the availability and quality of Brighton and Hove’s Housing Strategy, Housing local housing, the additional support being - the well-being of the city, recognises the provided to vulnerable people, and details the correlation between health and housing future actions that are planned. throughout its five priority areas: Housing and health outcomes 1. Affordable housing Homelessness has been linked to increased The provision of affordable housing is key to mental illness and mortality, especially amongst reducing the level of homelessness, helping those sleeping rough or in hostels (Acheson to eradicate poverty, and retaining and 1998). Poor housing is associated with social recruiting valued and experienced workers. isolation, crime, reduced privacy and reduced 2. Decent homes opportunities for children to play safely. Improving the city’s housing stock, in A high percentage of all fatal accidents happen particular houses occupied by low-income in the home and there are increased rates of residents, will improve the health and accidents among children living in unsuitable independence of local residents. temporary accommodation. People unable to afford to heat their homes or those living in 3. Care and support poorly heated homes are more vulnerable to Supporting vulnerable and older people health-related problems and to winter death in their own homes, rather than in hospital (Wilkinson et al 2001). Indoor air quality is or care homes, and enabling older people also influenced by many additional factors admitted to hospital to be discharged to including poor ventilation, tobacco smoke, their home or other appropriate place. cooking fumes, radon, and house dust mites 4. Equality (Thomson et al., 2002). Failure to address equality issues will mean that Improvements in housing have the capacity to as a city we will fail to meet the needs of all improve health, particularly mental health, with our local residents and will not enable people subsequent long-term benefits for local and to live in homes that are best adapted to national health economies (Thomson et al., 2002). their needs. National and local strategic context 5. Neighbourhoods and communities In 2000 the Government introduced the Decent Pursuing a policy of inclusion and renewal

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within neighbourhoods and communities support provision to help engage vulnerable to support residents, address anti-social people at the earliest opportunity. behaviour, and improve quality of life. The Brighton & Hove Affordable Warmth - Fuel A number of related strategies support the Poverty Strategy has a thirty-five point Action Housing Strategy. Schemes to minimise hospital Programme that sets out what needs to be done discharge delay and provide support services to eradicate fuel poverty from the city by 2010. and accommodation for older people have also Progress and performance been established. Map 3.8.1 shows the percentage of properties The Homelessness Strategy supports the in 2004 for each ward that failed at least principle of keep people in their own homes, one of the four components of the Decent providing appropriate support services and Housing Standard. treating individuals with respect and dignity to The Census 2001 demonstrated that Brighton combat discrimination. and Hove had an overcrowding rate of 12.7%, The Supporting People Strategy promotes the the highest outside London, affecting more development of flexible and responsive support than 1 in 8 households. Brighton and Hove also services, which contribute to community safety, had the 5th highest percentage of households social inclusion, and health improvement, and

Map 3.8.1 Properties failing any one of the four components of the decent homes standard in Brighton & Hove

% of properties failing by ward 27-32 33-38

Patcham 39-44 HollingburyHollingbury Withdean & Stanmer 40-51 North Portslade

HangletonHangleton & Knoll

Stanford MoulsecoombMoulsecoomb & Bevendean Preston Park 1 Hanover WoodWoodingdeaningdean GoldsmGoldsmidid & Elm Grove Wish 2 6 3 4 East BrightonBrighton 5 Queen's Park 1. South PorPortsladetslade 2. WestbourneWestbourne 3. Central HHoveove Rottingdean CoastalCoastal 4. BrunswBrunswick&ick& AdAdelaideelaide 5. RegencRegencyy 6. St. PetePeter'sr's & NoNorthrth Laine

Source: Public Health Directorate Information, Brighton & Hove City PCT (Building Research Establishment Ltd. 2005). help prevent homelessness and institutionalisation. in England & Wales lacking central heating and sole use of bath/shower and toilet. The Single Homeless & Rough Sleeper Strategy and Homeless Prevention Strategy fosters links Property prices and rental costs in Brighton and between health, education, employment and Hove have risen significantly over the last 8

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years with the associated risks of residence in accommodation for 25%; and domestic unsuitable accommodation, overcrowding and violence for 15%. Homelessness prevention homelessness (BHCC Housing Directorate). work is targeted at these causes (BHCC Housing Directorate). The city has seen a 50% Half of all households in the city have a median reduction in the number of new homelessness average income of less than £23,100. A one applications and acceptances since the Housing bedroom flat costs six times the median Options Teams were set up in autumn 2004. household annual income, with three bed houses now costing more than 10 times A balanced housing market will only be median annual income. Traditional mortgage achieved with residents being supported to multipliers suggest mortgages of no more than maintain their own independence. 3.5 times income. A household renting an Strengthening partnerships to commission average one bedroom flat would be paying just accommodation for the vulnerable, promoting over £600 per month in rent, which is the work of the independent living teams, and equivalent to the monthly repayment cost of a increasing housing support services will all help £104,000 mortgage. Such a mortgage would to achieve this. require an income of around £32,000, far Performance within the housing area has been above the average income in the city (BHCC steady. The proportion of ‘non-decent’ stock Housing Directorate). continues to fall, this is down from 58% of New affordable housing incorporating modern stock in 2002 to 52% of stock in 2004. The lifetime home and sustainability standards, and City Council is still involved in the stock options let through Choice Based Lettings will improve process and completion of this will hasten the profile of the social housing sector. Local progress towards the target of no ‘non-decent’ Planning policies on affordable housing dwellings by 2010. Since 2002 more than 500 combined with major regeneration projects empty properties have been bought back into such as Brighton Station and Preston Barracks use (BHCC Housing Department). will help in the supply of new affordable There is requirement for a 40% affordable housing into the next decade. element in new housing schemes. The target The Private Sector Leasing Initiative was of the completion of 300 new affordable established in 2004 and is a partnership houses each year between 2002 and 2007 between South Downs Health NHS Trust, has been surpassed, with 735 units completed Brighton & Hove City PCT and the Housing in 2003/04 and 286 completed and 437 new Department of Brighton & Hove City Council. starts in 2004/05 (BHCC Housing Department). The partnership flats are leased from the private Work commissioned around homeless sector and prioritised for users of adult mental prevention has led directly to the City Council health services. This scheme enables people to working in partnership with other agencies to move to independent living, with the prevent new homelessness through better appropriate community support. In 2004/05 a advice and introducing ‘Homelessness Prevention‘ total of 35 placements were made through the in commissioning schemes for vulnerable adults. scheme. The scheme is targeted at working age adults. Strategies for older people with mental A delivery plan for the implementation of strategic health issues aim to ensure that extra care housing objectives is outlined in Table 6.1. housing and sheltered housing initiatives are Next steps and recommendations inclusive of people with mental health problems. Brighton & Hove City Council by continuing There are three main causes of homelessness in to work with key partners - voluntary sector Brighton & Hove: during 2004/05, eviction by providers, Sussex Police, leaseholders associations family and friends accounted for 28% of all and the Economic Partnership - will meet homelessness in the city; loss of private rented strategic housing targets.

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3.9 Crime Introduction This section describes the links between crime driving offences. In over 40% of violent and health. It examines the evidence base for incidents the victim considered the offender the impact of crime and the fear of crime on to be under the influence of alcohol. Twenty health, health-related behaviour and health five percent of these were domestic assaults service usage. It outlines in brief the national between partners, relatives or household and local policy framework and reports on the members (Budd, 2003). Around three-quarters extent to which progress has been made of crack and heroin users claim they commit against local targets. The final paragraph crime to feed their habit. These crimes include highlights the key themes of the Community shoplifting, burglary and robbery (Home Office, Safety Strategy. 2005). Drug use is more prevalent in younger ages with class A drug use peaking in the ages Crime and health outcomes 20 to 24 years (Condon & Smith, 2003). Crime, and the fear of crime, has a serious impact on health and health service usage National and local strategic context (Keithley & Robinson, 2003). Crime can result Local residents regard safety as a key aspect of not only in direct physical injury, disability and a healthy city. In 2003-2004, Brighton and Hove death, but can also have a negative impact on residents nominated crime as the second most psychological health and living standards. Fear important attribute, after clean streets, that made of crime can lead to a wide range of health a city a good place to live. Feeling and being safe problems and health damaging behaviours such is one of the city’s top public and political priorities. as psychological distress, depression, increased The 1998 Crime and Disorder Act established smoking and alcohol consumption, social the legal framework for the current Community isolation and self-limited mobility. It particularly Safety Strategy. The Act requires a local audit affects women and older people, and may be and consultation to be carried out every three in excess of the actual risks (Acheson, 1998). years. Based on the consultation, Brighton and Young people are more likely than any other Hove Crime and Disorder Reduction Partnership age group to be the victims of assault, robbery (CDRP) has developed a Community Safety and rape. Young men are most at risk of Strategy. The CDRP is overseen by two main violent offences (Dodd et al, 2004). Crime bodies. The Responsible Authorities disproportionately affects homeless people, Partnership/Drug and Alcohol Action Team who in comparison with the general public, take statutory responsibility for the work of are 13 times more likely to have experienced the partnership and the Community Safety violence and 47 times more likely to be victims Forum is the key consultative group. of theft (Newburn & Rock, 2004). Domestic The Brighton and Hove Community Safety, violence has long-term effects on the physical Crime Reduction and Drugs Strategy 2005 - and mental health of victims and on the 2008 (CSCRDS) produced by the CDRP, sets children who witness it (Dodd et al, 2004). out the approach for making the city safer Living in deprived urban areas is associated (Partnership Community Safety Team, 2005). with raised levels of burglary, criminal damage, Strong cross partnership working is a key violent offences and anti-social behaviour such component of the strategy which also supports as neighbourhood disputes, vandalism, and the city’s Sustainability Strategy and other key harassment. This undermines community cohesion, strategy documents. Table 3.9.1 presents the physical environment and quality of life. four aims and 13 priority areas of the CDRP. Alcohol plays a part in a wide range of criminal Fear of crime and sustainability are crosscutting offences, especially violent offences but also themes and are addressed under each of the criminal damage, vehicle-related thefts and 13 priority areas. All of the priorities link with

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Table 3.9.1 The Brighton & Hove Community Safety Crime Reduction and Drugs Strategy (2005-2008)

Aims Priority Areas Reducing crime and disorder Physical Environment and Quality of Life Reducing fear of crime Violence in a Public Place Reducing harm from drugs and alcohol Alcohol Misuse Improving community safety Illicit Drug Misuse Domestic Burglary Vehicle Crime Business Crime Anti-Social Behaviour Children and Young People Domestic Violence Racist and Religiously-Motivated Incidents Homophobic and Transphobic Crimes and Incidents Prolific and Other Priority Offenders

Source: Brighton & Hove City Council, 2005. a number of other strategies and action plans, in the way police recorded crime during 2004- in particular the Children and Young People’s 2005. New recording methods have particularly Strategic Plan, Drug and Alcohol Action Team affected the category of ‘violent crime in a Action Plan, Neighbourhood Action Plans, public place’ which showed an increase of Children’s Trust Partnership, Anti-Social 39.4%. Public place assaults as recorded by Behaviour Team Plan. Accident and Emergency services do not show this increase suggesting that the rise is indeed The Children and Young People’s priority area is due to changes in police recording methods. linked to the Children and Young People’s Safety Strategy. This in turn draws on the five Progress against the 2020 Community Strategy outcomes of the Government report Every is shown in the summary table at the end of Child Matters in particular ‘Staying Safe’. Chapter 3. Changes in the way that crime is reported and recorded make comparisons over Progress and Performance time difficult. Some measures are comparable Following the 2004 Spending Review, a series such as the Community Safety Survey that was of Public Service Agreement targets were carried out in 2001 and 2004 with members of agreed with the Treasury. The Home Office set the Citizen’s Panel. This shows that there was a national target of a 15% reduction in crime an improvement in feelings of safety in central by 2007-2008 from a 2003-2004 baseline as Brighton, central Hove and local neighbourhoods, measured by the British Crime Survey (BCS). especially at night. The 2020 Community Other targets focus on reducing fear of crime, Partnership takes a monitoring role in relation reducing harm from drugs and increasing to community safety and the CDRP takes the community participation and cohesion. lead in targeting priority crime areas. The CDRP In Brighton and Hove, between 1 April 2004 is working towards the following targets: and 31 March 2005, there were 32,667 police • a 6% reduction in total police recorded recorded crimes, a 9.4% increase compared to crimes between 2004-2005 and 2007-2008; the previous year (Figure 3.9.1 and Table 3.9.2). 40% of offences took place within three • a 22% reduction in the number of police electoral wards in the city centre. This increase recorded BCS Comparator Crimes between is however likely to be a consequence of changes 2004-2005 and 2007-2008;

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Figure 3.9.1 Police Recorded Crime for key offences 2003-2004 in Brighton and Hove and in England and Wales

60 Rate per 1,000 population in Brighton and Hove Rate per 1,000 population in England and Wales 50

40

30

20

Rate per 1000 population 10

0 Violence Theft & Sexual Robbery Fraud Drugs Criminal Burglary against handling offences & forgery & other damage the person stolen offences goods Category of crime Source: Brighton & Hove City Council, 2005.

Table 3.9.2 Change in recorded crime in Brighton and Hove between 2003-2004 and 2004-2005 Recorded Crime Brighton & Hove Recorded Crime Brighton & Hove Apr 2003 to Mar 2004 Apr 2004 to Mar 2005 % Change All Crimes 29861 32667 9.4 BCS Comparator Crimes 17672 18432 4.3 Violent Crime in a Public Place 3263 4547 39.4 Sexual Offences 285 438 53.7 Robbery 460 462 0.4 Domestic Burglary 1938 2137 10.3 Vehicle Crime 4519 3327 -26.4 Criminal Damage 5352 5692 6.4 Domestic Violence 1050 1358 29.3 Racist Crimes and Incidents 313 415 32.6 Homophobic or Transphobic Crimes & Incidents 92 161 75 Source: Brighton & Hove City Council, 2005. Note: BCS Comparator Crimes comprise: Theft of motor vehicle; Theft from motor vehicle; Vehicle interference; Theft from person; Domestic burglary; Theft of pedal cycle; Criminal damage; Common assault; Woundings; Personal robbery

• a 6% reduction between 2004 and 2007 in In Brighton and Hove over 2,000 people go to the percentage of Citizen’s Panel respondents the Accident and Emergency Department each who have been a victim of crime in the last year with injuries or illness directly attributable 12 months; and to alcohol misuse. The proportion of the adult population consuming more than the • maintain or increase the percentage of recommended weekly levels of alcohol almost people in central Brighton, central Hove doubled between 1992 and 2003 (Scanlon, and local neighbourhoods who feel safe 2004). Brighton and Hove has a significant drug during the day and when out by night problem with an estimated 2,300 injecting drug between 2004 and 2007.

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users, resulting in one of the highest prevalence their environment without experiencing rates nationally (Hickman et al, 2004). crime, abuse or injury. The Brighton and Hove Community Safety Survey in 2004 found that “drunks and 3.10 Economic Development alcohol/drug misuse” was the most frequently Introduction cited reason for feeling unsafe in central Health and welfare are central to a socially Brighton and Hove. A study in 2005 of the inclusive and economically prosperous society. need for services across different agencies to But as the health divide between the rich and deal with problems relating to alcohol in the the poor continues to widen, the ability to city emphasised the importance of investment tackle health issues is further compromised. in prevention and services (Demuth, 2005). It This section describes the links between concluded that the city needed: economic development and health. It outlines briefly major national and local economic • effective informal education and harm reduction policies and reports on the extent to which messages for young people and young adults; progress has been made against local targets. • a range of well promoted open access The section finishes with recommendations. services providing advice, brief interventions, Economic development and health outcomes preparation for detoxification and relapse Differences in income levels are responsible for prevention; and health inequalities and socio-economic position • more detoxification beds, and support for is associated with morbidity and mortality. The those with particular needs to take the degree of variation in income levels in a society appropriate care pathway. may be as important, or more important than an individual’s absolute income (Marmot & Licensing Laws changes have come into effect Wilkinson, 2001). Good health equates with this year with the potential that premises can better productivity and economic success trade 24 hours a day 7 days a week. How this because healthy people make positive will affect alcohol misuse and violent offending contributions to the community and to economic will be the subject of a Health Impact Assessment. life (Milburn, 2000). Health is a social investment Next Steps and recommendations that builds economic infrastructure, whereas, The policies to tackle crime and community poor health imposes costs on individuals, safety are described in the CSCRDS. The four society and the economy (Wanless, 2002). recommendations listed below are taken from A recent literature review examined the this strategy and highlight the key areas where relationship between worklessness and ill action is required. Detailed plans can be found health (McClean et al, 2005). ‘Worklessness’ in the CSCRDS strategy. is a term used to denote those who are out 1. Reduce harm caused by alcohol misuse by of work but would wish to work. These include developing multi-agency work to deliver unemployment claimants, those out of work education and other services. and looking for a job, and those who are economically inactive. In England and Wales 2. Improve the quality of information and there is a strong association between death advice on drug misuse, especially for young rates and unemployment for all age groups, people and develop work to reduce the harm with suicide increasing within a year of job that drugs cause to local communities. loss, and death due to cardiovascular disease 3. Improve service delivery and co-ordination increasing after two or three years and of services to tackle relationship abuse and continuing for the next 10-15 years. domestic violence. Furthermore, during the anticipation and termination phase of factory closure, illness 4. Enable Children and Young People to enjoy and health service use increase, the rate of

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hospital admissions doubles, and conditions Neighbourhood renewal focuses on target five such as heart disease and higher blood pressure of the Department for Work and Pensions’ increase. There is a strong association between Public Service Agreement. This aims to increase unemployment and measures of psychological the employment rate of disabled people, lone and psychiatric ill health. Unemployment is a parents, ethnic minorities and the over 50s. significant cause of psychological distress New Deal for Communities (NDC) tackles multiple although factors such as social support, deprivation in the most deprived neighbourhoods geography, gender, age and type of previous giving additional resources to tackle problems employment contribute to the mental health in an intensive and co-ordinated way. The aim status of unemployed people. is to bridge the gap between these National and local strategic context neighbourhoods and the rest of England. There are several Government strategies that The local NDC programme is ‘eb4U’ in east support a sustainable economy. Brighton. Part of its strategy is to get people The national minimum wage is an important back to work. It gives people on benefits cornerstone of Government strategy aimed support to look for work, including training and at providing employees with decent minimum job preparation. The New Deal for Disabled standards and fairness in the workplace. People strand provides specialist job brokers for Rates are based on the recommendations of an people on disability and health-related benefits. independent Low Pay Commission. It is currently The aim is to achieve lasting paid employment. £4.85 per hour for workers aged 22 and over The Brighton and Hove and Adur Area Investment and it will be increased to £5.05 in October 2005. Framework seeks to strengthen social and The Shared Ownership Scheme provides support economic investment in the following areas: for key workers in purchasing affordable homes • supporting the creation, retention and over time. Key workers can buy a share of a development of local business; property while renting the remainder. The local authority or a housing association may hold the • narrowing the gap between deprived freehold. The share in the property can increase neighbourhoods and the rest of the area over time until the property is owned outright. including support for community engagement in regeneration; The Working Tax Credit tackles poor work incentives and persistent poverty among • reducing crime and the fear of crime; working people by toping up the pay of low • developing, promoting and supporting equal paid workers. It comprises a basic element plus access to new and existing cultural, leisure extra amounts for: people aged 50 years or and sporting facilities and supporting the over who are returning to work; people who visitor economy; work thirty or more hours a week; disabled workers; someone with a severe disability; and • increasing the provision of affordable homes; people needing help with childcare costs. • increasing opportunities to access and The Pathways to Work initiative provides participation in high quality learning and support to people on incapacity benefits who training opportunities; want to work again. It includes active support • improving transport infrastructure; and from employers and the NHS to help people get back to work when they fall ill. • reducing health inequalities. The Jobseeker’s Allowance is payable to people Progress and performance under pensionable age who are available for, In Brighton and Hove, the current working age and actively seeking, work of at least 40 hours population is approximately 163,000. Population a week. projections show that this will rise at an

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average of 1,200 people per year until 2020 The major growth during this time has been in (BHCC, 2005). the new media and financial service sectors. The public sector continues to be a major Unemployment source of local employment. Business start-up The city had a higher rate of unemployment rates are high but survival rates are below the (3.6%) compared to the South East and to regional and national rates. The visitor economy England & Wales (ONS, 2004) (Figure 3.10.1). and the cultural and creative sectors are also An unemployment figure of 1.5% of working central to the social and economy vibrancy of population is currently considered to be the city. The South East England Development indicative of full employment.

Figure 3.10.1 Economic inactivity in Brighton & Hove, the South East and England & Wales (2004)

50 Brighton & Hove (%) 45 South East (%) 40 England & Wales (%) 35 30 centage 25 20 % per 15 10 5 0 Unemployed Students Looking Retired Sick or Other after family disabled or home Category of economic inactivity

Source: ONS Census Briefing, 2001 (Brighton & Hove City Profile).

At present it is estimated that 3% of working Agency now regards the city as the second age people migrate out of the city to work, a main economic driver (after Gatwick) in the trend that is expected to continue for the East Surrey/Sussex sub-region. foreseeable time. Over the last 10 years in There have been falls in unemployment, increases Brighton and Hove, a net inflow of 3,700 in the number of people in work, and increases commuters has reversed to become a net outflow in local average earnings. With regard to the of 5,400. It is estimated that there are roughly Government’s baseline performance, ‘floor’, about 110,000 jobs currently in the city of target for employment, Brighton and Hove which about 2% are taken by people migrating currently have above average employment rates into the city from the surrounding area. (78.1%) compared to the England average (75%) In terms of the city’s most deprived areas, the and the NRF average (69.2%) for 2003/04. percentage of school leavers who are The City performs well on a range of unemployed has reduced from 18.5% in 2002, employment performance indicators: to 13.3% in 2005. There is still some way to go to get this to the Brighton and Hove average • the employment rate among ethnic minority however, which currently stands at 7.8%. groups is 62% employed compared to a national average of 54.3%; Employment The Brighton and Hove economy has • the employment rate of lone parents is 68.5% strengthened considerably over recent years. compared to a national average of 49%; and

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• the employment rate of those aged 50 to 60 Housing years is 58.8% compared with the national Property prices have increased more rapidly average of 54.1%. (Floor Target Interactive). than earnings so that owning a home is beyond the reach of many people including key workers. However one the employment targets in the The average sale price of property in the city 2020 Strategy, has not been attained: was £199,274 in the third quarter of 2003. • to increase the number of workless people from This is 140% more than the average price in disadvantaged areas moving into employment. 1998 in Brighton and Hove (BHCC, 2004). Housing affordability has created recruitment The target for March 2005 was 340 people, and retention difficulties and widened the however just 85 workless people from these economic divide between homeowners and areas moved into employment. non-homeowners. The strong market driven Table 3.10.1 shows the distribution of employment private rented sector may have contributed to across sectors in Brighton and Hove. the significant numbers of homeless people

Table 3.10.1 Economic Development: Distribution of employment across sectors in Brighton & Hove Brighton and Hove Brighton and Hove (employee jobs) (%) Total employee jobs 109,969 Full time 65,340 59.4 Part-time 44,611 40.6

Area Manufacturing 4,524 4.1 Construction 2,685 2.4 Tourism related 13,032 11.9 Services: Distribution, hotels & restaurants 29,078 26.4 Transport & communications 7,000 6.4 Finance, IT & other business activities 24,818 22.6 Public admin, education & health 32,140 29.2 Other services 7,439 6.8 Services total 100,474 91.4 Source: BHCC, Annual Business Inquiry Employee Analysis (2003). Note: Percentages are based on total employee jobs.

However, although the number of jobs in within the city. (Please refer to Housing section Brighton and Hove increased by 20% between within this chapter). 1998 and 2002, and despite around one-third Education and childcare of jobs being in growth and high-value-added The city has a higher than average well sectors (information economy, cultural educated workforce with 29% of the 16-74 industries and high-tech manufacturing), year olds holding a degree or equivalent average wages in the city are still amongst the qualification. However, significant numbers of lowest in the South East (Table 3.10.2). A total local people have no qualifications and lack of 19,900 households in Brighton and Hove basic essential skills for work life. Employment have an average income of less than £10,000. in the construction trades has grown rapidly in This represents 16.9% of all households in the recent years, but here too there is a specific city (Davey & Nairne, 2004). skills shortage.There are 12,900 zero to four

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Table 3.10.2 Economic Development: Average earnings of employees living in Brighton and Hove Brighton and Hove (£) South East (£) GB (£) Gross weekly pay Full-time workers 483.4 537.4 475.8 Male 543.4 602.6 525 Female 404.3 428.9 396 Hourly pay Full-time workers 12.5 13.6 12 Male 13.8 14.8 12.8 Female 10.7 11.4 10.6 Source: New Earnings Survey: residence based statistics by SOC 2000 occupation (2003). year olds in Brighton and Hove (ONS 2003 mid Neighbourhood Renewal and works within year estimates). The total number of full day existing plans for regeneration and renewal. care places (4 + hours) in Brighton and Hove Transport stands at 2,577, while the total number of The city has a well-used bus service, but transport sessional care places (3.5 hours) is 291 and congestion remains a key issue. Major sessional care places (2.5 hours) is 558 (EYDCP, development projects planned for the city 2005). Department for Education, Skills and will depend on improvements to the transport Training figures do not include childcare infrastructure (see Transport section). provision running for less than 3.5 hours. A lack of affordable childcare is consistently Next steps and recommendations identified as a barrier to the labour market and An important step in achieving a reduction in learning participation. This is especially relevant health inequalities is to increase employment for women whose current participation rates in rates in less prosperous areas, amongst single the labour market are below the men’s level mothers, older workers and in disadvantaged (OECD, 2005). In Brighton and Hove there are groups. This requires a strategic approach that 13,000 economically inactive men and 16,000 maximises employment opportunities and inactive women with 3 000 men and 5,000 sustainable economic growth for the city. women wanting a job (ONS, 2005) Such an approach will have a positive impact on the health of the local population as well The eb4U programme has been particularly as the local economy. successful in helping train 68 residents to obtain qualifications; 83 on non-accredited The following recommendations are made: courses and a further 46 in basic skills. 1. The EQUAL Programme should be mainstreamed It has also launched a “Pre-Cadet Scheme” and influence policy development. for 14-16 year olds, which leads to a vocational 2. There is flexibility to change practices based GCSE in social and health care (eb4U, 2004). on the evaluation of the success or failure Community capacity building of current interventions and in response to The voluntary and community sector has a the changing circumstances of local people. strong presence delivering a range of community 3. The sustainability of planned projects is support services, in particular education, always considered. employment, and training programmes. EQUAL Brighton and Hove is a £6 million city wide 4. There is continuous dialogue between the initiative funded by the European Social Fund partners in order to influence/shape policy making, that offers new flexible training and employment to reduce inequalities and promote equity. opportunities. It builds on existing programmes 5. Employers who adopt new recruitment/training such as New Deal for Communities and practices receive support and incentives.

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3.11 Environment Water Introduction The provision of clean drinking water is key to Historically, public health initiatives have public health. Water can have direct adverse succeeded through work in environmental effects on health when polluted with chemical action, such as, ensuring clean water supplies or bacterial contaminants, but there are other and effective drainage. As standards of living considerations such as the risk of flooding and and hygiene have increased the link between water as a leisure commodity. health and environment has changed. This Air section describes the links between environment The adverse effects of different air pollutants and health. It examines the evidence base for on human health are widely recognised (WHO, the impact of environment on health, outlines 2004). Exposure to particular pollutants can in brief the national and local policy framework, result in hospital admission for cardiovascular and reports on the extent to which progress and respiratory disease and mortality. In most has been made against local targets. European countries, including the United Environment and health outcomes Kingdom, ambient air quality has improved over In recent years there has been growing the last few decades and people in good health recognition of the links between the environment generally do not suffer any serious short-term and health. Although there is much focus on effects from air pollution. However more sensitive issues such as global warming and deforestation, individuals, such as the very young or old and for a growing proportion of the world’s population those with heart or lung conditions, may be it is the urban environment that has the adversely affected. The focus for outdoor air greatest impact on health (McCarthy, 1999b). quality in the UK is on the prevention and minimisation of health effects on those Land individuals most vulnerable to air pollution. Land use in the urban environment has a number of dimensions: the ‘recreational’ aspects of The quality of the community environment, open space, planning and development of and the health of natural ecosystems, impact land and the efficient use of resources and on the social well-being and health of the their sustainable management (Cave et al, population. The quality of people’s lives in a 2004). A high quality natural environment in city such as Brighton and Hove is a reflection urban areas is key to promoting regeneration of the environment in which they live. (ODPM, 2002). The health benefits of urban National and local strategic context green space are also extremely important. Many environment targets are set at the Green spaces give people the opportunity to National and European level in recognition engage in healthy outdoor exercise and also of the fact that the preservation of the have psychological effects reducing stress and environment cannot be achieved without anxiety (ODPM, 2002). co-ordination and agreement at these levels. The majority of the waste produced in the Nationally there is a wide range of bodies UK (80%) is deposited in landfill. This can responsible for developing policies that protect have a direct impact on the environment both the environment and the effects of the and on human health; if poorly managed environment on health. These include: the it can damage waterways, pollute the air, Department for Environment, Food and Rural contaminate soil, and at the very least will Affairs which sets strategies and targets for air involve the transport of waste materials from quality and waste management in accordance collection to disposal sites (Cave et al, 2004). with European Union (EU) legislation; the It also represents an under-utilisation of Environment Agency which monitors areas such available resources as the recycling of materials as water quality and hazardous waste; and the represents the opportunity to preserve natural Office of the Deputy Prime Minister which is resources and encourage economic development. involved in community regeneration and the

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preservation of green spaces and the promotion Energy Efficiency Strategy; Housing Strategy; of sustainable communities. East Sussex and Brighton and Hove Waste Local Plan; Air Quality Strategy for Sussex Framework; Brighton and Hove is an urban environment Brighton and Hove Wildlife Strategy; Unitary bounded by the sea to the south and the rural Development Plan; Brighton and Hove Food South Downs to the north. Protecting the local Strategy; Regeneration Plan and Brighton and environment has been identified by the 2020 Hove School Grounds Biodiversity Action Plan. Community Partnership as a priority, with their aim of making Brighton and Hove: Progress and performance Improve everyone’s access to ‘basics of life’ e.g. “A place to live that’s clean, attractive, uses good quality, local food and clean drinking water. energy efficiently, reduces pollution, ensures In Brighton and Hove water is supplied by the best use of land, approves well designed the Southern Water Company which provides developments and has accessible open spaces and water for a total of 2.28 million customers countryside.” (2020 Community Strategy, 2003) across the Isle of Wight and parts of Sussex, This priority is reflected in the Sustainability Hampshire, and Kent. 29% of the water comes Strategy, which has identified twelve key from rivers and 71% from boreholes and aquifers. objectives to make Brighton and Hove a There are 116 water supply zones, 210 service sustainable and healthy city (BHSC, 2004a). reservoirs, 94 treatment works and 13,394 Of these, six concern the environment and its kilometres of water mains (Southern Water, effect on the health of the population: 2005). The quality of the drinking water is dependent on the surrounding natural 1. Improve everyone’s access to ‘basics of life’ environment and its ability to buffer the effects e.g. good quality, local food and clean of pollutants. The local Farm Policy Steering drinking water. Group has representatives from a wide range of 2. Reduce air pollutants and improve long-term interested organisations, and looks specifically air quality. at ways of improving the natural environment of the South Downs around the city. 3. Reduce non-renewable energy use through support of alternative fuels and at the same The Environment Agency is the statutory body time reduce local fuel poverty. responsible for sea and river water monitoring. During the summer bathing season seawater is 4. Make the most effective and efficient use sampled at Hove, Brighton and Saltdean. of previously developed land (‘brownfield Bathing water quality needs to pass minimum sites’) and promote sustainable practice in standards to qualify as a government passed new development. beach as set by EU directives. The minimum 5. Maintain and improve the natural standard is that 19 of the 20 tests should environment, habitats and species and contain less than 10,000 total coliform per 100 ensure everyone has access to green spaces ml of water. In 2004 the Environment Agency of biodiversity value. gave all three beaches the highest rating of ‘excellent’ for water quality (EA, 2005). 6. Reduce, reuse and recycle more waste. A Brighton and Hove Food Strategy is also in The Brighton and Hove Sustainability Plan and preparation and will specifically promote its associated Action Plans (BHSC, 2002; BHSC, improved environmental protection because of 2004) give details of the various Local Plans and its links with food quality. strategies that address environmental issues. Some of the key documents, which link across Reduce air pollutants and improve long-term the various Action Plans include: air quality. Part IV of the Environment Act 1995 requires Brighton and Hove Local Development Plan; local authorities to assess air quality. In 2003 a Brighton and Hove Local Transport Plan; Home

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declarations and other known hotspots, both Total coliforms - coliforms are bacterial air quality and transport planning need to be a organisms that inhabit the gut of warm-blooded fundamental part of any project development. animals, but can also be present in vegetation and soils. Whilst not necessarily harmful Reduce non-renewable energy use in Brighton themselves, coliforms can indicate the presence & Hove, through support of alternative fuels of more harmful bacteria and viruses. and at the same time reduce local fuel poverty. Since October 2003, the main council buildings Fecal coliforms - these are specific coliform are serviced by electricity from 100% renewable bacteria found only in the gut of warm-blooded sources (wind power) (BHCC, 2005g). There animals. Their presence can indicate waters are a number of grants available from the City recently contaminated with sewage. Council that promote the use of renewable energy sources and increase energy efficiency. Local Air Quality Management Updating and These include: assistance in paying for all or Screening Assessment was carried out to examine some of the cost of installing energy efficient the levels of air pollutants across the city measures, such as central heating or room (Jenkins & Rawlinson, 2003a). The assessment heating, replacement boilers, solar water identified a number of areas where pollutant heating and other renewable energy products; levels may have exceeded the national annual and grants for cavity wall and loft insulation standards. A further Detailed Assessment (BHCC, 2005g). (Jenkins & Rawlinson, 2003b) of these possible problem areas found that this had only The 2002 amendments to Part L1 of the Building occurred at three sites: London Road, Lewes Regulations require the calculation of a Standard Road and Grand Parade (Map 3.11.1). These Assessment Procedure (SAP) rating for all new were designated as Air Quality Monitoring dwellings and those converted through material Areas (AQMAs) and a fourth site, Queen’s change of use (CHIC, 2005). The requirements Road, was identified as a ‘hotspot’ (Jenkins & also necessitate that the rating is displayed in Rawlinson, 2003b). the property upon completion. SAP ratings provide a simple means of reliably estimating As a part of continuing air quality monitoring, the energy efficiency performance of dwellings the City Council, in conjunction with the Sussex and are expressed on a scale of 1 to 100 with Air Quality Steering Group, has introduced a the highest number having the best rating. In series of progress reports in years when the Brighton and Hove the average 2005 SAP statutory three yearly Updating and Screening rating for council dwellings was 20 points Assessment and Detailed Assessments are not above national average (See Table 3.12.1). being carried out. In addition, an Air Quality Action Plan is currently being formulated and Progress in addressing fuel poverty is more fully is being integrated into the Second Local discussed in the Housing section of this chapter. Transport Plan. To make the most of effective and efficient use The 2005 Air Quality Progress Report shows of previously developed land (‘brownfield sites’) results from long-term surveys, which illustrate and promote sustainable practice in new that air quality in Brighton and Hove has development. generally improved since 2003, when a rise in This is discussed in the City Planning section of concentrations for a number pollutants were this chapter. seen, largely due to the weather conditions in Maintain and improve the natural environment, that year (BHCC & SAQSG, 2005). The report habitats and species of Brighton & Hove and to discusses the possible impacts of several major ensure everyone has access to green spaces of developments in Brighton and Hove that are at biodiversity value. various stages of the planning process. It Brighton and Hove has 173 green spaces of recommends that in light of the recent AQMA which 70% are informal multiple use spaces

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Map 3.11.1 Location of Brighton & Hove Air Quality Monitoring Areas declared in 2004

Hollingdean Road

Bear Road

Preston Circus

Viaduct Road

Lewes Road Ditchling Road

London Road

St. Peter’s Church

Victoria Grand Parade Gardens

Source: Brighton & Hove City Council and 10-15% are formal parks. Brighton & Hove There is increasing evidence about the covers an area of 8,474 hectares (ha) of this importance of the environment in terms of 13% (1,100ha) is public green space. In addition both social capital and general wellbeing. there are 37 allotment sites (2,250 plots), five Portslade Green Gym, in Brighton and Hove, cemeteries, 128 grassed areas and flowerbeds was one of the first Green Gyms in the UK. within housing estates (BHCC, 2005h). Launched by the British Trust for Conservation

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Volunteers in 1999, it is now entirely self- Next steps and recommendations supporting and meets twice a week to carry It is through working with the key partnerships out a range of conservation tasks. A similar of the Sustainability Commission, the scheme has recently started in East Brighton. Regeneration Partnership and the Sussex Air Quality Steering Group, and by supporting the The Brighton and Hove School Grounds key plans and strategies of these partners that Biodiversity Action Plan, published in 2005, the 2020 Community Strategy Attractive City includes a range of measures designed to targets will be met. promote improved pupil achievement through biodiversity conservation in school grounds. By supporting the implementation and mainstreaming of the Brighton & Hove New developments in Brighton and Hove, such Sustainability Strategy and its Action Plans, as those at Brighton Station and Westergate through the Sustainability Commission, House, incorporate ‘green roofs’, ‘green walls’ Brighton & Hove can become a sustainable city and a range of other biodiversity features which where human health is protected through a will help to ameliorate the health effects of safe, clean and pleasant environment. Global Warming and enhance local biodiversity. Reduce, reuse and recycle more of our waste. In the financial year 2002/03 each household 3.12 2020 Community Strategy produced on average 0.96 tonnes of waste Performance Targets (compared to national average of 1.09 tonnes Progress against the 2020 Community Strategy per household). A total of 99,254 tonnes of is covered more completely elsewhere. For the household rubbish was sent to landfill with purposes of this report, Table 3.12.1 summarises just 14.65% of household waste recycled or the progress that has been made against the composted. Household waste accounted for 2020 Community Strategy Performance Targets. 25% (by weight) of the total waste produced A rating is provided depending on whether in the city; 54% came from construction and targets are being met (green), almost met demolition (50-60% recycled); 18% from (amber) or not being met (red). commercial and industrial (35% recycled) In most areas progress has been good with and 3% special/difficult waste. 84% of most targets being met or almost met. In just municipal waste produced in Brighton & Hove four areas however targets have not been met: was disposed of in landfill. By 2008 landfills serving the city will be full (BHSC, 2004). • to increase the overall number of workless people from disadvantaged areas that move The 2020 target to increase the proportion of into employment; the population served by kerbside recycling to 85% by 2005 has not been met with just 65% • to reduce conception in under 18 year olds; of the population so served. • to reduce permanent exclusions from school; The Waste Local Plan has been prepared jointly • to increase the percentage of the population by East Sussex County Council and Brighton served by kerbside recycling. & Hove City Council and it sets out a strategy for the management of all types of waste generated in East Sussex and Brighton & Hove. It will be used as a basis for making decisions on planning applications for waste facilities and it also identifies sites for strategic waste management facilities, including the proposed waste transfer station at Hollingdean. This proposal is further discussed in the City Planning section of this chapter.

56 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH fic light raf Rating not given Rating not given T eas ch 2005 om c. Disease by eduction ove on 1406 pa educe by 6% om baseline om cir o maintain at or o r Next milestone 13000 in 2005 340 by Mar City average by 2010 7.82% by 2010 As Above Reduce death rates fr 135000 in 2005 45% r the England average 40% in those <75 As above fr cancer by 20% 30069 pa in 03/04 T impr T fr by 2010 Reduce the gap by at least 10% between the ar with lowest life expectancy and ch 05 ess April 05* eduction ogr Pr 15000 in 2003 85 by Mar 4.2% by April 2005 13.3% in 2005 4% r 2002 80.9 2002 108.7/1000 99% in 2004 127000 in 2003 124/1000 in 2002 32667 in 2004/05 96/1000 in 2004/05 1222 in 2004/05 150 in 2004 95% in 2004 in 04-05 2002 75.1 gets April 2005 18.5% in 2002 1997 125.8/ 1000 Baseline 25000 in 2000 0 in 2002 14.7% in 1999 49.7/1000 in 1999 1997 80.1 99% in 2001 119000 in 2000 135.5/1000 in 2000 30920 p.a. 2001/2 128/1000 in 2001/2 362 in 1999 1406 in 2001/2 94% in 2001 1997 73.9yrs mance tar for per e U/E to city ded in A&E eas into employment ecor y safe in Hove y safe in Brighton 2020 Community Strategy om East Brighton who ar om disadvantaged ar ded crime ted vehicle crimes in East Brighton ded crime in East Brighton tality rate ecor ecor epor ess against the esidents who feel fairly/ver esidents who feel fairly/ver get ogr ar ease in assaults a public place r tality e in daylight e in daylight y diseases mor mance T ease overall number of people working age in employment educe numbers of non employed people who want to gain work educe the % of JSA claimants in eb4U educe conception in under 18 year olds ease in workless people fr ease the % of r ease the % of r for culator able 3.12.1 Pr o r o incr o r o r o halt the incr Reduce % of school leavers fr Cir town centr T Per T T Incr T average by 2010 T Female life expectancy Reduce yearly total r Reduce incident of r town centr Incr Cancer mor Reduce number of r T Incr Male life expectancy

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 57 CHAPTER 3 TACKLING THE CAUSES OF ILL HEALTH fic light raf T Rating not given Rating not given dable d eafter for ently r Next milestone 100% of LA stock to meet decent homes standar by 2010 1200 new af 2002-2007 120/year her national average homes between 94.5% in 2005 92% in 2005 92% in 2010 23 by year end 70 in 2005 85% in 2005 B&H cur 20 points above 36.9M in 04/05 ess April 05* ogr Pr 48% in 03/04 132 homes 627 homes due 04-05 for completion 94.4% in 2004 92.4% in 2004 92.1% in 03/04 15 by Dec 2004 72 in 2005 65% in 2005 74 in 2005 34.3M in 03/04 50% in 2004 79% in 2004 get mance Management Framework (2005). Baseline 42% in 2002 735 units by 2004 Revised tar of 120/ year due to success completed 92.8% in 2001 90.3% in 2001 91.5% in 1999 25 in 02/03 61 in 2001 60% in 2002 68 in 2002 30.02 M in 01/02 38% in 2001 73% in 2001 for d y safe in Brighton y safe in Hove vices ecycling om school y schools y schools East Brighton y schools dable homes 2002-2007 ties to use / year om the Brighton & Hove 2020 Community Strategy Per esidents who feel fairly/ver esidents who feel fairly/ver for get ved by kerbside r ficiency in council dwellings ar oper manent exclusions fr gy ef e when out at night e out at night ties meeting the decent homes standar n 60 pr mance T oper ce: Modified fr etur ease the % of r ease the % of r for eet cleanliness (ENCAMS) o develop 1200 af o r T T Per Incr town centr Incr town centr LA pr Attendance rates in primar Attendance rates secondar Attendance rates in primar Reduce per Str % population ser Numbers of people using local bus ser Sour Home ener

58 CHAPTER FOUR INVOLVING LOCAL COMMUNITIES

CHAPTER 4 INVOLVING LOCAL COMMUNITIES

Involving Local Communities There are three Patient and Public Involvement Forums in the city, independent bodies that Introduction listen to the views of the public and raise these There are many partnerships and programmes with the three NHS trusts. engaging local people and making a positive difference to their health and well-being. This Examples of public involvement chapter describes the key processes through Neighbourhoods which communities are involved in planning and There is a wide range of neighbourhood-based decision-making within the city and illustrates initiatives supporting community involvement. this with examples of projects and services Key to this is the Neighbourhood Renewal (NR) developed through community involvement. Programme, a Government initiative, aiming to Mechanisms for the involvement of children narrow the gap between the most deprived and older people are also briefly described. neighbourhoods and the rest of the country. One of its five themes is health. Funding comes Processes for public involvement from national Government through the Single Involving local communities is a key principle Community Programme. of the development of a healthy city. Brighton and Hove has a wide range of mechanisms The Brighton and Hove NR Strategy (BHCC, 2005) for involving communities. was developed with community participation. Ten neighbourhoods were prioritised according The 2020 Community Strategy sets out the to level of deprivation. These areas participated top community priorities which reflect local in drawing up Neighbourhood Action Plans. needs and aspirations. Local people’s views Most of the areas have set up local action have been key in shaping all aspects of the groups to take these plans forward. Strategy and its priorities. It aims to build a sense of community. The 2020 Community The PCT has funded community led health Partnership has taken steps to strengthen the improvement projects in the 10 priority capacity of the community to participate in the neighbourhoods. Over 100 different projects delivery of neighbourhood renewal. There are have been funded so far. These include, exercise six community representatives on the partnership sessions for an older women’s group, first aid for (in addition to six voluntary sector representatives). people with learning disabilities, dance sessions for young women, a fruit and vegetable voucher The city has a large community and voluntary scheme, befriending for isolated older people. sector with over 1,600 organisations and has one of the largest membership-led networks New Deal for Communities funding has been in the UK: The Brighton and Hove Community granted to East Brighton (eb4U) to address and Voluntary Sector Forum (CVSF). The CVSF inequalities and build community involvement. brings together groups to share skills, Further funding for a Healthy Living Centre has information, experience and good practice supported work in this area. Over 2004-2005, to ensure views are considered and influence the Health4all ‘Healthy Living Centre’ project planning and policy decisions. A ’compact’ contacted over 1,500 residents and supported is in place that outlines the way local public over 60 volunteers to run their own healthy organisations work with this sector. Regular activities in the area. The Health4all project debate and consultations are undertaken team provide information and support to through the Dialogue 50/50 group which brings residents of East Brighton on sexual health, together representatives from the statutory mental health, physical activity, diet, substance and community and voluntary sector. misuse and carers issues. Brighton and Hove’s Citizens Panel has 1,600 There are two Sure Start funded programmes in public volunteers who are involved in many local the city in the Hollingdean and Central Brighton consultations and represent the views of an areas. One of their core principles is involving approximate cross section of the local communities. local people.

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The Hollingdean Community Partnership is primary school; made up of 13 local parents and residents • yoga and dance classes; together with 13 people from the service • an interactive toilet training pack; agencies working in Hollingdean. The • a sexual health peer education project for Partnership oversees the programme for young people; and neighbourhood renewal and the development • an English for Speakers of Other Language of children’s services. It has a range of action parent and toddler group. groups that do the detailed work on behalf of City-wide the partnership. The partnership is funded from The ‘Say Aah!’ Partnership, established in 2003 both Sure Start and NR. The Hollingdean by the City Council, comprises representatives Development Trust, directed entirely by local from a wide range of local organisations and residents, raises further funds and sustain aims to support and promote new and existing improved services in the future. arts and health initiatives in Brighton and Hove, All of the health services have been developed and develop an evidence base of the in response to locally identified needs, for effectiveness of arts and health activity. In 2004 example through an extended Health Counts the partnership launched a Challenge Fund to survey. Examples of health services include: stimulate new partnerships across sectors and make money available to new arts and health • weekly Healthshop at local Children’s Centre; projects. Applications from 49 new partnerships • mobile health education programme; were received and, of these, 10 each received one thousand pounds for their projects. The • subsidised complementary therapy sessions projects funded include: for children and adults; • a textile project with travellers exploring • support sessions for 8-16 year olds affected women’s health issues using traditional by parental/carer substance misuse; and Romany techniques; • fast track mental health assessments. • a drama project with LGBT young people Central Sure Start runs a wide variety of exploring attitudes to sexual health; and community projects. The Community Food • a carnival day featuring workshops and Project comprises volunteer parents living in the performances for mental health service users. area. Its objective is to promote healthy eating for families with young children. Sure Start area The Local Area Agreement (LAA) offers new families are also able to access Health Visitor opportunities to involve local people in the development run drop-in clinics offering a variety of services: of services and policies related to the three priority Playlink playgroup; health clinic; and some blocks: Safer and Stronger Communities, Children complementary therapy services. An Emotional and Young People and Healthier Communities and Well-being and Parent and Child Attachment Older People (BHCC, 2005i). Group provides support for women with post- The Children and Young People block builds natal depression and counselling for families on the work of the Children’s Trust Partnership with longer-term mental health issues. which has developed a strategy for change. Tarner neighbourhood receives NR funding in The Healthier Communities and Older People the Central Sure Start area. Tarner residents and block brings together the aspirations of the service providers set up a Health and Young Public Health White Paper, the Healthy City People Action Group and started working on and the vision of Opportunity Age (DWP, 2005) the community’s priorities for health, including: to work in an innovative and new way to improve the health of older people. Involvement • fruit & veg scheme at preschool nursery; of older people in shaping the development • cooking sessions for a youth drop-in project; and governance of local services is a key • an after school cookery club for the local

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CHAPTER 4 INVOLVING LOCAL COMMUNITIES

working principle. This work will be initiated The Children’s Trust will commission education, in two pilot neighbourhoods, Hangleton & social care and health services for children and Knoll and Queen’s Park, and then extended their families across Brighton and Hove. The across the city. Board is the strategic forum responsible for policy matters and decision-making regarding The Safer and Stronger Communities block the development of the Trust. The Children’s aims to improve city streets, community Trust Partnership Co-ordination Group is the involvement, and links with neighbourhoods main steering group for the Trust. It includes and community safety. A Best Value officers from all partner agencies, the voluntary Performance Indicators Survey undertaken in sector and client groups. 2003/04 (BHCC, 2004) reported that the two most important issues to local people were The Youth Council and Parent’s Forum are cleaner streets and reducing levels of crime. two representative bodies that are, at the This block outlines a prioritised programme time of writing, being established to enable of action to deliver this. Children and Young People and parents and carers to have a stronger voice within the Older people Children’s Trust Partnership. The Older People’s Council (OPC) is a directly elected body of older people. The current OPC The Children’s Rights Service and Coalition 4 was elected from an electoral role of over 40,000 Youth (C4Y) is a city-wide organisation focussing Brighton and Hove residents aged 60 or over. on children’s rights, advocacy and participation. It exists to ensure that the contribution of older At present the Children’s Rights Service and people to family, community and society is C4Y are located within the City Council but are recognised and valued, and that older people working towards independence. The service are able to influence the policies and services supports the work of the Youth Council, the UK that affect them. It works in partnership with Youth Parliament and the Young People’s Forum. the City Council, the health service and other Recommendations major service providers securing the right of Involving the public in an effective and older people to be heard and then acting as a sustainable way requires an awareness of the critical friend praising good practice, highlighting importance and value of this as well as personal shortcomings and proposing innovation. and resource commitment from statutory bodies. The Brighton and Hove Coalition of Older While much work has been done to improve People - The Pensioners’ Forum - has an public involvement there is still more to be done. individual and organisational membership of The following recommendations are made: over 3,000. The Forum campaigns on pensions, housing, transport, and health care. It provides 1. To increase community involvement in the information on activities and opportunities for Healthy City work across the city over the older people in Brighton & Hove. It confronts next two years by arranging a series of age discrimination and creates opportunities promotional events in neighbourhoods for older people to become involved in new and communities. activities. It also reviews and evaluates the 2. To recruit two additional new community work of the Older People’s Council. and voluntary sector representatives for the Children Healthy City Partnership by the end of 2005. The Brighton and Hove Children’s Trust is a 3. To continue to support the development of partnership of all the organisations that provide health improvement projects in the 10 areas services for children, young people and families of deprivation across the city by providing in the city. It is working together to implement evaluation support, funding and Health the Children Act 2004, which is the new Development Adviser time. legislative framework for Every Child Matters.

62 CHAPTER FIVE HEALTHY CITY PARTNERSHIP

CHAPTER 5 HEALTHY CITY PARTNERSHIP

Healthy City Partnership Background The first meeting of the Healthy City Partnership • Health Impact Assessment (HIA): applying (HCP) was held in September 2002. Since then, HIA processes within cities, to support members have agreed a vision, goals, aims, cross-sector action for promoting health objectives and formal terms of reference detailing and reducing inequalities. governance arrangements and accountability. • Healthy Ageing: working to address the The HCP has examined health inequalities health, the care and quality of life needs of within the city and considered the evidence base older people with special emphasis on active for effective interventions to improve health. and independent living, creating supportive Members used this evidence to select priorities environments and ensuring access to and work together to build upon existing sensitive and appropriate services. health improvement work within the city. Healthy Cities are also required to demonstrate The priorities include: how they strategically support physical activity, • supporting independence and maintaining encouraging and enabling participation for all the health of older people; in living active lives. • supporting children through early years The Healthy City Partnership will be responsible interventions; and for steering the development, implementation and monitoring of the WHO objectives. Table • improving healthy lifestyles by: 5.1 presents an overview of key performance - increasing access to smoking objectives in a step-wise progression for the cessation services; duration of Phase IV. - improving diet and nutrition; and Management structure The HCP reports directly to the 2020 Community - increasing participation in physical activity. Partnership and the Public Service Board. The The Healthy City approach and its priorities are HCP is supported by a Healthy City Strategy endorsed by the 2020 Community Partnership Board. The Board involves senior members (the Local Strategic Partnership). The HCP is a from key sectors. It provides strategic guidance, formal sub-group of the 2020 Community communicates Healthy City issues at a high Partnership. A ‘Healthy City’ is one of eight key level and resolves strategic problems. Figure priorities in the city’s 2020 Community Strategy. 5.1 outlines the partnership and engagement Actions in all the other priority themes have an structures for the HCP. impact on health: an enterprising, safer, Other key strategic relationships inclusive, affordable, attractive, mobile and The Local Area Agreement (LAA) (See Chapter customer focused city. 2) is increasingly becoming an important strategic Through participation in the WHO Phase IV vehicle for innovative cross-sector action and Healthy Cities Network 2003-7, Brighton and has the potential to positively impact on the Hove is committed to action on three core health, well-being and living circumstances themes: Healthy Urban Planning, Health Impact of local people. The LAA reinforces existing, Assessment, and Healthy Ageing. and offers new, mechanisms for involving communities in decision-making and the planning • Healthy Urban Planning: encouraging of policy and services (See Chapters 2 and 4). and supporting urban planners to integrate The HCP and LAA objectives have potential to health considerations in their planning come together on a number of fronts. strategies and initiatives, with emphasis on equity, well-being, sustainable development The children’s priorities are now led by the and community safety. Children’s Trust Partnership (CTP).

64

CHAPTER 5 HEALTHY CITY PARTNERSHIP

Table 5.1 Overview of the Phase IV core themes & key performance objectives: A step-wise progression Steps Healthy Urban Health Impact Healthy Planning Assessment Ageing Laying the foundations Reviewing the membership & terms of reference of the intersectoral steering group Creating task-forces or sub-committees to support the work on the themes Gaining the political commitment and high-level involvement of decision-makers Positioning the healthy city work Identifying stakeholders and engaging the key actors Gathering the evidence for policy-making and the city health profile Not losing sight of the broader city health development planning context Mapping out the Mapping out and reviewing city policies, programmes and actions in the areas current situation relating to the core themes Learning the concepts Raising awareness and creating a common understanding of the Healthy City concept, its added value and of the policy, institutional and process implications from action relating to the core themes Gaining hands-on • Increasing • Identifying strategic • Specifying the scope experience and understanding entry points and and purpose of beginning a capacity amongst urban building on existing selected interventions building process planners of the broad skills and other similar determinants of health processes and the practical implications of integrating health considerations in urban planning processes and projects • Identifying appropriate • Identifying appropriate • Specifying the role of projects/plans to test policies/projects the Healthy Cities these ideas to gain /plans to test these Office and the ways first hand experience ideas to gain first of working with the and consider feasibility hand experience and officials and of application on consider feasibility professionals larger scale of application on concerned larger scale • Actively engaging older people in influencing, advising and monitoring city sector policies, initiatives and service provision Cross-cutting the themes Exploring and actively exploiting the cross-cutting relevance of the three core themes; e.g.: • In the creation of health-enhancing living environments that support healthy ageing outcomes by being well-designed, accessible and safe and taking into account the functional capacity of ageing and disadvantaged groups, or • In ensuring that HIA becomes an integral feature of urban planning processes

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 65

CHAPTER 5 HEALTHY CITY PARTNERSHIP

Table 5.1 Overview of the Phase IV core themes & key performance objectives continued Mastering the tools To systematically document activities and progress made with all the themes, providing thus results and evidence from healthy urban planning, HIA and healthy ageing work in cities and sharing the learning with other European cities Forging ahead To integrate and To institutionalize and To create the policy and mainstream health mainstream HIA as a planning preconditions and considerations in city means of assessing the the resource base that will urban planning practices health and well-being ensure a holistic and well impacts of all city balanced approach to the policies and projects health development and care needs of older people Source: Adapted from WHO 2004 Delivering The Phase IV Core Themes.

Figure 5.1 Reporting & engagement structure

LSP PSB

HCSB

HCP Tobacco LAA

Food HUP

Active Crime & Sustainability Safety

Economic Health & Regeneration Housing Transport Education City Planning Social Care

HCSB Healthy City Strategy Board LAA Local Area Agreement HCP Healthy City Partnership LSP Local Strategic Partnership HUP Healthy Urban Planning PSB Public Service Board

Progress and performance A performance review of the Healthy City Healthy City objectives are monitored through objectives within the 2020 Community Strategy the performance management framework of was recently undertaken by the Government the 2020 Community Strategy. Progress on the Office of the South East (July 2005). At the implementation of Phase IV core themes is time of writing, results are not yet available. monitored through the WHO Annual Reporting However, local self-assessment of performance Template (ART). on these objectives is positive (Brighton and The WHO ART analysis for 2004-2005 notes Hove Community Partnership, 2005). strong performance from Brighton and Hove Consideration will be given to undertaking an across all Phase IV core themes (WHO, 2005). independent evaluation of the Healthy City In particular, the city is praised for its high work programme and partnership process in standard of activities on Healthy Urban Planning Brighton and Hove. This would demonstrate and progress on Health Impact Assessment.

66

CHAPTER 5 HEALTHY CITY PARTNERSHIP

the effectiveness of the Healthy City approach stakeholders can get involved and own the and would actively inform the renewal and Healthy City approach; and development of the approach. • the acknowledgement that the knowledge, A clearer functional relationship between the expertise and capacity of the community HCP and the Children’s Trust Partnership would and voluntary sector is a key asset and ally, help strengthen the development and delivery contributing to shared Healthy City objectives. of Healthy City objectives. To support community and voluntary sector leadership of Healthy City work-streams. The HCP undertook a review of its first three years of operation in February 2005. This has The following recommendations are made: resulted in a more focussed approach for active 1. The HCP should consider how the LAA may engagement of cross-sector partners in steering help facilitate the achievement of Healthy the development of the Healthy City programme. City objectives and how the Healthy City Actions were agreed by all members to programme may in turn contribute to the strengthen the functioning of the HCP. These delivery of LAA objectives. are outlined in the 2005 HCP Action Plan (Table 5.2). Actions included: 2. Build a clearer functional relationship with the Children’s Trust Partnership on • better engagement with the business sector the development and delivery of Healthy on public health priorities, such as food, City objectives. alcohol, physical activity, achieving a smoke free city and developer contributions to 3. Secure business sector involvement in, and healthy urban planning; champions for, the Healthy City approach. • the development of a Communications 4. Develop and implement a Healthy City Strategy to raise awareness of the Healthy Communications Strategy. City concept, priority themes, achievements 5. Support non-statutory leadership of Healthy and to explain how a broad range of City work-streams.

Table 5.2 Healthy City Partnership Action Plan 2005 Action How? Progress 1. Partnership to be less didactic, Establish different ways Fewer items are now placed on the more dynamic and involving of working and running agenda. Key issues are presented for meetings (see 15 below) debate, rather than for agreement alone. The June 2005 meeting involved lively debate on the new Health Inequalities Strategy and the development of the healthy ageing approach. 2. Partnership to be tougher Establish a prioritised To be informed by this report and an on action Delivery Plan with annual HCP workplan. clear accountabilities 3. Consider branding, Linked to new Communications Strategy in media profile/marketing Communications Strategy development. Draft to be presented & use of experts for help to HCP, October 2005. 4. Take risks and work across Potential for job PCT and voluntary sector members boundaries more shadowing to be explored involved in Local Government strategic planning processes to inform integration of explicit Healthy City approaches into the LAA, city and transport planning etc.

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 67 CHAPTER 5 HEALTHY CITY PARTNERSHIP

Table 5.2 Healthy City Partnership Action Plan 2005 continued Action How? Progress 5. Individual members to Further discussion required New membership has been invited to take responsibility about how to achieve this group to strengthen performance and leadership on healthy ageing and healthy urban planning themes. 6. Less focus on lifestyles Focus on social determinants Addressed in the Delivery Plan of this of health report, the new Health Inequalities Strategy & future HCP annual workplans. 7. Increase resourced More encouragement for Community & Voluntary Sector Forum neighbourhood representation neighbourhoods to to be approached for representatives participate in partnership work to replace vacant positions. 8. Some work to be led by Linked to different ways The non-NHS sector is currently playing non-NHS organisations of working a stronger role in the development of the healthy ageing approach. 9. Make work more meaningful Challenging agenda This will be addressed in the for deprived communities Communications Strategy, building upon strong engagement processes outlined in Chapter 5 of this report. 10. Embrace arts in healthy Arts Development Team Ongoing. Arts and health will be a key cities agenda to get involved with Healthy focus of the Celebrating Age Festival City Partnership planned for July 2006. 11. High profile for W.H.O Champion 2006 activities; Director of Age Concern will participate healthy ageing theme Use LAA; Pilot schemes; in the Healthy Cities Annual business Involvement of Older People; meeting, September 2005. Awareness learning from other raising activities are planned for the organisations Older People’s Council and Older People’s Coalition. 12. Improve clarity and definition Through City Health Explained in this Chapter. Links to the of relationship to 2020 Development Plan and LAA and Children’s Trust Partnership to Community Plan along developing relations be defined. with accountability 13. Establish broader constituency Work with Brighton & Hove A BCP representative participates in especially with commercial Business Community the HCP. Require a strategic approach /business sector Partnership (BCP) to involve the business in the healthy city programme. 14. Set and monitor Healthy Through City Health Reporting mechanisms established City indicators Development Plan to LSP. 15. Establish a more strategic Create Exec group, establish A Healthy City Strategic Board has met leadership approach thematic subgroups with three times as of June 2005. flexible membership /invited experts 16. Create a robust Use existing expertise at Communications Strategy in Communications Strategy Council and PCT and ensure development. Draft to be presented to appropriate consideration HCP, October 2005. of target audience, communication methods etc.

68 CHAPTER SIX CONCLUSIONS AND DELIVERY PLAN

Conclusions and Delivery Plan 70 Glossary of Abbreviations 78 References 79

CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN

Conclusions and Delivery Plan People born in Brighton in Hove in 2003 can Table 6.1 presents in summary form, a Delivery now expect to live on average four years longer Plan for this Report. Many of the actions are than people born 20 years ago. However, it is already in place and there is a common theme clear from a number of local documents: the of drawing together partnerships in a coordinated 2004 Annual Report of the Director of Public way to deliver on agreed strategies. Health, the 2005 Health Inequalities Strategy, This Delivery Plan outlines the actions to achieve A Strategy to Reduce Health Inequalities in the delivery of the recommendations in this Brighton & Hove, and this City Health report. Where current action is already planned Development Plan, that the ‘health gap’ or underway, this is not repeated here. between the rich and the poor in Brighton and Hove has continued to grow. WHO Healthy City status offers Brighton and Hove a vehicle for statutory and non-statutory The worst health problems in the city will not organisations and the community to come be overcome unless the root causes of this together and unite in making Brighton and Hove inequality are tackled. This Report has outlined a much healthier place for everyone. This is a the need for measures across employment, unique opportunity for the city and those of education, housing, transport, the environment, us who are trusted with delivering health in the economy, crime and safety, all of which, a Healthy City should take full advantage. it has been demonstrated, have an impact on health. There is also a need to increase community participation in policy and service developments. This in itself is a challenge for as can be seen from this report, the policy context is, to say the least, complex.

70 CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN . . ed. dinator . . equir , Police, oject ds, business ol Coor . ces identified in ces identified in ces identified in ficers. ces ces identified in LDP esour esour esour . . . oss sector orkplace Health rading Standar obacco Contr obacco Alliance. City City Council – Pr Manager Capacity r City Council, PCT T and hospitality sector T New r LDP New r LDP W Development Adviser Resour Cr Members of the B&H T Council of New r LDP Resour e. . y car ventions. get health uited by 2006. ecr ticipation. om primar y of tar t on sign-up and ral scheme in place with omotion inter ocess for implementation. ecommended actions to Refer take up fr Completion of strategy Repor r extend par Strategy and action plan. Healthy workplace policies. Strategy and action plan. Deliver pr Mental health in workplace facilitator r Action plan in place with pr Key Outputs . ter ral f and efer . f of final cise r orkplace Health opriate. oval by LSP ch 2006 and take action ch 2006. m minimisation campaign vices by 2006. esented to LSP September Pr 2005. Consult on draft strategy Appr Review sign-up to Char Mar as appr Develop exer scheme for people with diabetes by 2006. Draft for consultation by 2006. Sign-of strategy by July 2006. Har aimed at younger people. Appoint W Development Adviser by Mar Develop smoking cessation action plan for staf patients in mental health ser Milestones . ee t ol . om excessive cise and m fr obacco Contr y smoking among . oval and implementation ter ventions to suppor ove exer f and patients in mental oduce T educe weight in people Implement city-wide benefit take-up strategy Appr of the Brighton & Hove Health Inequalities Strategy Implement the Smoke Fr Char r with diabetes. positive mental health. Impr Develop workplace inter Pr Strategy incorporating a smoking cessation plan for 2007/10. Reduce smoking and secondar staf health units. alcohol intake. Reduce har Action y Plan . . cise and weight mful alcohol ticularly vulnerable ee City t action to achieve a ty and inequalities ove benefits take up. ease exer ease mental health omotion in workplace oups. able 6.1 Deliver Impr Strategic objectives Lifestyle Suppor Smoke Fr Pover Reduce health inequalities within the city Reduce har intake. Incr Incr pr settings. loss in par gr T

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 71 CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN . y y y oluntar oluntar oluntar oup and HCP ficers and ficers and ficers and . Healthy City ganisations. ganisations. ganisations. ces tnership. ough LDP ficers, Health Development HES Steering Gr Public Health Specialists, City Council of Community and V sector or City Council, PCT funded thr Par Public Health Specialists, City Council of Community and V sector or Public Health Specialists, City Council of Community and V sector or Schools and education of Advisers and Public Health Specialists. Resour d . eview oup on tise. ofile. esentation y disease mance r s pr for esentation on all t. epr y plan to PCT Boar esentation to HCP epor eed joint work-plan, oups. Annual per and r Campaigns, sponsorship, training and exper 6 monthly updates. Agr implemented. Pr to HES Steering Gr Healthy City priorities. HES pr Public r gr multidisciplinar Deliver by 2006. Older people’ Key Outputs . Sept y 2006. y plan eed by WHO. Full eed by ence include efer ofile complete esented to mance indicators and ch 2006. for ms of r ofile complete December oduction of deliver er Childhood Obesity campaign – Sept 2005 to Januar monitoring agr Mar Pr by 2006. Per Joint objectives agr December 2005. T public involvement. Draft pr 2005 pr pr 2006. Update 6 monthly Milestones s oups , tnership to oup and y gr ogramme. e pathways. onger working y plan. ee city ocess and mechanism cumstances of ogramme and the t achievement of cir e business sector essing car uit public to ed health objectives onic disease strategy ee a pr ough str ofile on the health and elationships between the Secur involvement in achieving a smoke fr implementation of the Food and Active Living Strategies. Chr and deliver Develop an older people’ Recr multidisciplinar Suppor shar thr r Healthy & Extended Schools (HES) pr Healthy City pr HES Steering Gr Healthy City Par agr pr living older people. addr Action . y . eas. eater e t gr vice design and deliver ease public involvement ease business sector engthen strategic ogramme. elationships between Strategic objectives Incr involvement in Healthy City and public health activity Incr in ser Suppor independence Healthcar Develop a positive emphasis on healthy ageing in all planning and policy ar Education Str r Healthy & Extended Schools and the Healthy City pr

72 CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN s om . ficers. ts. ficers. ficers. Input ficers. ts & trainers. t Planners and Public om 2005/06 LDP nal exper ces nal exper ranspor Public Health Specialists and City Planning of Public Health Specialists and City Planning of of exter Funds fr T Public Health Specialists and City Planning of Public Health Specialists and City Planning of Involvement of older people’ networks. WHO guidance. Health Specialists. Input fr exter Resour . om TP . Funds fr t of HIA for . raining of trainers. epor taken on all y r ements in urban design oposals and policy raining sessions on HIA and raining sessions on HUP and raining of trainers. equir All LDF local Development Documents. Summar each document. T HIA concepts and application; use of tools and checklists. T T Healthy City concepts and application; use of tools and checklists. T 2005/06 LDP Inclusion of age specific r pr HIA under documents within the L Key Outputs ch 2006. ed by December 2005 ed by December 2005 oduction of documents As above. Complete by Mar Comply with time-frame for pr outlined in the Local Development Scheme. Application in 2006. First training sessions deliver and full coverage by end of 2006 & ongoing. First training sessions deliver and full coverage by end of 2006 & ongoing. Milestones . t TP mance t Plan for , HIA and ranspor ed objectives. t education and t education and take a Health Impact take an HIA on the Under Assessment (HIA) on all LDF policy documents. Build explicit health considerations into development of all Local Development Framework documents. Suppor development of transpor to monitoring per Under new Local T (2006/07 – 2010/11) - L planners in HIA. on shar Suppor development of city planners in HUP and HIA. Apply WHO guidance and tools linking HUP healthy ageing. Action t ove oach to ove air ove ocesses and ocesses and . , impr t oach to city transpor ranspor ackle congestion, impr oad safety City planning Apply Healthy City principles and a Healthy Urban Planning (HUP) appr city planning pr policies. T quality and impr accessibility r policies. Strategic objectives T Apply Healthy City principles appr planning pr

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 73 CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN d. d om ough stock ces. esour ting People, . ces mined thr e investment in nal r ogramme £0.3m. ogramme (2004/05 educing annually). Housing Corporation (2004/06 £21m). RSL & Private finance (2004/06 est. £30m). Housing Investment (2004/06 £3.8m). Inter Suppor 2005/06 £12.9m (r Disabled Facilities Grants £0.875m. Housing Investment Pr Futur council housing to be deter Regional Housing Boar options appraisal. BHCC investment in private sector Housing Investment Pr £1.8m). Additional funding fr Regional Housing Boar (£0.8m 2004/05). • • • • • • • • • • • • Resour d get eview vey . oves. mance mine best e than 500 ought back for eview oved April 2005. ess. ting People Strategy ed housing r taking Housing Needs ess to deter ovider per ogr ts. vey – Completion tar ogr SP pr monitoring in development. Suppor 2005/10 appr Shelter in pr 2001/04 – 735 units completed. 2004/05 – 286 homes completed, plus 437 new star Under Sur Summer 2005. Since 2002, mor empty homes br 2004/05 – 687 private sector homes impr into use. completed. Options Appraisal in pr way to meet the standar (completion due 2005). Private Sector Renewal Policy under r Stock condition sur • • • • • • • • • • • Key Outputs s ties. ties. d. oper oper gets for e. ed housing. oduce assessments dable homes ensuring vey 2005. centage of vulnerable gets for bringing empty get to be updated vices. gets for SP funded 63% by 2005. 70% by 2010. 75% by 2020. 2005/06 – 129 pr 2006/07 – 129 pr for o intr ar ar • • • • • T and eligibility criteria for shelter Identify outcomes and tar ser 2001/06 complete 1,500 af a mixed range of types and tenur T following Housing Needs Sur 2010 100% of the council’ housing stock meets Decent Homes Standar National tar per households living in decent private sector homes: T homes back into use: • • • • • • • Milestones ting ough oss nise d by 2010. vices acr . y accommodation. . e council housing in dable homes per annum. y year ease the supply of ork with owners to bring for Reduce the number of vulnerable households in the private sector living in non-decent housing. W empty homes back into use ever Implement the Suppor People Strategy 2005/10. Refocus and moder single homeless and r the city Ensur the city meets Decent Homes Standar sleepers ser Incr temporar Develop an average of 300 af • • • • • • • Action dable e and for ces. esour ovision to make t Pr y of new af ove the quality of housing. Suppor best use of r existing housing stock. Impr Realignment of Car Strategic objectives Housing Deliver

74 CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN y . , Police, ds, business ficers and ganisations. ces rading Standar Dept of Health Grant £2.3m. City Council, PCT T and hospitality sector City Council of community and voluntar sector or Resour • es. ts of e epor get ding eduction in vices and in om 400 to 500 ecor vices. m, a r mation and oved ser oved r ovement in r eased fr get of 340 people into ar incr due to teams success. Coldean Extra Car Scheme in development (completion 2006). Adaptations tar feeling safe. of domestic violence, impr long ter Develop multi-agency work to deliver education, infor other ser Impr T new jobs. domestic violence. Reductions in crime figur Impr Key Outputs • • . vices educe y ugs. ease numbers en and young vice deliver m caused by elationship abuse dination of ser . y ug misuse, especially onment without mation and advice ove the quality of ove ser e housing units. m caused by dr get to incr Achieve 2* during the Audit Commission Inspection 2006. 2006 develop a minimum of 37 extra car 500 adaptations per year Reduce har alcohol misuse. Impr infor on dr for young people and r har Impr and co-or to tackle r and domestic violence. Enable childr people to enjoy their envir experiencing crime, abuse or injur 2020 Community Strategy tar of workless people in deprived communities moving to employment. Milestones • • • , e omote om mor tunities for . vices for teenage ces to commission ove oppor ents, young people and ugs Strategy esour independent living. Redistribute existing r new ser par homeless families. Adapt homes to pr Implement the Brighton and Hove Community Safety Crime Reduction and Dr Impr work in people fr deprived communities. Action • • . oss city ove community . Strategic objectives Crime Reduce crime, fear of crime and impr Economy Reduce inequalities in employment acr safety

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 75 CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN , business, , business, , community , community y sector y sector ces ganisations. ganisations. City Council, PCT hospitality sector and voluntar or City Council, PCT hospitality sector and voluntar or Resour gets. gets with eased numbers of 2020 Attractive City tar Meet EQUAL tar incr vulnerable people in employment and training. Key Outputs . gy een e eviously fective ecycle t of ownfield ove the s access to m air quality educe local . enewable ener yone’ onment, habitats omote sustainable . ty euse and r ough suppor , local food and clean ficient use of pr ove ever ove long-ter native fuels and at yone has access to gr e waste. Impr ‘basics of life’ e.g. good quality drinking water Reduce air pollutants and impr Reduce non-r use thr alter the same time r fuel pover Make the most of ef and ef developed land (‘br sites’) and pr practice in new development. Maintain and impr natural envir and species to ensur ever spaces of biodiversity value. Reduce, r mor Full implementation of Phase II of EQUAL. Milestones . eam EQUAL ogramme. Implement Brighton and Hove Sustainability Strategy Mainstr pr Action , water onment. enewable fuel omote sustainable onment ove quality of air and natural envir Reduce non-r use and pr waste disposal. Envir Impr Strategic objectives

76 CHAPTER 6 CONCLUSIONS AND DELIVERY PLAN y d. , Healthy ficer time. ficers time. ficer time. ces . Community and voluntar sector Dedicated of Dedicated of Dedicated of City Council, PCT City Strategic Boar Resour . eness eams. y sector leads esentatives epr . eed joint work-plan, eed work-str omotional, awar Non-statutor Agr implemented. agr Communication Strategy Pr on HCP raising and stakeholder events. 2 new r Key Outputs eed by eed by eased activity Ongoing. Incr demonstrated in 2006 and 2007. Joint objectives agr December 2005. Joint objectives agr December 2005. Draft to HCP October 2005. Complete December 2005. December 2005. Milestones . ticipation tnership ed er working y sector er functional ust Par r y of Healthy City hood and s T . tunities for community en’ uit 2 new community esentatives for the HCP ovide training, par elationship between the HCP epr elationship between the Pr in WHO planning and guidance meetings. Develop and implement a Healthy City Communications Strategy In consultation with neighbour community develop oppor engagement. Develop clear r and LAA on shar objectives. Recr and voluntar r and HCP on the development and deliver objectives. Build a clear r Childr Action y ed oups. y of shar tnership eams. ovement ole in leading Healthy ogramme. ease community tnership and gr engthen the non-statutor engthen deliver health impr objectives between strategic par City work-str Strategic objectives Healthy City Par Str Str sector r Communicate clearly with all stakeholders. Community engagement Incr engagement in the Healthy City pr

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2005 AND CITY HEALTH DEVELOPMENT PLAN 77

GLOSSARY OF ABBREVIATIONS

Glossary of Abbreviations A&E Accident and Emergency GP General Practice AIF Area Investment Framework GUM Genito-Urinary Medicine AQMA Air Quality Monitoring Area HCP Healthy City Partnership ART Annual Reporting Template HES Healthy and Extended Schools BHCC Brighton & Hove City Council HIA Health Impact Assessment BHCPCT Brighton & Hove City HUP Healthy Urban Planning Primary Care Trust LAA Local Area Agreement BHSC Brighton and Hove LDD Local Development Documents Sustainability Commission LDF Local Development Framework BSC British Crime Survey LDP Local Delivery Plan C4Y Coalition for Youth LDS Local Development Schedule CAMHS Child and Adolescent Mental Health Services LGTB Lesbian, Gay, Transgender and Bisexual CDRP Crime and Disorder Reduction Partnership LSP Local Strategic Partnership CHD Coronary Heart Disease LTP Local Transport Plan CHDP City Health Development Plan mph miles per hour CHICH Central Heating Information Centre NDC New Deal for Communities CLSP Community Legal Service NHS National Health Service Partnership NICE National Institute for Health COPD Chronic Obstructive and Clinical Excellence Pulmonary Disease NR Neighbourhood Renewal CSCRDS Community Safety, Crime NRF Neighbourhood Renewal Fund Reduction and Drugs Strategy NRU Neighbourhood Renewal Unit CTP Children's Trust Partnership NSF National Strategic Framework CTS Children's Trust Strategy ODPM Office of the Deputy Prime Minister CYP Children and Young People OECD Organisation for Economic DAAT Drug & Alcohol Action Team Co-operation and Development DfEST Department for Education OFCOM Office of Communication Skills and Training ONS Office of National Statistics DfT Department for Transport OPC Older People's Council DH Department of Health PCT Primary Care Trust DWP Department of Work and Pensions SAP Standard Assessment Procedure EA Environment Agency SEU Social Exclusion Unit eb4U East Brighton for You STI Sexually Transmitted Infections ECM Every Child Matters SySx Surrey and Sussex EYDCP Early Years Development WHO World Health Organisation and Childcare Partnership

78 REFERENCES

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