Public Health priorities

"Public mental health is the art and science of improving mental health and wellbeing and preventing mental illness through the organised efforts and informed choices of society, organisations, public and private, communities and individuals” - Faculty of Public Health, 2022

Good mental health is an asset and is linked to good physical health. Poor mental health is associated with an increased risk of mortality and morbidity due to a combination of socioeconomic disadvantages and poor lifestyles rather than the mental health issue itself. Mental health disorders account for almost a quarter of the total burden of ill health in the UK, and suicide is of particular concern. Suicide is of specific concern. These issues have been further exacerbated by the COVID-19 pandemic, with data showing that mental wellbeing has declined globally, nationally, and within Suffolk (Office for National Statistics, 2021). The 2021 Suffolk Annual Public Health report made a key recommendation that the Suffolk Health and Wellbeing Board should prioritise strategic leadership for public mental health on behalf of the wider system.

This suggests positioning public mental health at the heart of public health policy is essential for the health and wellbeing of the nation, must be high on the agenda for all partners in Suffolk. Tackling this will lead to improvements in health behaviours and reduce health-risk behaviours, thereby both preventing physical illness and reducing the burden of mental illness.

An adequate and fair healthy standard of living is critical to reducing health inequalities. Insufficient income is associated with worse outcomes across virtually all domains, including long-term health and life expectancy.” Marmot, 2010

Work is a key influence on health. Work matters for health directly, as well as underpinning other factors that influence health such as income or social networks. Employment is a primary determinant of health, impacting directly and indirectly on the individual, their families, and communities, and contributing to health inequalities. Unemployment, low quality work, and income deprivation are associated with an increased risk of mortality and morbidity, including limiting illness, cardiovascular disease, poor mental health, and suicide. It is also associated with health-damaging behaviours such as alcohol misuse and smoking. Individuals in more disadvantaged socioeconomic groups are more likely to be unemployed or have poorer working conditions, which, in turn, leads to poorer health (The King’s Fund, 2020).

Health and wealth also have intergenerational impacts. Children growing up in wealthy households are more likely to have access to support, which in turn generates good educational outcomes. In turn, those positive outcomes lead to employment opportunities in adulthood, and an adequate income to live well to support families of their own (Karagiannaki, 2017).

In Suffolk, income and employment deprivation has increased. Of those claiming benefits, the number of those in work has also increased, demonstrating that in-work poverty has increased in Suffolk.

Post-pandemic, the task of refocusing and restarting our economy has never been more urgent, especially in light of the cost of living crisis. We need to come together to understand what ‘better’ really means for us and our communities. But it must include access to healthy work, sustainability, and growing an economy where people and places matter. We need to foster a wellbeing economy.

Our vision is for children and young people in Suffolk to have the best start in life, enjoy good mental health, be resilient and productive, enjoy school, make friends, achieve their full potential and have positive and happy relationships. - Suffolk Children and Young People’s Emotional Wellbeing Plan

Improving the wellbeing of children and young people is seen as an important priority for stakeholders across Suffolk. We are aware that the experiences children have early in their life play a key part in their health as adults, for good or ill. Moreover, giving every child the best start in life was the highest priority recommendation in the Marmot Review (2020). This is because advantage starts before birth and a positive childhood experience is vital to ensure children are ready to learn, which leads to better health and wellbeing throughout life and greater life chances.

There has been a continued decrease in average happiness with life among 10-15-year-olds in the UK, according to data from the Children’s Society’s Good Childhood Report (2021) which reported 7% of 10 to 15-year-olds (an estimated 306,000 children) in the UK are not happy with their lives. This trend was reflected in the 2020 ONS State of the Nation Report on children and young people’s wellbeing.

COVID-19 has had a profound impact on the lives of our young people. Overall, children have coped, but an estimated quarter of a million have struggled (Children’s Society’s Good Childhood Report (2021). As a result of the pandemic, they have experienced bereavement and other traumatic experiences causing worry, anxiety, and fear for the future. Some suffered from not seeing friends or family. Evidence suggests that the most vulnerable children such as those suffering socio-economic inequality as well as young people with challenging home environments are more likely to have had more experiences associated with a risk to mental and emotional health. Family relationships are especially important to the wellbeing of children and young people and some family relationships have been negatively affected by the economic impact of the pandemic: redundancies; financial stress; and parents juggling working from home with childcare. Moreover, vulnerable children, living with domestic violence or existing mental health issues could find the lockdowns during the pandemic especially difficult, as usual support was harder to access. Indeed, Suffolk MIND found a third of young people in Suffolk reported worse mental health as a consequence of COVID-19.

"We need to value difference and the local voice. Understanding local difference enables the delivery of services which genuinely level up communities.” Local Government Association, 2021

The role of communities in improving health and wellbeing is receiving more attention in health policy and practice, reinforced by the experience of people during the COVID-19 pandemic. This is to be welcomed as the places people live, their social connections and having a voice that is heard in local decisions, are factors that contribute to health and wellbeing. As part of this recognition, more emphasis is being placed on the value of place-centred partnerships and asset-based approaches to involve and support local people to live healthier and more fulfilled lives.

The reasons for this include that:

• The communities where people are born, live, work and socialise have a substantial influence on health. Although estimates vary about how much influence, these factors have a much greater influence on health and wellbeing than health services.
• There are many strengths and ‘assets’ within communities that can be mobilised to promote health and wellbeing. This approach centres on a focus of ‘look what we’ve got’ rather than a deficit approach concentrating on ‘what’s missing?’.
• Health inequalities are continuing to widen, and evidence suggests focusing on building healthy, resilient, connected, and empowered communities is an important way of improving the health of those with the poorest health faster.
• Evidence such as that from the National Institute for Health and Care Excellence (NICE) states the importance of community engagement as a strategy for health improvement. Communities have great knowledge and insight regarding what they need from health services, and what works – for them - so involvement can lead to more effective services that better meet the community members’ needs.
• Empowering people to use their strengths and capabilities can have wider benefits such as people remaining independent for longer, reducing the impact of social isolation and loneliness, and delaying the need for more complex services and care.

However, this will be challenging for many of us. It will require all system partners to be brave enough to have ‘learning conversations’ with residents. It will require a movement away from doing things ‘to and for’ people, towards a shared approach which accentuates ‘listening’ and where things are done ‘with’ and ‘by’ people and communities. This is a paradigm shift in how we think and work. 

Fortunately, there is a long history and expertise in local government and the voluntary sector regarding working with communities which can be drawn on. Considering this, the Board have asked our Collaborative Communities Board – a board with members closest to our communities – to take this forward. We have asked them to work together and across our integrated care systems to explore good practice and find inventive ways to gain insights into people’s lives and lived experiences to improve health and wellbeing. We are also tasking those working in our other three priority areas – work and health, public mental health, children, and young people – to find ways to listen to the voices coming from business, have conversations that support mental wellbeing, and hear the priorities of our young people.

As already indicated, this transitional strategy is primarily about preparing us for the future, a future where shared working with our communities and partners becomes the norm. We acknowledge that there are challenges in getting voice and engagement right and ensuring it is inclusive and meaningful as it is only too easy to perpetuate the unequal experience of specific groups, especially those with protected characteristics such as ethnicity, sex and disability. This is why we recommend that this strategy seeks to put down the foundations and take the initial steps toward this change in thinking and behaviour about how we work together, provide services, talk about health and wellbeing, and measure success. 

So this year we ask that the Collaborative Communities Board and our working groups start to develop their approach and consider how to tackle the substantial amount of groundwork necessary to develop meaningful engagement and partnerships with local people and communities. This will include identifying key community members/influencers and building capacity within the community as well as considering how we can work towards meaningful engagement, i.e., seeing the community as a co-partner and a co-leader.

There were also several cross-cutting themes identified during the workshops.