Addressing health inequalities: five practical approaches for local authorities.

Abstract

The 2013 shiftof public health functions in England to local authorities, along with the introduction of local Health and Wellbeing Boards, presents significant opportunities for public health, particularly in terms of the social determinants of health and health inequalities. As well as being evidence-based, there is also a clear need for the interventions we champion to be practical for local authorities to implement, and to be made accessible, understandable and attractive to elected officials. This paper suggests some practical approaches that local authorities could - and have - considered in terms of addressing health inequalities, focusing on five key areas that are within local authority control: environment and obesity, improving active travel and reducing accidents, income maximisation, housing and health-related worklessness.ENVIRONMENT AND OBESITYThere is an association between the concentration of fast food takeaways and levels of obesity. Levels of obesity tend to be higher in deprived areas than in wealthier areas, and lowincome groups are more likely to consume 'energy-dense' foods (e.g. pizzas, processed meats and fast foods) than higher income groups.1 The 2007 Foresight Report2 shows that becoming obese is much more than a matter of poor choices about diet and exercise. Individual psychology and behaviour are hugely influenced by a range of external social, cultural and environmental factors. Research in 2005 looking at the location of McDonald's restaurants in England and Scotland found that there were four times as many in the most deprived areas as in the least deprived.3The Marmot review of spatial planning4 found that environmental disadvantages affect the poor the most, with greater deprivation being linked to reduced likelihood of good-quality open space, easy walking and cycling routes, welllocated services and a good housing mix and design. National Child Measurement Programme (NCMP) data has demonstrated a strong positive correlation between deprivation and obesity prevalence for children and National Obesity Observatory (NOO) data does the same for adults.PRACTICAL APPROACH: RESTRICTING FAST FOOD OUTLETSRestricting fast food outlets in terms of numbers and proximity to local schools is one measure which could have an effect on obesity in local communities. Davis and Carpenter5 found that exposure to poor-quality food environments has important effects on adolescent eating patterns and conclude that policy interventions limiting the proximity of fastfood restaurants to schools could help reduce adolescent obesity. Limiting fastfood takeaways to within 400m of schools is generally an accepted threshold, representing a five-minute walk.6 It is used by a number of London councils when restricting hot food takeaways in the vicinity of schools; in 2010, a High Court case to challenge a decision by Tower Hamlets local authority to grant planning permission to open a new hot food takeaway hit the headlines. This experience, and the process subsequently entered into, provides an illuminating example of a local authority journey to develop a comprehensive and evidence-based approach to the public health impacts of fast-food takeaways.7 Residents of deprived areas could particularly benefit from policies which aim to improve the availability of healthier food options and better access to shopping facilities. Having local shops within walking distance and a general high accessibility to shops which stock healthy food is likely to improve health within these areas, especially when coupled with planning restrictions on the density of fast-food outlets within deprived areas.IMPROVING ACTIVE TRAVEL AND REDUCING ACCIDENTSA growing body of literature suggests likely positive impacts of travel policies and interventions to increase walking and cycling.8 Britain has the highest percentage of pedestrian road fatalities in Europe (22.5%) and the lowest level of children walking and cycling to school. …