LOCAL HEALTH GOVERNMENT

Local government and public health focuses on the leadership role of local government in developing local public health systems that are capable of addressing the wider determinants of health. It maps available evidence and highlights some options for local decision makers.

Local government is the leading local democratic institution and as such is responsible for shaping the way that citizens are involved in their own wellbeing, can improve wellbeing in their communities, and hold local health and wellbeing services to account.

As part of local government’s place-shaping role, health needs to be brought into local policies and strategies, such as spatial planning or transport.

The scope for action is wide and the review has highlighted a range of approaches across different levels and sectors of local government activity. While an evidence base exists for some approaches, for newer ones the local government role has yet to be fully realised and evaluated.

Public health is best viewed as a system comprising interrelated networks and structures with many organisations and people having a part to play. Partnership working is necessary to develop coordinated action on public health and there exists a sizeable evidence base on the factors which make for success and failure; however, the evidence on outcomes is weak.

Prior to the return of public health to local government, research suggests that it was hard to maintain a focus on the social determinants of health; this was in part a consequence of tensions between national and local priorities pushing and pulling in different directions but also a consequence of the NHS’s focus on acute hospital care and treating individuals.

There is some evidence on the role of health scrutiny and on citizen participation in area based initiatives, but generally there is a lack of research on local democracy and public health, including the health role of mayors and elected members.

Evidence needs to feed into local government planning and decision making, but what is understood by evidence and the different types of evidence are hotly debated issues in public health. The review provides a guide to some of the major sources of evidence and highlights research gaps.

International research can provide some useful pointers to alternative models of local government action.