Sunday, 25 January 2015

Will Croydon's proposed annual public health report for 2015 really tell us about inequalities?

The Director of Public Health’s proposed approach to the theme and content of the Annual Public Health report for 2015 being considered by one of Croydon's Scrutiny Committees on 27 January is very welcome in its emphasis on looking at geographic inequalities in the Borough.  As such it is in line with what I recommended last year in dialogue over the 2014 report. However, I am not convinced that the proposed work goes far enough.

It is vital as the inequalities in Croydon grow that the Council, other agencies and the community and voluntary organisations, have an in-depth understanding of them and their impact on public health and other social problems. The aim for the proposed 2015 Annual Report analysis to assist the work of the Opportunities and Fairness Commission is vital to its work, especially as the delay in its start makes meeting its original timetable difficult.

I submitted comments on the 2014 Annual Report to the 14 July Cabinet meeting and followed it up with a paper to the Director.  He expressed his appreciation for my analysis of the trends in deprivation in Croydon and my suggestions ‘of how we could widen our conceptual thinking about tackling this.’ ‘Whilst the public health team is committed to reduce inequalities through all its work, we do not have the staff capacity to deal with your paper in full.  … (W)e will take note of your suggestions for our further work, and our planning for next year’s report in particular.’

While I am pleased that this has turned out to be the case,  I have some reservations about the proposed depth of the analysis to be undertaken.

Public Health Priorities

Para 3.4 of his paper to the Committee suggests a focus on the Council’s public health priorities. This misses two elements of concern.

(1)      The negative impact on well-being and therefore health of the growing population density in some parts of the Borough especially in the North resulting from the growth of the private rented sector especially through multiple occupation and the conversion of family houses into flats, with growing conflicts over neighbour noise, cars using residential streets as rat runs and car parking conflicts. 

(2)      The linkage of alcohol and drug related crime and health. This ignores the fact that these addictions are illnesses that affect all social classes and groups, and include many famous people. Many addicts are high functioning, maintain their jobs, and do not need to resort to crime. Yet the health impact on themselves and their families can be enormous. There is an urgent need for greater public understanding about the nature of addiction and a more understanding response by agencies. I have attempted to do this with a paper to members of the four Norbury Residents Association Committees, who have been concerned about the level of street drinking.  

Inequalities analysis

In para 3.5 of the report the Director states:

‘There are many forms of health inequalities including those associated with geographic deprivation, gender and ethnicity, and other protected characteristics. To keep focus and manage within existing capacity, the report will focus on geographic deprivation alone.’

I think that this will still give too limited an understanding of how geographically concentrated heath inequalities associated with gender, ethnicity and other protected characteristics will be, as discussed in my paper to the Director last year. 

Having worked with IT statisticians on the Censuses in 1991 and 2001 in several local authority areas I am aware of the fact that the kind of analysis that I advocate should be capable of being done within current resources. If extra officer man hours are needed perhaps they could be made up by  IT apprentices.

Spending on Public Health and Inequalities

In its answer (7 October 2014) to the Freedom of Information Inquiry by Jack Stanson, for the separate annual spend on some public health areas for 2014/15: the Council provided the following information:

Sexual Health: £7,310,238
Drug and Alcohol misuse: £2,713,371
Alcohol misuse: £2,713,371
Smoking: £1,285,059
Obesity: £557,117
Physical activity: £278,558

Total: £14,857,71

It would underpin understanding of inequalities and tackling them if there is a geographic breakdown of the spending on all the public health priorities.


I have emailed members of the Committee in the hope that while endorsing the theme of the proposed 2015 Annual Public Health report they will agree that the Public Health Director should produce a more in depth analysis than he is currently proposing.

The Committee report can be accessed via

For further details about my two papers mentioned above contact 

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