Public health has been at the heart of the local response to COVID-19. The early stages of this pandemic were a mixture of frustrations with the national response, and pride in a good job done locally under pressured circumstances.
Councils have spent a lot of effort trying to “stitch” together different elements of the pandemic response, whether it be on ensuring PPE reached care homes, volunteering or testing – because of a disconnect between how policy is formed nationally and how it is implemented on the ground. And whilst resources were diverted to respond to the crisis, councils still had to work hard to ensure vital public health services were kept running. By reprioritising the delivery of crucial support services around early life services, sexual health clinics and drug and alcohol services were able to continue operating.
Central government cannot have insight into the local mechanics of Sheffield, Newham or Devon. That local knowledge lies with councils. There is a disconnect between how policy is formulated and how it is implemented, that requires more local involvement – and that means bringing bodies like the LGA and Association of Directors of Public Health (ADPH) and others closer to the design.
The challenge for now is to ensure an effective contact tracing system. Councils have a unique understanding of their communities and are ideally placed with the skills, knowledge and experience on the ground to help ramp up the level of testing and contact tracing necessary to respond to the virus. To help councils understand where the outbreaks are happening and be able to act quickly to contain them, government must share vital and up-to-date data with them alongside other agencies and this must be accompanied by consistent and ongoing funding.
In the long term the Government must commit to sufficiently fund and reprioritise prevention. The pandemic has shown that investing more in prevention would have led to better outcomes. A more robust strategy should be set out in a new Prevention Green Paper, which considers the long-term impact of COVID-19 on our communities.
There is early evidence which suggests that some of the social determinants of health, including obesity, poor mental health, ethnicity and socio-economic status are contributing to higher levels of COVID-19 deaths. This is worrying and underlines the need for a strong Government commitment to tackling health inequalities and the need for more council resources and flexibilities to tackle the underlying economic and social causes of ill-health and premature death, including increased support to public health teams.
We need to invest in the ongoing resilience of our communities with an assets-based approach which invests in the strengths and capabilities of our communities. Councils need the resources to work in partnership with their voluntary and community sector (VCS) to provide low-level support to improve health, wellbeing, participation and resilience. Community resilience and support has been vital in addressing the crisis, but it will also be vital in delivering a meaningful recovery.
If public health at a local level is given the parity of esteem it deserves, health inequalities could be levelled and prevention put at the centre of our future approach.
To convene the wide range of local partners needed in order to deliver a place-based approach to public health.
While we live with COVID-19, Government must work with council leaders and partners to ensure the consequences do not impact more on some groups, communities and places than others and result in further increases in health inequalities.