Riots: providing a public health perspective
There was a battery of instant analysis in the immediate aftermath of the riots in August, and central government peppered the airwaves with policy responses: evictions for people convicted of rioting, more help for so-called problem families, curfews and a strategy to tackle gang culture.
With five months having elapsed since those fraught nights in the summer, a series of more considered reviews are now being published.
One of these - the Riots Communities and Victims Panel interim report called 5 Days in August - finds quite a lot to praise local government for in its response to the disturbances. The panel was heartened by the success of areas that had developed multidisciplinary teams (including local authority, police and voluntary sector staff) that provided ‘a concerted and unified street presence to talk to groups as they formed and to persuade them to disperse'.
It also highlights the work that social and youth workers did to contact young people individually to persuade them not to get drawn in: ‘the very low number of children in care involved was attributed mainly to these actions'.
While the report has a short discussion on the challenges of building economic and social resilience, it is mainly focused on improving the response to a future riot emergency should that happen again. If local authorities are looking for a blueprint for what to do to help prevent it occurring in the first place, then they won't find one here.
A public health framework for responding to the riots
Longterm prevention will need many more participants than local councils, but it is interesting to note the conclusion of one commentary on the riots that ‘local government will have to deliver much of the post-riot agenda assembled by the Conservatives [sic].'
So far, this agenda has been dominated by the Home Office, the Department for Work and Pensions, and Communities and Local Government. These responsibilities are crucial, but I can't help thinking that there is a major player absent from the discussion: health. As an editorial in the BMJ following the riots put it: ‘a public health perspective could help, if politicians would listen.'
A quick re-read of the Marmot Review published in 2010 - much of which found its way into the white paper Healthy Lives, Healthy People later that year - confirms that a public health perspective could indeed be of assistance. Whatever your take on what motivated people to get involved in the riots, the general thrust of the data analysis appears to be that young people not in employment, education or training who live in poor areas were disproportionately represented.
This complex mix of individual, societal and environmental factors - the social determinants of health - needs a holistic response, which is what public health attempts to offer. The Marmot Review sets out six inter-related policy responses to reducing health inequalities:
- give every child the best start in life
- enable everyone to maximise their capabilities and have control over their lives
- create fair employment and good work for all
- ensure a healthy standard of living for all
- create and develop healthy and sustainable places and communities
- strengthen the role and impact of ill health prevention.
The first three of these clearly overlap with the profile highlighted above of people who took part in the riots. The remaining three have an indirect link. For example, one of the themes that stood out from many of the interviews conducted with people living in areas affected by the riots was dismay that rioters could feel so disconnected to where they lived that they wanted to trash it. That is not a healthy or sustainable situation for any local area.
Taking a holistic approach
As we set sail into a future where public health will be the responsibility of local government it will be important to remember the value that a holistic approach to a local area could bring. It also means helping new players to understand their public health responsibilities.
Encouragingly, the new guidance on joint strategic needs assessments (JSNAs) published by the Department of Health in December 2011 does include pointers to this, and fleshes out JSNAs to include potential assets as well as needs when drawing up health and wellbeing strategies.
In this context an ‘asset' can be anything that could be used ‘to improve outcomes and impact on the wider determinants of health'. The guidance suggests things such as green spaces or local providers with a specific expertise.
While those in the know on health will be up to speed on all of this, who has told the parks department manager that green spaces now feature in advice on how to improve the wider determinants of health?
If they are working in the London Borough of Hackney, then perhaps the assistant director for health and wellbeing will have been on the phone to discuss it. His varied management responsibilities range from adult social services through to - you guessed it - parks and green spaces.
Although this level of integration is unusual the Marmot Review does recommend that councils should ‘fully integrate the planning, transport, housing, environmental and health systems to address the social determinants of health'.
Health and wellbeing boards
One local forum that could, and should, bring all these together is the new health and wellbeing boards (HWBs). Guidance on HWB operating principles published by the LGA, Solace and ADCS, among others, says that one of the criteria for the success of a board should be that it is ‘addressing the wider determinants of health by including education, housing, transport, employment and the environment in the joint health and wellbeing strategy.'
How to prevent a rerun of the 2011 riots will be high on the agenda of many of the boards as they start to develop and take shape. Musing on the quality of green spaces in a local area might seem to be tangential to the question of how to avoid a repeat of the riots. But it is an excellent example of the level of integrated thinking and working that will be required if local areas are to tackle the causes of the disturbances of summer 2011, not just the consequences.
5 Days in August
BMJ editorial [paywall]
Healthy Lives, Healthy People (public health white paper)
Operating Principles for Health and Wellbeing Boards
Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies Explained
30 January 2012