In rural areas some aspects of the public health agenda may be easier to address than others, discovers Brian Wilson.

In rural areas some aspects of the public health agenda may be easier to address than others, discovers Brian Wilson.

A recent publication by the King's Fund health charity is a report called Improving the Public's Health: A Resource for Local Authorities.

As many readers will know, from April 2013 the Health and Social Care Act transferred – or some might say returned – the main policy responsibility for public health to local authorities. Upper tier local authorities take the lead on Health and Wellbeing Boards, which co-ordinate actions by agencies in their area. Recognition, then, that so much of what local authorities do can impact on public health and has the potential to address health inequalities.

Funding remains an issue. The Rural Services Network publication, State of Rural Public Services 2013, highlighted the extent to which Government funding for this role is skewed towards urban authorities and the urgent need, therefore, to revise how it is allocated.

The focus of the King's Fund report, however, is nine topics where the evidence suggests that local authorities can make a practical difference. Some of these have a more obvious rural dimension than others.

One such topic is 'warmer and safer homes', under which the report identifies three concerns – making homes warmer, preventing accidents at home and preventing falls among the elderly. The rural case for intervention to tackle fuel poverty and to make housing more fuel efficient is very clear. With a growing older population, rural areas might also be a focus for adapting housing to enable continued living in their own home.

With fuel poverty there is a considerable experience to build upon, including the FREE initiative run by Calor and work by many rural community councils. Local authorities can help people access schemes such as the Green Deal and ECO, many provide advice to private landlords and some have organised collective switching schemes.

With respect to preventing falls among the elderly, interventions such as targeted risk assessments of homes, work with home improvement agencies and developing handyperson schemes have all proved to be effective.

Another topic is 'active and safe travel'. Not least because lack of physical activity is linked with chronic conditions, such as heart disease, diabetes and obesity-related illnesses. In rural areas opportunities to walk or cycle are often limited, given distances and road conditions. More generally, traffic accident levels can be a particular rural concern.

A number of suggestions by the King's Fund emphasise promoting walking and cycling, including through GP surgeries, employer initiatives and training for school children. Speed limits for traffic are one issue where local authorities have some control. Almost by definition this seems a harder agenda outside larger settlements, though there must be rural lessons including from projects funded under the Sustainable Transport Fund.

'Strong communities' is yet another topic. Isolation and weak social networks can damage physiological health and are related to common health risks. While evidence has, in general, flagged the strength of rural communities, that cannot be assumed in all places and individuals can become physically isolated. As the report notes, local authorities can support initiatives such as befriending schemes and might encourage volunteering opportunities.

Other topics in the King's Fund report imply a need to target policies at deprived groups. For example, giving children a better start in life and ensuring schools support healthy outcomes. The rural challenge, here, may in large part be a geographical one: how best to identify and support those individuals or families that need help. As ever, the scattered nature of rural disadvantage is an issue in itself.

It is striking that so much of the public health agenda is essentially a matter of good practice across a wide range of service areas. In some cases this aligns well with rural circumstances and policy experience, but in others rural delivery may prove rather challenging. It would be useful to see this addressed in future guidance.

For completeness, the nine topic areas listed in the King's Fund report are:

* The best start in life
* Healthy schools and pupils
* Helping people find good jobs and stay in work
* Active and safe travel
* Warmer and safer homes
* Access to green and open spaces and the role of leisure activities
* Strong communities, wellbeing and resilience
* Public protection and regulatory services
* Spatial planning and health

Against each of the topics in this checklist of public health concerns there are reference lists of further resources and, near the back of the report, a ready reckoner to help with local prioritisation of issues.

This article was written by Brian Wilson whose consultancy, Brian Wilson Associates, can be contacted at [email protected]. Brian also acts as the RSN Research Director.