David Barbour, SCSN Communications Officer
Our Public Health and Community Safety Masterclass event in September will be one of the first major coming together occasions for community safety and public health practitioners. It’s great to see the ever evolving understanding and appreciation that both are inextricably linked.
Some in community safety may be relatively new to public health theories, and some in public health may be relatively new to community safety themes. So here I’m going to take a brief and informal look at some of the links. Consider it an idiots guide or exploration if you will!
A very brief history of public health
Previously, health was thought of as something medical, and traditionally, medical approaches were taken to tackle physical health problems. However, gradually over the last century or more there has been an increased understanding that health is not just about the presence or absence of disease. In many cases, this change in understanding was led by doctors, who began to understand their role as preventing ill health from occurring rather than simply just treating ill health once it had occurred.
They began to realise that a lot of the health problems they were seeing had their roots not just in choices people were making about their lifestyles or genetic factors, but that these ‘lifestyle choices’ (and indeed genetic factors!) were influenced by the conditions in which people live and are born into. Two of the most eminent figures in public health globally were previously practising doctors who realised these issues and decided it was their responsibility to drive change – Professor Sir Michael Marmot, plying his early trade in Australia, and Professor Sir Harry Burns, then a surgeon in Scotland.
So how do Community Safety and Public Health overlap?
If you aren’t familiar with public health theory, you may not have heard of Dahlgren and Whitehead’s model of the social determinants of health.
This model shows us how a range of factors interact to create and influence health, beginning with genetic and constitutional factors of individuals, through individual lifestyle factors, social and community networks, living and working conditions and up to wider socio-economic, cultural and environmental conditions.
You only need to look at the model to see where some obvious overlap with community safety policy areas exists. Let’s take each one and do a quick match the community safety issue to each section of the Dahlgren and Whitehead model! (Many issues will cut across each section of the model of course!).
Age, Sex and Constitutional Factors influencing health
These would broadly speaking be factors of an individual that they are born with or cannot change. Community Safety issues here might include – woman and gender based violence, older people and falls prevention, LGBT or BAME people and hate crime etc.
Individual Lifestyle Factors
These are ‘choices’ people make in terms of health behaviours, behaviours that may positively or negatively impact on their health. How much of a choice people have in their behaviour is debatable and will be influenced by whether they are empowered to make good choices. Community Safety issues here may include alcohol and drugs, travel safety, crime and justice, anti-social behaviour, unintentional harm and many more!
Social and Community Networks
This is about social and community connectedness and how that impacts on people’s health. Human beings are social animals and we need to feel connected to others in order to be healthy – whether that be to family, friends or our wider community. Community Safety issues here might include social isolation and loneliness, looking out for your neighbours (Neighbourhood Watch), living close to family and friends and feeling that you are involved in decisions in your local community (community councils and participation, including participatory budgeting).
Living and Working Conditions
The conditions in which people live and work also contribute to health. Poor quality housing and homelessness can have a major impact on people’s mental and physical health, as well as increasing the chances of accidents in the home (Home Safety and Unintentional Injuries). Noise pollution can impact on sleep quality which can have a severe impact on health, for example increasing the risk of cardiovascular disease. Poverty and crime cause stress. Consistently heightened stress levels caused by feeling unsafe or insecure can lead to a range of health problems including higher risk of heart disease, high blood pressure, diabetes and obesity.
Poor working conditions (overwork, dangerous environment, low pay) can impact upon health, but being unemployed also impacts negatively on health. In terms of community safety issues, criminal/community justice and rehabilitation of offenders impacts on employment – so again the links are there to see!
General socio-economic, cultural and environmental conditions
These are more macro influencers of health – so we’re thinking here of wider society and perhaps both local authorities and national government, services or policy which create the conditions for either good health outcomes or poor health outcomes.
Poverty and economic inequality are strongly correlated with poorer health outcomes, (see this piece by Dave Liddell of the Scottish Drugs Forum for an example) but they are also correlated with higher rates of crime. Government economic or welfare policies therefore impact not just on health, but on community safety policy areas.
Again, policies that help people to feel empowered in their lives are beneficial to health, so policies around citizen participation, local democracy, community empowerment, provision of cultural and social amenities and much more besides are all areas of crossover between public health and community safety.
Clearly, this also ties in with the recent development of the Place Standard Tool, looking at how the physical and social environments in which people live and work can be used by planners to tackle health inequalities.
Improving health and community safety outcomes together
The factors that interact to create safer communities and better health outcomes are many and complex – so it is no accident that at SCSN we have given focus to complex systems and measuring outcomes with one Masterclass last year and part 2 of that Masterclass also taking place in September.
The Nuffield Health Intervention Ladder shows us that we can intervene at many different levels of our systems to improve health outcomes. Local authorities and government have their hands on the levers of many of these steps on the intervention ladder – so it is all of our responsibility to think about how we can best intervene to improve health outcomes. In order to affect truly positive outcomes, it will almost always be necessary to implement a range of interventions on different steps on the ladder, or at different places in the system.
Indeed, all of these considerations feed into the National Performance Framework for Scotland. So it looks like we’re on the right track – and that community safety and public health in Scotland are going to have an increasingly stronger relationship!
If you’re interested in learning or reading more on the social determinants of health, including actions to create and sustain healthy and sustainable places and communities, read the Marmot Review 2010.