| 3. | SUSTAINABLE HEALTH AND WELL-BEING
This chapter considers factors which prevent illness and promote health and well-being. |
3.1. Sustainable health is achieved when people and communities can take control of their lives and are able to live their lives to the full. The factors contributing to a state of well-being include feeling safe, having the security of a home and enough to live on, satisfying relationships, interesting and varied activities, and having a sense of moving forward.
3.2. A person's social and economic circumstances are probably the strongest influence on health, avoidable sickness and premature death. There are strong links between the pattern of deprivation and the pattern of ill-health and disease. Where you live and whether you are in work, influences diet, smoking, stress and lifestyle. Where you work, how well the risks at work are controlled, and to some extent where you live, can influence exposure to environmental hazards, including hazards in the working environment.
3.3. A marked pattern of ill-health, sickness and absenteeism can be seen in Wales and may be partly explained by a history of heavy industry. In the past, reliance on industries such as coal and steel made for differences in education, skills and aspirations. When the industries closed down, people were not well-equipped to take other jobs and the former mining areas were not seen as good places for investment by new industries. An economic regeneration strategy has been in place for many years, but the interaction between social, economic, environmental and health issues is not always well understood.
3.4. Long-term action is needed to tackle the root causes of health and economic inequality. This may mean a new approach to maintaining health and to using health and social care services as a community resource. The introduction of health impact assessment, health promotion that addresses the pressures of multiple disadvantage in some communities, and refocused professional responsibilities may all be needed. A major priority is to recognise the importance of sustainable health in economic and social regeneration.
Employment
3.5. On the whole, being in work is healthier than being unemployed. Meaningful work, whether paid or unpaid, is protective of mental health and fosters a sense of self worth and belonging. Employers have a legal duty to ensure work places and work practices are safe and healthy. Employers can also have considerable influence on the overall health of employees.
Welfare to Work
3.6. Central to everyone's sense of well-being and to the creation of sustainable communities is the assurance that comes from playing a useful part in the life of the community, usually through work. The New Deal for the long-term unemployed is about improving people's employability and helping them into sustainable employment. Welfare to Work is designed to focus the help available on the needs of individuals; to foster a sense of ownership among its clients and to deliver its objectives through partnership working. Further help will be available in the North West Wales Prototype Employment Zone. This is one of 5 prototypes in which local partnerships aim to draw together various strands of help to create a more coherent package, focused on the individual.
Healthy Workplaces
3.7. For people who work, the working environment is an important influence on their health. For many people, going to work is a positive part of their lives, and it helps them to stay healthy. But we need to make sure that work doesn't make people ill, and that they leave work at the end of the day at least as healthy as when they arrived. Factors such as how well workplace risks are controlled in accordance with health and safety law play their part in creating healthy workplaces. The Health and Safety Commission (HSC) and Executive (HSE) are developing a National Occupational Health Strategy and expect to issue a discussion paper during 1998. This strategy will complement and contribute to the strategy for a healthier Wales.
3.8. The Health and Safety Executive recently published the results of a survey of self-reported work-related illness.as This estimates that 100,000 people in Wales (4.7 per 100 people who have ever been in employment compared to 4.8 per 100 in Great Britain) suffer from work-related illness. However people in Wales took more days off work per worker as a result of these illness (0.84 days per worker, compared with 0.71 days per worker for Great Britain as a whole). The personal suffering that this represents, and the economic cost to Wales of the 1.1 million days lost annually, could be reduced.
3.9. HSE's Good Health is Good Business campaign seeks to raise awareness of health risks at work and to help small firms control the health risks in their workplaces. Campaigns such as this have an important role to play in ensuring good health in Wales. Current national initiatives, such as Health at Work: The Corporate Standard developed by the Health Promotion Authority for Wales, provide practical assistance and guidance on best practice. HSC is also looking at ways of driving forward a flexible framework of occupational health services that will address possible inequalities of access to occupation health advice.
3.10. Employers can be influential in promoting health through providing a supportive environment for people who want to give up smoking, healthy choices of foods in catering facilities and promoting cycling, walking and public transport as alternatives to car travel to work. Health promotion in the workplace can improve productivity, improve morale, reduce absenteeism and staff turnover, improve organisational image and help to attract high-calibre staff.
| How can more employers, employees and organisations such as trade associations and trade unions make even more effective contributions to controlling workplace risks and ensuring sustainable health in the workplace?
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Community Safety
3.11. A safe environment free from crime (or fear of crime) contributes significantly to an individual's sense of well-being. Victims of violent crime (which, fortunately, is rare) experience significant health effects. One in five adults questioned in the British Crime Survey (1996) were very worried about being burgled, mugged or having their car stolen, and one in three women continue to be anxious about rape. Reducing crime and the fear of it is important. Combating crime requires joint working at many levels in order to reduce offending behaviour and to prevent re-offending. It is significant that three-quarters of young people convicted of the most violent and serious crimes have themselves been victims of physical, sexual or emotional abuse.
3.12. The Crime and Disorder Act (1998) will place new obligations on local authorities and the police, ('the responsible authorities') to:
- review levels and patterns of crime and disorder;
- publish a report analysing the audit's implications for a crime reduction strategy;
- consult with partners prescribed by the Home Secretary (police authorities, Health Authorities and probation committees) and others with an interest:
- formulate and publish a strategy for the reduction of crime and disorder.
Subject to parliamentary approval, provisions of the Act will be enacted from 1 September 1998. Partnerships are expected to start work on the community safety strategy and audit immediately, with strategies in place, supported by audits, by 1 April 1999. In Autumn 1998, the Home Office will also publish a Strategy On Violence against Women.
3.13. Possible ways of breaking into the cycle of anti-social behaviour and tackling known risk factors for offending include:
- reducing teenage and unwanted pregnancies and developing schemes to improve parenting skills;
- focusing services on areas of deprivation to help vulnerable young people and to encourage them to take part in activities that will promote self-esteem and social skills;
- ensuring that preventative treatment of, and rehabilitation from, drug and alcohol misuse is a priority;
- ensuring child and adolescent mental health services have expertise in dealing with conduct disorders and aggressive or hyperactive children.
| How could action to improve health strengthen crime reduction strategies?
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Personal and Family Support
3.14. Networks of families, friends and social institutions (e.g. churches, clubs, sports facilities, voluntary organisations) can be important in developing self esteem and confidence and in providing support. These traditional networks have become less effective over recent years with the changing patterns of employment and entertainment.
3.15. New parents can gain support from talking to other parents, from links with the wider family and from schemes to help increase their knowledge and skills in parenting; these can come from a range of agencies.
3.16. An intimate confiding relationship with a partner or close friend is a known protective factor against mental illness. Breakdown of relationships and divorce have profound consequences for the individuals concerned. These include reduced income and diminished economic activity, particularly for women. The children of such relationships are more likely to show emotional disturbance and subsequently to divorce as adults.
3.17. Effective interventions in these areas might include:
- support for marriage counselling and mediation services;
- promoting education for parenting, support programmes and befriending schemes for isolated parents;
- making unmarried and separated parents assume greater parental rights and responsibilities;
- reducing the number of unwanted pregnancies;
- supporting youth and family groups at the community level;
- strengthening the role of Health Visitors and midwives in supporting families and parents;
- addressing issues of citizenship, parenthood, sex and relationship education in schools;
- tackling domestic violence and homelessness;
- promoting parental leave and family-friendly employment practices;
- encouraging community support networks.
Children
3.18. Children's health is an important indicator of health in later life. High levels of poor health among adults has a damaging effect on their children's health. The major causes of illness in children are acute respiratory infections and ear disorders. Accidents are the major cause of death. Relatively high numbers of children are referred for accident and emergency treatment.
3.19. The Welsh Office intends to focus on children's health and well-being as an investment in the future. The Welsh Office will build on The Health of Children in Wales (1997)cn to develop a comprehensive strategy to improve children's health.
| How should public policy protect children and families and how can all sectors of the community develop caring roles?
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Social Exclusion
3.20. Unemployment, poor skills, low incomes, poor housing, high crime environments and family breakdown, as well as bad health or disability, can lead to individuals and communities failing to participate fully in society.
3.21. Some communities and families are isolated by their race, colour or religion. Others are unable to access a full range of opportunities because they are in remote areas. These are socially excluded not because of individual problems, but because of circumstances. Addressing health inequalities through comprehensive and integrated policies must include the perspective of ethnic and other minority groups.
3.22. The Welsh Office has announced funding for co-ordinators to work with communities to devise Local Action Plans which address social exclusion. Proposals must take account of the partnership and collaborative working within Local Authorities and other agencies. This work complements the Social Exclusions Unit's work in England and the public health strategy in Wales.
| How should minority groups be included in policies for improving health and well-being?
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