Public health is awash with threats and risks which directors of public health work in partnership with a wide range of people to prevent and mitigate against. These protective measures, which go unmentioned in the press, help thousands of people live longer, healthier lives and should be celebrated for their impact on both individuals and the communities they live in.
As director of public health for Sheffield City Council, I am responsible for the health of over 580,000 residents. Twenty years ago, Sheffield had a disproportionately high rate of infant mortality with 116 babies dying before their first birthday between 2001 and 2003.
In 2010, the city made a commitment to reducing this rate to below the national average by 2020, as well as to reduce inequalities between the different communities in the city.
Services from the council, NHS, and voluntary sector worked with families and communities on eight different programmes of work addressing the highest risk factors associated with infant mortality: maternal smoking, breast feeding, teenage conception, recessive genetic conditions, child poverty, maternal weight, early access to maternity care and safer sleep.
To reduce maternal smoking rates, we implemented a range of measures to support mums and dads to stop smoking during, and after, pregnancy. For example, we introduced a smoke-free hospital policy, midwifery stop smoking provision, and relapse prevention.
Thanks to support from partners including the health visiting service, children’s centres, councillors, and local businesses, Sheffield became a World Health Organization accredited breastfeeding friendly city. We were also one of the first to develop and deliver a Doula UK peer support programme within the council which involved volunteers supporting vulnerable women with breastfeeding initiation and maintenance. The results speak for themselves, with the city’s breastfeeding rates now much higher than both the England and Yorkshire average.
We also worked to reduce teenage conceptions by improving access to contraception and sexual health services through schools, colleges and GPs. As a result, our teenage pregnancy rates for women under 18 have fallen since 2006 from 49.0 to 15.7 per 1,000.
Meanwhile, by providing staff training on genetic inheritance, and employing a community-based genetics worker to raise awareness of recessive genetic conditions and consanguinity in our communities (as opposed to expecting our communities to come to us), we are increasing awareness of this lesser-known risk factor.
There are areas where we have not made as much progress. For example, supporting women to maintain a healthy weight during pregnancy remains a significant challenge with unhealthy food around three times cheaper than healthier alternatives – and accessible at every turn.
Between 2018 and 2020, 62 babies died before their first birthday. This is 62 too many but represents a reduction of 47% and puts Sheffield below the average for England and on a par with areas considerably more affluent.
No one element made the difference. Instead, working consistently together over a long period of time to engage health professionals, wider partners and families alike, reaped incredible rewards.
Despite our interventions, we are noticing rates rising again and there are worrying signs in national data that the inequality in infant mortality rates is also beginning to widen.
However, together the city has created a resilient community, versed in the risk factors and with expertise in overcoming them.
What is happening in Sheffield is not unique. Similar public health initiatives are happening all over the UK away from the headlines; the dog that doesn’t bark. You never read about children that don’t die, or ill-health avoided thanks to fewer low birthweight babies, or greater attachment as a result of high breastfeeding rates. Yet, despite the lack of fanfare, these benefits of prevention and protection will have a ripple effect through communities for generations to come.
Greg Fell is president of the Association of Directors of Public Health (ADPH) and director of public health for Sheffield City Council
