Leicester City Council: Treating health inequalities as a public health emergency

Leicester City Council enjoyed great success in curbing an outbreak of measles by developing a rapid response involving a mobile vaccination service. The success prompted the council’s public health team to ponder what would happen if they deployed public health emergency techniques to tackling health inequalities. The result has been a new approach with five priority areas targeted for action with the aim on getting some quick, high-impact wins.

“There is a tendency when it does not involve an infectious disease to try to spread ourselves too thinly and try to do a bit of everything. So we thought we would look at what in terms of prevention and health inequalities we could treat as a public health emergency and see what impact it could have” – Rob Howard, Director of Public Health

Last year when Leicester experienced a measles outbreak, the council’s public health team swung into action. A major incident team was set up with the NHS and UK Health Security Agency and a rapid response organised involving dispatching a mobile unit to carry out vaccinations in schools, mosques and community venues in places with the lowest rates of vaccination.

Director of Public Health Rob Howard said: “It was based on some of the learning from the Covid vaccination programme – we developed really good relationships with community organisations and knew the benefit of taking the vaccinations out into the community.

“It made a real difference. We got hundreds of vaccinations done and got on top of the outbreak. It got us thinking ‘why don’t we treat non-communicable health problems like this?’

“There is a tendency when it does not involve an infectious disease to try to spread ourselves too thinly and try to do a bit everything. So we thought we would look at what in terms of health inequalities we could treat as a public health emergency and see what impact it could have.”

‘Quick, high-impact wins’

The public health team organised a workshop in summer 2024, which was attended by more than 80 people from across the council, local NHS and voluntary and community sector to brainstorm what areas should be prioritised.

Mr Howard said: “We have really significant health inequalities in the city – there is a 17-year gap in life expectancy between the most deprived neighbourhoods in the city and least deprived areas in the county. But the inequalities are really complex here. Leicester is one of the most culturally diverse cities in the country with those identifying as white British in a minority.

“When it comes to health inequalities, we see distinct differences between our communities with some of the worst health outcomes being faced by the British white community living in Leicester’s most deprived areas. Newer migrants to the city such as eastern Europeans and people seeking asylum also tend to face the most significant challenges, for example in accessing healthcare.

“So in the workshop we looked carefully for priorities which were contributing most to that inequality and where we would not be duplicating what else was going on. The aim is to have some quick, high impact wins.”

In the end, five areas were chosen to focus on. They were:

• healthy weight
• social isolation of people with severe mental ill health
• increasing bowel cancer screening uptake
• increasing HPV vaccination uptake
• finding cases of high blood pressure and preventing more cases.

Task and finish groups were set up for each, with representatives from the NHS, council and voluntary sector recruited.

Public Health Consultant Dr Katherine Packham said while it is still early days, plans have already started to be formed. “They are all looking at the data and really drilling down into it to see where the challenges are and what the evidence is saying. But we are starting to see ideas formulate.

“For high blood pressure we are looking to work with community pharmacies to take blood pressure checks out into the community. We have an estimated 24,000 undiagnosed high blood pressure cases so the potential impact is huge.

“We may do something similar with the HPV vaccine, but first we are thinking about how we counter some of the stigma around it. It’s seen as an STI vaccination – and some parents are saying their children don’t need that.

“We’re looking at how we can promote it as an anti-cancer vaccine for both boys and girls to protect them from cancer for the rest of their lives and are using behavioural science techniques to work out the most effective approaches.

“And with bowel cancer we know men in particular are presenting late – and they have lowest rates of one-year survival in the country. We see significant numbers of them being diagnosed after being admitted to hospital as an emergency. We want to know why that is. Is it stoicism? Is there something stopping them going to the GP or not getting screened? Once we know more, we can develop an action plan.”

Given how broad healthy weight is, Dr Packham said, the project is targeting two areas. One involves doing something on a neighbourhood level in the areas with the highest rates of obesity, while the second is based on making use of the anchor organisations of the council and local NHS trust. The council has signed a healthy weight declaration, with the intention that this is extended to the NHS, to provide added impetus to take action whether it is the food being served in the canteens or introducing active travel schemes.

Crucial to the success of the five priority areas will be the close involvement of local community groups. And thanks to the work on the Covid vaccination programme, there are already strong foundations in place.

Leicester has a well-established community wellbeing champions network, which includes over 500 organisations representing different ethnicities, religions, geographical areas and health conditions.

This network is support by a team within public health that act as co-ordinators who have built up relationships with the organisations, hosting regular forum meetings and conferences. There was also a £60,000 pot available recently for community grants to help fund small-scale, neighbourhood projects.

Dr Packham said: “It originally came together during Covid, but we have now invested our own money in it. It is all too tempting in public health to think you have a good idea, but you need to know what the community think, how they would address the problem at hand. That is what we have got with this network.

“We provide training opportunities for champions, including healthy conversation skills, and have actually just started a three-month internship programme for three people from the network. It’s a chance for them to spend time with us and learn more about public health and for us to learn about them.

“We have worked hard to support this network – it’s going to play a crucial role in this new approach.”