Like many cities, there is high substance-related harm and health inequalities in Southampton.
Recognising that there is a relationship with the wider determinants, and that the council has control or a strong influence over these and related service areas, the City Council sought to apply a Health in All Policies (HiAP) approach to a new cross-council Tobacco, Alcohol and Drugs strategy, to optimise efficiency, effectiveness and outcomes.
Southampton Health and Wellbeing Board then committed to a pragmatic Health in All Policies (HiAP) approach across all work, more generally, in 2023.
The Southampton City Council Public Health and Policy Teams spent a year (2022) developing a single, Tobacco, Alcohol and Drugs strategy, to sit under the Joint Health and Wellbeing Strategy and link with the Community Safety Partnership.
Work began with extensive early engagement with the Health and Wellbeing Board, with individual meetings with each Board member. This enabled each person to have the time and trust to speak about what mattered to them.
A programme of work was co-produced, working with a strategic lead for each directorate, enabling shared leadership and collective expertise. The final strategy had a programme for each directorate in the Council. The directorate programme approach aimed to make it easy for staff to find, understand, lead and implement the part of the strategy that relates to them, and to understand the benefits.
The strategy’s vision and programmes were developed based on the local context, evidence of what works, wider engagement (partnerships, meetings and emails) and lengthy public consultation. It was specifically a Council strategy, with the Council taking responsibility for actions as an organisation, making commitments which are within its gift to deliver. The strategy describes how the Council will work with other agencies, noting that the pace and scale of delivery are shaped by funding.
The vision for the 2023-28 strategy reflects the whole council approach that HiAP enabled: Southampton is a city of help, harm reduction, hope, health promotion & prevention, and health equality. The strategy covers all ages, communities and settings.
Delivery of the strategy is through five programmes, one for each council directorate (covering transport, education, children’s services, adult services, housing amongst other topics) and a corporate programme for internal, cross-cutting work, such as human resources. Holding individual directorates accountable for their contributions to HiAP ensures a cohesive approach and built a solid foundation for building a local partnership to reduce drug-related harm, in line with grant-funding. When directorate structures have changed, commitments have been reassigned to make sure leadership continued. It takes ongoing work to ensure new staff are aware of their strategy commitments.
A HiAP approach relies on relationships, and these take time to develop: respect, listening and transparency are important; there isn’t a common understanding of public health risks and harms; it is important to understand the benefits other than to health, for example economic growth, educational attainment, city pride. Some topics, like tobacco, alcohol and drugs, can involve sensitive conversations where people have difficult personal experiences, feel stigmatised or have strong feelings.
It can require new skills and peer support to adopt a HiAP approach, with people working outside their usual expertise and stakeholders. This can be a challenge but is also rewarding and revitalising.
This is long-term work and Southampton continues to have significant tobacco, alcohol and drug-related harm. However, services are performing well and most metrics are showing good progress.
For further information see The 10-year drug strategy: Southampton City Council or Southampton: Embedding stop smoking expertise across services.
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