Wednesday, 24 October 2012

Drugs and alcohol spending must not lose out

Drugs and alcohol spending must not lose out: From April 2013, money for drugs and alcohol services will no longer be ringfenced but will be lumped together with money for other public health services

The biggest-ever overhaul of the public health system in England becomes a reality in six months. Local authorities, most without any history of public health management, will take over responsibility for improving the health of local populations. Money currently spent on the delivery of drug, alcohol and sexual health services will contribute about 60% of the funding. But, as of April 2013, money previously ringfenced for those services will be lumped together with money for other public health services.
No one really knows how clinical commissioning groups, responsible for commissioning local services, and local health and wellbeing boards will work together. There are fears that, with an emphasis on localism, access to drug and alcohol services could suffer. Will councillors turn their backs on electorally unpopular services? Or will it lead to joined-up locally led responses that address issues across sectors and tackle the determinants of health and wellbeing?
When galvanised by political will, cities act quicker and more comprehensively than governments. With the identification of Aids in the mid-1980s, several cities in the UK and overseas, including Liverpool, San Francisco and Amsterdam, swiftly provided condoms and syringes to high-risk populations. In Liverpool, the Mersey harm reduction model involved the NHS, communities, primary care, police, church leaders, drug users and sex workers. It led to one of the first needle exchanges in the UK, extensive outreach and an expansion of drug treatment.
Cities can also deliver public health prevention. Community-based alcohol projects of the kind implemented in Glasgow, Birmingham and Cardiff can reduce alcohol-related problems. The projects work best when there is a range of local actions that change the drinking environment, such as promoting responsible serving of alcohol in bars and shops, training bar staff, enforcing licensing laws, and working with transport and fast-food outlets (often a source of friction late at night). In Stockholm, community involvement, bar staff training and stricter enforcement of existing alcohol laws has led to a 29% decrease in violent crimes.
But cities can also get it wrong. In Vancouver's Downtown Eastside, large numbers of drug users with serious physical, mental and social problems were concentrated into an area the size of six blocks, with little or no services.
In the UK, the regeneration of inner cities has concentrated bars and clubs into small areas, with competition for customers leading to unhealthy drinking incentives, overcrowding, lack of public toilets, and large numbers of people leaving at the same time and vying for scarce transport.
Cities need to bring together expertise and powers across local planning, policing, licensing, urban design and transport, and environmental and public health in order to reduce alcohol-related issues. The changes being ushered in for public health provide huge potential to both maintain and improve alcohol, drug and sexual health services, and also to develop truly integrated responses.
The evidence is in – we would be foolish to ignore it as English public health takes its first steps towards a new brave world. The Guardian

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