For a city that has one of the worst health inequalities in Europe, Glasgow provided a fitting backdrop to the tenth UK Public Health Association conference, held in March, and was a stark reminder of the challenges that lie ahead for the public health movement. Despite being the fourth largest economy in the world, according to the Organisation for Economic Co-operation and Development (OECD), the UK continues to suffer from huge disparities of wealth and very high levels of poverty.

Now that the Government has recognised the importance of health inequalities and placed the issue high on the political agenda, the challenge ahead is to develop and implement effective strategies that will reduce and eliminate ill-health. The message from this year's event was clear: Any measures to tackle health inequalities will require supportive national and regional policies, but equally there is a need to build sustainable communities at a local level. Building on the success of last year's event, the conference encompassed the whole spectrum of the public health movement, taking in topics as diverse as smoking, transport, healthy eating, sustainable development and the role of local authorities.

Parliamentary Under Secretary of State for Public Health, Yvette Cooper's opening address was encouraging for its emphasis on the health inequalities agenda and underlined the sea change in government thinking since the Labour Party's election. Speaking to a packed audience, she voiced concern that at the beginning of the 21st century, the opportunity for a healthy life was still linked to social circumstances and childhood poverty. Her reference to the crosscutting treasury spending review and its implications for health spending was well received and delegates will be keenly awaiting the outcomes for health gains. The absence of Conservative and Liberal party representatives did not go unnoticed and emphasised the urgency of making public health improvements at a time when the political will to tackle issues exists.

While the Government establishes priorities for action, the local dimension and its contribution to tackling inequalities remains core to the debate and a repeated theme throughout the three-day event. Alyson Morley from the Democratic Health Network told delegates, at a session on strategic planning and the role of local authorities, that one of the main challenges to emerge in the re-organisation of NHS structures was to ensure that local priorities were not sidelined to meet national targets. Ms Morley added that the Government's targets for reducing health inequalities could only be achieved through co-ordinated action by local partnerships. While many participants acknowledged that local authorities and health bodies "spoke a different language", there was a consensus that the opportunity to link all the agendas together had never been greater.

The launch of a local and regional government special interest group during one of the lunchtime sessions enabled practitioners from across the UK to share their knowledge on good practice and to discuss a range of public health issues, including benchmarking and best value. Chaired by Rachel Flowers, health development manager at Coventry City Council's Environmental Services, the overall aim of the session was to foster a "virtual" UK-wide multi-professional network around health development, health inequalities and the broader public health agenda. The organisers said that plans were being made to follow up the group meeting at future conferences.

This year's event highlighted the great opportunities created by the devolutionary process. Speaking on local government's contribution to health improvements across the UK, Steve Thomas, head of strategic policy at the Welsh Local Government Association said that the unitary system was the "best thing to happen to local government in Wales", and had played a key role in bringing the crosscutting agenda together. The region will see major governance changes in April 2003, when the five health authorities are abolished and replaced with 22 local health boards, based on local authority boundaries. Partnerships between the local health boards and local authorities will jointly formulate and implement health strategies that promote economic, social and environmental wellbeing.

A parallel session on sustainable development and environmental health focused delegates' attention on the wider public health challenges by linking together the environmental, economic and social factors that affect health inequalities. Brian Hanna, CIEH president and a member of the Sustainable Development Commission, highlighted five key issues - climate change, food and farming, waste impact and resource productivity, transport and governance, which the Commission argue require urgent action. Citing climate change as the single biggest environmental issue facing the UK, Mr Hanna emphasised how regional and local community contributions to reducing carbon emissions was key to stabilising and slowing down climate change and its impact on health.

Placing public health into a global context, Chris Church, adviser to the Community Development Foundation, said that national policy needed to do more to create frameworks in which local voluntary action could flourish. Referring to a report for the Joseph Rowntree Foundation due out this month, entitled Thinking locally, acting nationally, he said that one of the key lessons to be learnt was that while individual local projects had a small environmental impact they had a cumulative effect. He added that such projects also provide vital social skills and services that foster sustainability. Local sustainability, he concluded is working but much good work is going unrecognised by authorities and agencies. Mary Mulligan, Deputy Minister for Health in Scotland, presented the conference's keynote address after Malcolm Chisholm, Minister for Health and Community Care was forced to pull out. Citing smoking and poor diet as the two killers in Scotland, Ms Mulligan said smoking was "the most preventative cause of ill-health in this country". The National Health Service spends £140m per year on smoking-related illnesses and one in five deaths are directly related to the activity. She said that the Scottish Executive had established a health improvement fund to tackle ill-health relating to smoking and drew attention to the region's community diet programmes, which are being funded to improve the diet of the less privileged.

In the closing address Geof Rayner, chair of the UKPHA, continued the theme of diet-related illness while emphasising the impact on health of globalisation. Criticising current food and farming policy and citing a report entitled Why health is the key for the future of farming and food, Mr Rayner said the UK was adopting a US-style diet that was leading to more obesity. The costs, he said, would ultimately fall on the NHS, industry and society. He went on to say that people were negating a healthier diet due to the high cost of purchasing healthy food and the advertising of unhealthy foods. He also criticised the current import-export trade, which he described as being ecologically unsustainable. Concluding, Mr Rayner emphasised the importance of preventative health and said that "joining up the environmental, social and economic factors under the public health umbrella" lay at the core of sustainability and improving health.

Further details on membership of the UKPHA and future events can be obtained from:
The UK Public Health Association,
7th Floor,
Holborn Gate,
London, WC1V 7BA.
E-mail: info@ukpha.org.uk. Telephone: 0870 010 1932

For further information about the special interest group please contact Rachel Flowers at: rachel.flowers@coventry.gov.uk