The Director of Public Health has a duty under the Health and Social Care Act 2012 to produce an independent report on the health of the local population. This report complements and builds upon the JSNA.

This year’s report focuses on the four main unhealthy behaviours of smoking, unhealthy diet, being physically inactive and, drinking too much alcohol, which are underpinned by emotional and mental wellbeing, and shows how these are primarily influenced by the environment and people around us. The report presents the size and scale of the problem in Richmond and demonstrates how these behaviours lead to long-term conditions and ill health, resulting in personal and societal costs.  The report makes a case for preventative approached in a time of austerity- place and community level approaches (that help to make the healthy choice the easy and preferred choice) are highligh

ted as they have a potential for a scaled, universal and population impact. The report also illustrates the importance of tailored and targeted individual level approaches for vulnerable groups.

To download the report- visit

What does this mean for Richmond?

Key messages

The Challenge

  • In the London Borough of Richmond upon Thames, like elsewhere, cost pressures in the health and care system are due to the inexorable rise in numbers of people with multiple long-term conditions and, on current trends, this will become unaffordable.
  • Cardiovascular disease and cancers remain the main killers, but an increasing burden of disease and suffering is also due to mental ill health.
  • The main unhealthy behaviours of smoking, alcohol misuse, poor diet and lack of physical activity, as well as poor emotional and mental well-being are responsible for at least a third of ill health and are amenable to cost-effective preventative interventions.
  • In Richmond, despite favourable comparison with elsewhere, the absolute numbers of people who adopt unhealthy behaviours and lack emotional and mental well-being are large (tens of thousands).
  • Health behaviours are driven by choice, but also by the places and conditions we live and work in and the pressures of our day-to-day life. Emotional and mental well-being underpins all we do.

The Solution

  • Public health interventions have an important part to play to stem the tide of long-term conditions and increasing costs.
  • Preventative strategies that combine interventions at individual, community and population level work best.
  • There is growing evidence that, compared with population level interventions, those limited to the individual level cost around five times more and are less effective in reducing health inequalities.
  • Focusing on prevention earlier in the life-course will accumulate greater benefits, but even in middle and older age, preventative approaches are cost-effective.
  • Public health prevention strategies (both at individual and population level) are much more cost-effective than clinical interventions.
  • Health-promoting environments, i.e. those where the healthier choice is both the easier and the preferred choice, are also more economically and environmentally sustainable.
  • Local people are engaging in the debate and are willing to trade-off some of their individual choice in exchange for health-promoting environments to improve their health, the health of their families and the health of future generations.