Agenda and minutes

Venue: Council House, Plymouth

Contact: Jamie Sheldon  Email: democraticservices@plymouth.gov.uk

Items
No. Item

61.

Declarations of Interest

Cabinet Members will be asked to make any declarations of interest in respect of items on this agenda. 

Minutes:

No declarations of interest were made.

62.

Minutes pdf icon PDF 82 KB

To sign and confirm as a correct record the minutes of the meeting held on 24 November 2025.

Minutes:

The minutes of the meeting held on 24 November 2025 were agreed as an accurate record.

63.

Questions from the Public

To receive questions from the public in accordance with the Constitution.

 

Questions, of no longer than 50 words, can be submitted to the Democratic Support Unit, Plymouth City Council, Ballard House, Plymouth, PL1 3BJ, or email to democraticservices@plymouth.gov.uk. Any questions must be received at least five clear working days before the date of the meeting.

 

Minutes:

There were no questions from members of the public.

64.

Chair's Urgent Business

To receive reports on business which, in the opinion of the Chair, should be brought forward for urgent consideration.

 

Minutes:

There were no items of Chair’s urgent business.

65.

Civic Centre

Additional documents:

Minutes:

Councillor Mark Lowry (Cabinet Member for Finance) introduced the Civic Centre update and discussed:

 

a)     The Civic Centre project had faced delays due to various issues, but these had now been resolved, and the project was progressing positively;

 

b)    The building was now fully secure, and unauthorised access had been addressed;

 

c)     Homes England had confirmed funding of £18.4 million to move the project forward;

 

d)    The first phase of asbestos removal had been completed, enabling surveys and structural assessments to proceed, expected to conclude by February 2026;

 

e)     New branding had been installed outside the building to communicate the vision for redevelopment;

 

f)      Extensive public engagement had been undertaken, with feedback to be shared during the meeting;

 

g)     The building was listed and could not be demolished, making redevelopment essential and exciting for the city.

 

Emma Wilson (Head of Regeneration and Growth), Mark Braund (Architect Director, BDP) and James Harrison (Designer, Atkins Realis) added:

 

a)     The design team brought significant experience in delivering award-winning regeneration projects;

 

b)    Mark Braund had a strong track record in housing and regeneration and was passionate about transforming this landmark building;

 

c)     James Harrison had extensive experience across multiple sectors and had worked on major Plymouth projects including City College and Devonport Dockyard;

 

d)    The project aimed to submit a planning application early in the new year, 2026;

 

e)     The redevelopment would deliver 144 new homes as part of Homes England funding and integrate City College Plymouth facilities;

 

f)      The design sought to remove unsympathetic additions and restore original modernist principles;

 

g)     The podium level would house City College spaces, with residential units above and a proposed commercial use on the roof;

 

h)    The building was classified as high-rise under the Building Safety Act, requiring compliance with gateways and installation of a new lift;

 

i)      Sustainability was central, with reuse of existing assets and integration of modern ventilation and heat recovery systems;

 

j)      The design incorporated the Fibonacci sequence and original architectural language to respect heritage;

 

k)     Proposed homes would be bespoke, space-standard compliant, and include exposed waffle ceilings for loft-style living;

 

l)      The scheme aimed to create vibrant ground-floor activity and improved public realm;

 

m)   A new Blue-Green Skills Hub would deliver training for future industries, including offshore wind, sustainable energy, and electric transport;

 

n)    The hub would offer around 60 courses, supporting 2,000 learners annually;

 

o)    Design drivers included access, active frontages, community connectivity, and integration with the historic building;

 

p)    Plans featured large workshop spaces, immersive digital technology rooms, and atrium-linked classrooms;

 

q)    The ground floor would include a college square, restaurant, and spa operated by the college;

 

r)     Phase zero (asbestos removal and site security) was complete;

 

s)     Structural surveys were underway and due to finish in February;

 

t)     The team was concluding evaluation of the pre-contractor services agreement and progressing through RIBA stages;

 

u)    Public engagement had attracted 13,000 website visitors, 250,000 social media views, and 207 survey responses;

 

v)     66% supported redevelopment, with young people particularly positive;

 

w)  ...  view the full minutes text for item 65.

66.

The Director of Public Health Annual Report: The Health and Wellbeing of Women in Plymouth pdf icon PDF 165 KB

Additional documents:

Minutes:

Councillor Aspinall (Cabinet Member for Health and Adult Social Care) introduced the report and discussed:

 

a)     The Director of Public Health had a statutory duty to produce an independent annual report on the health of the population, and the Council had a duty to publish it;

 

b)    This was the first annual report from Professor Steve Madden, marking his first year in post;

 

c)     The theme of the report was the health and well-being of women and girls in Plymouth, highlighting that while women lived longer than men, they spent significantly more years in poor health;

 

d)    The report was a call to action for councillors, partners, and residents to tackle inequalities and help women in Plymouth to thrive;

 

e)     The Government was expected to commission a similar report focusing on men in due course.

 

Professor Steve Madden (Director of Public Health) presented the report and highlighted:

 

f)      Women in Plymouth lived longer than men but spent more years in poor health, making this an issue of equity, dignity, and opportunity;

 

g)     Female life expectancy in Plymouth was 82.4 years, close to the national average, but healthy life expectancy was only 55.7 years, nearly six years below the English average;

 

h)    Thousands of women were living long lives but spent up to 27 years in ill health;

 

i)      The report was structured around the four petals of the Thrive Plymouth programme: Healthy Body, Healthy Mind, Healthy Places, and Healthy Communities;

 

j)      Evidence included quantitative data and qualitative insight from 27 Plymouth women who participated in listening circles facilitated by Improving Lives Plymouth;

 

k)     Key findings included:

 

                i.         Only 67.6% of women in Plymouth could expect to live in good health compared to 74.5% nationally;

              ii.         Over 36,000 women in Plymouth were likely to experience harassment each year;

             iii.         One in five women were considered disabled under the Equalities Act;

             iv.         80% of women employed in Plymouth earned below the national median salary;

              v.         1,330 young women were not in work or education, significantly higher than male peers;

 

l)      Mental health was a major concern, with nearly 20,000 women estimated to experience common mental health problems;

 

m)   Violence against women and girls remained a national priority with profound impacts on health;

 

n)    Women reported barriers to accessing healthcare including long waits for gynaecological treatment, limited menopause support, and difficulty securing GP appointments, often feeling unheard or dismissed;

 

o)    The report called for action to strengthen trauma-informed services, improve access to screening and contraception, address gender pay gaps, support women into education and employment, and create safer public spaces;

 

p)    Councillors were asked to consider how their portfolios could contribute to tackling these challenges;

 

q)    Improving the health of women and girls was a shared responsibility across the Council and partners.

 

In response to questions, the Cabinet discussed:

 

r)     Members welcomed the report and emphasised the need for collective action to improve outcomes for women and girls;

 

s)     It was noted that existing strategies already addressed some issues, including initiatives under the  ...  view the full minutes text for item 66.

67.

Corporate Plan Monitoring Report Quarter Two

Additional documents:

Minutes:

Councillor Jemima Laing (Deputy Leader of the Council, and Cabinet Member for Children's Social Care, Culture and Communications) introduced the Corporate Plan and highlighted:

 

a)     The report covered performance for the second quarter of 2025/26, from July to September 2025;

 

b)    Public confidence in reporting antisocial behaviour had risen significantly, with 354 incidents reported in Quarter 2 compared to 102 a year earlier, reflecting the success of awareness campaigns and community engagement;

 

c)     Early intervention strategies continued to prevent escalation of antisocial behaviour issues, supporting safer communities;

 

d)    Operational delivery on highways maintenance remained strong, with carriageway works consistently achieving 96% to 100% on-time completion rates;

 

e)     Over 3,750 square metres of pavement improvements had been completed in the six months to September, demonstrating commitment to improving public infrastructure;

 

f)      Planning performance remained high, with 100% of major applications determined on time and no planning appeals overturned during the period;

 

g)     Housing delivery had slowed slightly, and unlocking stalled developments remained a priority for the Council;

 

h)    Educational outcomes continued to improve, with 94% of primary schools and 84% of secondary schools now rated Good or Outstanding by Ofsted;

 

i)      The Council was particularly focused on improving attendance at secondary schools through its place-based working and belonging strategy;

 

j)      While strong progress had been made in many areas, ongoing challenges remained, particularly around health service pressures, NHS dental access, and housing delivery, which required continued partnership working.

 

In response to questions, the Cabinet discussed:

 

k)     The importance of accelerating housing delivery, noting that fewer homes had been built this year than in previous years, making it critical to progress initiatives with Homes England to deliver more homes across the city, including the city centre;

 

l)      Thousands of people remained on the housing waiting list, reinforcing the urgency of improving delivery;

 

m)   Members highlighted the positive performance in highways and planning but raised concerns about public perception of street conditions and traffic flow;

 

n)    It was noted that traffic flow remained a challenge, and members discussed the need to boost public transport and explore behavioural change;

 

o)    The report was recognised as an honest assessment of successes and areas needing improvement, demonstrating the Council’s commitment to transparency and accountability.

 

The Cabinet agreed:

 

  1. To note the Corporate Plan Monitoring Report, Quarter Two of 2025/26.

 

68.

Council Tax Base Setting 2026/27 and Council Tax Support Scheme 2026/27 pdf icon PDF 156 KB

Additional documents:

Minutes:

Councillor Lowry (Cabinet Member for Finance) introduced the Council Tax Base Setting 2026/27 and Council Tax Support Scheme 2026/27 report and discussed:

 

a)     The council tax base represented the estimated number of Band D equivalent properties within the city and was a key component in determining the level of council tax for the coming year;

 

b)    The calculation incorporated assumptions on collection rates and adjustments for discounts and exemptions, including those arising from the Council Tax Support Scheme;

 

c)     For 2026/27, the recommended council tax base was 76,887 Band D equivalent dwellings, reflecting an increase of approximately 330 properties compared to the previous year’s figure;

 

d)    This growth was primarily attributed to a modest increase in the number of chargeable dwellings and adjustments for long-term empty property premiums;

 

e)     The calculation assumed a prudent collection rate of 97.5%, based on recent performance and economic conditions;

 

f)      The council tax base also incorporated discounts and exemptions, including those arising from the Council Tax Support Scheme, which continued to provide vital assistance to households on low income, with around 20% of households currently receiving support;

 

g)     In addition to the main Council Tax Support Scheme, the Council operated a discretionary Exceptional Hardship Fund to support residents facing severe financial difficulty;

 

h)    The fund provided temporary help where support did not fully cover council tax liability, offering relief in exceptional circumstances such as ill health or sudden income changes;

 

i)      Following a review in 2025, the Council decided not to make any changes to either scheme, ensuring stability for residents and maintaining administrative efficiency;

 

j)      The cost of the overall scheme was expected to remain within the financial envelope, with increased cost driven primarily by the rise in council tax rather than growth in claimant numbers;

 

k)     The Government had recently completed a consultation on modernising and improving the administration of council tax. Views were sought from the Council and residents, and updates on proposed changes were awaited. The Council would continue to monitor developments and provide updates when announced;

 

l)      The report would be presented to Full Council in January for approval.

 

In response to questions, the Cabinet discussed:

 

m)   Appreciation was expressed to Ian Trisk-Grove (Service Director for Finance) for his diligent and committed work with Cabinet, acknowledging the challenges of the subject matter and wishing him for the future.

 

The Cabinet agreed:

 

  1. To recommend a council tax base for 2026/27 of 76,887 Band D equivalent dwellings, as set out in the report;

 

  1. To continue the current Council Tax Support Scheme and Exceptional Hardship Scheme for 2026/27 with no changes.

 

69.

The Food Waste Collection Project pdf icon PDF 177 KB

Additional documents:

Minutes:

Councillor Briars-Delve (Cabinet Member for Environment and Climate Change) introduced the report and discussed:

 

a)     Plymouth had historically been behind the curve on food waste compared to regional neighbours, but significant progress had been made to prepare for the statutory requirement announced by Government;

 

b)    Food waste was currently incinerated at the Energy from Waste plant between Devonport and St Budeaux, which was inefficient because food was approximately 70% water and required more energy to burn;

 

c)     Separating food waste for processing through anaerobic digestion would create beneficial by-products such as renewable energy, biogas, and fertiliser;

 

d)    Fun facts were shared to illustrate benefits: nine recycled banana peels could generate enough electricity to charge a laptop, and one caddy load of food waste could power a home for almost an hour;

 

e)     Plymouth’s phased roll-out of food waste collections would begin in March 2026, delivered in five phases, starting with selected areas of Devonport, Plympton, Plymstock, Stoke, Southway, and Whitleigh;

 

f)      Phase one would cover approximately one-fifth of the city, chosen to represent a diverse mix of property types and communities to maximise learning;

 

g)     A postcode checker had been developed to help residents confirm whether they were included in phase one;

 

h)    Plymouth had the simplest household recycling system in the UK, and the new service would only add one small caddy to existing bin days, maintaining the same collection day for convenience;

 

i)      Residents would receive an outdoor caddy, an optional kitchen caddy, and a starter roll of liners;

 

j)      A new team of four officers had been appointed to lead recycling engagement with communities, schools, and local groups;

 

k)     Concerns raised on social media about smell were addressed: food waste would be collected weekly instead of fortnightly, and caddies would have lockable lids to contain odours;

 

l)      The service would be primarily funded by national Government as a statutory requirement, with three stages of funding:

 

                i.         Stage 1: Nearly £2 million capital funding for vehicles and containers;

              ii.         Stage 2: Transitional revenue funding of just over £0.5 million for distribution and engagement;

             iii.         Stage 3: New burdens funding for staff, vehicle operating costs, haulage, and disposal, with final confirmation awaited;

 

m)   Government investment had enabled Plymouth to deliver the service without significant local cost, saving the Council thousands of pounds through early vehicle procurement;

 

n)    The initiative would increase recycling rates, reduce emissions, and help families save money by reducing food waste.

 

Rachel Hawaidi (Senior Project Manager) and Andy Sharp (Interim Service Director for Street Services) added:

 

o)    The project was driven by legislation and mirrored similar initiatives across 170 local authorities in England;

 

p)    Ten vehicles and containers had already been procured, with containers made from recycled material and recyclable at end-of-life;

 

q)    Food waste would be processed via anaerobic digestion, producing biogas and electricity, supporting Plymouth’s Net Zero Action Plan;

 

r)     Recycling rates were expected to rise significantly, citing Cornwall’s increase from 34% to 44% following similar changes;

 

s)     Processing food waste via anaerobic  ...  view the full minutes text for item 69.

70.

Plymouth City-wide All-age Unpaid Carers Strategy 2025 - 2027 pdf icon PDF 158 KB

Additional documents:

Minutes:

Councillor Aspinall (Cabinet Member for Health and Adult Social Care) introduced the report and discussed:

 

a)     The strategy represented a shared commitment across Plymouth to ensure unpaid carers were recognised and valued for their vital contribution;

 

b)    The vision was to create a community where carers were acknowledged as essential partners in care, their contributions celebrated, and their needs fully supported;

 

c)     The strategy was co-produced by Plymouth City Council, Livewell Southwest, University Hospitals Plymouth, St Luke’s Hospice, Improving Lives Plymouth, and unpaid carers themselves, ensuring lived experience shaped priorities;

 

d)    The document was more than a strategy; it was a pledge to work collaboratively to make Plymouth a carer-friendly city.

 

Louise Ford (Head of Commissioning for Adults and Children’s Services) presented the strategy and highlighted:

 

e)     The strategy covered all ages, including adult and young carers, and reflected the voice of carers throughout;

 

f)      It set out clear priorities for supporting carers, with an implementation plan and governance through the Carer Strategic Partnership Board.

 

Claire Sterling (Patient Experience Manager, Livewell Southwest) and Carlina Hall (Senior Commissioning Officer, Plymouth City Council) added:

 

g)     The strategy aimed to support unpaid carers of all ages and backgrounds, creating an inclusive environment and guiding decision-making;

 

h)    A carer was defined as anyone, including children and adults, who looked after a family member, partner, or friend needing help due to illness, frailty, disability, mental health problems, or addiction, without payment;

 

i)      Key facts included:

 

  1. Women had a 50/50 chance of providing care by age 46; men by age 57;
  2. Plymouth had over 23,000 carers based on the last census;
  3. The 2025 school census identified 846 young carers, with a further 516 recorded on Eclipse, totalling 1,299 known young carers;
  4. Every day, 12,000 people became unpaid carers, and one in three people would be an unpaid carer at some point;
  5. 70% of carers had long-term physical or mental health conditions compared to 59% of non-carers;
  6. Carer’s Allowance remained the lowest benefit of its kind at £83.30 per week (2025/26 rates);
  7. Young carers providing 35+ hours of care weekly were 86% less likely to obtain a degree and 46% less likely to enter employment;

 

j)      Challenges included workforce retention and recruitment issues in social care, insufficient funding, over-reliance on informal carers, and increasing “excessive caring” responsibilities;

 

k)     The strategy was fully accessible online via Plymouth Online Directory, with full, easy-read, one-page summary, and audio versions available;

 

l)      Development involved a task-and-finish group, research, statutory guidance review, surveys, and engagement sessions with carers;

 

m)   The six co-produced priority areas were: Access to Services, Financial Support, Health, Safety, and Wellbeing, Early Identification and Recognition, Improving Information, Advice, and Communication, and Transitions and Changing Roles;

 

n)    An action plan would be overseen by Carer Strategic Partnership Board, with regular updates and partner-led workstreams for each priority;

 

o)    Progress would be measured through qualitative and quantitative indicators, including health outcomes, identification rates, and participation in community activities;

 

p)    A research project was underway to assess impact of the strategy  ...  view the full minutes text for item 70.

71.

Plymouth City Council People Strategy pdf icon PDF 155 KB

Additional documents:

Minutes:

Councillor Dann (Cabinet Member for Customer Experience, Sport, Leisure, HR & OD) introduced the item and highlighted:

a)    That the People Strategy had been developed following a collaborative development process involving trade unions and extensive workforce engagement (over 300 staff);

b)    The importance of the strategy in positioning the Council as an employer of choice amid increased economic investment in the city and the need for skills to match new job opportunities;

c)    There was a focus on embracing digital skills, understanding the age profile of the workforce (with many staff over 50), and backfilling with younger people through methods such as extra training and new skills;

d)    Recognition of the breadth of the Council’s workforce, including paid employees, subcontractors, and volunteers, and the need for a wide offer that valued all contributions;

e)    A commitment to being a diverse, inclusive and respectful organisation that attracted people and represented Plymouth as a place;

f)     Progress had already been made: 100 staff completed the Level 5 management and leadership development programme over the last year; continued development via the Digital Academy and apprenticeships to attract, equip and retain talent;

g)    There was an emphasis on valuing, developing and supporting staff so they were passionate, innovative and brave in delivering excellent public services;

h)    The strategy aimed to benchmark the Council’s position as a leading city employer supporting staff, who often lived locally.

Chris Squire (Service Director for HR & OD) added the following points:

i)     Sustained focus on health, safety and wellbeing across the Council, reflecting the principle that ‘health and safety trumps everything’, visible in high?vis protective equipment and the ‘Work Safe, Home Safe’ approach;

j)     The People Strategy document’s design aligned with the new city branding, incorporating real photographs of staff (not AI?generated);

k)    Launch of Digital Academy Cohort 2: 40 staff commencing apprenticeships in data and AI, funded via apprenticeship levy transfers from Google and Microsoft; in the past 12 months, nearly £2,000,000 of apprenticeship funding had been spent or committed (including £1.5m attracted via transfers), ensuring full utilisation of the Council’s levy;

l)     Pride in presenting an ambitious and supportive People Strategy linking strong people practices and the values required in public service to improved outcomes for the city.

In response to questions, the following was discussed:

m)  Expressed strong support for a strategy that championed officers and aligned with the city’s branding;

n)    The need to develop a detailed action plan and to track impacts over time, noting growth in training and organisational support and union satisfaction with the collaborative approach;

o)    Recruitment challenges in specific service areas were acknowledged; induction messages continued to stress the significance of public service to approximately 260,000 residents across Plymouth and the imperative to be a good employer;

p)    It was confirmed that the corporate management team would review progress against the action plan quarterly to ensure delivery.

Cabinet agreed:

1.    To approve the new People Strategy for Plymouth City Council.

 

72.

Leader's Announcements

Minutes:

Councillor Laing (Deputy Leader and Cabinet Member for Children’s Social Care, Culture and Communications) made a number of announcements including:

a)    A formal tribute to Councillor Dann, who would retire from her Cabinet role (Customer Experience, Sport, Leisure and HR & OD) with effect from 01 January 2026; her two decades of leadership across HR, economic development, transport, street scene and environment, customer experience and leisure were acknowledged, including safeguarding Mount Wise Pools, delivering thousands of free Fit and Fed sessions for children, guiding the city through the cost of living crisis, and advancing digital transformation, and her hard work, advocacy for women in politics and support for colleagues were warmly recognised;

b)    Councillor Taylor would be welcomed back to Cabinet in January 2027 to succeed Councillor Dann, bringing significant prior experience as Cabinet Member for Health and Adult Social Care during the COVID?19 pandemic;

c)    Submission of a joint proposal with Exeter City Council to government for local government reorganisation in Devon, aimed at addressing duplication in the two?tier system;

d)    Continued work with MHCLG (Ministry of Housing, Communities and Local Government) and Homes England on a new towns proposal for 10,000 homes in Plymouth city centre; officials had visited recently and the proposal was being assessed with a decision expected in later Spring 2026;

e)    The Secretary of State John Healey visited Plymouth to open Helsing’s first UK resilience factory, set to create hundreds of jobs producing a sub-sea autonomous AI?enabled glider to protect sea lanes and infrastructure;

                      i.        Thanks were recorded to the Economic Development and Freeport teams;

                     ii.        Inward investment enquiries were at a record high (around one per week), with as much interest in the last three months as in the whole of last year;

f)     Capital programme highlights included: completion of the Derriford district centre; Tinside enhancements; completion of the £23m ABP port improvements; commencement of shore?power delivery; Freeport seed funding fully spent unlocking £73m of investment; works at the Mountbatten Centre; key demolitions at OceansGate to deliver innovation barns; near?completion of the 15th direct development at Langage;

g)    The Box programme update: a very busy ‘Super Saturday’ and, since opening, 1.1 million visitors as well as £244m economic impact and £100m health benefits;

                      i.        Current exhibitions included the Grayson Perry tapestries;

                     ii.        Highlights for 2026 would include the largest ever Beryl Cook exhibition (‘Pride and Joy’) launching 24 January 2027 (free but ticketed, with over 3,000 bookings already);

                    iii.        ‘Journeys with My …’ would bring a world?famous Reynolds painting to Plymouth on 14 February 2026 before travelling to New York and the Getty Museum, valued at £50m and jointly acquired by the National Portrait Gallery and the Getty in 2023;

h)    The Park had won Building of the Year 2025 at the Devon and Cornwall Building Forum in November 2025.

73.

Cabinet Member Updates

Minutes:

Councillor Aspinall (Cabinet Member for Health and Adult Social Care) provided the following update:

a)    Progress at Meadow View: public visits with seasonal activities, positive impressions of the building’s scale and the work that was underway.

Councillor Dann (Cabinet Member for Customer Experience, Sport, Leisure and HR & OD) made the following announcement:

b)    A forthcoming Memorandum of Understanding with Swim England to make the Life Centre the first local authority strategic partner, aligning national aquatics outcomes with local delivery, recognising that safe water access included pools, Tinside lido and open water; signing was scheduled for Wednesday and would showcase local swimmers and the growth of diving in the city.

Councillor Stephens (Cabinet Member for Strategic Planning and Transport) added:

c)    Simon Lightfoot MP, visited Plymouth ahead of a national grant announcement, seeing Stagecoach’s free services on Thursdays and Sundays from Coypool, supporting cost?of?living, as well as visiting Citybus to see the first roll?out of 50 electric buses;

d)    The Department of Transport had cited Plymouth’s Enhanced Partnership and analytical granularity as national good practice and would signpost other authorities to Plymouth’s approach; commendations were recorded for the Public Transport Team.

 

74.

LGA Update

Minutes:

Councillor Laing (Deputy Leader and Cabinet Member for Children’s Social Care, Culture and Communications):

a)    The Local Government Association’s (LGA) response to the autumn budget and council funding: while funding had increased in recent years, it was insufficient to ensure financial sustainability, protect services and support communities;

b)    Significant pressures remained in adult social care, temporary accommodation, special educational needs and disabilities (SEND), home?to?school transport and children’s placements and homelessness;

c)    These areas would be central to setting a balanced budget for 2026/27;

d)    The Council echoed the LGA stance on tackling child poverty and welcomed the lifting of the two?child benefit cap announced in the budget; the Council had written to the Chancellor, Rachel Reeves MP, urging action to tackle child poverty;

e)    The LGA called for sustainable support across employment, education, housing, social care and health to address root causes of poverty.