Councillor Mary Aspinall (Cabinet Member for Health and Adult Social Care) introduced the Director of Public Health Annual Report: The Health and Wellbeing of Women in Plymouth and discussed:

 

a)     That Directors of Public Health had a statutory duty to produce an annual independent report on the health of the communities they served, and that this year’s report focused specifically on the health and wellbeing of women and girls in Plymouth;

 

b)    That the report set out clear evidence that, whilst women in Plymouth generally lived longer than men, they spent a significantly greater proportion of those years in poor health, with healthy life expectancy locally being markedly below the England average;

 

c)     That behind the statistics were the lived experiences of real women in the city, many of whom had contributed their voices and insights to the report, and that the report therefore represented both quantitative data and qualitative community insight;

 

d)    That the report highlighted the multiple roles women played in society, often leading them to place their own needs last, and that this had profound implications for their physical and mental health;

 

e)     That the report emphasised the wider determinants of health, including income, education, housing, feelings of safety in public spaces and access to green and blue spaces, and that these factors collectively shaped the health outcomes of women and girls in Plymouth;

 

f)      That the report had been designed to prompt action and progress, showcasing work already under way in the city and setting out a call to action for partners to improve outcomes for women and girls;

 

g)     That the recommendations invited Board members and their organisations to note the content of the report, reflect on how they could support its findings, acknowledge the contribution of women and the organisations supporting them, and commit to considering what more could be done to improve health and wellbeing for women and girls across the city.

 

Professor Steve Maddern (Director of Public Health) presented the report and discussed:

 

h)    That it was his first statutory report for Plymouth, and that the decision had been taken to focus on women and girls in response to evidence that women in Plymouth had one of the worst healthy life expectancies compared with similar areas;

 

i)      That, while average life expectancy for women in Plymouth was well into the 80s, healthy life expectancy was 55.7 years, almost six years lower than the England average, meaning women in the city were likely to live for approximately 26–27 years in relatively poor health;

 

j)      That this disparity was not just a health issue but one of equity, dignity and opportunity. Women who faced barriers to basic health care often felt unheard and unsupported, and this undermined their ability to thrive;

 

k)     That the report described how the wider determinants of health, such as income, education, housing, safety, and access to green and blue spaces, shaped women’s health, and that these determinants were critical to understanding and addressing inequalities;

 

l)      That the report highlighted positive work already taking place in Plymouth, including the Thrive Plymouth programme with its holistic and trauma?informed framework of ‘Healthy Body, Healthy Mind, Healthy Places and Healthy Communities’, which sought to ensure lived experience shaped service design and delivery;

 

m)   That examples of targeted initiatives included cancer champions working in communities to improve screening uptake and tackle inequalities, investment by NHS Devon in a dedicated menopause pathway and GP training, and the work of organisations such as Improving Lives Plymouth, Trevi and Gifted Women in providing safe spaces and support for women facing multiple disadvantage;

 

n)    That trauma?informed practice was increasingly being embedded across citywide services, alongside strengthened partnerships to address violence against women and girls, recognised as a national emergency with significant local impact;

 

o)    That, despite progress, major challenges remained, including that around one in five women in Plymouth would be considered disabled under the Equality Act, that approximately 36,000 women were estimated to experience at least one incident of harassment each year, and that HPV vaccination rates among girls were below the national average at around 66%, with concerns about the long?term impact on cancer outcomes;

 

p)    That economic inequality was a key concern, with around 80% of women employed in Plymouth earning below the national median salary, and that access to good education and employment was known to be vital to health and wellbeing;

 

q)    That the report called for a focus on improving access to health care (from contraception through to menopause care and cancer screening), ensuring safer public spaces and tackling online harms, addressing economic inequality, and supporting women into education and employment in settings that actively supported their wellbeing;

 

r)     That the voices in the report, including women describing difficulties in accessing GP appointments, fear of walking alone at night and the exhaustion of navigating complex systems, underlined that improving outcomes would require concerted and collective action across organisations, not just from public health;

 

s)     That the report should therefore be seen as a citywide call to action to build a Plymouth in which every woman and girl could live not only longer but healthier, safer, more independent and more fulfilling lives.

 

In response to questions, the Panel discussed:

 

t)     The role of community builders in capturing women’s voices, and concern that the report appeared to reference a community builder post for men but not explicitly for women and girls. It was clarified that community builders had been used to bring women’s voices into the report and that this would be confirmed;

 

u)    The significantly below?average uptake of HPV vaccination among girls in Plymouth, and concern that young women in the city were missing out on life?long protection against cervical cancer. Members questioned what specific best practice, interventions or campaigns could be pursued to increase uptake;

 

v)     The importance of ensuring HPV vaccination was accessible through the school?based vaccination programme and via primary care recall for girls who had missed their initial opportunity. It was noted that HPV would be a core priority within the wider “Protect Plymouth” vaccination campaign, which aimed to address vaccinations across the life course, and that further communications work would be undertaken to understand why girls were not being vaccinated;

 

w)   Opportunities for collaboration with the University of Plymouth and further education providers, including the potential for vaccination clinics linked to the university’s Faculty of Health to communicate with young women, including those not engaged in higher education but in further education. It was confirmed that the Protect Plymouth campaign had historically focused “get ready for university” messaging on meningitis, and that there was an opportunity to broaden this to maximise exposure to HPV vaccination messaging for young women;

 

x)    The need to communicate that HPV vaccination could still be accessed after leaving school and that protection could still be gained, even if the vaccination had not been taken up when first offered;

 

y)     The value of identifying areas of the country with significantly higher?than?average HPV uptake, learning from their best practice and considering how those approaches could be adapted for Plymouth;

 

z)     The high levels of harassment reported in the city and a request for further breakdown of the harassment figures (for example, domestic, external or workplace). It was noted that the figures had been drawn from a Plymouth survey, which captured women who had experienced at least one incident of harassment, and that harassment was often subjective, but further detail would be sought where available and shared with the Board;

 

aa)  The position of women veterans in Plymouth and the reference in the report to a women’s veterans “listening circle”. It was noted that this aspect of the report had attracted significant interest, reflecting that people often did not automatically think of women when they considered veterans, and that more work was required with military partners to understand and support women veterans’ needs;

 

bb)The potential for the city’s major employers to act as a lever for communications, hosting programmes or interventions and amplifying key messages about women’s health, vaccines and support services. It was noted that reducing inequalities for women and girls would be of particular interest to the ‘anchor’ collaboration;

 

cc)  How the findings and themes of the report should be connected into wider strategic work, including developing NHS neighbourhoods and commissioning of services, to ensure that the report’s insights informed priority setting and service design rather than sitting in isolation;

 

dd)The importance of celebrating the value and contribution of women in the city, to avoid the report being framed purely as a deficit narrative. Members emphasised that recognising women’s strengths and contributions was essential to shaping positive, asset?based responses;

 

ee)  The need to link the report into forthcoming discussions about Health and Wellbeing Board strategic priorities and the governance arrangements for neighbourhood teams, with an emphasis on using the Board’s position to drive and oversee progress on women’s health;

 

ff)    Whether the annual report’s focus on women meant that there would be reduced visibility of overall population health trends and men’s health. It was explained that the broader state of health in Plymouth continued to be monitored through the Joint Strategic Needs Assessment, and that a separate, light?touch piece of work was being planned to respond to the Government’s men’s health strategy and consider men’s health in Plymouth, with an intention to bring this back to a future Health and Wellbeing Board;

 

gg)  The balance between targeting multiple issues and focusing on a smaller number of areas for maximum health gain. It was noted that, at whole?population level, cardiovascular disease remained the primary driver of mortality and morbidity in Plymouth, and that considering this within future Board priorities could allow the city to align multiple interventions (for example, smoking cessation and lifestyle changes) towards a common goal;

 

hh)Issues of safety and violence against women and girls, including the experience of women feeling inherently more at risk in public spaces simply by virtue of being female, and the impact this had on decisions such as whether to exercise outside or wear headphones;

 

ii)     A recent local ‘Lift the Curfew’ event, linked to the ‘This Girl Can’ campaign and organised by women’s running groups, which had highlighted concerns about harassment, catcalling and women’s experiences of running and exercising in public, and the intersection between physical activity, health and feeling safe in the city;

 

jj)     The wider question of how well understood it was, particularly by men, that women and girls often perceived a baseline level of risk when moving through public spaces, and that this implicit sense of unsafety was not acceptable. Members noted that while safe, protected spaces for women were important, the longer?term goal must be that all spaces were safe;

 

kk)  The role of schools in shaping safer experiences for girls and young women, and the value of engaging with headteachers and senior leaders, including at primary level, to raise awareness of the report’s findings and discuss how schools could contribute to improving safety, confidence and health outcomes for girls;

 

ll)     The existence of current programmes in schools addressing safety, relationships and behaviour, and the need to raise the profile of women and girls’ safety issues further, including through presentations of the report at headteacher and senior leader conferences;

 

mm)    The links between domestic abuse, women’s safety and public health, and the need to treat domestic abuse as a public health issue as well as a criminal justice matter. Members discussed the recent award of the city’s domestic abuse service tender to a new partnership and the importance of ensuring that the partnership engaged effectively with the wider health system;

 

nn)The need to strengthen the ability of health and voluntary sector services to respond to disclosures of domestic abuse, including building staff competence and confidence to identify and support victims much earlier, rather than after multiple incidents;

 

oo)The value of aligning domestic abuse work with community?based approaches, including the wellbeing hubs and community connections work, and ensuring that training and support were available across the system;

 

pp)The opportunity to share the report with Plymouth’s Youth Parliament and to develop a more accessible summary version for young people, so that young people were aware of issues such as HPV vaccination and could make informed choices as they became able to decide for themselves.

 

Action: The Director of Public Health would clarify the position on community builder arrangements for women and girls;

 

Action: The University of Plymouth would explore, through the Faculty of Health and the wider anchor collaboration, how the university and further education partners could support HPV vaccination uptake and broader women’s health messaging, including options for hosting clinics and joint communications;

 

Action: The Director of Public Health would seek further breakdown and context for harassment statistics used in the report and share clarifications with Board members (for example, domestic, external or workplace).

 

Action: The Director of Public Health, working with the Director of Children’s Services, would consider presenting the annual report and its key messages to a headteacher and senior leader conference, and explore how schools could further support the safety, health and wellbeing of girls and young women, including reinforcing HPV vaccination messaging.

 

Action: The Director of Public Health would work with Youth Parliament representatives to develop and share an accessible version of the report, with particular emphasis on HPV vaccination and other preventative measures relevant to young women and girls.

 

Action: The Director of Public Health would bring an update on Men’s Health to a future meeting of the Health and Wellbeing Board, in order to provide visibility of overall population health trends and ensure that the Board maintained oversight of emerging priorities affecting men’s health alongside the thematic focus on women and girls.

 

The Panel agreed:

 

1. To note the content of the Director of Public Health Annual Report: The Health and Wellbeing of Women in Plymouth;

 

2. To acknowledge the contribution from women in the city and the organisations that supported them, whose experiences and insights had shaped the report;

 

3. To commit to considering what more could be done, individually and collectively, to improve the health and wellbeing of women and girls across the city;

 

4. To recommend that the Director of Public Health collaborates with city partners to ensure HPV vaccine uptake amongst young women in Plymouth increases towards and beyond the national average, and brings an update report to a future meeting of the Health and Wellbeing Board for consideration.