Blog by Dr Emily Clark, Public Health Registrar, Public Health Wales; Member of the Faculty of Public Health Child Health Special Interest Group

The views expressed in this article are the author's own, and do not necessarily reflect those of other organisations or agencies the author is affiliated with.

We all know the saying “we do not inherit the Earth from our ancestors, we borrow it from our children”. But, as a society, we haven’t exactly been putting our words into action. That’s where the Well-being of Future Generations (Wales) Act 2015 comes in! You don’t need to read too much about the Act to realise just how important it is in a world facing increasingly complex problems, like COVID, climate change, and environmental breakdown. It’s a world-first piece of legislation, and the world is watching Wales.

The Act’s progress is kept in check and supported by the first Future Generations Commissioner, Sophie Howe. She was kind enough to grant me some of her time so I could quiz her on what she calls “the best job in the world”. (1) As you might expect, her energy and passion for her job was contagious, and brightened up an otherwise cold February day in Cardiff.

A cursory look through any media outlet will demonstrate the enormity of the task ahead as we face interrelated problems playing out on a national and global scale. How does she decide where to start and what to prioritise? At the start of her term, Ms Howe asked people across Wales: “what are the things that if we got right would make the biggest contribution to each of the seven national well-being goals?” Two themes emerged: infrastructure and people. Within infrastructure, three priority areas of housing, planning, and transport were identified. Improvements here should impact health, equality, decarbonisation, biodiversity, poverty. The three priority areas identified on the theme of people were jobs or skills for the future, better ways of keeping people well, and adverse childhood experiences (ACEs). The cross-cutting priority of decarbonisation was selected due to the climate emergency. Not at all overwhelmed by the task ahead, Ms Howe continues by saying that “both the beauty and the challenge of the Future Generations Act is that it covers everything”. The challenges? We know about the wider determinants of health, and we know that silo-based working isn’t the most effective, yet we still focus on treatment over prevention, and we still work in silos. And the beauty? “Everything is connected to everything. When you start looking through a different lens: environmental justice is a racial justice issue, because why is it that if you're from a BAME background, you're more likely to live in areas of high air pollution?”

With what I’ve learned about the world, encouraging people to think about well-being as a more aspirational and better metric than finances must also be a challenge. However, Ms Howe thinks that change is in the air! “Our younger generations, Millennials increasingly entering into work, or being in the workplace and entering into leadership decisions, Generation X and Z coming behind them: they have different aspirations”, she tells me. They value “their work-life balance, they are increasingly embracing vegetarianism and veganism… fewer young men in particular are learning to drive, for example, because they are embracing physical activity…I think that there's a different mindset coming up, which is challenging the status quo and is a lot more focused around well-being.” The impact of COVID might be seen here, too. As we have all been confined to our local areas, it’s given us an opportunity to ask ourselves, “what is it that matters in life?”. The answer: relationships - “it's your sense of community”. Ms Howe cites recent research using the National Well-being Indicators, linked to the Well-being of Future Generations Act. One key question is, “is there a sense of community in the place that you live?”. Prior to COVID, 52% of respondents believed that there was a sense of community, but results from December 2020 showed an increase to 74%. Recent polls echo this desire amongst young people to prioritise well-being over economics. “I think a combination of all of those things, younger generations, COVID, that changing political climates and views are all starting to raise well-being policies on the agenda.” Watch this space!

The conversation moved to COVID – as all conversations do at the moment. I wondered how the Act can be used to reduce the inequalities across Wales that have been exacerbated by the pandemic. Incorporating the 5 ways of working from the Act in her own thinking, Ms Howe reflects that it was predictable that “those people who would be hardest hit by COVID would be our most deprived areas, or BAME communities. Grenfell exposed a whole load of things that lots of people knew about already - it all goes back to socioeconomic disadvantage, and voices of people and whether they're listened to.”

“When things enter into the public consciousness, they move up the agendas of politicians. I think that there are significant opportunities now, when everyone is talking about the green and just recovery,” she continues. She is currently investigating the potential for jobs in the green economy in Wales, based on Wales TUC estimates that 60,000 new jobs could be created in the next two years (2). Jobs could be in housing retrofits (“good for health reasons, decarbonisation reasons”), or electric vehicle infrastructure (“not so good for health reasons, but good for decarbonisation and reducing air pollution”), for example. “However,” she warns, “we have nowhere near the skills pipeline to take advantage of those 60,000 new jobs that could be created”, and the concern is that these jobs would not necessarily benefit those who need them most. “So when you talk about green and just recovery, you can't just do the soundbite, you actually have to work down through all of your systems and get into the real kind of nitty gritty of how that green and just recovery is going to make any difference to a female who might be Black, for example, as we know ethnic minorities have been disproportionately affected by both Covid and the climate crisis.”

As a blog post for the BACAPH it was critical to ask about how the Act can benefit the children and young people of Wales! Ms Howe first started advocating for young people “many moons ago” and told me a story which clearly made an impact on her at the time, and is something she still reflects on even to this day. In a previous job as a councillor, she worked with young people to get a local skatepark. Shortly afterwards, the adults started to complain about the noise. Of the four councillors in her patch, three voted to close the skatepark, with Ms Howe the only councillor fighting to keep the skatepark open. Even after all this time, “I often reflected on how different that might be if those 16-year olds who were using the skate park had had a vote, and how that might have led to a different decision by the other by the other councillors… I don't think that you can underestimate the power of that in terms of young people's issues and getting on the agenda.” It will be interesting indeed to see the impact of 16-year olds in Wales getting the vote this year for the first time.

Reiterating her earlier point about listening to the voices of those in your community, Ms Howe states, “we need to be hearing the voice of young people…throughout all of our decision-making infrastructure.” She immediately illustrates this with an example, “people are recruited to public appointments in Wales on the basis of previous experience of governance, risk, financial expertise, and so on. Is anyone asking, “is there anyone on this board who has any idea about the needs or interests of future generations?” No, they're not. And so we need to be having that as a specific criteria in any decision making forum.”

Happy as ever to turn things on their heads, I had read about Ms Howe’s vision for a National Wellness System. In the few remaining minutes of our call, I wanted to know what this would look like. Demonstrating her personal commitment to considering wider determinants of health, she tells me, “one of my favourite graphs is from the World Health Organization on the determinants of health inequality: 35% of the difference in life expectancy gap being down to income, or income security and social protection; 29% is living conditions; 19% is social situations, relationships, community.” Turning information into action, Ms Howe quickly follows up: “what I want to see at a strategic level from governments is how they are investing in those areas that are most likely to keep people well and to reduce that health inequality gap.” She has been investigating the feasibility of a Universal Basic Income in Wales, and applied the lens of the Act. Even prior to COVID, there were an increasing number of people experiencing unstable work, and that has only worsened over the last year. “We’re looking at the impact a basic income could have on poverty and the emerging results are hugely significant,” she informs me, “what impact would that have on health and well-being?“. And finally, because economics are still currently the bottom line – “what could be the cost savings to services by reduction in demand in those areas?”

Sophie Howe’s Manifesto for the Future outlines features of a National Wellness System, including improving housing quality, reducing air pollution, and working to protect our environment (3). The government has already committed to enable people to access nature within 300 metres of home, and the creation of 20-minute neighbourhoods (where all services should be accessible within a 20 minute walk, cycle, or public transport journey).

Closing the interview with a bright vision for the future, Ms Howe leaves me with this: “I think the closest that I've seen to what we're trying to describe is in Bromley by Bow. It's the only GPs surgery you can go to, to drop off a urine sample and join the choir! In a nutshell, in the hub - you might see the GP if it is a particular medical problem, but there's not an assumption that it's a medical problem that needs to be addressed, the lead might actually be the social prescribing coordinator, or might be the physiotherapist, or might be the debt advice people.”

A GP surgery where you can drop off a sample and pick up new singing skills is definitely the surgery for me (as anyone who has heard me sing will attest to!). This is just the tip of the Act-iceberg – we didn’t have time but I would have loved to have asked Ms Howe about her office becoming the first in Wales to provide paid leave for employees experiencing domestic emergencies such as escaping domestic violence as part of an ACE-informed approach (4); about the international partnerships the Act has set up (5); about her vision for a Ministry of Possibilities (6). It’s clear that she means it when she says, “we have big ambitions for protecting our environment and future generations in Wales” (7) – so watch this Welsh-shaped space closely!

A companion article with additional details was written for the BACCH Newsletter June 2021 edition. Please visit their website for further details.

What is the Well-being of Future Generations (Wales) Act 2015?

The Act aims to improve the social, economic, environmental, and cultural well-being of people in Wales (1), which are also the 4 pillars of sustainable development.

All public bodies in Wales are legally required to incorporate the 5 ways of working, which means they should:

  1. Balance short term needs with long term needs
  2. Prevent problems from worsening or occurring in the first place
  3. Integrate well-being objectives with other objectives within organisations
  4. Collaborate with other organisations and individuals
  5. Involve communities

There are seven well-being goals (Figure 1) to which all public bodies must work towards, which set a vision for a Wales that we would all like to live in.

The Well being goals

Figure 1. The Well-being Goals (8)

References

1) Welcome to the Jungle. Sophie Howe on working for future generations [Internet]. Welcome to the Jungle. [Accessed 27.04.2021] Available from: https://www.welcometothejungle.com/en/articles/sophie-howe-future-generations-commissioner

(2) Future Generations Commissioner for Wales. Equality skills gaps in green jobs, finds new analysis by Future Generations Commissioner, Wales TUC and NEF [Internet]. 2021. Wales: Future Generations Commissioner for Wales. [Accessed 30.04.2021] Available from: https://www.futuregenerations.wales/news/equality-skills-gaps-in-green-jobs-finds-new-analysis-by-future-generations-commissioner-wales-tuc-and-nef/

(3) Future Generations Commissioner for Wales. Manifesto for the Future [Internet]. 2020. Wales: Future Generations Commissioner for Wales. [Accessed 27.04.2021] Available from: https://www.futuregenerations.wales/manifesto-for-the-future/

(4) Future Generations Commissioner for Wales. Domestic abuse survivors at Future Generations Wales will get financial support to leave an abusive relationship [Internet]. 2020. Wales: Future Generations Commissioner for Wales. [Accessed 20.04.2021] Available from: https://www.futuregenerations.wales/news/domestic-abuse-survivors-at-future-generations-wales-will-get-financial-support-to-leave-an-abusive-relationship/

(5) Future Generations Commissioner for Wales [Internet]. Wales: Future Generations Commissioner for Wales. [Accessed 20.04.2021] Available from: https://www.futuregenerations.wales/making-it-happen/international/

(6) Future Generations Commissioner for Wales. Case Study Bank [Internet]. Wales: Future Generations Commissioner for Wales. [Accessed 20.04.2021] Available from: https://www.futuregenerations.wales/international_work/case-study-bank/

(7) Future Generations Commissioner for Wales. Well-being of Future Generations (Wales) Act 2015 [Internet]. Wales: Future Generations Commissioner for Wales. [Accessed 20.04.2021] Available from: https://www.futuregenerations.wales/about-us/future-generations-act/

(8) Future Generations Commissioner for Wales. Well-being of Future Generations (Wales) Act 2015 The Essentials [Internet]. 2015. Wales: Future Generations Commissioner for Wales. [Accessed 20.04.2021] Available from: https://www.futuregenerations.wales/wp-content/uploads/2017/02/150623-guide-to-the-fg-act-en.pdf

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