Taking the Long View of Public Health
Download
Report
Transcript Taking the Long View of Public Health
∂
School of Medicine Pharmacy & Health
Taking the Long View of Public
Health: a new dawn or poisoned
chalice?
Presented by David Hunter
Professor of Health Policy and Management
31st October 2013
School of Medicine Pharmacy & Health
What is Public Health?
Public health is the science and art of preventing
disease, prolonging life and promoting health
through the organised efforts
of society.
∂
Sir Donald Acheson, former Chief
Medical Officer for England (1988)
School of Medicine Pharmacy & Health
Domains of Public Health
Health protection
Health promotion
Health service performance
∂
UK Faculty of Public Health
School of Medicine Pharmacy & Health
A Tale in Two Parts
Looking back
A not too Horrible History of
Public Health
∂
School of Medicine, Pharmacy & Health
A Tale in Two Parts
Looking forward
New dawn or poisoned
chalice?
∂
School of Medicine, Pharmacy & Health
Looking Back (1)
History tells us that local government played the
greatest historical role in the sanitary revolution
during Britain’s rapid industrialisation in 1800s
Improved housing
∂
Cleared nuisances
Introduced gas lighting
Provided public bathing and washing facilities
Implemented infectious disease control
School of Medicine, Pharmacy & Health
Looking Back (2)
Rediscovery of public health in more recent times
Rise of non communicable diseases: cause of
86% of deaths in the WHO European Region – 53
countries, 900 million people
Smoking
Obesity
Alcohol misuse
∂
Communicable disease control: flu pandemics,
sexually transmitted infections
School of Medicine, Pharmacy & Health
Looking Back (3)
From 1974 - 2013 the National Health Service
(NHS) had responsibility for public health
Clinical dominance of public health workforce
Multidisciplinary public health workforce becomes
a reality (2003):
∂
Introduction of UK voluntary register for public health
specialists
Faculty of Public Health Medicine becomes Faculty of
Public Health
Joint Directors of Public Health appointments between
NHS and local government
School of Medicine, Pharmacy & Health
Public Health and the NHS: a
difficult relationship
While the NHS claimed from the outset to give
high priority to the promotion of health…in reality
this aspect of the service was never more than
∂
weakly developed, notwithstanding claims to the
contrary, habitually made in ministerial speeches.
Charles Webster (1996)
(Official NHS Historian)
School of Medicine, Pharmacy & Health
Looking Back (4)
Brief renaissance of public health under New Labour: first
Minister for Public Health (1997)
Wanless I (2002) and II (2004): 'fully engaged scenario'
Joint Directors of Public Health posts: recognition of local
government's role in public health – 'multidisciplinary public
health will become a reality' ∂(Blears, 2002)
NICE assumes responsibility for public health evidence
(2005)
World class commissioning: focus on population health
(2007)
The Marmot Review: focus on SDH (2010)
School of Medicine, Pharmacy & Health
Wanless’s Critique
Numerous policy statements and initiatives in the
field of public health have not resulted in a
rebalancing of policy away from health care (a
‘national sickness service’) to health (a ‘national
∂ happen until there is a
health service’). This will not
realignment of incentives in the system to focus
on…tackling the key lifestyle and environmental
risks.
Derek Wanless (2004), Government Adviser
School of Medicine, Pharmacy & Health
Looking Back (5)
Persistent tension between focus on individual
lifestyle change (nudge) and government action to
improve health (shove): ‘lifestyle drift’ prevails over
‘nanny state’
∂
Responsibility deals
Behaviour Insights Team (Nudge Unit)
No action on plain packaging for cigarettes or
alcohol minimum pricing
School of Medicine, Pharmacy & Health
Where are we Now?
The coalition programme…involves a restructuring
of…public services that takes the country in a new
direction, rolling back the state to a level of intervention
below that in the United States – something which is
unprecedented. Britain will abandon the goal of attaining
∂
a European level of public provision. The policies include
substantial privatisation and a shift of responsibility from
state to individual.
Taylor-Gooby and Stoker, The Political Quarterly (2011)
School of Medicine, Pharmacy & Health
Reflections: the Negatives
Public health caught up in neoliberal agenda:
from the welfare state to the market state
Continuing tension between the nanny state
and the enabling state
∂ especially evident in
‘Lifestyle drift’ policy bias,
England
Medical resistance to non-medical specialists
School of Medicine, Pharmacy & Health
Evolutionary Trends: How far
have we really come?
∂
Source: The Economist, 12 November 2003.
School of Medicine, Pharmacy & Health
Reflections: the Positives
Acknowledgement of wider public health
and its multidisciplinary workforce
Smoking ban – example of government
action with public support
∂
Example of evidence informed
policy
Recognition of local government’s
key role in public health
School of Medicine, Pharmacy & Health
Looking Forward
∂
School of Medicine, Pharmacy & Health
Key Challenges
Return of public health to local government
(April 2013): realising the potential
New organisation at centre to lead on public
health: Public Health England
∂
Making the public health workforce fit for
purpose with new skills
Changing leadership styles
Applying evidence and strengthening
knowledge to action
School of Medicine, Pharmacy & Health
Local Government: public health’s
natural home
Many people in local government believe it
is their organisations, rather than health
∂
authorities, that are public
health authorities.
Tony Elson (1999)
(former local authority chief executive
and adviser to Department of Health)
School of Medicine, Pharmacy & Health
The Main Determinants of Health
∂
School of Medicine, Pharmacy & Health
Meeting the Public Health Challenge
Investment in public health
Health spend per capita: £2000 per year
Preventive spend: £80 per year (4%)
Using ring-fenced public health budget to unlock
resources elsewhere in∂ local government
New partnerships: are Health and Wellbeing
Boards the answer?
New skills and competencies required
Relationship building
Political astuteness
School of Medicine, Pharmacy & Health
Concluding Reflections (1)
Is the glass half-empty?
Demise of the public health profession as we
know it: future of specialist-practitioner-wider
workforce paradigm at risk
End of DsPH as we know them
∂
Emergence of a divided and fragmented
workforce split between different cultures
Failure to recognise and invest in public
health skills training
Devaluing the evidence base in political
world of local government
Time of austerity: public spending cuts
School of Medicine, Pharmacy & Health
Concluding Reflections (2)
Is the glass half-full?
Transform the way public health is conceived and
delivered
Break away from the shackles of a biomedical
model and embrace a social model: from a deficit to
an assets-based approach
∂
Develop new skills and competencies
– not a case
of preserving the old and familiar
Embed new leadership style focused on influencing
others engaged in health improvement and
wellbeing
Use of ring-fenced public health budget to lever in
resources from elsewhere
School of Medicine, Pharmacy & Health
The Journey Continues–
Thank you!
∂
School of Medicine, Pharmacy & Health