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School of Medicine & Health
The Return of Public Health to Local
Government and the Implications for
the Public Health Workforce: New
dawn or poisoned chalice?
Presented by David Hunter
Professor of Health Policy & Management
21st June 2012
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A Little History
History tells us that local government played the
greatest historical role in the sanitary revolution
during Britain’s rapid industrialisation
 Improved housing
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 Cleared nuisances
 Introduced gas lighting
 Provided public bathing and washing facilities
 Infectious disease control through MOH
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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
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than weakly developed, notwithstanding claims
to the contrary, habitually made in ministerial
speeches.
Charles Webster (1996)
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Local Government: public health’s
natural home
Many people in local government believe
it is their organisations, rather than health
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authorities, that are public health
authorities.
Tony Elson (1999)
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The Main Determinants of Health
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New Public Health System: A tale
of two parts
 Return of public health locally to local
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government
 Creation of Public Health England at
centre
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Is the Glass Half-Empty?
 Demise of the public health profession as
we know it: future of specialistpractitioner-wider workforce paradigm at
risk
 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
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From public health medicine to
public health
 Clinical public health workforce uncertain,
demoralised, demotivated
 Are their skills still fit for purpose?
 Dilution of epidemiology and
∂ emphasis on finance
and politics
 Focus on short-term rather than long-term
 Where will career support and advancement come
from?
 How will public health presence in NHS be secured?
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Or is the Glass Half-Full?
 Welcome opportunity to transform the way
public health is conceived and delivered
 Need for new skills and competencies – not a
case of preserving the old and familiar
 Potential for new leadership focused on
influencing others engaged in health
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improvement and wellbeing
 Opportunity to break away from the shackles of
a biomedical model and to embrace a social
model: from a deficit to an assets-based
approach to tackle SDH and Marmot agenda
 New opportunities to strengthen the evidence
base
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Strengthening the Evidence Base
 NICE public health guidance being given a
makeover to be more local government facing
 Relationship between NICE
and PHE
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 NIHR School for Public Health Research
(SPHR)
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NICE’s Public Health ‘Offer’
 Evidence reviews, guidance, quality
standards, other evidence based outputs
 Accreditation of other public health guidance
producers
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 Methodological leadership and support on
optimal ways of reviewing and appraising
evidence
 QOF for public health
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NIHR SPHR
 Narrowing gap between users and suppliers
of research
 Increasing evidence base for effective public
health practice: applied
∂ research
 Undertaking applied translational research
 Considering local public health needs and
evaluating innovative local practices with the
potential for wider benefit
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What we Already Know about
Improving Health and Wellbeing
 Complex: ‘wicked issues’, cross-cutting, multifactorial, multi-levelled
 Evidence base is patchy,
uneven, poor fit to
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local context, often contested
 Uptake of evidence-based changes is poor
 Bias towards ‘lifestyle drift’
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Evolutionary Trends
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Source: The Economist, 12 November 2003.
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5 Questions to Ask Yourself
Question 1
Do the interactions among the various
∂ parts of the complex public health
system generate energy and innovative ideas for change, or do they drain
the system?
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Question 2
Are decisions about change made rapidly and by the people with the
most knowledge of the issue, or is change bogged down in hierarchy
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and position-authority?
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Question 3
Do individuals and groups acquire and exercise power in positive,
constructive ways toward a collective purpose, or is power coveted
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and used mainly for self-interest and self-preservation?
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Question 4
Are conflicts and differences of opinion embraced as opportunities to
∂ these seen as negative and
discover new ways of working, or are
destructive?
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Question 5
Is the system naturally curious and eager to learn more about itself and
about what might be better, or is new
∂ thinking viewed mainly as
potentially risky and threatening to the status quo?
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