Day 1 - Session 1

What is public health?

Dr Alison HillDirector, South East

Public Health Observatory

Public health

• What is it? (Informed by today’s topical issues)• Early history• Who works in or contributes to public health?• How is it organised?• Main functions• Major public health issues• Some examples of practice

"Health care matters to all of us some of the time,

public health matters to all of us all of the time"

C. Everett Koop

What is health?

What public health issues are in the papers today?

Take one of today’s topical health issues

1 What is the issue? 2 What is the impact on health?3 Who will be affected?4 Who can promote change?5 Who can oppose?6 Who decides?

What is health?“A state of complete physical , mental and social

well-being and is not merely the absence of disease or infirmity.”(World Health Organisation, 1948)

“The extent to which an individual or group is able to realise aspirations, satisfy needs and to change or cope with the environment “(World Health Organisation, 1984)

What is Public Health?The science and art of preventing disease,

prolonging life, and promoting health through the organised efforts of societyAcheson 1988 in the Public Health in England report

• Public health is concerned with improving the health of the population, rather than treating the diseases of individual patients.Chief Medical Officer

Well-being?

For these purposes we will consider health and well-being to be the same thing

Public healthFocuses on the entire population even when they are not ill

Rather than

Individuals when they become ill

Therefore

Public health regards the community as its patient

The Public Health Approach

Is population based • Emphasises collective responsibility for health, its

protection and disease prevention • Recognises the key role of the state, linked to a

concern for the underlying socio-economic and wider determinants of health, as well as disease

• Emphasises partnerships with all those who contribute to the health of the population

• http://www.fphm.org.uk/about_faculty/what_public_health/default.asp

Individual & Population HealthIndividual Population

History Symptoms of illness

Indicators of population health

Examination Signs of illness, bio- chemical tests

Surveillance, epidemiological information, Health Needs Assessment

Diagnosis Label to describe what has gone wrong

Key health issues

Prognosis Outlook associated with individual disease

Outlook associated with trends and disease patterns

Treatment Individual interventions

Population based interventions, Health Protection, screening, Vacc & Imm, NSFs

The parable of the health worker

Every so often a drowning person is swept alongside. The lifesaver dives in to the rescue, retrieves the ‘patient’ and resuscitates them. Just as they have finished another casualty appears alongside. So busy and involved are the lifesavers in all of this rescue work that they have no time to walk upstream and see why it is that so many people are falling in the river.(Ashton and Seymour, 1988, The New Public Health)

Policies and strategies for promoting social equality in health

Hill, Griffiths, Gillam. Public Health and Primary Care: Partners in Population Health. OUP 2007

W H Duncan (1805-1863)• Liverpool Town Council (1847)• Act of Parliament (specific to Liverpool): for the

Improvement of the Sewerage and Drainage of the Borough of Liverpool

• UK’s first medical officer• Died aged 57 “worn down by the uneven contest”

of struggling with Liverpool’s health problems• Obituary: the health of Liverpool was so improved

that there was “no longer any occasion for the salary of a medical officer at £700 per year”

Thanks to Dr Tim Crayford, DPH Croydon PCT

Sir John Simon• First Medical Officer of Health for London

(1848)• Medical Officer to the General Board of

Health (1855 c/o Public Health Act) Lecturer, St. Thomas’ hospital

• Medical Officer to the Privy Council in (1859)• President Metropolitan Association of

Medical Officers of Health (1856-65)• Chief Medical Officer to the local

government board• Published the first annual public health

reports• Vaccination• 'He endured, perhaps with too little patience,

the constantly recurring pinpricks of official interference' Thanks to Dr Tim Crayford, DPH Croydon PCT

John Snow

Who contributes to public health? (even though it may not say so in their job description)

• 3 main categories (CMO)– Professionals who spend some of their time in PH related

work – teachers, other healthcare workers, other government officers, systems engineers

– Professionals who spend major part of their work in PH issues – health visitors, health promotion, information, EHO

– Specialists – strategic/senior level – ability to manage change and lead PH programmes

• Who else?

What does it involve?• Assessment of health needs• Monitor health status of population• Programmes for risk reduction/screening• Communicable disease control• Planning health services• Evaluation of provision of health services• Manage and implement change• Work with other agencies to maximise health gain

How is PH organised?• Department of Health (DH)• Strategic Health Authorities (SHA)• Primary Care Trusts (PCT)• Regional Public Health Groups (RPHG)• Local Authorities and Local Strategic

Partnerships• Health Protection Agency (HPA)• Public Health Observatories• Faculty of Public Health (FPH)

Organisation of public health

DH

RPHG

HPA

SHA

PCT

HPU

FPH Other Government Departments

Regional offices

Local AuthoritiesVoluntary agencies

etc

Main functions

3 main areas

1. Health protection2. Health and social care3. Health improvement

1. Health protection

• Communicable disease control• Environmental health• Emergency planning• Disease and injury prevention

2. Health and social care

• Quality• Clinical effectiveness and efficiency• Clinical governance• Audit and evaluation• Service planning

3. Health improvement

• Inequalities• Lifestyles• Education/housing/employment/environment

– broader determinants of health

Link to inequalities – geographical variations• A boy in Manchester can expect to live over 7

years less than a boy in Barnet• A girl in Manchester can expect to live 6 years

less than a girl in Kensington, Chelsea and Westminster

• but there are pockets of deprivation everywhere and health inequalities affect all parts of the country

• Premature CHD deaths one of the biggest reasons for inequalities

Drivers for Public Health (1)

Drivers for public health (2)• Wanless and the PH imperative• Policy: Tackling Inequalities & Choosing Health• Public Service Agreements (PSA)• Community Service Agreements (CSA)• Local Authority Agreements (LAAs)• Local Strategic Partnerhsips (LSPs)• Local Operational Plans (LOPs)• Organisational change – reform agenda PBR / PBC and

new structures• Financial imperatives and contrary aims

Summary• Public Health contributes to health on a

population basis by assessing needs, interventions and by implementing population level changes by working within and beyond the health sector

• Public Health is vital if we are to prevent illness and have affordable health care, now and in the future

• Organisational change and government policies both help and hinder the public health agenda

You should now know a little about:

• What is it?• Early history• Who contributes to public health?• How is it organised?• Main functions• Major public health issues• Some examples of practice