Presented by David Hunter Professor of Health Policy & Management 21st June 2012

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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 HunterProfessor of Health Policy & Management21st 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 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 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 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 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 specialist-practitioner-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 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 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 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, multi-factorial, multi-levelled

Evidence base is patchy, uneven, poor fit to local context, often contested

Uptake of evidence-based changes is poor Bias towards ‘lifestyle drift’

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Evolutionary Trends

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

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

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

discover new ways of working, or are these seen as negative and

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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Presented by David Hunter Professor of Health Policy & Management 21st June 2012

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Transcript of Presented by David Hunter Professor of Health Policy & Management 21st June 2012