Public Health and Healthy Local Government

Maggi MorrisExecutive Director of Public Health

Central Lancashire

Overview

• What is health and what is public health?• 150 years of public health• Ways of working, making it work• How public health is organised now and in the

future • Opportunities and benefits• What it means to you as elected members

What is Health?

World Health Organisation

And, health means different things to different people

So, what does public health mean?

What comes to mind when you think of public health?

Definition of Public Health

“The science and art of preventing disease, prolonging life and

promoting health through the organized efforts and informed choices of society, organizations, public and private, communities

and individuals.” (Winslow. 1920)

Influences on illness, health & wellbeing

Social Psychological

Environmental

Biological

Public health

Concerned with the interactions between the influences on illness, health and wellbeing

Why are people healthy and well?

• Understand why people that experience risk factors and risk conditions are healthy and well

• How can we help people and populations to cope and flourish?

• Focus on health rather than disease

80% of the influences of health and wellbeing are outside health services

World Health Organisation

150 years of Public Health

Duncan, Liverpool

The impact of low cost alcohol on

the working class

John Snow Cholera

epidemic, London

1854

Trends in life expectancy in England and Wales since 1700

The creation of the NHS - 1948

Four phases of modern public health in the UKFirst wave: 1830-1900

• Environmental, sanitation, housing improvements

Second wave: 1890-1950• Therapeutic era, rise of hospital

services, • antibiotics

Third wave 1940-1980• Welfare State, Health Education

The New Public Health: 1970-2000• Ecological approach to health and wellbeing

The three legs of the Public Health stool

Health Protection

What is it?• Protecting the population

from threats to health and wellbeing, including:– Infectious diseases– Chemicals and poisons– Radiation– Major incidents and

emergencies – Environmental health

hazards– Floods– Violence and abuse

How do we do it?• Undertake communicable

disease control• Promote infection control• Develop community and

individual resilience• Commission vaccination and

immunisation programmes• Undertake emergency

planning and manage response to major incidents

• Integrated solutions

Health Improvement

What is it?• Keeping people

well• Promoting good

health • Preventing ill health

and disease• Addressing

inequalities in health

How do we do it?• Work with partners accountable for

the root causes of health• Develop healthy settings (e.g.

healthy schools, councils, workplaces• Promote healthy behaviours

(tobacco control, physical activity, healthy weight)

• Address risk conditions and risk factors

• Commission prevention services for those at high risk of disease

• Prevent relapse or exacerbation in those with disease

Health and social service quality

How do we do it?• Develop and implement

commissioning policies• Evidence based practice• Efficiency and health

economics• Service planning and

commissioning • Clinical governance• Equity audit• Quality assurance and

improvement

What is it?• Ensuring health

and social care services are effective, of high quality and equitable

Public Health Approaches

• Intelligence and analysis • Evidence of what works • Asset approaches to producing health and

wellbeing • Communication and social marketing

Principles

•Equity•Community Participation•Intersectoral Collaboration•Sustainable Development

Health for All

Organisation of Public Health

Before 1974Medical Officer for Health

within local authoritiesResponsible for :

Health of the populationAdministration of

community health services (family planning,

environmental health, health visiting, health

centres)

1974-2013Community physicians

(1974-1989)/ Directors of Public Health (1989-2013)

Based within the NHS (health authorities/ primary

care trusts)Responsible for:

Health of the populationProviding/ planning/

commissioning preventative services

Public health advice to Planning/ commissioning of

NHS treatmentBut not Environmental

health

From 2013Directors of Public Health

based within upper tier local authority

Responsible for the health of the population: health

improvement, health protection, health and social service quality

Public Health England, Executive agency of the Department of Health

National Commissioning Board responsible for commissioning some prevention and public health services (health

visitors, screening)

Opportunities• Local government the locus for health and wellbeing• Shift the balance towards addressing the determinants of health• Localism - Local responsibility and influence for health and

wellbeing• Increase democratic legitimacy for health and grow civic society• Citizens and communities have greater influence on the health

and wellbeing agenda• Unlock community assets and capacity for wellbeing and

prevention• Maximise individual and community resilience to promote

wellbeing and independence• Leadership and influence to re-organise primary care

Role of elected members?

• Add to the intelligence on assets and needs through contact with communities

• Influence public health priorities • Balance evidence of effectiveness with

considerations of would work locally• Advocate for the health and wellbeing of your

constituents• Influential community leaders and champions

for health and wellbeing

Five scenarios

Aims of the scenarios:– to explore your role in public health

– to understand how the local public health service can support you

Scenario 1 – seasonal flu vaccination

Scenario 2 - Affordable warmth

Scenario 3 – Workplace health

Scenario 4 – Alcohol harm

Scenario 5 – Sexual health