The Changing Context for Health and Wellbeing
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Transcript of The Changing Context for Health and Wellbeing
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School of Medicine, Pharmacy & Health
School of Medicine, Pharmacy & Health
The Changing Context for Health and Wellbeing
Presented by David HunterProfessor of Health Policy and Management7th November 2013
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School of Medicine, Pharmacy & Health
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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)
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Wanless’s CritiqueNumerous 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 health service’). This will not happen until there is a realignment of incentives in the system to focus on…tackling the key lifestyle and environmental risks.
Derek Wanless (2004), Government Adviser
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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)(former local authority chief executive
and adviser to Department of Health)
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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)
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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
‘Lifestyle drift’ policy bias, especially evident in England
Medical resistance to non-medical specialists
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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
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Looking Forward
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Emerging Issues Progress in embedding public health in local
government
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Emerging Issues Organisation of public health function: centralised
versus distributed model
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Emerging Issues How is Public Health England being viewed?
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Emerging Issues Health and Wellbeing Boards: are expectations
too high?
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Emerging Issues Where is public health on the national agenda?
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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
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From ‘Lincoln’
A compass, I learnt when I was surveying, it’ll…it’ll point you true North from where you’re standing, but it’s got no advice about the swamps, deserts and chasms that you’ll encounter along the way. If in pursuit of your destination, you plunge ahead heedless of obstacles, and achieve nothing more than to sink in a swamp, what’s the use of knowing true North?
Abraham Lincoln (Daniel Day- Lewis) speaking to Thaddeus Stevens (Tommy Lee Jones)
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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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WHO Europe Health 2020
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Key Principles Underpinning Health 2020
Renewed emphasis on public health Health is wealth Health inequalities must be redressed Health systems are more than just health care Whole of society and whole of government approaches
needed Systems thinking approach adopted to analyse problems
and devise solutions From analysis to supporting delivery
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Health 2020: Key Studies
Health 2020
Governance for health in the 21st century (Ilona Kickbusch)
Report on social determinants of health and the health divide
in the WHO European Region (Michael
Marmot)
The economic case for public health action (OECD)
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Health 2020: How does it differ from its predecessors?
Health for All (1980) Health 21 (1998) Tallinn Charter: Health Systems for Health and Wealth
(2008) Health 2020 (2012) The difference....
Focus on implementation and the importance of European Action Plan
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European Action Plan (1)Avenues for Action Surveillance of population health and wellbeing Monitoring and response to health hazards and
emergencies Health protection including environmental and
occupational health, food safety and others Health promotion, including action to address social
determinants and health inequity Disease prevention including early detection of illness
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European Action Plan (2)Avenues for Action Assuring governance for health and wellbeing Assuring a sufficient and competent public health
workforce Assuring sustainable organisational structures and
financing Advocacy, communication and social mobilisation for
health Advancing public health research to inform policy and
practice
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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
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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
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The Journey Continues…
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Until…
Election in May 2015 – more change in prospect?