200 Days On – My Reflections as ADPH President

(given as the introduction to the December 2018 ADPH annual conference)  

It’s 200 days today since I was inaugurated as President of the ADPH. Usually Presidents get asked what they’ve achieved in their first 100 days – but I’m proposing that, seeing as I’m a part-time President, my time gets doubled. So, time to see how we’re doing on the priorities I set out in May:

• Challenging the norm and advocating for equality in all its forms
• Developing a vibrant, member-led organisation
• Promoting our unique local system leadership role
• Ensuring we continue to be well-respected as an organisation – but with an ‘edge’ 

My first priority was to seek to highlight the insidious normalisation of injustice or structural inequalities related to some or other characteristic of who we are – our class, race, gender, disability. This normalisation of inequality in our society serves to protect the power of some groups over others, yet it is unjust and profoundly damaging to our health and wellbeing.  

When I spoke at my inauguration in May, the UN’s Special Rapporteur on racism had just published their report, which noted that racism in Britain was becoming ‘normal’ again. This week, analysis showed a record number of children are being excluded for racist bullying (The Guardian, 1 December 2018).  

And in November, we had the report of the UN’s Special Rapporteur on extreme poverty and human rights, which found that ‘for almost one in every two children to be poor in twenty-first century Britain is not just a disgrace, but a social calamity and an economic disaster, all rolled into one’. He noted that it was women and children and those most vulnerable who were being disproportionately impacted by recent tax and welfare reforms. The 49% real-term reduction in government funding from 2010/11 to 2017/18 was cited as a contributory factor, with people no longer having access to the vital services they needed. The UN’s Rapporteur’s view was that the UK government could end poverty if it wanted to. 

Many believe that austerity is now actually costing more to the UK government than it is saving, with the Rapporteur noting: ‘the many billions [taken from] the benefits system since 2010 have been offset by the additional resources required to fund emergency services by families and the community, by local government, by doctors and hospital accident and emergency centres, and even by the ever-shrinking and under-funded police force.’  

While the renewed focus on ‘prevention’ is welcome, the reality is that interventions to prevent poverty, poor outcomes and mental distress are being cut on a massive scale. And the money and focus continue to prioritise crisis management – rising A&E attendance, knife crime, suicide, homelessness.  

Increasingly, our members are shining a light on the negative impact that the changes in our public services are having on citizen’s health; this month the Guardian covered research commissioned by Alice Wiseman, DPH Gateshead, on the negative impact of the roll out of Universal Credit particularly on claimants with disabilities, mental illness and long-term health conditions, as well as homeless people, forces veterans and care leavers. The findings led Alice to make the damning comment that: ‘I consider universal credit, in the context of wider austerity, as a threat to the public’s health.’  

Our members have also been leading efforts to challenge the new cultural norms created in society by commercial interests, which perpetuate the concept that our major public health issues are down to a collective failure of individual willpower. In London, Danny Ruta, Steve Whiteman and Vicky Hobart have been key in the efforts to challenge what’s normal to impose on our children, with the ban on junk food ads across the Transport for London network; or Ruth Tennant’s work with ASH on reducing children’s exposure to smoking in their homes.   

Today, we are in the middle of the international 16 Days campaign to end violence against women and girls. The ability of those in power to maintain their positions through normalisation and victim-blaming is no better demonstrated than by this form of violence and control. We kick-started our ADPH policy work on violence (in all its forms) through a lively conversation at the ADPH Council in October – and hope many of you will be engaged as it evolves.  

And finally, I recently had a fantastically positive challenge to my own preconceptions of what’s normal, when Becky Rich, a Dance Leader and Ambassador for DanceSyndrome (http://dancesyndrome.co.uk/) – a dancer-led, disability-inspired organisation – spoke about her many years managing her heart condition, how she had lost 3 stone through dance and healthy eating, and how she wanted to support others to do the same. I celebrate Becky who inspires us all to challenge the norms that limit us from living our lives fully. 

My second priority was you, our membership. Today, our ADPH conference was over-subscribed for the first time, with a waiting list – that suggests to me a vibrant organisation, where people want to be a part of a body that learns, challenges and improves, together. I’m particularly thankful for the contributions that our members make through the Board, our strengthened Council and soon-to-be reinvigorated Policy Advisory Groups (PAGs); many have also been active through our peer mentoring, our immersive days (one on DsPH with expanded portfolios is coming up in March; do send ideas for further topics!) and the recent workshop for new DsPH – please join in and be part of our growth.  

I, with members of our brilliant ADPH team, have been visiting many of you across England – Cheshire and Merseyside, Yorkshire and the Humber, the east of England, the north east and the south east of England, and in Wales. I’ve enjoyed getting out to meet you and hear about your challenges and successes – you’re doing amazing work under increasingly difficult circumstances. What’s struck me is how committed you all are to improving the public’s health in our local places – but that we also have our heads raised to working to improve as a sector, respectively and collectively, in our regions and at a country level.  

I’m looking forward to connecting with those of you I haven’t yet met, when I complete this round of first visits early next year.   

I’ve also enjoyed hearing our members’ voices commenting on visions and plans and budget decisions, prevention, population health and public health interventions. For this contributes to what’s needed to deliver on my third and fourth priorities – promoting the unique leadership role of the DPH in local systems; and ensuring we continue to be a well-respected – and ‘edgy’ – voice for public health nationally.  

These priorities require a lot of relationship-building – with Public Health England and Public Health Wales, the LGA, ADASS, ADCS, the Faculty, Royal Society, and of course with the NHS. And the ADPH team and many of you, our members, have worked tirelessly to ensure that we get our voice into the many spaces and places shaping our context and our role as DsPH within this – from PHE’s and other agencies’ initiatives, to the NHS long term plan and the Secretary of State’s prevention vision, to the budget and forthcoming spending review. 

We need to - and are - raising our public voice and profile, developing our ‘edginess’ and trumpeting our successes – through tweeting and writing blogs and pieces for the LGC, HSJ, BMJ and elsewhere, and presenting our local work nationally, in the media, through social media, conferences or hosting visits. And we’ve also continued our presence in public hearings, parliamentary committees and other parliamentary bodies, and the many different summits and conferences.  

At November’s Health and Care Committee on the impact of the budget on health and care, the messages I gave were:  

• Prevention – or health creation – needs investment in all the things that help make us happy, healthy and able to lead fulfilling lives – our childhoods, our friends and our play and learning, our houses and the places where we eat and live, and our occupation and income. Yet there has been a 40% cut to local government funding and a £700m cut to the Public Health Grant over the last 5 years (2014/15 – 2019/20)  
• DsPH have been doing the best we can, and managed the cuts to the Grant through innovation and transformation of our teams and services (many provided by the NHS) and through a focus on integrating and strengthening local systems; but this is not sustainable   
• We are local system leaders and ambitious for our population’s health, with proven positive impact – just think what more we could achieve if we were fully resourced. 

We need to continue to develop and strengthen our key messages and overarching narrative. We need you to help us do this with your examples of local successes – watch out for the requests for this, and please contribute yours.  

So, 200 days on: 

• Priority 1: With Brexit on the horizon, there are many areas for concern in our society, and we need to keep calling these out and championing human rights and equity 
• Priority 2: I’m loving the way we’re developing as a vibrant, member-led organisation 
• Priority 3: We need to be much clearer on our impact and our successes 
• Priority 4: As an organisation, we continue to be well-respected – but I definitely see our ‘edge’ developing. 

I look forward to working on these priorities over the next 200 days!