Half way on – my reflections as ADPH President
This blog is an adaptation of Dr Jeanelle de Gruchy’s opening speech at the ADPH conference on 22 November 2019
It’s half way through my three-year term as President of the ADPH. In the spirit of Sector-Led Improvement, I thought I’d do a stock-check of the priorities I set out at the start, to see how we’re doing on them. A reminder of what they are:
- 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’
A critical part of that first priority has been highlighting the insidious normalisation of injustice or structural inequalities related to some or other characteristic of who we are – our class, race, nationality, gender, disability, sexuality.
At the same time, there is increasing poverty and inequality; and blame for it being the fault of the ‘other’ - the people not like ‘us’. This ‘othering’ leads us to deny the characteristics that we give to those who are not the ‘same’ as us - dignity, love, pride, heroism and ultimately any entitlement to human rights. This is unjust and profoundly damaging to our health and wellbeing.
Language is a key part of this process of ‘othering’. The language we choose to use, how we frame things, what we say – and don’t say – influences how people make sense of and engage with others, communities and society. Framing can be done for good – or for bad.
You’ll remember, a few years ago, the headlines that screamed: ‘Benefits system is broken – UK’s top scroungers on £300 a week more than the average family’. A framing of welfare was created that shamed and scapegoated people, perpetuating inequalities and facilitating a shift that made certain welfare policy decisions more possible.
The Joseph Rowntree Foundation believe that we need to tell a different story about poverty so that we can build public and political will to solve it. They’ve developed a new frame of compassion and justice, with a toolkit of recommended metaphors and words to use, to show that poverty matters, that we can solve poverty and that benefits are part of the solution not the problem. Already they can point to changes in the public narrative on poverty.
Efforts to reframe health is learning from this work. At our conference last year, Tim Elwell-Sutton spoke about the work the Health Foundation are doing with FrameWorks Institute to reframe the conversation around what makes us ‘healthy’ in order to develop new ways of focusing on the social determinants of health.
I wrote a blog on the ‘Lazy Language of Lifestyles’ and Tim and I ran a session at PHE's conference, challenging ourselves and the public health community to stop using the language of ‘lifestyles’. We believe it frames health disproportionately about individual willpower and choice, over the social determinants of health – and leads to an overemphasis on individualistic behaviour change solutions.
We built on this at the UK Public Health Network summit in October, which centred around the theme ‘Reframing Public Health’. Among some of the conclusions we reached, was the need to establish a set of principles on public health language to create consistency of messaging.
This important work on reframing public health to challenge the current norm which helps perpetuate inequalities, to develop public understanding of the breadth of health, will continue through this next year.
My second priority was you, our members. This year’s conference was held in a new, larger venue, as last year’s one was over-subscribed; we are providing a place for people to come together to learn and share and get geared up for taking our work forward for the next year. Once again, I’m thankful for the contributions that our members make through our new Board, our strengthened Council and Policy Advisory Groups (PAGs). Many have also been active through our peer mentoring, our immersive days (on finance, ICSs and DsPH with expanded portfolios) and the workshops for new DsPH and for our Associate Members – please join in and be part of our growth.
Visits across DPH networks have continued and it has been great to get out to talk to you in your local places. I’m just embarking on my second visit to you all in England and Wales – and hope to get to Scotland and Northern Ireland in 2020.
What’s really striking is the strength of many of our networks and the importance you place on coming together to support each other. Our Sector Led Improvement work is continuing to evolve and we are developing ways to drive improvement in our practice and outcomes.
However, I do think we need to go much further on this – for reducing variability and having a really strong sector is a key element in my third priority: promoting our unique local system leadership role. I’d like to pick up how we do this when I come out to visit you over this next year.
Finally, my fourth priority – ensuring we are a well-respected voice for public health. We are getting our voice into the many spaces and places shaping our context and our role as DsPH within this.
We have raised our public voice and profile and showcased our successes – through social media, blogs and articles for the LGC, MJ and HSJ; through our conferences and workshops and hosting of local visits, for example, for our colleagues in the Department of Health and Social Care. And we’ve also continued our presence in parliamentary committees and engagement with our key partners.
We have also made the most of these opportunities, using them to push back in private or, when necessary, publicly - for example on funding, PreP, relations with the alcohol industry or in responding to those who choose to present a blinkered or siloed view of how we develop a strong public health system; our response to para 2.4 – and the subsequent successful outcome that followed - is an ideal example of our ‘edge’.
We have maintained and further developed our relationships with key partners like LGA, DHSC, FPH, Public Health Wales, existing alliances (Obesity Health Alliance and Alcohol Health Alliance) and PHE - continuing the regional visits with Duncan to all DsPH, and now co-hosting the gathering of DsPH and the PHE top team at the PHE conference this year.
As importantly, we are creating new links. For example, we are part of the coalition, along with CRUK, Health Foundation and King’s Fund among others, campaigning on public health funding and wider determinants spending.
We are working with sexual health charities such as Terrence Higgins Trust and BASHH to campaign for a new sexual and reproductive health strategy (win), working with children’s charities/professional organisations like IHV, SAPHNA and others on championing a good childhood and working with Collective Voice to align messages on drug and alcohol treatment.
We’ve joined up with our local government counterparts - ADCS, ADASS and ADEPT - to call for sustainable funding for local government.
Finally, we’re taking our local voice to national – meeting with Chris Witty, the new Chief Medical Officer, and with government, the Treasury, Home Office and Defra – and of course to the Secretary of State at the PHE conference.
In all this work, your voice is critical – through your comments on the Green Paper and spending round settlement, screening and immunisation reviews, particular issues with the services we commission, or the reorganisation of the NHS into regions – and PHE’s reorganisation too, with the new Regional DPH role.
So, half way through my Presidency, my assessment is:
- Priority 1: With poverty and inequalities on the rise, 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: We’re becoming ever stronger as a vibrant member-led organisation, with more engagement and involvement
- Priority 3: We’re maintaining good relationships and forging new ones, our voice is getting heard
- Priority 4: I think we’re developing and perfecting our particular form of ‘edge’ – with results, for example the reaffirmation of our commissioning role and remit.
I think we’re doing really well, given the context in which we’re working; it’s testament to all of you, our members. I also want to give a shout out to our Chief Exec Nicola and the amazing ADPH team we have behind us. And I look forward to working with all of you on these priorities for the next half of my Presidency.