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July 26, 2022
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ADPH Presidential blog: Public health is not just for emergencies!

Public health first “shot to fame” at the time of the Salisbury poisonings. It returned to prominence during the pandemic and continues to be in the spotlight as we work to tackle the current outbreak of Monkeypox. But, public health is not just for emergencies!

So, what do we actually do if it's not just about getting jabs into arms and help with tracing contacts as a result of exposure to Covid, Monkeypox or indeed Novichok?

A Director of Public Health (DPH) is “an independent advocate for the health of the population who provides system leadership for the improvement and protection of a population’s health” – a local ‘Chief Medical Officer’ if you will.

The role has taken different names and forms over the years and is replicated in similar roles across the globe – in fact, we are celebrating the 175th anniversary of the UK’s very first ‘Medical Health Officer’ this year. 

In England, the DPH sits in Local Government; in Scotland and Wales, they sit in the NHS and in Northern Ireland, the DPH sits within the Northern Ireland Public Health Agency. Regardless of where they sit and who they report to though, the DPH role provides system leadership across local authorities, the NHS and other partners to improve and protect the health and well-being for a defined population.  

Protecting and promoting the public’s health is no mean feat – take any town at random whose inhabitants face a whole range of social determinants of health:

Some of those inhabitants may smoke or drink alcohol, they may be overweight or only have access to unhealthy food, they may have mental health issues or live in poor housing. When they have children, they want the pregnancy, labour and resulting baby to be healthy and when they get older, they want to live a long, healthy life. They want their children to thrive and their adults to be looked after at work.

Yes, of course they also want to be protected from emerging viruses and dangerous substances - and for when that is an issue, we work closely with the local and national Government and the medical profession, amongst others.

However, day to day people want – and indeed expect – an infrastructure to be built around them that promotes and maintains their wellbeing and, when there is a problem, they want to have access to effective services. These services are needed not just to help them when they are critically ill (services which are ably provided by our NHS colleagues) but also when they need a helping hand to keep well.

This is where the local public health team really comes alive – through working in partnership with colleagues from local authorities, the NHS, the police, schools and the voluntary sector, DsPH and their teams commission and deliver a huge range of services and promote them amongst their communities. Health visitors, family planning services, school nurses, weight management, tobacco control, sexual health services, drugs and alcohol and much, much more sits with your local public health team.

The aim? To overcome the enormous disparity in experience and outcomes and tackle the health inequalities faced by our populations so that everyone, regardless of their background, their job or their postcode, can live a happy, healthy life.  

The catch? Money! From air quality to alcohol and women’s health to weight management, DsPH provide the best possible services to their communities they can but we simply can’t keep delivering these services to an ever-increasing population with different levels of need linked to a whole range of environmental and societal factors without adequate funding.

In England alone, the public health grant has been cut by 24% on a real-terms per capita basis since 2015/16.  We estimate that restoring the public health grant to its historical, real-terms per capita value – and accounting for both cost pressures and demand levels – would require an additional £1.4bn a year in 2021/22 price terms by 2024/25.

There needs to be a ‘health in all policies’ approach from central Government with a commitment to long term, consistent public health funding that takes into account the different factors different populations are faced with.

That means an increase in public health funding in each of our four nations, increased investment in prevention services and a shift in focus so that all government departments put public health at the top of their agendas.  Only with this level of investment in public health will we see a real step change in health outcomes for all.

That may require different pipelines to be used for money and accountability to flow in the four different nations, but the purpose is clear: better health for all. 

Until then, our members and their teams will continue to work closely with partners and stakeholders in the joint business of health protection and promotion – as well as, of course, answering the call when the next emergency comes.

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