What we have, what we want and what we need

In this month’s blog, I want to look at the context Directors of Public Health (DsPH) are working in, and think about what is expected, wanted and needed – and whether those things are the same.

If we look back at the strategic successes of the last few years, I think it is fair to say that public health teams have played a pivotal role in decreasing smoking rates and tobacco harm, increasing people’s awareness of what healthy eating looks like – and why it is important – and in helping people get more active. We have been successful in other areas too, encouraging breast feeding and giving children a healthy start in life, tackling alcohol harm and substance use and making great strides in promoting good sexual health.

There is further to go, particularly in terms of closing the unacceptable gap in health equity, and none of this work is possible in isolation – public health is dependent on partnership and collaboration. Without the tireless support of the voluntary and community sector for example, our Covid-19 story would be very different, with community volunteers having been instrumental to ensuring the vaccine reached vulnerable and marginalised groups.

This collaborative element is important to understand because public health does not fall into any one department. While DsPH have a budget (albeit a much underfunded one following sustained cuts over the last eight years), we have to use evidence, perspectives and experiences to decide what to spend it on.

Some things are more obvious than others – tobacco causes harm, so we spend money on prevention and cessation. Poverty causes harm too and is one of the most important determinants of our health. However, its causes are far more complex than one single product and responsibility to tackle it straddles multiple sectors, mostly involving people without ‘health’ even in their titles.

So, our job is as orchestrators and influencers, sometimes owners, sometimes contributors, and understanding how to get things done in other sectors and settings is vital. We need to understand both what the problems are and be able to provide input into solving them so that we can help shape the future provision of services. This is both at a local level on the ground, through our work as DsPH, and also at a national level, through ADPH, contributing our knowledge and expertise to national policy discussions.

Sometimes this can feel like an uphill struggle, with the argument of public health wanting a “nanny state” often cited as to why public health measures and services aren’t wanted or needed.  If we really want to make a difference to the public’s health, then we need to ensure that the marketing of public health as a negative set of recommendations is reversed.

In a survey published last year by Ipsos and The Health Foundation, 80% of those asked thought that the Government had a ‘great deal’ or ‘fair amount’ of responsibility for helping people to stay healthy. This was particularly the case for reducing smoking (87%) and alcohol-related harms (76%) and, in terms of specific public health interventions, measures related to smoking and unhealthy food and drinks received high levels of support. However, nearly half of the respondents felt that the Government did not have the right policies to improve public health.

These statistics paint a picture of a society that wants to have policies in place that support a healthier lifestyle and should add weight to the already large body of evidence to show that public health will improve if we can make our society one where health is considered at its heart.

So, what could public health look like in the future?

We first need to recognise what has gone on before, harness the wins and learn from the losses. Tobacco is a perfect example. We have done an incredible job of decreasing smoking rates, largely through marketing restrictions, regulation and legislation, but also by supporting those already addicted, to stop. There’s much more we need to do, and the Government’s plan to achieve Smokefree 2030 is not enough.

In the meantime, let us harness the wins and use what we know works to reduce other harms. What we have learnt about industry tactics, the commercial determinants of health, for example has huge implications for how we can tackle harm caused by obesity, alcohol and gambling.

Let’s also learn from what works in different geographical areas and apply them to others. We do this well as a profession, continually improving our practice, but it is an approach that could be harnessed nationally for everyone’s benefit, with lessons to be learnt from the devolved nations, our neighbours in Europe and across the world.

Through working in partnerships, and using each others’ expertise, we can work towards a future where being healthy is the norm. For instance, safe, green, open spaces will enable communities to come together, children will be protected from harm, there will be increased opportunities to be active through active transport links, housing will be warm in winter and cool in summer, people will enjoy their work for longer, and everyone, regardless of their background, will have access to health and social care.

By listening to what the public want and working together to provide solutions that truly embed health in the heart of our society, we will of course not only benefit everyone’s physical and mental health, but also future-proof the country – financially and in terms of health. Afterall, a healthy society means one where children grow up to become a healthy workforce that stay in work for longer and place fewer demands on the NHS and social care.

In conclusion, it feels that what we want and what we need to achieve it are in our grasp, because what we’ve got in our network of partnerships is doing a great job. In fact, far from being a nanny state intervention, public health has the potential to give us the freedom and opportunity to live longer, healthier lives.

What we need – and want – now is for the Government to agree and help make that future a reality. This requires long-term thinking, putting short-term politics aside and will need bravery, flexibility and honesty but will, ultimately, put us all on a much better, more sustainable, healthier footing for the future.