Public Health’s ‘Greatest Hits’

Last week, I had the privilege of hosting ADPH’s annual conference. With over 120 members in attendance, and a range of insightful speakers and guests, the day – which this year was on the theme of ‘Public Health’s Greatest Hits’ – was a great success.

Having a dedicated time to reflect, not just on achievements of the past, but on what contributed to their success and, even more importantly, what we can learn and carry forward to our practice now, was both inspiring and thought-provoking.

Ever keen to embrace technology, we carried out an online poll during the day of what people considered the absolute ‘greatest’ of hits for public health. Clean water and sanitation came top with just short of 30% of the vote, closely followed by vaccination with 24% and tobacco control at 22%. During the day, we also discussed the progress made in reducing unwanted teenage pregnancy and the valuable role healthy cities play in public health.

What all these things have in common is their impact on preventing illness and disease and promoting good health and wellbeing. In short, what Directors of Public Health and their teams do – and have done on a daily basis for over 175 years – and what saving lives and changing futures is all about. Like the dog that doesn’t bark, you can’t necessarily count it and very often, no one thing can solve it. Instead, determination and consistent, continual improvement in policy and delivery, based on solid evidence and anchored by a coherent, joined up system across national and local government, and civil society, are what really makes the difference.

There is no argument that ill health is harmful for individuals on a personal level, and communities and the country on an economic level, both through missed days at work and the cost of health and social care, all of which runs to a quarter of a trillion pounds. Yet, despite this, there is plenty of argument about how to prevent it.

What these greatest hits show is that we know what works – national policy change that is implemented consistently at a local level. Directors of Public Health are responsible for the health and wellbeing of their local area, and so it is their job to know the make-up of their local population. They are also experts in public health – we even have qualifications! Together, that means we are uniquely positioned to advise on what works and how it can be implemented at ground level.

This can though be misinterpreted as wanting to run a ‘nanny state’ so it is important that we make the case in different ways to different stakeholders – this is the ‘art’ of public health and is the USP of Directors of Public Health.

The situation we are facing is stark. 89% of deaths in England alone are caused by illnesses, including many cancers, respiratory, heart and liver disease, that are preventable. They aren’t transmitted by air or water. Instead, they are a result of consumption of harmful products, like tobacco, and unhealthy food and drink, or exposure to harmful environments, including poor air quality, housing and education, or, most often, a combination of both, transmitted through clever advertising and marketing, low prices and easy availability.

The answer then – which is what has happened successfully in our greatest hits – is to tackle these wider, often commercially driven, determinants of health as opposed to concentrating on changing individual behaviour.

For example, cholera and other nasty, water borne diseases have been eradicated in the UK thanks to sanitation and making clean water available to all. Infectious diseases have been dramatically reduced through widespread vaccination and immunisation campaigns, and there was a 2.4% reduction (equivalent to around 1200 cases) in emergency admissions to hospital for heart attack in the year following implementation of the smokefree law.

Teenage pregnancy has also been reduced as a result of understanding that the causes weren’t down to individual choice. Instead, it is often a result of social exclusion and inter-generational inequality and has only been addressed through recognising that a wide range of partners needed to work together to improve circumstances and outcomes for young parents, while simultaneously reducing barriers to accessing advice and contraception.

The thread throughout all these success stories, is that the solution is a whole society effort. It requires a cross-sector, cross-party, cross-Government approach that puts people’s health and wellbeing in its widest sense at the heart of every single policy.

The good news is that there is widespread recognition that this approach works. In England, the Government has acknowledged that prevention will always be better than cure and in some areas, like the Child Poverty Taskforce, has begun to work across departments to improve outcomes. In Scotland, the Population Health Framework sets out a collective approach to improving health and in Wales, the Wellbeing of Future Generations Act prescribes an integrated, collaborative approach to decision making.

Now comes the hard part of translating this good intention into actual improvement. The covenant for health, a project led by this year’s ADPH Conference keynote speaker, Lord Filkin, and co-written with our keynote speaker from last year’s event, Lord Bethell, sets out an achievable roadmap. There’s no doubt it will be hard and takes real vision and commitment to put political differences aside and shut out industry influence. However, good health really matters and that there is an average gap in healthy life expectancy of 22 years between local authorities is a critical justice issue.

It is particularly hard at the moment – across the globe we are seeing widespread political instability, in England we are seeing significant changes as a result of local government reform, devolution and the abolition of NHS England, and as we heard in this week’s budget, money is incredibly tight.

However, this means making the case for long term prevention is even more critical, and our role as Directors of Public Health is even more relevant. By providing strategic leadership at a local level to stitch together the different roles of a whole range of organisations, we can ensure that evidence-based programmes and initiatives are delivered to the right people in the right way at the right time so that they bring about real, long-lasting change.