Annual DPH Workshop and AGM 2020

February 8, 2020 in Events, Headline Events, Masterclasses and workshops, Upcoming events

Date TBC

The Annual DPH Workshop will comprise an interactive programme looking at key policy issues as well as challenges and opportunities within the wider PH system. The ADPH Annual General Meeting will be held on the same day.

The results of the Annual Report Competition will also be announced. Visit this page to view last year’s winners.

Further details about the day will be available as soon as possible. Contact Teresa for any queries.

The nation’s new year’s resolution

January 30, 2020 in ADPH Updates, President's Blog

A blog based on the presentation by ADPH President Dr Jeanelle de Gruchy on: factors influencing public health in England and priorities for policy for improving healthy life expectancy at Westminster Policy Health Forum – Thursday 16th January.

Laughter is just the best medicine. One of my more successful New Year’s resolutions was simply ‘to laugh more’. This simple statement of intent led to quite profound personal changes for me that year. My laughter and wellbeing went hand in hand, tripping along nicely among the daisies.

I’m suspecting many had a bit of a nod to a new year’s resolution or two – and I’m guessing most of them were broadly about improving health and wellbeing. However, no matter how many of us had new year’s resolutions, I suspect the large, unchannelled rush of resolve on this across the land won’t actually deliver an improvement in the population’s wellbeing and health.

So what are the key forces driving the public’s health in England today – and what should the nation’s collective new year’s resolutions to improve healthy life expectancy for all be? 

I believe there are four overarching factors influencing the public’s health and wellbeing:

  1. Firstly, social trends and the rise of social movements. Social movements, social media, digital technology – all enabling us, the citizen, to shape our society; and of course all shaping us as citizens. At speed. It’s messy and complex, for the public’s good – and not good. The ‘New Year, New Me’ mantras of individuals are now more supported by inspiring social public health movements, such as Dry January and Parkrun. The level of public engagement demonstrates the huge appetite that exists for wellbeing. However social media has also helped those who would, to drive a rise in the dismissal of inconvenient facts (or the dismissal of evidence and facts altogether) – from the UK’s relationship to the EU to vaccination to climate change.
     
  2. So on to the climate emergency. Extinction Rebellion and Greta Thunberg inspired social movements to more successfully challenge the dominant denial of climate change by vested interests over the last decade. Yet our actions so far fall woefully short of what is needed to achieve net zero by 2050. The British Heart Foundation yesterday warned this month that heart and circulatory disease deaths attributed to particulate matter air pollution could exceed 160,000 over the next decade in the UK (read the recently released report here).

  3. Politics – austerity and uncertainty, rising inequality, and Brexit. Currently 4.1m children in the UK are living in poverty. Poverty is the most significant determinant of the health of our children and young people. These are the consequence of political choices. After a decade of austerity and a bruising process leading to Brexit, our institutions are under strain as never before with, some would argue, a challenge to democracy itself. After a long period when we believed that inequality was reducing in this country, the deeply entrenched structural inequality in our society has been exposed. It remains to see what ‘levelling up’ means, and how it is delivered. Brexit and all its repercussions and consequences will have a profound impact on the nation’s health and wellbeing over the next decade.    

    Publically funded services have become more efficient over the last decade, however a huge amount has just disappeared; and we will continue to see considerable change in public services – their purpose, funding and delivery – over the next decade. For now, England continues to have an incredible universal health – and public health – service offer free at the point of need, treating ill-health – and protecting the financial impact of poor health.

    Political decision-making has its own short-term timing rhythm and preference for a simple response with shiny things that grab headlines; this continues to drive the award of small, disconnected pots of funding and contradictory policy positions from different Westminster departments. It’s generally left to local places to integrate and make sense of how all of this can impact positively on residents’ lives. Advocates for the public’s health and wellbeing, with the necessary focus on complex causation and evidence-based, whole system responses to deliver in the future, struggle to make our case nationally and locally. Indeed we need to be constantly alert to being side-lined with less and less influence and resource. I’m hoping that the next decade will see a new narrative and a new approach to making the case for health and wellbeing in our society – and a deeper appreciation by public and policy-makers.

  4. Finally, the social and commercial determinants of health and wellbeing – Health expectancy is stalling and the healthy life expectancy gap widening. Poverty – of money, of good housing, good relationships, of good air, good jobs, good food – is the root cause. Take transport – the dominance by the car and fossil fuel industries has profoundly shaped our society where cities and streets are designed by middle-aged men primarily for middle-aged men, where passenger roads deaths have decreased whereas those of cyclists and pedestrians have not; it’s contributed to climate change, a rise in poor air quality and a reduction in people being physically active.   

    Yet too little are these social and commercial determinants understood or addressed. Instead, the myth of the ‘lifestyle choice’ is used to perpetuate a disproportionate focus on the individual over the range of behavioural, environmental and social determinants of health – and on individualistic solutions aimed at the individual just making different choices and changing their ‘unhealthy lifestyle’. It remains to be seen whether we can make ‘the lazy language of lifestyles’ an anachronism by the end of the decade (see ‘The lazy language of lifestyles’)

Social movements and politics, the climate emergency, poverty and inequalities, and the kind of country we live in – the local places we live in – these are the key factors influencing the public’s health as we enter the 2020s.

So what now of the policy priorities we need to influence this context to improve healthy life expectancy over the next decade.

Firstly, we need to shift the public and policy-makers’ understanding of the factors driving the population’s health. We need to reframe the conversation, from one that simplistically uses the words NHS and health interchangeably and sees the NHS as providing the best and only route to the nation’s health. Rather we know that only about 10-20% of healthy life expectancy is determined by access to the NHS. The remainder is shaped by the economic, social and environmental conditions of our lives. We need a new narrative for health and wellbeing.

The Association of Directions of Public Health published a Manifesto for Public Health in the lead up to the General Election. Our aim was defining a realistic programme that would make ‘prevention is better than cure’ – and indeed health creation – a reality. Our asks are:

  1. Make wellbeing a cross-government ambition. Drawing inspiration from the Wellbeing legislation in Wales and New Zealand, wellbeing should be built into the fabric of Government decision-making when it comes to both policy-making and funding allocation. This means challenging the dominance of GDP as a measure of national successes with a ‘health index’ and the introduction of a Wellbeing Act. This should drive public investment across the social determinants of health.

  2. Set binding targets to reduce child poverty. Poverty is the most significant determinant of children and young people’s health in the UK. Currently, 4.1 million children in the UK are living in poverty. At the turn of the millennium the Government committed to abolish child poverty by 2020 and this was enshrined into law in 2010. We must renew this commitment.

  3. Take a whole-system and place-based approach to health inequality. We need to take wide-ranging action on the social determinants of health (including housing, the environment and skills), as well as acting on health inequalities caused by the commercial determinants of health such smoking, alcohol use and obesity, expanding the use of the ‘Polluter Pays’ principle. A combination of bold national action and trusting, empowering and funding councils is essential.

  4. A new era of partnership and collaboration. The relationship between the NHS – the home of treatment – and local government – the home of prevention – is key. We need to be in the same room and on the same page about both creating seamless care pathways in services like smoking cessation and sexual health, as well as health creation – working together to make the places we live and work help rather than hinder our health and wellbeing.

  5. Deliver a multi-year funding settlement for public health. With the Spending Review coming up, we need to make the case for not just more investment in public health but also more long-term certainty. The ADPH supports the call from the Health Foundation and The King’s Fund for at least £1 billion more a year for the Public Health Grant in England.

On public health specifically – since the transfer of public health services from the NHS to local government, there has been intense scrutiny on how well the move has worked. Seven years on – despite austerity – the evidence for making local government the primary promoter of public health is strong. An independent review of the reforms published earlier this week by the King’s Fund finds that “significant innovation and integration” has been achieved and “public health teams have integrated well into local government, influencing policy at both local and regional level.” The Local Government’s most recent evaluation of performance – as measured against the Public Health Outcomes Framework – shows 80 per cent of indicators improved or were unchanged in the financial year to 2018.

So, there is a really good story to tell.

Last century, Antonovsky spoke of ‘the creation of appropriate social conditions which underlie or facilitate health-promotive behaviour’. This is a timeless articulation of what public health should be about. At the start of a new decade, the challenge for the public health community is clear: we need to work to create the conditions for public health and wellbeing. This should be the nation’s new year’s resolution.

Sector-Led Improvement: the ‘what’ and ‘how’ of success

December 16, 2019 in PH System, Sector Led Improvement

Click below to view a presentation by Prof. Jim McManus (DPH Hertfordshire and ADPH Vice-President) and Sara Blackmore (DPH South Gloucestershire and ADPH SLI Network Lead) on the principles of Sector-Led Improvement in Public Health with examples from SLI activity in the South West.

Finance Masterclass: influencing budget decisions within local authorities

November 14, 2019 in Events, Masterclasses and workshops

14th November 2019

Wellington House, London SE1 8UG

Though primarily aimed at new/interim/acting DsPH, this workshop was open to any member who felt they could benefit from support in this area. The objective of the day was to broaden knowledge around financial processes within LAs, so as to support confidence in leading challenging conversations around this topic.

The masterclass focused on the following key areas:

  • An overview of how LA finances work and what a good budget making process looks like.
  • The priorities of an LA Director of Finance and how best to collaborate with them.
  • Negotiation skills/strategies for influencing budget distribution and embedding the PH agenda in other budgets.

Please contact Lucia for any questions

New in Post DsPH Workshop

July 24, 2019 in Events, Masterclasses and workshops

3rd October 2019, central London

The workshop for new DsPH which took place in early October was well received by attendees.

The day, chaired by ADPH Vice-President Prof Jim McManus, featured an informative presentation from the CEO of Barnet, John Hooton; a very well-received session on Leadership Style from ADPH Membership Secretary, Rupert Suckling; as well as ADPH Council member Tracy Daszkiewicz’s highly valued reflections on a day in the life of a DPH.

Click here to view the agenda

Attendees found the opportunities for discussion and networking extremely useful and described the event as ‘reassuring, supportive and energising.’

The evaluation summary of the event can be viewed here.

Annual Review 2018-19

May 28, 2019 in Annual Reviews, Publications

ADPH Annual Report Competition 2019

May 21, 2019 in Annual Report Competition

Entries to this year’s Annual Report Competition presented great use of data and statistics in variety of innovative formats, with the reports touching on a range of interesting and at times unusual topics. 

The results from the competition were:

1st place – Manchester

2nd place – NHS Highland

3rd place – Cardiff and Vale

The lazy language of ‘lifestyles’ – let’s rid this from our talk about prevention

April 17, 2019 in ADPH Updates, President's Blog

By Jeanelle de Gruchy, President ADPH

I’m writing this blog as I drink my flat white following my yoga class where the yoga teacher was wearing a fab ‘Carbs and cuddles’ sweatshirt; this is the life I think, this is my choice, this is my lifestyle.

I go out to my car and head for the motorway, annoyed that I will now have to sit for 40 minutes in traffic to my new office up north. Not really my choice I think, not really the lifestyle I want. Down south, I didn’t have to do that, I lived closer to work, and public transport was [subsidised] better. In one place I walk more and in another sit in a car in traffic more – same me, same motivation, different place, different behaviour. Environment and the choice landscape matters to how physically active I am. ‘Lifestyle’ doesn’t really explain it. So why do we keep using this word as if it explains everything about our health?

A number of years ago I read a blog that has stuck with me ever since – in 2015, Paul Lincoln wrote ‘Lifestyle: a plea to abandon this word in public health’ https://ukpublichealthnetwork.org.uk/lifestyle-a-plea-to-abandon-the-use-of-this-word-in-public-health/.  

In this strongly worded piece, Paul targeted the public health communities’ widespread and unquestioning use of the term ‘lifestyle’ and called for its use to be completely abandoned. His main argument was that its use frames public health at an individual level – ‘effectively blaming individuals for making irrational decisions that are detrimental to their health’.

The lazy language of lifestyle, and the lazy thinking behind it perpetuates a disproportionate focus on the individual over the range of behavioural, environmental and social determinants of health – and on individualistic solutions aimed at the individual just making different choices and changing their ‘unhealthy lifestyle’.

Apart from being ineffective, this framing of the problem, he argues, suits certain ideological viewpoints that tend to frame any counter view as nanny state-ism, and ‘helps industries that produce health-harming goods escape responsibility’. It also leads too easily to blaming those who don’t change their ‘lifestyles’ and are therefore responsible for their own early illness and death.

Paul asserted that continued use of ‘lifestyles’ was in fact ‘a harmful and unethical determinant of bad public health practice’, and should become anachronistic, especially given claims of a new narrative on prevention which demands a focus on the social determinants of health.

Unfortunately, ‘lifestyle’ has not become an anachronism. Unfortunately – and I would argue unacceptably – it’s still all too normal for public health professionals to uncritically use the term ‘lifestyles’. And despite the evidence, we continue to situate solutions in individuals and interventions to change their ‘lifestyle choices’.

The current use of ‘lifestyle’ has its origins in business marketing, a word capturing how to create desire and promote consumption. This isn’t done individually, but by using very sophisticated techniques targeting particular segments of society – groups of people, not individuals – selling cigarettes, alcohol, the best odds, Easter Eggs and fizzy drinks to make the world sing in perfect harmony. It’s a commercial determinant of health – and Paul Lincoln suggested the word ‘deathstyle’ would be more apt, given the way many of these commodities contribute to early death.

‘Lifestyle’ does two things – it puts emphasis on the individual, framing health-harming behaviour as individual choice so that secondly, it takes the focus away from the socio-economic determinants of health and from the health inequalities experienced by groups of people.

The Health Foundation and Frameworks Institute has been leading work to reframe the conversation on the social determinants of health – and I strongly recommend their Briefing to you (https://www.health.org.uk/thinking-differently-about-health ).

How we choose to frame things is critical, as the language we use, how we explain things and what we don’t say influences how people make sense of and engage with issues. They note that, ‘despite extensive evidence of the impact of social determinants on people’s health, public discourse and policy action is limited in acknowledging the role that societal factors such as housing, education, welfare and work play in shaping people’s long-term health’. It’s the differences in these factors that drive the profound inequalities in health outcomes.

Their research shows that the dominant way people conceptualise health is through models of individual choice and health care – and the solution is ‘raising awareness’ so people make different choices (and if they don’t, well then…) and the NHS. It’s not surprising therefore that the focus for policy makers is on individual-focused interventions and on the NHS.

They set out some preliminary steps to build support for the policies and programmes that will be much more effective in improving health and reducing health inequalities. The first one is: ‘Beware of gesturing to the importance of individual choice or responsibility’. I think we need to stop prioritising talk about ‘lifestyles’. 

Of course, there is another use of the term – the Urban Dictionary reminds me that many use the term for sex and sexuality – and that it wasn’t that long ago that a dominant discourse was about some people adopting a ‘gay lifestyle’ to denote active choice and how that, so easily, led to victim-blaming. ‘Lifestyle’ was problematic then, it remains problematic now. What I like about this reminder of usage is that it shows the power of language – and how it can work insidiously and ideologically to maintain hegemonic power, the power of the ‘norm’, in this case of the heterosexual community. What I also like about this reminder is it shows how this power was challenged by citizens working collectively, using the language of human rights to deconstruct this dominant discourse and impacting positively on this inequality. Isn’t it time for us to do the same with the use of ‘lifestyles’ in health?

The new enthusiasm for prevention and population health are important opportunities for us as public health professionals to get our own thinking and language in order on what matters.

While I know a lot of us don’t like the emphasis on the individual, we do need to think through our role in continuing to privilege this problematic paradigm. We need to reframe our own narrative – which too often favours individualistic approaches – in order to more effectively influence priorities and plans. If we’re serious about preventing ill-health, reducing inequalities and improving health and wellbeing, we do need to focus on those things that will actually make a sustainable difference.

So the next time we cycle to work, nip out for sushi at lunch, sip on our cappuccinos and plan our pensions, let’s think through how we’re able to do this, and let’s talk about how we talk about those things that determine whether our lives are healthy or not. 

ADPH Annual Conference 2019

February 22, 2019 in Events, Headline Events

Leading into the Future: the role of the Director of Public Health

22nd November 2019
Oval Kennington, London SE11 5SS

With over 130 delegates in attendance, the 2019 ADPH Annual Conference comprised a varied and dynamic programme of interactive sessions and keynotes from leaders in the field exploring different perspectives on this year’s theme “Leading into the future: the role of the Director of Public Health”.

Morning Session

Dr Jeanelle de Gruchy (ADPH Vice President and DPH Tameside) opened the day with some reflections as she approaches the halfway mark of her three-year Presidency term. Click here to read the transcript of her speech. 

Shaping Healthy Places

The morning session sought to explore what a healthy place looks like in the 21st century, and what the role of the Director of Public Health should be in shaping healthy places. Delegates heard keynotes from David Rudlin (Director at Urbed), Marcus Morrell (Foresight Lead, UKIMEA Region at Arup) and Dr Oliver Jones (Director of Architecture and Built Environment, Design Council) and participated in the subsequent panel discussion chaired by Prof. Jim McManus (ADPH Vice-President and DPH Hertfordshire).

Afternoon session

Responsible Leadership: DPH Perspective

The afternoon opened up with a panel discussion exploring the future of wider partnership work with a focus on the changing role of the Director of Public Health. Adam Grodecki (Founder and CEO at Forward Institute) provided an introduction to the work of the Forward Institute and its approach to fostering responsible leadership. Alice Wiseman (DPH Gateshead), Sarah Scott (DPH Gloucestershire), Dr Louise Smith (DPH Norfolk) and Dr Sandra Husband (DPH City of London and Hackney) contributed to the discussion with commentaries on what responsible leadership meant to them and their thoughts of leadership programmes they had participated in that helped them to take their journey forward.

Preparing for the future: the Wellbeing of Future Generations Act

The last session from the day welcomed Jyoti Atri (Interim Director of Health and Wellbeing, Public Health Wales) who provided an introduction to the Welsh public health context and the Wellbeing of Future Generations Act. She was joined by Ruth Tennant (ADPH Honorary Secretary – Infrastructure and DPH Solihull) and Sarah Price (Director for Population Health and Commissioning, Greater Manchester Health and Social Care Partnership) who offered their thoughts on how the learning from the Welsh experience could be applied to the English context.

The conference provided plenty of opportunities for discussion and networking with colleagues on topics related to the sessions, as well as key public health issues such as the public health approach to violence, Adverse Childhood Experiences and Integrated Care Systems.

The event was sponsored by

Other exhibitors included

Annual DPH Workshop and AGM 2019

February 21, 2019 in Events, Headline Events, Masterclasses and workshops

16th May 2019

St Brides Foundation, Central London

The Annual DPH Workshop provided some engaging discussions on key policy issues as well as challenges and opportunities within the wider PH system. The ADPH Annual General Meeting was held on the same day. 

The programme included:

  • Presentations by Niven Rennie, Director of the Scottish Violence Reduction Unit and Lib Peck, Director of the London Violence Reduction Unit followed by panel discussions focusing on the PH approach to violence
  • Table discussions – on specific PH policy topics as well as the wider PH system
  • Annual Report Competition results – overview of submissions and announcement of this year’s winner
  • Sharing practice on measuring impact – examples and presentations from Networks
  • Networking opportunities

Click here to view the evaluations’ summary. Further material, including speaker presentations, is also available to view on eForums

Please contact Teresa Grandi for any queries.