∂ School of Medicine & Health

The Return of Public Health to Local Government and the Implications for the Public Health Workforce: New dawn or poisoned chalice? Presented by David Hunter Professor of Health Policy & Management 21st June 2012

∂ School of Medicine & Health A Little History History tells us that local government played the greatest historical role in the sanitary revolution during Britain’s rapid industrialisation  Improved housing  Cleared nuisances  Introduced gas lighting  Provided public bathing and washing facilities  Infectious disease control through MOH

∂ School of Medicine & Health Public Health and the NHS: a difficult relationship While the NHS claimed from the outset to give high priority to the promotion of health…in reality this aspect of the service was never more than weakly developed, notwithstanding claims to the contrary, habitually made in ministerial speeches. Charles Webster (1996)

∂ School of Medicine & Health Local Government: public health’s natural home Many people in local government believe it is their organisations, rather than health authorities, that are public health authorities. Tony Elson (1999)

∂ School of Medicine & Health The Main Determinants of Health

∂ School of Medicine & Health New Public Health System: A tale of two parts  Return of public health locally to local government  Creation of Public Health England at centre

∂ School of Medicine & Health

∂

∂ Is the Glass Half-Empty?  Demise of the public health profession as we know it: future of specialist- practitioner-wider workforce paradigm at risk  Emergence of a divided and fragmented workforce split between different cultures  Failure to recognise and invest in public health skills training  Devaluing the evidence base in political world of local government

∂ School of Medicine & Health From public health medicine to public health  Clinical public health workforce uncertain, demoralised, demotivated  Are their skills still fit for purpose?  Dilution of epidemiology and emphasis on finance and politics  Focus on short-term rather than long-term  Where will career support and advancement come from?  How will public health presence in NHS be secured?

∂ School of Medicine & Health Or is the Glass Half-Full?  Welcome opportunity to transform the way public health is conceived and delivered  Need for new skills and competencies – not a case of preserving the old and familiar  Potential for new leadership focused on influencing others engaged in health improvement and wellbeing  Opportunity to break away from the shackles of a biomedical model and to embrace a social model: from a deficit to an assets-based approach to tackle SDH and Marmot agenda  New opportunities to strengthen the evidence base

∂ School of Medicine & Health Strengthening the Evidence Base  NICE public health guidance being given a makeover to be more local government facing  Relationship between NICE and PHE  NIHR School for Public Health Research (SPHR)

∂ School of Medicine & Health NICE’s Public Health ‘Offer’  Evidence reviews, guidance, quality standards, other evidence based outputs  Accreditation of other public health guidance producers  Methodological leadership and support on optimal ways of reviewing and appraising evidence  QOF for public health

∂ School of Medicine & Health NIHR SPHR  Narrowing gap between users and suppliers of research  Increasing evidence base for effective public health practice: applied research  Undertaking applied translational research  Considering local public health needs and evaluating innovative local practices with the potential for wider benefit

∂ School of Medicine & Health What we Already Know about Improving Health and Wellbeing  Complex: ‘wicked issues’, cross-cutting, multi- factorial, multi-levelled  Evidence base is patchy, uneven, poor fit to local context, often contested  Uptake of evidence-based changes is poor  Bias towards ‘lifestyle drift’

∂ School of Medicine & Health Evolutionary Trends Source: The Economist, 12 November 2003.

∂ School of Medicine & Health 5 Questions to Ask Yourself Question 1 Do the interactions among the various parts of the complex public health system generate energy and innovative ideas for change, or do they drain the system?

∂ School of Medicine & Health Question 2 Are decisions about change made rapidly and by the people with the most knowledge of the issue, or is change bogged down in hierarchy and position-authority?

∂ School of Medicine & Health Question 3 Do individuals and groups acquire and exercise power in positive, constructive ways toward a collective purpose, or is power coveted and used mainly for self-interest and self-preservation?

∂ School of Medicine & Health Question 4 Are conflicts and differences of opinion embraced as opportunities to discover new ways of working, or are these seen as negative and destructive?

∂ School of Medicine & Health Question 5 Is the system naturally curious and eager to learn more about itself and about what might be better, or is new thinking viewed mainly as potentially risky and threatening to the status quo?

∂ School of Medicine & Health

∂ !