1. Serving the people of Cumbria Do not use fonts other than Arial for your presentations Public Health

2. Serving the people of Cumbria Do not use fonts other than Arial for your presentations Content History of public health Future of public health? Role of General Practice

3. Serving the people of Cumbria Do not use fonts other than Arial for your presentations What do you understand by the term “Public Health”? (…and is that different from “public health”?

4. Serving the people of Cumbria Do not use fonts other than Arial for your presentations Public Health: a definition “The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society” (Faculty of Public Health)

5. Serving the people of Cumbria Do not use fonts other than Arial for your presentations Three key domains: Health improvement (health and risk factor surveillance, tackling the wider determinants of health, addressing health inequalities, promoting healthy lifestyles) Improving services (service planning, audit, clinical governance, clinical pathways) Health protection (infectious diseases, chemicals and poisons, radiation, emergency response)

6. Four waves of public health First wave Sanitary reform; great public works; growth of municipal power; concern for civil order. Social reformers key players. 1830 1900200019801950 Edwin Chadwick, born Longsight Dr William Duncan, first Medical Officer for Health (Liverpool)

7. Four waves of public health First wave Sanitary reform; great public works; growth of municipal power; concern for civil order. Social reformers key players. 1830 1900200019801950 Second wave Rise of scientific medicine; hospitals, health services etc; rationalist/reductionist approach dominates. Florence Nightingale, nursing pioneer

8. Four waves of public health 1830 1900200019801950 Second wave Rise of scientific medicine; hospitals, health services etc; rationalist/reductionist approach dominates. Third wave Welfare state; institutional reform; NHS established; social housing; focus on living conditions. Politicians key players. William Beveridge, architect of the post-war welfare state Aneurin Bevan, architect of the NHS

9. Four waves of public health 1830 1900200019801950 Third wave Welfare state; institutional reform; NHS established; social housing; focus on living conditions. Politicians key players. Fourth wave Focus on risk factors, especially lifestyles and behaviours; emerging concerns about inequalities. Sir Richard Doll, epidemiologist who connected smoking and lung cancer Sir Michael Marmot, epidemiologist, author of global and national reviews of health inequalities

10. Four waves of public health First wave Sanitary reform; great public works; growth of municipal power; concern for civil order. Social reformers key players. 1830 1900200019801950 Second wave Rise of scientific medicine; hospitals, health services etc; rationalist/reductionist approach dominates. Third wave Welfare state; institutional reform; NHS established; social housing; focus on living conditions. Politicians key players. Fourth wave Focus on risk factors, especially lifestyles and behaviours; emerging concerns about inequalities.

11. “On the state of public health” Cancer Circulatory disease

12. However…

13. Serving the people of Cumbria Do not use fonts other than Arial for your presentations Approach Planning for and act to protect the health of the people of Cumbria from communicable disease and environmental risk factors; Working with and for communities to change society and the environment in a way that protects and promotes health and wellbeing and enables people to take control over their own lives; Supporting individuals to build their sense of self-efficacy and control, enabling them to take decisions that support their own health and wellbeing and reducing their dependence on other public services.

14. Serving the people of Cumbria Do not use fonts other than Arial for your presentations Multiple actors… Local government Public Health England NHS England Delivery orgs – Primary Care, Trusts, community groups…

15. Serving the people of Cumbria Do not use fonts other than Arial for your presentations What is the role of GPs in this conception of public health?

16. Serving the people of Cumbria Do not use fonts other than Arial for your presentations The challenge for future PH Re-integrating dimensions of life that have been separated in recent times: –the interior and the exterior; –the objective and the subjective; –the individual and the collective; –the true, the good and the beautiful (science, ethics and aesthetics) Greater future focus

17. Serving the people of Cumbria Do not use fonts other than Arial for your presentations Implications? New economic models Contraction and convergence More holistic focus on individuals including greater psychological/cognitive input “Mobilising inner resources for self healing”

18. Aaron Antonovsky 1923-1994

19. “.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement." Sense of coherence....

20. Wilber’s integral model Subjective – InteriorObjective - Exterior Individual level I (mind) The inner world of the individual: how I think and understand myself; my values; my ethical stance It (body and environment) The physical body and brain; the results of empirical, objective study of human experience and the physical world that produce scientific evidence and theories Collective level We (culture) Our intersubjective or cultural world of learned and shared beliefs, ideologies and values; collective, negotiated and symbolic systems of meanings; the basis for our ethics Its (society) Economies; social structures and hierarchies; organizations; government policies; the world of business and production; eco- systems

21. Opportunity, decent housing, social networks, self esteem and sense of control Consistent parenting, safe, nurturing early years, supportive education Health related behaviours Comprehensible Manageable Worthwhile

22. Possible framework? Subjective – InteriorObjective - Exterior Individual level I (mind) Positive parenting Promote reflective / mindful practices Promote positive thinking / cognitive skills / sense of control Promote creative participation It (body and environment) Health protection Define and promote positive (salutogenic) environments Holistic approach to personal lifestyle improvement Asset based approaches Clinical practice mobilising inner resources for healing Collective Level We (culture) Create new narratives describing “how life should be lived” – challenging consumer culture Its (society) Build social networks based on positive health behaviours Define and promote salutogenic and sustainable economic models

23. Serving the people of Cumbria Do not use fonts other than Arial for your presentations What is the role of GPs in this conception of public health? What is currently happening? What should we be doing? How do we make this happen? How will we know we’re doing it?