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Public Health Policy: The Issues, The Future

Public Health Policy: The Issues, The Future. Professor David Hunter. Three Domains of Public Health. Protection Promotion Performance. Rediscovery of Public Health. Public health high on the political agenda Tobacco control Food safety Obesity Bio-terrorism threat

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Public Health Policy: The Issues, The Future

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  1. Public Health Policy: The Issues, The Future Professor David Hunter

  2. Three Domains of Public Health • Protection • Promotion • Performance

  3. Rediscovery of Public Health Public health high on the political agenda • Tobacco control • Food safety • Obesity • Bio-terrorism threat • Communicable disease control: SARS, bird flu, STDs • Good health is good economics

  4. Policy Highlights (1) • 1997 Minister for Public Health • 1999 Saving Lives: Our Healthier Nation • 1999 Health Development Agency • 1999 Public Health Observatories • 2000 NHS Plan • 2001 National Health Inequalities Targets • 2001 Health Committee Inquiry Report • 2001 CMO’s public health function review: final report • 2002 Wanless I • 2003 Tackling Health Inequalities: a programme for action

  5. Policy Highlights (2) • 2004 Wanless II • 2004 Choosing health? Consultation • 2004 Treasury-led PSA targets • 2004 NHS Improvement Plan • 2004 Public health white paper

  6. Wanless I – Three Scenarios • Solid progress • Slow uptake • Fully engaged

  7. Fully Engaged Scenario (2022) • Levels of public engagement in relation to their health are high • Life expectancy increases beyond current forecasts • Health status improves dramatically • People are confident in the health system and demand high quality care • Health service is responsive with high rates of technology uptake, especially in relation to disease prevention • Use of resources is more efficient

  8. Health Care Spending: Growth Rate, 2003-4 to 2022-23 Total UK NHS Spending

  9. What does Wanless II Say? • NHS remains a sickness rather than a health service • Failure over 30 years to shift the balance from health care to health • Key challenge is delivery and implementation, not further discussion • Public health workforce is not ‘fit for purpose’ • Poor state of evidence-base and underinvestment is R&D • Weak capacity of PCTs to deliver • Health literacy of population is poor

  10. Wanless II: Selected Recommendations • Secretary of State for Health should ensure that Cabinet assesses impact on population health of any major policy development • Productivity measures in health services should focus on health outcomes rather than outputs and allow comparisons of effectiveness of prevention and cure

  11. A public health research strategy should be put in place • Annual report on the state of people’s health should be produced at national and local levels to improve understanding • Production of strategic public health workforce plan • Healthcare Commission should develop its public health assessment role

  12. Choosing Health: Three Principles • Supporting informed choice, balancing rights and responsibilities • Personalisation of support to make healthy choices • Working in partnership to make health everybody’s business

  13. Choosing Health: Key Issues • Enabling not dictating healthy choices • Understand better why people make choices and design services around them • Coherent and consistent messages from national to local level • Role of employers and employment • Focus on delivery, leadership and incentives

  14. Making it Happen • Evidence and information • Workforce capacity and capability • Systems for local delivery

  15. Evidence • Strengthening public health research and research capacity • New investment in research funding • National strategy for public health • Improved coordination between research funders • Focus on applied research and real-time evaluation • Evidence on cost-effectiveness of interventions

  16. Information • Health Information and Intelligence Task Force to develop a comprehensive public health strategy • Strengthened Public Health Observatories to support DsPH and skills in equity audits and HIA • Health Poverty Index

  17. Building the Workforce • New role of NHS health trainers • Induction programme for all NHS Staff • Leadership for health • Health Improvement Workforce Steering Group

  18. The Challenge • Political will and commitment • Power and advocacy • Confronting ‘wicked problems’ • Managing complex adaptive systems • Can the NHS break with the past?

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