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The Changing Context for Health and Wellbeing

The Changing Context for Health and Wellbeing. Presented by David Hunter Professor of Health Policy and Management 7 th November 2013. Public Health and the NHS: a difficult relationship.

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The Changing Context for Health and Wellbeing

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  1. The Changing Context for Health and Wellbeing Presented by David Hunter Professor of Health Policy and Management 7th November 2013

  2. 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) (Official NHS Historian)

  3. Wanless’s Critique Numerous policy statements and initiatives in the field of public health have not resulted in a rebalancing of policy away from health care (a ‘national sickness service’) to health (a ‘national health service’). This will not happen until there is a realignment of incentives in the system to focus on…tackling the key lifestyle and environmental risks. Derek Wanless (2004), Government Adviser

  4. 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) (former local authority chief executive and adviser to Department of Health)

  5. Where are we Now? The coalition programme…involves a restructuring of…public services that takes the country in a new direction, rolling back the state to a level of intervention below that in the United States – something which is unprecedented. Britain will abandon the goal of attaining a European level of public provision. The policies include substantial privatisation and a shift of responsibility from state to individual. Taylor-Goobyand Stoker, The Political Quarterly (2011)

  6. Reflections: the Negatives • Public health caught up in neoliberal agenda: from the welfare state to the market state • Continuing tension between the nanny state and the enabling state • ‘Lifestyle drift’ policy bias, especially evident in England • Medical resistance to non-medical specialists

  7. Reflections: the Positives • Acknowledgement of wider public health and its multidisciplinary workforce • Smoking ban – example of government action with public support • Example of evidence informed policy • Recognition of local government’s key role in public health

  8. Looking Forward

  9. Emerging Issues • Progress in embedding public health in local government

  10. Emerging Issues • Organisation of public health function: centralised versus distributed model

  11. Emerging Issues • How is Public Health England being viewed?

  12. Emerging Issues • Health and Wellbeing Boards: are expectations too high?

  13. Emerging Issues • Where is public health on the national agenda?

  14. Meeting the Public Health Challenge • Investment in public health • Health spend per capita: £2000 per year • Preventive spend: £80 per year (4%) • Using ring-fenced public health budget to unlock resources elsewhere in local government • New partnerships: are Health and Wellbeing Boards the answer? • New skills and competencies required • Relationship building • Political astuteness

  15. From ‘Lincoln’ • A compass, I learnt when I was surveying, it’ll…it’ll point you true North from where you’re standing, but it’s got no advice about the swamps, deserts and chasms that you’ll encounter along the way. If in pursuit of your destination, you plunge ahead heedless of obstacles, and achieve nothing more than to sink in a swamp, what’s the use of knowing true North? • Abraham Lincoln (Daniel Day- Lewis) speaking to Thaddeus Stevens (Tommy Lee Jones)

  16. 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)

  17. WHO Europe Health 2020

  18. Key Principles Underpinning Health 2020 • Renewed emphasis on public health • Health is wealth • Health inequalities must be redressed • Health systems are more than just health care • Whole of society and whole of government approaches needed • Systems thinking approach adopted to analyse problems and devise solutions • From analysis to supporting delivery

  19. Health 2020: Key Studies • The economic case for public health action (OECD) Health 2020 • Report on social determinants of health and the health divide in the WHO European Region (Michael Marmot) • Governance for health in the 21st century (IlonaKickbusch)

  20. Health 2020: How does it differ from its predecessors? • Health for All (1980) • Health 21 (1998) • Tallinn Charter: Health Systems for Health and Wealth (2008) • Health 2020 (2012) • The difference.... • Focus on implementation and the importance of European Action Plan

  21. European Action Plan (1) • Avenues for Action • Surveillance of population health and wellbeing • Monitoring and response to health hazards and emergencies • Health protection including environmental and occupational health, food safety and others • Health promotion, including action to address social determinants and health inequity • Disease prevention including early detection of illness

  22. European Action Plan (2) • Avenues for Action • Assuring governance for health and wellbeing • Assuring a sufficient and competent public health workforce • Assuring sustainable organisational structures and financing • Advocacy, communication and social mobilisation for health • Advancing public health research to inform policy and practice

  23. Concluding Reflections (1) • Is the glass half-empty? • Demise of the public health profession as we know it: future of specialist-practitioner-wider workforce paradigm at risk • End of DsPH as we know them • 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 • Time of austerity: public spending cuts

  24. Concluding Reflections (2) • Is the glass half-full? • Transform the way public health is conceived and delivered • Break away from the shackles of a biomedical model and embrace a social model: from a deficit to an assets-based approach • Develop new skills and competencies – not a case of preserving the old and familiar • Embed new leadership style focused on influencing others engaged in health improvement and wellbeing • Use of ring-fenced public health budget to lever in resources from elsewhere

  25. The Journey Continues…

  26. Until… • Election in May 2015 – more change in prospect?

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