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A TALK BY PROFESSOR DAVID HUNTER

A TALK BY PROFESSOR DAVID HUNTER. PUBLIC HEALTH. UNCHAINED. A Tale in Two Parts . Looking back 2003 – 2013: a not too Horrible History of Public Health. A Tale in Two Parts. Looking forward 2013 – 2023: new dawn or poisoned chalice?. Looking Back (1).

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A TALK BY PROFESSOR DAVID HUNTER

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  1. A TALK BY PROFESSOR DAVID HUNTER PUBLIC HEALTH UNCHAINED

  2. A Tale in Two Parts • Looking back • 2003 – 2013: a not too Horrible History of Public Health

  3. A Tale in Two Parts • Looking forward • 2013 – 2023: new dawn or poisoned chalice?

  4. Looking Back (1) • Renaissance of public health under New Labour: first Minister for Public Health • Wanless I (2002) and II (2004): ‘fully engaged scenario’ • Joint DsPH posts: recognition of local government’s role in public health: ‘multidisciplinary public health will become reality’ (Blears, 2002) • Multidisciplinary public health workforce comes of age: arrival of UK voluntary register for public health specialists (2003) • New look Faculty of Public Health – Medicine dropped (2003)

  5. Looking Back (2) • NICE assumes responsibility for public health evidence (2005) • World class commissioning: focus on population health (2007) • The Marmot Review: focus on social determinants of health (2010) • Tension between nudge (responsibility deals) versus shove (smoking ban in public places) in England

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

  7. 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-Gooby and Stoker, The Political Quarterly (2011)

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

  9. Evolutionary Trends: How far have we really come? Source: The Economist, 12 November 2003.

  10. Looking Forward

  11. Looking Forward (1) Policy and Governance • Coming home: return of public health to local government • WHO Europe’s health policy framework and health strategy, Health 2020 • Main pillar of implementation – European Action Plan for Strengthening Public Health Capacities and Services

  12. 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)

  13. 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)

  14. The Main Determinants of Health

  15. WHO Europe Health 2020

  16. 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

  17. 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)

  18. 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

  19. 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

  20. 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

  21. Looking to the Forward (2) Policy and Governance • New skills and competencies required • Focus on softer, relational rather than technical skills • New styles of leadership with emphasis on boundary spanning; influence rather than control • New approaches to evidence and knowledge exchange • Importance of politics

  22. 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)

  23. 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

  24. Or is the Glass Half-Full? • Welcome opportunity • To transform the way public health is conceived and delivered, including the work of UKPHR • To break away from the shackles of a biomedical model and embrace a social model: from a deficit to an assets-based approach • To develop new skills and competencies – not a case of preserving the old and familiar • To embed new leadership style focused on influencing others engaged in health improvement and wellbeing • To strengthen the evidence base, e.g. NIHR School for Public Health Research

  25. Known Known: Realising the Potential for Health and Wellbeing • UKPHR: the future is bright

  26. THE END

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