Public health and environmental protection

1. Public health and environmental protection Making Links

2. What I hope to cover • Lifting up • Other angles • Public Health and PH reform

3. What is health? • ‘a state of complete, physical, mental and social well-being and not merely the absence of disease or infirmity’ • World Health Organisation, 1946

4. What does it feel like? • Think of a time when you felt healthy. • What did it feel like?

5. The Experience of Health • Having Energy • Being loved, loving • Being in control • Fit, fitting in • Stress-free • Outdoors, nature • Friends, family • Giving/receiving, sharing • Meaning in life • Able to do things I enjoy • Peak Physical shape • Happiness • Creativity • Spiritual contentment • Wholeness • Playfulness • Belonging

6. Physical Vitality, energy Ability to do things one enjoys Good social relations Well being Mental Social Meaning and purpose Connectedness to community Control over life Labonte 1998

7. What is Public Health? “Public Health is the science and art of preventing disease, prolonging life and promoting health through organised efforts of society” Acheson

8. Public Health Functions Health Improvement Health Care Public Health Health Protection Wider Determinants of Health Strategic Intelligence

9. New PH System • Public Health England • PH in Local Government • Public Health Grant • Mandated to provide PH advice back to CCG • SoS can mandate services to be provided • Sexual Health • National Child Measurement Programme • Health Protection • NHS Health Checks • Public Health Outcome Framework • Health and Wellbeing Board / JSNA / HWB Strategy

10. Public Health in Local Government • New Duty • It’s OUR duty – not just our duty • Need to understand • What is Public Health • What it does • How it works • In order to • Make health everyone’s business

15. Medical Approach Behavioural Socioenvironmental Approach Approach ‘What is wrong with ‘Why are you ‘What is stopping you you ?’ unhealthy ?’ from being healthy ?’    Heart Disease Smoking  • Powerlessness • Isolation • Pollution • Stress • Hazardous living conditions Cancer  Poor diet  HIV / AIDS   Lack of fitness  Diabetes  Drug and alcohol  Obesity misuse Mental Health Poor coping skills    Hypertension  Lack of lifeskills

16. Inequalities in Health • “ The millions of people condemned to live in poverty or bad housing do not need elaborate studies to discover whether their physical and mental health is being undermined” Draper, 1985 • “The poverty we face most of all is the poverty of aspiration” Jenkinson, People making Places Public Arts 2001

17. Inequalities in Health • ‘ … even if we cure or prevent all leading causes of premature death (including improving all those health behaviours that contribute to these diseases) … a new set of diseases will arise to kill or disable the poor years earlier than the rich’ LaBonte, Prof. R (1997) Health Visitor Journal, Vol. 70, No.2 p. 64

18. “The fundamental relation between spatial patterns of social deprivation and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.” The Ghost of Christmas Past, Dorling et al, BMJ, 2000, 321: 1547-1551

19. Marmot: Life course approach

20. The burden of collective action • The pollution of the environment gives utility • We do not individually or collectively discount the cost and impact • Tragedy of the commons

21. Are we asking the right questions? • The world is in a mess, and much of this mess is of our own making • Events such as the financial crisis and climate change are not quirks of the marketplace or quirks of nature. • They are markers of massive failure in international systems that govern the way nations and their populations interact. • The contagion of our mistakes shows no mercy: • WHO Director General: Dr Margaret Chan

22. Are we really thinking about healthAll Age All Cause Mortality

23. Life satisfaction has run approximately flat through time in Great Britain” Blanchflower and Oswald 2004 Journal of Public Economics 88 (2004) 1359 – 1386

24. Model of Healthy Communities Community Convivial Livable Equitable Environment HEALTH Economy Adequately Prosperous Viable Sustainable Adapted from work by Hancock, T

25. Hancock’s Sustainability Duties • Duty to other species • the health of humans cannot be purchased at the expense of the health of other species and the ecosystem • Duty to future generations • the health of present generations cannot be purchased at the expense of that of future generations

26. Hancock’s Equity Duties • Duty to the disadvantaged • the health of the advantaged cannot be purchased at the expense of the health of the disadvantaged • Duty to other places • the health of my community cannot be purchased at the expense of that of other communities

27. Options • Doing the same things • Doing the same things better • Doing better things

29. Public Health Outcomes Framework • Air Pollution: Inclusion of this indicator in the PHOF will enable DsPH to prioritise action on air quality

31. Public Health Outcomes Framework • Air Pollution: Inclusion of this indicator in the PHOF will enable DsPH to prioritise action on air quality • “Attitudes count, not numbers, and control is rooted not in hierarchy but in values and beliefs” Hunter, 2003

32. Work against reductionism • Health as a concept needs constantly to be contrasted with a medical reductionist model which emphasises fragmentation, towards a model of health as integral to and as a result of social justice • Adams and Armstrong 1996

33. Contact Stephen Turnbull Assistant DPH BARNSLEY MBC Stephenturnbull@barnsley.gov.uk 01226 787412