Building the voice of citizens into public health evidence – the view from NICE’ Putting the public back into public health, Leeds Metropolitan University,

Building the voice of citizens into public health evidence – the view from NICE’

Putting the public back into public health, Leeds Metropolitan University, 16 th January 2014.

. Professor Mike Kelly, Director of the Centre for Public Health, NICE and the Institute of Public Health, University of Cambridge.

Key ideas.

• Practical steps at citizen involvement.

• Theoretical implications for Public Health Guidance.

NICE needs

YOU

Stakeholder involvement

• Scope of the work drawn up by the NICE team.• Scope published on the web.• Public stakeholder meeting.• Stakeholder comments received and responded to on

the web

• Scope amended and final version published.

Who writes the guidance?

Guidance developed

• Evidence reviewed.• Evidence appraised.• All committees have lay and community members on

them.• Draft recommendations published.• Stakeholders comment on the draft

recommendations.• Recommendations revised.

• Guidance published.

The Public Involvement Programme at NICE

• Recruits lay members to committees.• Inducts the lay members.• Provides on going support to lay members.• The importance of the lay and community

perspective.• Meetings held in public.• http://www.nice.org.uk/getinvolved/patientsand

public/patientandpublichome.jsp

http://www.nice.org.uk/getinvolved/patientsandpublic/patientandpublichome.jsp

http://www.nice.org.uk/getinvolved/patientsandpublic/patientandpublichome.jsp

The Citizens’ Council

• 30 members of the general public.• Deliberates on complex problems.• Presents independent reports to the Board.• Its views help to frame the production of NICE

guidance.

A methodological and theoretical departure.

The discourse of risky behaviours

• Tobacco


• Tobacco• Alcohol


• Tobacco• Alcohol• Inactivity


• Tobacco• Alcohol• Inactivity• Food


• Tobacco• Alcohol• Inactivity• Food• Drugs


• Tobacco• Alcohol• Inactivity• Food• Drugs• Travel


• Tobacco• Alcohol• Inactivity• Food• Drugs• Travel• Sex


• Tobacco• Alcohol• Inactivity• Food• Drugs• Travel• Sex• Age


• Tobacco• Alcohol• Inactivity• Food• Drugs• Travel• Sex• Age• Being alive







Social practice.

• Social practices not behaviour.

• Acknowledges agency and structure.

• Non–determinist.

Theories of Social Practice and Public Health

Conventional methods of understanding and influencing non communicable disease and smoking, obesity, alcohol

“wider determinants” Behaviour and lifestyle choices

Nudge, getting messages across, enabling people to make better choices for themselves.

Something missing

• materials (objects, consumer goods, infrastructures);

• competence (including understandings of the situation; practical know-how)

• meanings (including embodied understandings of the social significance of the practice; past experiences of participation etc.).

YYXX

YYXX D C B AXX11

YY

XX4

XX5

XX3

XX1

XX2

M

N

O

P

HG

FE

D C B A

L

KJ

I

T

S

R

Q

YY

4

XX5

XX3

XX1

M

N

O

P

HG

FE

D C B A

L

KJ

I

T

S

R

Q

How practices change

Practices depend on the active integration of elements. Practices emerge and change when new links are made Practices disappear when links are broken.

A practice – in which elements are linked

An ex-practice - In which links between elements are broken

competence

materialsmeanings

competence

materialsmeanings

Tobacco smoking

How has the practice has evolved?

How the elements of the practice have changed?

Who is captured by the practice?

How does smoking relate to other social practices?

Smoking has changed significantly during the course of its 2,000 year ‘lifetime’.

What are the materials, the meanings, the skills involved?

Who smokes, social class associations, gender, age?

Drinking, relaxing, taking a break, eating.

Smoking depends on an integration of

materials: not only, cigarettes, matches and lighters; but also tobacco plants, factories, transport systems, retail infrastructures, an economy..

competence: to know how to smoke, not only practically how to light a cigarette and inhale; but how to smoke in the ‘correct’ manner for a given social situation e.g. in a beer garden, during a break at work

meaning: understanding that smoking is a normal and socially acceptable thing to do, variously associated with relaxation, sociability, masculinity, glamour and toughness.

http://www.morguefile.com/archive/#/?q=cigarette&sort=pop&photo_lib=morgueFile

Practices make and use social networks? People are linked by practices, practices recruit through networks

Example of social network from Nick Crossley

Social practices interact – links are made and broken between one practice and another

“wider determinants”

Behaviour and lifestyle choices

Nudge, getting messages across, enabling people to make better choices for themselves.

Impasse

Social practices that persist across space and time

That have lives of their own

That are constantly on the move

Conclusions

'Many of the triumphs of public health in the past ...relating to infectious diseases have been brought about by primary prevention. Similar victories over those modern maladies , the chronic degenerative diseases seems however far from grasp. ....[T]he strategies of preventive medicine do not seem to have come to grips with the sorts of behavioural and societal manipulations necessary to allow these conquests to be made'

(Donaldson & Donaldson, 1983:130).[ Donaldson, R.J. & Donaldson, L.J. (1983) Essential Community Medicine (Including Relevant Social Services) , Lancaster: MTP Press.]

Implications

• We need to understand the lived experience of citizens in their lifeworlds.

• We need to eschew predictive causal models.

• We need to understand the relational nature of social life.

Documents

Building the voice of citizens into public health evidence – the view from NICE’ Putting the public back into public health, Leeds Metropolitan University,