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School of Medicine, Pharmacy & Health

The Changing Context for Health and Wellbeing

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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. - PowerPoint PPT Presentation

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Page 1: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Page 2: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

The Changing Context for Health and Wellbeing

Presented by David HunterProfessor of Health Policy and Management7th November 2013

Page 3: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Page 4: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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)

Page 5: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Wanless’s CritiqueNumerous 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

Page 6: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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)

Page 7: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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-Gooby and Stoker, The Political Quarterly (2011)

Page 8: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 9: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 10: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Looking Forward

Page 11: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Emerging Issues Progress in embedding public health in local

government

Page 12: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Emerging Issues Organisation of public health function: centralised

versus distributed model

Page 13: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Emerging Issues How is Public Health England being viewed?

Page 14: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Emerging Issues Health and Wellbeing Boards: are expectations

too high?

Page 15: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Emerging Issues Where is public health on the national agenda?

Page 16: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 17: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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)

Page 18: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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)

Page 19: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

WHO Europe Health 2020

Page 20: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 21: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Health 2020: Key Studies

Health 2020

Governance for health in the 21st century (Ilona Kickbusch)

Report on social determinants of health and the health divide

in the WHO European Region (Michael

Marmot)

The economic case for public health action (OECD)

Page 22: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 23: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 24: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 25: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 26: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

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

Page 27: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

The Journey Continues…

Page 28: The Changing Context for Health and Wellbeing

School of Medicine, Pharmacy & Health

Until…

Election in May 2015 – more change in prospect?