Making Links

What I hope to coverLifting upOther anglesPublic Health and PH reform

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

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

The Experience of HealthHaving EnergyBeing loved, lovingBeing in controlFit, fitting inStress-freeOutdoors, natureFriends, familyGiving/receiving,

sharing

Meaning in lifeAble to do things I

enjoyPeak Physical shapeHappinessCreativitySpiritual contentmentWholenessPlayfulness Belonging

Physical

Mental SocialMeaning and purpose

Vitality, energy

Connectedness to community

Good social relations

Ability to do things one enjoys

Well being

Control over life

Labonte 1998

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

Public Health Functions

Health Improvement Health Protection

Wider Determinants of Health

Health Care Public Health

Strategic Intelligence

New PH SystemPublic Health EnglandPH in Local GovernmentPublic Health GrantMandated to provide PH advice back to CCGSoS can mandate services to be provided

Sexual Health National Child Measurement Programme Health Protection NHS Health Checks

Public Health Outcome FrameworkHealth and Wellbeing Board / JSNA / HWB Strategy

Public Health in Local GovernmentNew DutyIt’s OUR duty – not just our dutyNeed to understand

What is Public HealthWhat it doesHow it works

In order toMake health everyone’s business

11

1

Levels of workforce intervention for public health‘Slice’ of the workforce for

the function

Community engagement and public action

Professional input, partial and episodic actions for public health, Remit usually not labelled as public health

Professional input, Identified as public healthpractitioner actions

Specialist leadership for the key areas ofpublic healthservice and academic practice

Note: Levels 2-4 can operate within one professional group.

12 3 4

‘What is wrong with ‘Why are youunhealthy ?’

‘What is stopping youfrom being healthy ?’

Smoking Poor diet Lack of fitness Drug and alcohol

misuse Poor coping skills Lack of lifeskills

• Powerlessness• Isolation• Pollution• Stress• Hazardous living conditions

you ?’

Heart Disease Cancer HIV / AIDS Diabetes Obesity Mental Health Hypertension

Medical Approach BehaviouralApproach Approach

Socioenvironmental

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

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

“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

The burden of collective actionThe pollution of the environment gives utilityWe do not individually or collectively discount

the cost and impactTragedy of the commons

Are we asking the right questions?The world is in a mess, and much of this mess

is of our own makingEvents 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

Are we really thinking about healthAll Age All Cause Mortality

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

ViableAdequately Prosperous

Sustainable

Convivial

EquitableLivable

Community

Economy

EnvironmentHEALTH

Adapted from work by Hancock, T

Hancock’s Sustainability DutiesDuty to other

speciesthe health of

humans cannot be purchased at the expense of the health of other species and the ecosystem

Duty to future generationsthe health of

present generations cannot be purchased at the expense of that of future generations

Hancock’s Equity DutiesDuty to the

disadvantagedthe health of the

advantaged cannot be purchased at the expense of the health of the disadvantaged

Duty to other placesthe health of my

community cannot be purchased at the expense of that of other communities

OptionsDoing the same thingsDoing the same things betterDoing better things

Public Health Outcomes Framework

Air Pollution: Inclusion of this indicator in the PHOF will enable DsPH to prioritise action on air quality

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

Work against reductionismHealth 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

ContactStephen Turnbull

Assistant DPHBARNSLEY MBC

Stephenturnbull@barnsley.gov.uk01226 787412