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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School of Medicine, Pharmacy & Health

The Changing Context for Health and WellbeingPresented by David HunterProfessor of Health Policy and Management7th November 2013

School of Medicine, Pharmacy & Health

School of Medicine, Pharmacy & Health

School of Medicine, Pharmacy & Health

Public Health and the NHS: a difficult relationshipWhile the NHS claimed from the outset to give high priority to the promotion of healthin 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)

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Wanlesss 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 ontackling the key lifestyle and environmental risks. Derek Wanless (2004), Government AdviserSchool of Medicine, Pharmacy & Health

Local Government: public healths natural homeMany 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)School of Medicine, Pharmacy & Health

Where are we Now?The coalition programmeinvolves a restructuring ofpublic 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)School of Medicine, Pharmacy & Health

Reflections: the NegativesPublic health caught up in neoliberal agenda: from the welfare state to the market stateContinuing tension between the nanny state and the enabling stateLifestyle drift policy bias, especially evident in EnglandMedical resistance to non-medical specialists

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8Reflections: the PositivesAcknowledgement of wider public health and its multidisciplinary workforceSmoking ban example of government action with public support Example of evidence informed policyRecognition of local governments key role in public health

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Looking Forward

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Emerging IssuesProgress in embedding public health in local government

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Emerging IssuesOrganisation of public health function: centralised versus distributed model

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Emerging IssuesHow is Public Health England being viewed?

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Emerging IssuesHealth and Wellbeing Boards: are expectations too high?

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Emerging IssuesWhere is public health on the national agenda?

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Meeting the Public Health ChallengeInvestment in public healthHealth spend per capita: 2000 per yearPreventive spend: 80 per year (4%)Using ring-fenced public health budget to unlock resources elsewhere in local governmentNew partnerships: are Health and Wellbeing Boards the answer?New skills and competencies requiredRelationship buildingPolitical astuteness

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From LincolnA compass, I learnt when I was surveying, itllitll point you true North from where youre standing, but its got no advice about the swamps, deserts and chasms that youll 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, whats the use of knowing true North?

Abraham Lincoln (Daniel Day- Lewis) speaking to Thaddeus Stevens (Tommy Lee Jones)

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Strengthening the Evidence BaseNICE public health guidance being given a makeover to be more local government facingRelationship between NICE and PHENIHR School for Public Health Research (SPHR)School of Medicine, Pharmacy & Health

WHO Europe Health 2020

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Key Principles Underpinning Health 2020Renewed emphasis on public healthHealth is wealthHealth inequalities must be redressedHealth systems are more than just health care Whole of society and whole of government approaches neededSystems thinking approach adopted to analyse problems and devise solutionsFrom analysis to supporting deliverySchool of Medicine, Pharmacy & Health

Health 2020: Key StudiesHealth 2020Governance 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)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 School of Medicine, Pharmacy & Health

European Action Plan (1)Avenues for ActionSurveillance of population health and wellbeingMonitoring and response to health hazards and emergenciesHealth protection including environmental and occupational health, food safety and othersHealth promotion, including action to address social determinants and health inequityDisease prevention including early detection of illnessSchool of Medicine, Pharmacy & Health

European Action Plan (2)Avenues for ActionAssuring governance for health and wellbeingAssuring a sufficient and competent public health workforceAssuring sustainable organisational structures and financingAdvocacy, communication and social mobilisation for healthAdvancing public health research to inform policy and practice

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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 riskEnd of DsPH as we know themEmergence of a divided and fragmented workforce split between different culturesFailure to recognise and invest in public health skills trainingDevaluing the evidence base in political world of local governmentTime of austerity: public spending cuts

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Concluding Reflections (2)Is the glass half-full?Transform the way public health is conceived and deliveredBreak away from the shackles of a biomedical model and embrace a social model: from a deficit to an assets-based approachDevelop new skills and competencies not a case of preserving the old and familiarEmbed new leadership style focused on influencing others engaged in health improvement and wellbeingUse of ring-fenced public health budget to lever in resources from elsewhere

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The Journey ContinuesSchool of Medicine, Pharmacy & Health

UntilElection in May 2015 more change in prospect?

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