public health and healthy local government maggi morris executive director of public health central...
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Public Health and Healthy Local Government
Maggi MorrisExecutive Director of Public Health
Central Lancashire
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Overview
• What is health and what is public health?• 150 years of public health• Ways of working, making it work• How public health is organised now and in the
future • Opportunities and benefits• What it means to you as elected members
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What is Health?
World Health Organisation
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And, health means different things to different people
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So, what does public health mean?
What comes to mind when you think of public health?
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Definition of Public Health
“The science and art of preventing disease, prolonging life and
promoting health through the organized efforts and informed choices of society, organizations, public and private, communities
and individuals.” (Winslow. 1920)
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Influences on illness, health & wellbeing
Social Psychological
Environmental
Biological
Public health
Concerned with the interactions between the influences on illness, health and wellbeing
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Why are people healthy and well?
• Understand why people that experience risk factors and risk conditions are healthy and well
• How can we help people and populations to cope and flourish?
• Focus on health rather than disease
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80% of the influences of health and wellbeing are outside health services
World Health Organisation
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150 years of Public Health
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Duncan, Liverpool
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The impact of low cost alcohol on
the working class
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John Snow Cholera
epidemic, London
1854
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Trends in life expectancy in England and Wales since 1700
The creation of the NHS - 1948
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Four phases of modern public health in the UKFirst wave: 1830-1900
• Environmental, sanitation, housing improvements
Second wave: 1890-1950• Therapeutic era, rise of hospital
services, • antibiotics
Third wave 1940-1980• Welfare State, Health Education
The New Public Health: 1970-2000• Ecological approach to health and wellbeing
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The three legs of the Public Health stool
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Health Protection
What is it?• Protecting the population
from threats to health and wellbeing, including:– Infectious diseases– Chemicals and poisons– Radiation– Major incidents and
emergencies – Environmental health
hazards– Floods– Violence and abuse
How do we do it?• Undertake communicable
disease control• Promote infection control• Develop community and
individual resilience• Commission vaccination and
immunisation programmes• Undertake emergency
planning and manage response to major incidents
• Integrated solutions
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Health Improvement
What is it?• Keeping people
well• Promoting good
health • Preventing ill health
and disease• Addressing
inequalities in health
How do we do it?• Work with partners accountable for
the root causes of health• Develop healthy settings (e.g.
healthy schools, councils, workplaces• Promote healthy behaviours
(tobacco control, physical activity, healthy weight)
• Address risk conditions and risk factors
• Commission prevention services for those at high risk of disease
• Prevent relapse or exacerbation in those with disease
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Health and social service quality
How do we do it?• Develop and implement
commissioning policies• Evidence based practice• Efficiency and health
economics• Service planning and
commissioning • Clinical governance• Equity audit• Quality assurance and
improvement
What is it?• Ensuring health
and social care services are effective, of high quality and equitable
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Public Health Approaches
• Intelligence and analysis • Evidence of what works • Asset approaches to producing health and
wellbeing • Communication and social marketing
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Principles
•Equity•Community Participation•Intersectoral Collaboration•Sustainable Development
Health for All
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Organisation of Public Health
Before 1974Medical Officer for Health
within local authoritiesResponsible for :
Health of the populationAdministration of
community health services (family planning,
environmental health, health visiting, health
centres)
1974-2013Community physicians
(1974-1989)/ Directors of Public Health (1989-2013)
Based within the NHS (health authorities/ primary
care trusts)Responsible for:
Health of the populationProviding/ planning/
commissioning preventative services
Public health advice to Planning/ commissioning of
NHS treatmentBut not Environmental
health
From 2013Directors of Public Health
based within upper tier local authority
Responsible for the health of the population: health
improvement, health protection, health and social service quality
Public Health England, Executive agency of the Department of Health
National Commissioning Board responsible for commissioning some prevention and public health services (health
visitors, screening)
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Opportunities• Local government the locus for health and wellbeing• Shift the balance towards addressing the determinants of health• Localism - Local responsibility and influence for health and
wellbeing• Increase democratic legitimacy for health and grow civic society• Citizens and communities have greater influence on the health
and wellbeing agenda• Unlock community assets and capacity for wellbeing and
prevention• Maximise individual and community resilience to promote
wellbeing and independence• Leadership and influence to re-organise primary care
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Role of elected members?
• Add to the intelligence on assets and needs through contact with communities
• Influence public health priorities • Balance evidence of effectiveness with
considerations of would work locally• Advocate for the health and wellbeing of your
constituents• Influential community leaders and champions
for health and wellbeing
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Five scenarios
Aims of the scenarios:– to explore your role in public health
– to understand how the local public health service can support you
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Scenario 1 – seasonal flu vaccination
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Scenario 2 - Affordable warmth
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Scenario 3 – Workplace health
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Scenario 4 – Alcohol harm
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Scenario 5 – Sexual health