1. What is public health?

2. 2 Learning objectives What is public health? Early history Main functions of public health Who works in or contributes to public health? Organisation of public health in England What is public health?

3. What is health How would you rate the health of a man in his 30s who has diabetes and ulcerative colitis (a disorder of the lower bowel)? 1.Worse than average 2.About average 3.Better than average

4. 4What is public health?

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6. 'Eat right, exercise regularly, die anyway.' Anonymous 6What is public health? ‘I am short, fat and proud of that’ Winnie the Pooh What is health?

7. 7 “A state of complete physical, mental and social well-being and is not merely the absence of disease or infirmity.” (World Health Organisation, 1948) “The extent to which an individual or group is able to realise aspirations, satisfy needs and to change or cope with the environment “ (World Health Organisation, 1984) What is public health?

8. 8 What is Public Health? “The science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society.” Acheson 1988 in the Public Health in England report “Public health is concerned with improving the health of the population, rather than treating the diseases of individual patients.” Chief Medical Officer What is public health?

9. 9 Public Health Focuses on the entire population even when they are not ill Rather than Individuals when they become ill Therefore:- Public health regards the community as its patient What is public health?

10. 10 The Faculty of Public Health Approach Public health: Is population based Emphasises collective responsibility for health, its protection and disease prevention Recognises the key role of the state, linked to a concern for the underlying socio-economic and wider determinants of health, as well as disease Emphasises partnerships with all those who contribute to the health of the population http://www.fph.org.uk/what_is_public_health What is public health?

11. 11 "Health care matters to all of us some of the time… public health matters to all of us all of the time" C. Everett Koop What is public health?

12. 12 The history of Public Health What is public health?

13. 13 Believed disease was caused by Miasmas – foul odours from rubbish and sewers Sponsored legislation requiring registration of births, deaths & marriages Correlated vital statistics with data about living conditions Published Inquiry into the Sanitary Conditions of the Labouring Population in Great Britain Led campaign for first Public Health Act Edwin Chadwick (1800-1890) Member of London Board of Health 1848-1854 Champion of the “sanitary idea” What is public health?

14. 14What is public health? In the year 1836-7, I attended a family of 13, twelve of whom had typhus fever, without a bed in the cellar, without straw or timber shavings-frequent substitutes. They lay on the floor, and so crowded, that I could scarcely pass between them..... ‘There are upwards of 8,000 inhabited cellars in Liverpool, and I estimate their occupants at from 35,000 to 40,000.’

15. Report on the Sanitary condition of the labouring population and on the means of its improvement London, May 1842. Liverpool 1840Average Age of Deceased Gentry and professional persons35 years Tradesman and their families22 years Labourers, mechanics and servants15 years Comparative chances of life in different classes of the community Bath 1840Average Age of Deceased Gentry and professional persons55 years Tradesman and their families37 years Labourers, mechanics and servants25 years

16. Dr William Duncan, UK’s first Medical Officer of Health James Newlands, UK’s first Borough Engineer Thomas Fresh, UK’s first Inspector of Nuisances Liverpool Sanitary Act 1846

17. 17What is public health? Sir John Simon First Medical Officer of Health for London (1848) Medical Officer to the General Board of Health Lecturer, St. Thomas’ hospital Medical Officer to the Privy Council in (1859) President Metropolitan Association of Medical Officers of Health (1856-65) Chief Medical Officer to the local government board Published the first annual public health reports Vaccination 'He endured, perhaps with too little patience, the constantly recurring pinpricks of official interference'

18. 18 John Snow (1813 - 1858) Born 15 March 1813 in York He showed that the Southwark and Vauxhall Waterworks Company, taking water from sewage-polluted sections of the Thames caused an increased incidence of cholera compared to the Lambeth Water Company The 1854 Broad Street cholera outbreak was studied by Snow who showed that cholera is spread by contaminated water leading to public health measures to prevent spread. At the age of 45, Snow suffered a stroke while working in his London office dying on 16 June 1858 What is public health?

19. 19What is public health?

20. 20What is public health? Impact of Public Health vs. Impact of Medicine TB Deaths

21. 21What is public health? Impact of Public Health vs. Impact of Medicine TB Deaths

22. 22 What proportion of the improvement in life expectancy since the 1950s can be attributed to medical care? 1.85% 2.70% 3.50% 4.30% What is public health?

23. 23What is public health? History of public health – a brief timeline 460 BC Hippocrates 1601 Poor Law Act 1839 Chadwick – Sanitary Condition of the Labouring Classes 1848 Public Health Act 1904 Inter departmental committee on physical deterioration 1942 Beveridge report 1946 Establishment of NHS 1974 NHS reform – AHAs, DHAs and FPCs – transfer LA functions 1982 NHS reform – Abolition of AHAs 1988 Acheson report 1991 NHS reform - Internal market 1997 New Labour – Commissioning replaces purchasing 2002 NHS Reform – SHAs and PCTs 2006 NHS Reform – Fewer PCTs 2010 NHS Reform – End of PCTs and SHAs 2013 many public health functions transferred to local/national govt.

24. Who contributes to public health? Who works in public health in your area? Who else contributes to public health?

25. 25 Who contributes to public health? (even though it may not say so in their job description) 3 main categories (CMO) 1)Professionals who spend some of their time in PH related work – teachers, other healthcare workers, other government officers 2)Professionals who spend major part of their work in PH issues – health visitors, health promotion, information, EHOs 3)Specialists – strategic/senior level – ability to manage change and lead PH programmes What is public health?

26. 26 Who works in PH (by function) Improving health (e.g. health promotion specialist) Health protection (e.g. Microbiologist) Public Health intelligence (e.g. Information analyst) Teaching and research (e.g. Research fellow) Health and Social Care quality (e.g. Health and Safety Advisor) PH leadership and Planning (e.g. DPH) What is public health?

27. What do PH teams do? 27What is public health? Assessment of health needs Evaluation of evidence base Monitor health status of population Programmes for prevention/risk reduction/screening Communicable disease control Planning health services Evaluation of provision of health services Manage and implement change Work with other agencies to maximise health gain

28. 28 Main functions of Public Health What is public health? Health protection Health improvement Improving Services

29. 29 1. Health Protection Infectious diseases Chemicals and poisons Radiation Emergency response Environmental health hazards What is public health?

30. 30 2. Improving Services Clinical effectiveness Efficiency Service planning Audit and evaluation Clinical governance Equity What is public health?

31. 31 3. Health Improvement Inequalities Education Housing Employment Family/community Lifestyles Surveillance and monitoring of specific diseases and risk factors What is public health?

32. Wider determinants of health 32What is public health? Source: Dahlgren G and Whitehead M (1991) Policies and strategies to promote social equity in health. Stockholm, Institute for Futures Studies

33. 33 How is PH organised? Department of Health (DH) Faculty of Public Health (FPH) Public Health England (PHE) Local Authorities and Local Strategic Partnerships What is public health?

34. 34What is public health?

35. 35 Summary Public Health contributes to health on a population basis by assessing needs and by implementing population level changes by working within and beyond the health sector Public Health is vital if we are to prevent illness and have affordable health care, now and in the future Organisational change and government policies both help and hinder the public health agenda What is public health?

36. 36 Learning objectives You should now know a little about: What public health is Early history of public health Main functions of public health Who works in or contributes to public health? Organisation of public health in England What is public health?

37. Further materials BBC Bite size History -Changes in public health http://www.bbc.co.uk/bitesize/standard/history/1830_1930/public_health/revisio n/1/ Science Museum – Public Health http://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspx 37What is public health?