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The science and art of promoting health: public health and the role of culture Colin Cox Public Health Consultant Public Health Manchester.

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Presentation on theme: "The science and art of promoting health: public health and the role of culture Colin Cox Public Health Consultant Public Health Manchester."— Presentation transcript:

1 The science and art of promoting health: public health and the role of culture Colin Cox Public Health Consultant Public Health Manchester

2 Defining Health “Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity” World Health Organization

3 Defining public health “The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society” Faculty of Public Health

4 It all starts with the Greeks… Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces. We must also consider the qualities of the waters and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labour, and not given to excess in eating and drinking. Hippocrates, 400 BC

5 Four waves of public health First wave Sanitary reform; great public works; growth of municipal power; concern for civil order. Social reformers key players. 18301900200019801950 Second wave Rise of scientific medicine; hospitals, health services etc; rationalist/reductionist approach dominates. Third wave Welfare state; institutional reform; NHS established; social housing; focus on living conditions. Politicians key players. Fourth wave Focus on risk factors, especially lifestyles and behaviours; emerging concerns about inequalities.

6 Characteristics of public health  Population focus rather than services to individuals  Upstream action: emphasising prevention and the determinants of health and wellbeing  Focus on social justice: the role of the state and the need to tackle inequalities in health outcome and access to health improving resources  Partnerships with all those who impact on the health and wellbeing of the population.

7 Determinants of health Barton & Grant (2006): A health map for the local human habitat. Journal of the Royal Society for the Promotion of Health 156: 252-3 (after Dahlgren & Whitehead, 1991)

8 Tackling health inequalities Life expectancy at birth by social class, England and Wales, 2002-05

9 “On the state of public health” Cancer Circulatory disease

10 However…

11 Phil Hanlon “What happens After Now?”

12 The challenge for future PH  Changing ourselves, our mindsets and our culture;  Re-integrating dimensions of life that have been separated in recent times: the interior and the exterior; the objective and the subjective; the individual and the collective; the true, the good and the beautiful (science, ethics and aesthetics)  Greater future focus

13 Wilber’s integral model Subjective – InteriorObjective - Exterior Individual level I (mind) The inner world of the individual: how I think and understand myself; my values; my ethical stance It (body and environment) The physical body and brain; the results of empirical, objective study of human experience and the physical world that produce scientific evidence and theories Collective level We (culture) Our intersubjective or cultural world of learned and shared beliefs, ideologies and values; collective, negotiated and symbolic systems of meanings; the basis for our ethics Its (society) Economies; social structures and hierarchies; organizations; government policies; the world of business and production; eco-systems

14 Public Health response - wellbeing Subjective - InteriorObjective - Exterior Individual level I (mind) Contemplative, mindful practices such as meditation, prayer and yoga to promote self-awareness and ethical self-mastery It (body and environment) Treatments such as anti- depressant medication/ cognitive behavioural therapy; healthy lifestyle advice; relationship counselling Collective level We (culture) We understand our motivations in order to change deep-seated individualist and materialist values. We move towards global forms of consciousness, aware of the finite and vulnerable nature of our environment. We think and act out of concerns for a sustainable, equitable human future. Its (society) Policies and action on structural determinants of health; promotion of work– life balance; community development; social capital development; move towards a globally sustainable society through contraction and convergence

15 Implications?  New economic models  Contraction and convergence  More holistic focus on individuals including greater psychological/cognitive input  “Mobilising inner resources for self healing”

16 Stress and grade of employment: men Time of Day Steptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

17 Environmental determinants of inflammatory status Deprivation level (low to high) CRP (median) mg/dl Never smoked Smokers 10.711.42 21.002.34 31.112.25 41.212.44 51.132.53 61.253.07 71.483.29

18 P<0.001 P=0.03 Quartile of hs-CRP (Range, mg/dL) P Trend <0.001 <0.055 0.056–0.114 0.056–0.114 0.115–0.210 0.115–0.210 >0.211 >0.211 Relative Risk of MI Ridker. N Engl J Med. 1997;336:973–979. 0 1 2 3 1234 hs-CRP and risk of future MI in apparently healthy men

19 0 1 2 3 4 5 00.511.522.533.544.55 Q1 : <0.66 mg/l Q5: > 4.18 mg/l Years in study % diabetic CRP and cumulative risk of type 2 diabetes Freeman et al. Diabetes 2002,51;1596

20 Aaron Antonovsky 1923-1994

21 “.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement." Sense of coherence....

22 Action vs Pride

23 The true, the good and the beautiful Creating new symbols and narratives to facilitate culture change Creativity as part of wider wellbeing Inspiring new solutions Connections to regeneration Art and creativity as therapy

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