Public Health and Healthy Local Government Maggi Morris Executive Director of Public Health Central Lancashire

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

What is Health? World Health Organisation

And, health means different things to different people

So, what does public health mean? What comes to mind when you think of public health?

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)

Influences on illness, health & wellbeing Social Psychological Environmental Biological Public health Concerned with the interactions between the influences on illness, health and wellbeing

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

80% of the influences of health and wellbeing are outside health services World Health Organisation

150 years of Public Health

Duncan, Liverpool

The impact of low cost alcohol on the working class

John Snow Cholera epidemic, London 1854

Trends in life expectancy in England and Wales since 1700 The creation of the NHS

Four phases of modern public health in the UK First wave: Environmental, sanitation, housing improvements Second wave: Therapeutic era, rise of hospital services, antibiotics Third wave Welfare State, Health Education The New Public Health: Ecological approach to health and wellbeing

The three legs of the Public Health stool

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

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

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

Public Health Approaches Intelligence and analysis Evidence of what works Asset approaches to producing health and wellbeing Communication and social marketing

Principles Equity Community Participation Intersectoral Collaboration Sustainable Development Health for All

Organisation of Public Health Before 1974 Medical Officer for Health within local authorities Responsible for : Health of the population Administration of community health services (family planning, environmental health, health visiting, health centres) Community physicians ( )/ Directors of Public Health ( ) Based within the NHS (health authorities/ primary care trusts) Responsible for: Health of the population Providing/ planning/ commissioning preventative services Public health advice to Planning/ commissioning of NHS treatment But not Environmental health From 2013 Directors 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)

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

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

Five scenarios Aims of the scenarios: – to explore your role in public health – to understand how the local public health service can support you

Scenario 1 – seasonal flu vaccination

Scenario 2 - Affordable warmth

Scenario 3 – Workplace health

Scenario 4 – Alcohol harm

Scenario 5 – Sexual health