1. What is public health? Stuart Harris Public Health Intelligence Analyst Course – Day 1

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 Health inequalities What is public health?

3. 3 What is health? “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?

4. 4 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?

5. 5 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?

6. 6 The Faculty of Public Health Approach 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.fphm.org.uk/about_faculty/what_public_health/default.asp What is public health?

7. 7 "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?

8. 8 The history of public health What is public health?

9. 9 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?

10. 10 Edwin Chadwick 1842 Inquiry into the Sanitary Conditions of the Labouring Population in Great Britain “open sewers, stagnant pools of liquid refuse, insanitary privies and the stench of underventilated, overcrowded tenements” What is public health?

11. 11What 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.’

12. 12 W H Duncan (1805-1863) Liverpool Town Council (1847) Act of Parliament (specific to Liverpool): for the Improvement of the Sewerage and Drainage of the Borough of Liverpool UK’s first medical officer Died aged 57 “worn down by the uneven contest” of struggling with Liverpool’s health problems Obituary: the health of Liverpool was so improved that there was “no longer any occasion for the salary of a medical officer at £700 per year” What is public health?

13. 13What is public health?

14. 14What 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'

15. 15 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?

16. 16 John Snow What is public health?

17. 17What is public health?

18. 18What is public health?

19. 19 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?

20. 20What 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.

21. Wider determinants of health 21What is public health? Source: Dahlgren G and Whitehead M (1991) Policies and strategies to promote social equity in health. Stockholm, Institute for Futures Studies

22. What do PH teams do? 22What is public health? Assessment of health needs Monitor health status of population Programmes for 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

23. 23 Main functions of Public Health 3 main areas:- 1.Health protection 2.Health and social care 3.Health improvement What is public health?

24. 24 1. Health Protection Communicable disease control Environmental health Emergency planning Disease and injury prevention What is public health?

25. 25 2. Health and Social Care Quality Clinical effectiveness and efficiency Clinical governance Audit and evaluation Service planning What is public health?

26. 26 3. Health Improvement Inequalities Lifestyles Education/housing/employment/ environment - broader determinants of health What is public health?

27. 27 Who works in Public Health? List some of the key professionals who work in Public Health What is public health?

28. 28 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?

29. 29 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?

30. 30 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?

31. 31What is public health?

32. 32What is public health? Structure of PHE

33. Structure of PHE K&I directorate 33What is public health?

34. 34What is public health?

35. Drivers for public health 35What is public health? Demographic change and future cost of health care Wanless and the fully engaged scenario Choosing Health Marmot review on inequalities Equity and excellence: Liberating the NHS Organisational change – reduced management costs Targets are out – Outcomes are in Healthy lives, healthy people: strategy for PH

36. 36What is public health?

37. 37 Health inequalities – geographical variations A boy in Sandwell can expect to live 10 years less than a boy in Kensington & Chelsea A girl in Stoke-on-Trent can expect to live 3.6 years less than a girl in Herefordshire There are pockets of deprivation everywhere and health inequalities affect all parts of the country Premature CHD deaths one of the biggest reasons for inequalities What is public health?

38. Actions to tackle inequalities 38What is public health? Providing a sure foundation through a healthy pregnancy and early childhood Improving opportunity for children and young people Improving NHS primary care services Tackling the major killers: CHD and cancer Strengthening disadvantaged communities Tackling the wider determinants of health

39. 39 Marmot Review: Reducing health inequalities, actions: Give every child the best start in life Enable all children young people and adults to maximise their capabilities and have control over their lives Create fair employment and good work for all Ensure healthy standard of living for all Create and develop healthy and sustainable places and communities Strengthen the role and impact of ill health prevention What is public health?

40. 40 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?

41. 41 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 Health inequalities What is public health?