Faculty of Public Health top five public health priorities

Public Health

Thank you very much for inviting the Faculty of Public Health to speak at your conference. I’m the Faculty of Public Health’s Registrar and I’m delighted to be here with you all today.

Maggie Rae
So my brief for this presentation was to talk – in 20 minutes – about the Faculty’s top five public health priorities if we were in government.

I wanted to start the session by quickly telling you all about the Faculty of Public Health. The Faculty of Public Health is a membership organisation for nearly 4,000 public health professionals across the UK and around the world.  We are also a registered charity. The Faculty of Public Health was the first ever public health professional body in the UK. We were set up by the three Royal Colleges of Physicians in the UK in March 1972 and tasked with the assessment of specialist training for, and standards of practice in, ‘community medicine’.

Our role now is to improve the health and wellbeing of local communities and national populations.  We do this in a number of ways:

  • We support the training of the next generation of public health professionals. We design and manage the curriculum and exams that people training for a career in public health need to take.
  • We also support the training and development of our members after they’ve passed their exams, throughout their careers, and even after they retire.  As part of this we offer advice and guidance to our members on what they need to do to have their licence to practice renewed by the General Medical Council.
  • We are a place for our members to discuss new policy ideas and share best practice and learnings through our growing network of over 30 Special Interest Groups (SIGs). Our SIGs cover a wide variety of public health issues including Housing, Arts, Global Violence Prevention and LGBT Health.
  • We encourage and promote new research and understanding of public health through our Journal of Public Health, Public Health Today magazine, award-winning blog and annual events, lecture and conference programme.
  • We champion excellence in public health through our annual awards and prizes programme.
  • And finally, we seek to improve public health policy and practice at a local, national and international level by campaigning for change and by working in partnership with local and national governments on specific public health projects.

And that last point leads me nicely to the exam question you’ve set me – which five aspects of public health policy would we want to prioritise first if the Faculty was in power?

There are – at least – two really big challenges in trying to pick just five priorities.

The first is that ‘public health’ is a very broad topic. For us it’s about promoting and protecting the health and wellbeing of people at a population-level and covers everything from tobacco to transport, children’s health to climate change, and violence to viruses.  Pretty much anything which directly or indirectly impacts on people’s health and wellbeing. And, perhaps not surprisingly therefore, our members do a very wide variety of jobs. The majority work in local government leading or working within public health teams doing things like developing strategies to tackle air pollution or reduce smoking, obesity and drug-use in their local communities. They also help to protect the public from things like infectious diseases, flooding and unsafe housing. But they also work in the NHS helping to ensure hospitals and other health services are run as effectively as possible. And they work in universities, think tanks and public-sector bodies like Public Health England, which is where I work. And we also have a growing number of international members in more than 80 different countries.

But equally as challenging as the breadth of ‘public health’ and what our members do in their ‘day jobs’, is that nearly all the people I’ve worked with in public health over the years are, at heart, idealists. We want everything to improve now and in a pretty radical way. And I mention these challenges not just to stress how difficult picking five priorities was for this presentation. I think these challenges go to the heart of why public health is such a difficult space to secure public health reform. If everything is public health then nothing is public health, if everything is a priority then nothing is a priority.

So with that in mind, here are the Faculty of Public Health’s five public health policy priorities as clearly and concisely as possible.

The first is the need to invest in local public health services.

In setting out this case I wanted to start with a question. When people talk about investing more in cancer services – or in most other types of acute services – the conversation largely begins and ends with the number of additional lives that are likely to be saved, extended, or improved, the cost of the innovation in relation to the current service, and any barriers that would need to be overcome in implementing the new service. When we talk about investing more in prevention we also need to have answers to those questions. But we are also expected to explain the potential downstream financial savings or the likely return on investment.  Why is that? In some ways the answer is obvious – when it comes to cancer treatment there’s a person sitting in a hospital bed.  If you don’t treat them they’ll probably die. If we treat them better than we treated them last year they’ll probably live for longer.  There’s a burning platform, someone’s life is at stake, we must act now. But in other ways it isn’t as obvious. Because getting public health services right is crucial in determining the future health, wellbeing and prosperity of local communities up and down the country. Isn’t that enough of a burning platform to act now?

But the thing about investing in public health is that the future health and wellbeing of local and national populations is only part of how compelling our story is. We can answer the downstream savings point as well.

As both NHS England and Public Health England have made clear, we will not solve the myriad challenges facing our GP practices, hospitals and care homes unless we properly value and invest in public health and continue to encourage people of all ages and backgrounds to be happier, healthier and more productive for as much of their lives as possible. In short, investing in public health is absolutely vital if we are to slow down the ever-growing demand in NHS and social care services and create a sustainable NHS and social care system for the next generation. And it is vital if we are to continue to have a productive economy as our population gets older.

I’m going to set you a little bit of homework on this point if I may. When the next round of ‘NHS and social care in crisis’ media activity happens, listen out for how many times you hear that investing in public health needs to be part of the long-term solution.  I suspect you won’t hear it very often.

So what do I mean when I say investing in public health? Well I don’t mean simply reversing the £200 million in cuts to public health services we saw in 2015/16 or the £600 million in further cuts planned by 2021 according to the King’s Fund.  And I don’t mean that public health teams in local authorities should simply carry on delivering prevention services in the way they were a decade ago. This isn’t about more of the same.

The huge potential of digital technology alone to transform how we deliver prevention services and improve our effectiveness in persuading and incentivising local communities to make heathier choices means we can’t, and mustn’t, go backwards. Just by way of example, your mobile phone already knows far more about your health and wellbeing than your GP does. It knows about your sleep patterns, how frequently you contact your friends, whether your purchasing decisions are out of character, how much physical activity you’re doing in a week, how many times you go to the pub or the gym, how fast you drive, how much alcohol you buy, and whether you’re making healthy food choices. And the big difference is that you can’t lie to your phone.

Our members are telling us two things when it comes to investing in public health. They have gone to heroic lengths to deliver more with less and less. But they cannot make the ‘radical upgrade’ in prevention services required without a significant increase in funding to allow them to innovate and transform the types of services they provide. The LGA has talked about the need for a £1 billion Prevention Transformation Fund to support local authorities in modernising prevention services. We think that’s a good start and that’s what we would put centre stage in the next Comprehensive Spending Review.

The second priority for FPH is closely connected to the first.  We need to continue to invest in our public health workforce. Our members tell us on a daily basis that they want to do even more to improve people’s health and wellbeing and give everyone the best chance to live a healthy life, no matter who they or where they live. And to do that we need to continue to improve the training and development of public health professionals so that they are even better equipped to tackle the many new health challenges facing our local communities.

The third priority for FPH is Brexit. The Faculty has been going out over the summer talking to the public health community and it’s fair to say that Brexit gets a mixed response. Alongside the frustration that Brexit is happening at all, some very senior people in the public health world think Brexit isn’t really a public health issue. Well I’m here to tell you that it most definitely is – in fact we think it has the potential to be the defining public health issue for the next generation. The Brexit health conversation has so far focused primarily on the possible impact on our NHS and social care workforces.

It’s a vitally important issue but the public health implications are so much bigger than that. I’ll give you one example – amongst many – that we at the Faculty are actively thinking about at the moment. During the summer Michael Gove and Liam Fox had a pretty public debate about whether a trade deal with the US would mean we have to start allowing chlorinated chickens into our country. The debate highlighted the fact that the trade deals we make with our key trading partners when we leave the EU will have a huge impact on the health and wellbeing of our populations – for better or worse. It’s not just about the quality of the foods we put on our supermarket shelves. It is also about whether our goods and services are produced in ethical, environmentally sustainable ways. It’s also about how much our workers get paid, it’s about their working conditions, what they produce, and what jobs they do. If we get it right, these trade agreements could help to create healthier, happier, more productive communities. That’s why we think the Government needs to pursue ‘healthy’ free trade agreements built around a core commitment to protecting people’s health and wellbeing in all our future trade negotiations.

The fourth priority for FPH is Children and Young People, and specifically the implementation of the 1001 Critical Days Manifesto. For those of you who aren’t aware of this cross-party manifesto, it was originally launched in Autumn 2013. It sets out a new vision for the provision of services from when a baby is conceived until they reach their second birthday. There is now a wealth of evidence to show how crucial these first 1001 days are in influencing every child’s life chances. We’ve made some progress since the manifesto was launched but there’s a lot more that still needs to be done.

FPH’s fifth – and I hesitate to say final – public health priority is climate change which virtually everyone recognises is one of the biggest threats to the public’s health over the next century. Right now we think the most important action a British Government could take on this is to work in partnership with as many other countries, and US states, as possible to mitigate the impact of the US decision to remove itself from the 2015 Paris Agreement. But it is also vital that the UK ‘walks the walk’ and that we meet our own climate change commitments in this country as well. And that means building an energy economy based on renewables.

I wanted to finish my presentation if I may with a bit of a rallying cry – largely because FPH and the wider public health community isn’t likely to be in government in the near future. The public health community’s role is to work to influence and encourage whichever government is in power to do the right thing when it comes to the UK’s future health and wellbeing. There is an argument I hear a lot, often at conferences like this, that local, and particularly national governments can’t do ‘public health and prevention’ because they are slaves to the short-termism inherent in the electoral cycle. Prevention has too long a lead-in time so the argument goes. The money invested now doesn’t bring political reward quickly enough so politicians make cynical judgements to invest in hospital A&E wards, even if deep down they know that that’s never going to be enough to deliver healthier and more productive communities. I think some find that argument reassuring in explaining why our public health budgets have been cut and why our influence over health and social care policy has arguably diminished over the past decade or so. But the truth is that local and national governments make long-term, strategic decisions ‘in the national interest’ all the time, on all sorts of issues – from HS2 to Hinkley Point to Trident.

And even if there is some truth in the ‘political cycle’ argument – how should the public health community respond? I think our response needs to be to tell our story in a way which local and national decision-makers find even more compelling.

First and foremost, we need to be clearer and more coordinated as a community about what our public health priorities are.

Yes it’s about having really strong evidence about the likely return on investment but we also need to be able to show the impact on health and wellbeing outcomes this year from a decrease in funding last year.

We need to be able to model the likely outcomes from decreases in spending next year, in five years’ and in ten years’ time.  And we need to communicate this modelling clearly, simply and again and again and again. We need to be able to show more effectively the political and public support for further public health policy reform. We need to better tell personal stories that sit underneath the stats – the positive changes in people’s lives and the impact that has on them, their families, their friends and colleagues.

We desperately need to invest in innovation and use the huge potential of technology even more effectively. We need to preach less and nudge more. We need more people lobbying for our sector and more champions among the decision-makers. And we need to get better at saying thank you and squeezing out every last ounce of value when our local and national politicians take positive actions to improve the health and wellbeing of our populations.

The public health community has an amazing story to tell.  Now more than ever we need to tell it well.  If you’d like to help the Faculty to tell our story, then please do join us.You can find out more about how to become an FPH member on our website.

Faculty of Public Health

And with that I’ll say thank you very much again for inviting me to speak and I hope you find the thinking helpful.

This was presented at our conference Public Health Priorities for Labour