The first head of Public Health Scotland says a “monumental opportunity” now presents itself to embed public health within both health and social care.

Delivering keynote addresses at the annual (online) Voluntary Health Scotland conference this week, Public Health Scotland’s Professor Jim McGoldrick and Wigan Council Director of Public Health Professor Kate Ardern say growing recognition of what public health is and the potential it has to improve society is an opportunity that neither Scotland or the rest of the UK can afford to miss.

A former chair of NHS Fife health board, Professor McGoldrick expresses some frustration about the importance of prevention being overlooked before the pandemic.

“The narrative of prevention became the narrative of preventing delayed discharge…it focused on preventing multiple admissions to hospital – HEAT targets (health improvement, efficiency, access and treatment) – not around the population, not around wellbeing,” he said.

“But I think the whole world of public health is now front and centre in a way it wasn’t before. If you looked at the hierarchy within the health system, the directors of public health on each of the territorial health boards before recent NHS reforms – including the appointment of medical and nurse directors and so on – the status of public health officials was not what they are now.

“…the current government wants to make public health and population health the centre of the approach of government.

“I think there is a narrative now around population health that there wasn’t before, and I think we have to capitalise on that.

“As people will be aware there is the adult social care review going on at the moment and part of our input to that is to say there is a monumental opportunity now to embed public health in health and social care.”

In Wigan, Professor Ardern explains, the director of adult social care works directly with the public health team with a shared vision of care:

“For me social care is about improving the quality and potential of people’s lives – it’s not just about delivering care. It’s a fundamental good in its own right.”

Public Health Scotland came into being in April this year – taking over from NHS Health Scotland’s 17 years as the country’s health improvement agency – just as the pandemic was surging towards a first peak.

The organisation started against the backdrop of the most significant public health challenge of recent decades in the form of covid-19, but also in a country still dogged by some of the worst health inequalities in Western Europe.

Recently ten charities called for action on preventable diseases like cancer and heart disease that place tens of thousands of Scots at an increased risk of the worst effects of covid-19 while claiming the lives of around 39,000 in a normal year.

Despite this, Professor Ardern from Wigan Council says Scotland’s community planning partnerships have been a serious step in the right direction, helping communities to help themselves and improve their health:

“I love what you have in Scotland with the community planning partnerships and community empowerment legislation in Scotland – I wish we had that in England but I guess what we are trying to do in Wigan is replicate that within the English system as best we can.”

When it comes to the spotlight that now shines on public health, Professor Ardern agrees the narrative has moved in a way that must be preserved:

“If people ask me now what my job is, and I say I’m a director of public health, they say ‘oh that’s a really important job isn’t it – you much be incredibly busy at the moment’ – before the pandemic they wouldn’t have known what that role was.

“So, there is that recognition now that we should not lose.

“The role of directors of public health in local government is so important – I would never go back to working in an NHS role because it’s not the right place for public health.

“I also think there is a real recognition about how important health protection is – it tends to have always gone under the radar and yet as we can see with this virus that is a very simple organism, but one that can really disrupt society.

“It’s generated that fundamental discussion about how important health protection is and getting that right to enabling us to function as a society, not just as a set of systems or individuals.

“This has to be about every citizen being their own director of public health – I’m just the person with the job title.

“And it’s about utilising skills and knowledge in a way that empowers people, not disables them. So much of what we do in medicine and health unfortunately does disable people in that it takes away people’s power and agency.

“Sometimes I think when we adopt too scientific an approach – which is important, I’m not trying to decry that – we fail to recognise the power of people’s emotions, the psychology of public health and what people feel is important in their lives, what’s important to us as human beings.

“Recognising and respecting that and giving people the space to tell their own story, and recognising different types of expertise is really crucial.

“Local government is much closer to that – not every council of course, but it’s a much closer model to doing that sort of direct involvement and accountability to the public.

“The last thing I would observe about this is there is a huge opportunity – if we seize it – during covid to change the dialogue on public health from discussions of individual lifestyle behaviour into what it really is about, which is that fundamental community wealth and health building.

“That’s what we are trying to do in Wigan and that’s I think a national dialogue that follows in the footsteps of what is happening in places like New Zealand, where they see health as an economic good – Scotland is doing that and I would like England to follow suit. We will do it in Wigan because that for me is the real prize – health in every policy.”

 

Voluntary Health Scotland’s annual conference – #WeArePublicHealth: Building Forward for Health and Wellbeing – was held on the 4^th and 5^th November 2020.

 

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