This thought-provoking breakfast session at the 1000 Lives Plus national learning event left me wondering why we are still so poor at using the expertise of our public health colleagues as a central resource in driving health services forward.
Peter Bradley’s excellent presentation confronted some key public health myths with evidence to the contrary. The myths that public health achieves little, has little evidence and is too slow to make an impact may quickly be de-bunked simply by pointing to the response to the recent measles outbreak, but other issues are trickier to address.
The myth that: “We can’t involve other agencies in prevention – we already have enough to do,” provoked important discussion about the enormous and largely untapped potential there is to link public health more closely with primary care. An acceptance that this would require investment and support led to a discussion about how clear we can be about the return on investment in public health.
Evidence from systems founded on prevention, such as Kaiser Permanente, suggest that the return on investment can be strong. However, when we only look within the NHS resource envelope, making the business case for savings can be tough. One board member referred to the difficulty he had recently had in getting a case for a modest public health investment past his team. A health and social care system that is mature enough to seek and value system-level savings still seems a long way off.
However, engaging other agencies in public health work is not always about resources, and by happy coincidence, I found an excellent example of that shortly after leaving the session in the poster presentation by a healthcare student, Becci Johnson. Her work in engaging mothers in a breastfeeding group has brought spin-off benefits to partner agencies as well as health benefits to the participants and attracted wider local investment – a true example of co-production for public health.
Another thing that struck me from the session was the extent to which many of our biggest public health challenges relate to behaviours of people of working age. For employers, the case for investment in public health interventions should be very straightforward to make: a healthier workforce will be more productive and costs of sickness and absence will be less.
NHS Wales is already showing signs of creative thinking in this area with in initiatives like Champions for Health, but how much further could we go by engaging more actively with other businesses and services?
The biggest take-home message for me was that public health is not about mapping inequalities and publishing evidence. It is about taking action and that action needs to start locally, with strong leadership. One participant suggested that health boards should publish a collective health profile that includes all board members and map changes over time, as exemplars of good practice (any takers?).
Another suggested we need to start with ourselves and find ways to make doing the right thing easy. Apparently, he has recently moved his stock of wine from the kitchen to the garage, making it easier to resist reaching for a bottle after a hard day at work. I look forward to seeing the run chart of his weekly alcohol consumption as a result of this test of change.