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Healing the divide with Public Health England

Source: PSE Feb/March 2019

Paul Johnstone, north of England regional director for Public Health England (PHE), discusses his organisation’s work in assisting the devolution and public health agenda.

With the 2012 Health and Social Care Act, the statutory role of improving and protecting the public’s health moved from the NHS to local government and, nationally, to PHE. While many of the NHS changes brought about by the 2012 Act were controversial, reuniting public health and local government was welcomed, given that many of the causes of poor health in the 21st century are social and environmental – housing, schooling, pollution, poverty, and, most importantly, access to a decent job.

This is not to say the NHS has no further role – as the recently published NHS Long-Term Plan (with a welcome ‘place’ focus) and the health secretary’s vision for prevention make clear.

In the north of England, these changes took place against a backdrop of headlines on the worsening north-south divide in health. Put simply, people living in the north live shorter lives and with more years of ill health. These health inequalities are a feature in many countries, and in many parts of our country, but for the north it is the sheer scale that impacts – a legacy from our industrial story over 150 years.

One of the early acts of directors of public health, PHE, councillors, academics, and voluntary and community sector organisations across the north was to meet in Blackpool to see what fresh approaches might come with this new opportunity. We subsequently commissioned a panel led by Dame Margaret Whitehead, a world-leading academic in health inequalities, to provide evidence and recommendations. Her 2014 report ‘Due North’ proved to be a focus for change driving local and national developments. What have we learnt and what is working?

To start, there is clear evidence that:

  • Devolving power closer to communities improves health and wellbeing;
  • Empowerment is key to supporting local communities, working with local leaders and social entrepreneurs;
  • Statutory organisations need to work with community assets – local ‘anchor’ organisations such as schools, hospitals, cultural organisations, and faith groups – rather than trying to plug deficits;
  • The extra burden of poor health is not only a social burden, but an economic and productivity challenge: health and wealth are two sides of the same coin.

One development we have prioritised is working with new elected mayors in Manchester, Liverpool, and other areas where devolved arrangements are emerging. Local authority directors on public health have organised themselves alongside PHE so that we are part of emerging structures, for example in the Greater Manchester Health and Social Care Partnership.

PHE has dedicated staff to liaise and work on this, particularly in data and evidence offering direct advice to local leaders. This, together with local public health teams, supported mayoral narrative and policy so that ‘inclusive growth’ becomes ‘inclusive health.’

Another prioritised area is working with and learning from the most marginalised communities. This is an ‘assets’ approach because we need to turn away from the traditional public sector/health approach of plugging ‘deficits.’ This builds on local, often isolated energy for change, empowers local entrepreneurs and leaders, and re-casts the relationship with statutory organisations.

The Well North pilot programme is an example of exploring the potential for local health and wellbeing that comes through partnering and support for local entrepreneurs and community-generated projects.

All this has led to an impressive amount of learning across the north – an evidence base developed by a new network of academics across our universities.

We want sustainable, prosperous communities; we will only have them if we are healthy. Reducing health inequalities is an economic imperative as much as a moral one. This is challenging with the pressures on budgets and demands for services, but is essential if we are going to address the north- south divide.

This is why the public health sector is working with devolution, elected mayors, and the Northern Powerhouse movement, aligning energies and sharing learning – an opportunity which have only started to grasp.


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