Personal Reflections on Leadership and Wanless II

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Personal Reflections on Leadership and Wanless II

• Dr Selena Gray
• SOLAR/UWE Bristol
• Public Health Leadership
• in the Real World

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What does Wanless II say about leadership?

• Not much!
• Last paragraph of the summary
• Full engagement will mean achieving the best
  outcomes that individuals in aggregate are
  willing to achieve with strong leadership
• Implicit rather than explicit

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Improving the publics health
Government action
Individual choices
Community and social norms
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Smoking
Ban on workplace smoking
Individual understands risks
Smoking not seen as normal behaviour
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Tooth decay
Individuals clean teeth, know risks and restrict
sugar and carbonated drinks
Flouridation provision of toothpaste and
brushes ? in sugar in childrens drinks
Perceptions of normal weaning, childrens diets
and toothbrushing habits manufacturers ? sugar
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Salt consumption
Food labelling restrictions on salt in food
Individual knows desirable salt intake and how to
limit it
Food manufacturers and producers lower salt
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Wanless II
Individuals need help to make better decisions
about their health
Measures should be justifiable
Changing social norms is legitimate goal of
government
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Philosphy of informed choice

• Individuals are ultimately responsible for their
  own and childrens health.
• Individuals should balance their right to choose
  their own lifestyles against any adverse impacts
  their choices have on others
• Need to help individuals make better decisions

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But

• What about the patient who acquired Hepatitis C
  following a blood transfusion?
• Individuals may well value their needs eg to
  drive fast, to smoke and so on, above adverse
  effect on others
• Choice may be limited by availability

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Flaws

• Health is an investment not a consumption
  decision (quoted from Grossman 1972)
• Report persists in seeing individual behaviour
  choice as a consumption decision
• Short term benefits from unhealthy decisions may
  be entirely rational

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Weaknesses

• The phrase marketing failure to denote
  individuals choice of unhealthy lifestyles- often
  a result of successful marketing strategies!
• No recognition of the potential anti- health
  effects of markets
• Emphasis on individual choice may widen health
  inequalities

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What has all this to do with leadership?

• PHPs need to help challenge an overly
  individualistic market orientated view of public
  health
• PHPs need to contribute to the serious and so
  far unresolved debate about the stewardship
  function of government in creating the conditions
  for people to lead healthier lives. (David
  Hunter UKPHA)

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Evidence base

• Welcome emphasis on evidence base, costs and
  benefits and modelling
• Done 10 years ago re ban on tobacco advertising
  by government economic adviser
• Likely to show costs and benefits of government
  wide approaches in improving health AND
  especially in reducing inequalities

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Leadership around evidence

• To move public health generally to a more
  critical evidence-based culture
• Championing the use of personal and anonymous
  data in a hostile climate which fails to
  understand surveillance, quality assurance and
  public health monitoring

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Leadership at local level

• Promote the need for action in all three areas
• Promote understanding of differences between
  improvements in health and reduction in
  inequalities
• Help reduce fear of nanny state

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Practical aspects

• Produce hard hitting annual reports
• Volunteering to be in national pilots and
  evaluations
• Champion of evidence of effectiveness of public
  health programmes
• Get NHS to be model employer

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In primary care

• Engaging primary care in lifestyle advice
• Using new GMS quality framework
• Using community pharmacists/ expert patients
• Using PMS to develop services
• Secondary care for CHD in primary care
  collaborative led to ? 2 fold reduction in death
  rates compared to other sites

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Primary/secondary care interface

• Getting resources into active prevention eg
  asthma, diabetes, COPD- admissions should be seen
  as failures of primary care systems
• Falls prevention programmes ? admissions by 30
• Championing the importance of social care in ?
  acute admissions

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Community and social norms

• Lead shifts in thinking around community and
  social norms eg
• Include domestic violence in community
  development programmes
• Change attitudes to legislation around workplace
  smoking (smoking ban in Montana led to 20? in
  acute MI admissions)
• Challenge social acceptability of speeding

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Government action

• Generate local support for key measures eg
• Workplace smoking ban
• Bill to prevent children receiving reasonable
  chastisement
• Reduction in food advertising to children

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Improving the publics health
Government action
Individual choices
Community and social norms
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Frontispiece to Wanless II

• We are not tinkers who merely patch and mend
  what is broken.we must be watchmen, guardians of
  the life and the health of our generation, so
  that stronger and more able generations may come
  after.
• Dr Elizabeth Blackwell (1821-1910). The first
  women doctor.