Public Health Policy: The Issues, The Future

1
Public Health Policy The Issues, The Future

• Professor David Hunter

2
Three Domains of Public Health

• Protection
• Promotion
• Performance

3
Rediscovery of Public Health

• Public health high on the political agenda
• Tobacco control
• Food safety
• Obesity
• Bio-terrorism threat
• Communicable disease control SARS, bird flu,
  STDs
• Good health is good economics

4
Policy Highlights (1)

• 1997 Minister for Public Health
• 1999 Saving Lives Our Healthier Nation
• 1999 Health Development Agency
• 1999 Public Health Observatories
• 2000 NHS Plan
• 2001 National Health Inequalities Targets
• 2001 Health Committee Inquiry Report
• 2001 CMOs public health function review final
  report
• 2002 Wanless I
• 2003 Tackling Health Inequalities a programme
  for action

5
Policy Highlights (2)

• 2004 Wanless II
• 2004 Choosing health? Consultation
• 2004 Treasury-led PSA targets
• 2004 NHS Improvement Plan
• 2004 Public health white paper

6
(No Transcript)
7
Wanless I Three Scenarios

• Solid progress
• Slow uptake
• Fully engaged

8
Fully Engaged Scenario (2022)

• Levels of public engagement in relation to their
  health are high
• Life expectancy increases beyond current
  forecasts
• Health status improves dramatically
• People are confident in the health system and
  demand high quality care
• Health service is responsive with high rates of
  technology uptake, especially in relation to
  disease prevention
• Use of resources is more efficient

9
Health Care Spending Growth Rate, 2003-4 to
2022-23
Total UK NHS Spending
Average annual real growth, Average annual real growth, Average annual real growth, Average annual real growth, Average annual real growth,
Projections Projections Projections Projections Projections
2003-4 to 2007-8 2008-09 to 2012-13 2013-14 to 2017-18 2018-19 to 2022-23
Solid progress 7.1 4.7 3.1 2.7
Slow uptake 7.3 5.6 4.0 3.5
Fully engaged 7.1 4.4 2.8 2.4
10
What does Wanless II Say?

• NHS remains a sickness rather than a health
  service
• Failure over 30 years to shift the balance from
  health care to health
• Key challenge is delivery and implementation, not
  further discussion
• Public health workforce is not fit for purpose
• Poor state of evidence-base and underinvestment
  is RD
• Weak capacity of PCTs to deliver
• Health literacy of population is poor

11
Wanless II Selected Recommendations

• Secretary of State for Health should ensure that
  Cabinet assesses impact on population health of
  any major policy development
• Productivity measures in health services should
  focus on health outcomes rather than outputs and
  allow comparisons of effectiveness of prevention
  and cure

12

• A public health research strategy should be put
  in place
• Annual report on the state of peoples health
  should be produced at national and local levels
  to improve understanding
• Production of strategic public health workforce
  plan
• Healthcare Commission should develop its public
  health assessment role

13
Choosing Health Three Principles

• Supporting informed choice, balancing rights and
  responsibilities
• Personalisation of support to make healthy
  choices
• Working in partnership to make health everybodys
  business

14
Choosing Health Key Issues

• Enabling not dictating healthy choices
• Understand better why people make choices and
  design services around them
• Coherent and consistent messages from national to
  local level
• Role of employers and employment
• Focus on delivery, leadership and incentives

15
Making it Happen

• Evidence and information
• Workforce capacity and capability
• Systems for local delivery

16
Evidence

• Strengthening public health research and research
  capacity
• New investment in research funding
• National strategy for public health
• Improved coordination between research funders
• Focus on applied research and real-time
  evaluation
• Evidence on cost-effectiveness of interventions

17
Information

• Health Information and Intelligence Task Force to
  develop a comprehensive public health strategy
• Strengthened Public Health Observatories to
  support DsPH and skills in equity audits and HIA
• Health Poverty Index

18
Building the Workforce

• New role of NHS health trainers
• Induction programme for all NHS Staff
• Leadership for health
• Health Improvement Workforce Steering Group

19
The Challenge

• Political will and commitment
• Power and advocacy
• Confronting wicked problems
• Managing complex adaptive systems
• Can the NHS break with the past?