The anatomy of a healthy city

implementing “health in all

policies” and “what’s a DPH

supposed to do”

Greg Fell

Director of Public Health . Sheffield

@felly500

Greg.fell@sheffield,gov,uk

Thanks to those I have stolen slides from

Why, what and how….

Firstly some context

“public health” is……..

The scope of “public health”

• It IS

• A Function or

responsibility

• Commissioned

services (scope?)

• Some source of

Expertise

• Strategic leadership

sort of stuff.

It is NOT:

• Prevention

• The “Public Health

grant”

• Health inequalities.

The (real) job description of the DPH

redesigning a city for about 570,000

people where health was and inequality

was a key criterion what would it look

like

healthy cities reborn?

More than “commissioning some

services”

more than bananas and a massage

My job description:

• give people in Sheffield the best start in

life to maximise their life chances.

• increase healthy life expectancy.

• narrow the gap in healthy life expectancy.

• make sure your kids are immunised,

screening, respond to incidents.

• Oh…. And write a strategy please…..

The problem

Why are we poorly. Why we die.

Or put another way

25

if this is the answer what is the

question

25 year difference in healthy life

expectancy

Moving towards an answer

I already had one go at this

https://www.sheffield.gov.uk/home/public-health/director-public-health

https://www.youtube.com/watch?v=8niZ59yF8Bc

Causes of "health"

• 'Care' c20% contributor to 'health'

• The totality of the City's activities may have a material impact on health

• Some immediate, some downstream

• Some direct, some indirect.

the determinants of well being –

“health” is one of those

https://www.youtube.com/watch?v=yEh3JG74C6s

http://www.who.int/bulletin/volumes/89/10/11-021011/en/

What’s your starting point

“Absence of disease….” etc (WHO 1948)

Vs

positive concept of well being in social context

Huber et al BMJ 2011

How should we define health?

http://www.bmj.com/content/343/bmj.d4163

https://www.rcpe.ac.uk/sites/default/files/burns.pdf

“There is no doubt that avoiding health-damaging behaviours

makes sense. However, creating health is a proposition at

least as sensible and as practical as simply avoiding

disease.”

the determinants of well being

What is your starting point

• outside government, looking in

– “if only government took its responsibility re the social determinants seriously”

– Starting point = biomedical paradigm?

• or starting from the inside

– looking to get better on what's already there, link agendas together, get better value (outcomes) from existing or reducing resource envelope.

– Starting point = social paradigm

Starting point 2

• “public health” ≠ “something the DPH does”

• This Council has fundamental belief in the notion of Health in All Polices

• Inequality / social justice is at the heart

• There are some significant constraints and many things are not under the control of the council.

• SCC or Sheffield.

• Influence of wider govt, and society.

Starting point 3

• Framing and language

• “Health” ≠ “health services”

• but the very term health is so deeply

enshrined as short cut to health care

• concerted and v public effort to change the

narrative or we use another term.

• nervous about “health imperialism”

Why change

• It’s the right thing to do • Social justice • Future care costs • Investment in the health of the population

is just that – an investment in infrastructure • Set the tone, the backdrop and the

narrative • Specific interventions – policy context,

environment, life chances, lifestyles, care and support.

It’s an anatomy lecture

• Ways of carving it up into manageable

chunks

– Life course / population age groups

– Disease or outcome groups

– Geography

• Is this all a bit reductionist and avoids the

complexity of it all?

• Is it the whole that matters?

The best start is the best value

• Development at 22m is excellent predictor of outcomes at 26y

• Not only "health" interventions but the totality of emotional, social and environmental issues

• Some excellent practice • Some areas for attention

Living well

• Premature mortality is falling – good news

• Inequality & not falling as fast as England

• No single thing - environments, life chances, life styles, primary care

• Need to make the healthy choice the easiest and default choice

• Four things to press on: – Employment

– Neighbourhoods

– Move more and active travel, smoking

– Self care

Ageing well

• Starts in childhood

• It is not an "ageing thing" -

it's a complex interaction

of genes, environment,

choices we make

• The ageing population is

not the cause of ever

increasing care costs.

The health dividend is largely

invisible – needs to be on the

balance sheet

Health is needed for:

―Prosperous economy

―Social justice

―Two way relationship

Some specific examples and

targets

here we get into specific body

parts. This isn’t an exhaustive list.

How far upstream do you want to

go

Causes of health

Causes of causes

How far upstream do you want to go

Causes of causes – in scope?

• Individualisation of social issues

• Dominance of market mechanism

• Misplaced belief in trickledown economics

• Privatisation of profit, socialisation of risk

• Concentration of wealth

• Neo liberalism

Political origins of health inequities: trade and investment agreements

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31013-3/fulltext?rss=yes

Joseph Stiglitz Says Standard Economics Is Wrong. Inequality and Unearned Income Kills the Economy

http://evonomics.com/joseph-stiglitz-inequality-unearned-income/

Ha-Joon Chang | The economic argument against neoliberalism - https://m.youtube.com/watch?feature=youtu.be&v=ti3rjogF_VU

• The best drugs for cholera wont work if the

system to deliver them is rubbish

• The best treatment system wont be of any

use if the water is still filthy

• Sort the water

• So you DO do the rats and drains then?

• Why is the water filthy…. Even further

upstream

Asthma is important

• We’ve got access to

the best asthma drugs

on the planet

• But we ignore the

basics

– System to deliver best

quality care

– Inhaler technique

– Cigarettes

– Air Quality

Reframing transport policy – bike lanes vs

more roads vs screening and cancer drugs.

How to define “success” in transport policy

https://gregfellpublichealth.wordpress.com/2016/10/17/ten-thoughts-on-reframing-transport-

policy-as-a-health-investment/

https://gregfellpublichealth.wordpress.com/2016/10/01/parks-and-bike-lanes-and-healthy-folk-on-

the-value-of-different-forms-of-investment/

http://publications.arup.com/publications/c/cities_alive_towards_a_walking_world

http://lcc.org.uk/articles/healthy-streets-are-cycling-and-walking-streets

We over-medicalise non medical problems

The script for anti depressants and statins

is written before you walk in the door

this wastes resource and does harm

or

Lancet June 2012

Some obvious opportunities -

Cholesterol control beyond the clinic

Population wide blood pressure

Scotland - Its not the pies and cigs, it

might be the booze

• What happened in the 1950, 60,

70s - Catastrophic loss of

industry in Scotland - shipyards

• Fundamental changes in social

structure and patterns

• Gorbels -from close knit

community to large flats and

build new towns.

• Men had no jobs, no community

facilities, no schools, no shops.

http://www.gcph.co.uk/publications/635_history_politics_and_vulnerability_explaining_excess_mortality

policy recommendations - http://www.gcph.co.uk/assets/0000/5587/Excess_mortality_-_Policy_recommendations.pdf

https://www.theguardian.com/cities/2016/jun/10/glasgow-effect-die-young-high-risk-premature-death

“planning and health” – here’s some

detail you can go over at your leisure • Inequality – creating more equal societies where all have equal opportunity

• Transport – air q, activity, carbon and sustainability

• walkable environments being the default option and the hierarchy

• Obesity – food environment, activity, obesogenic environment etc. hot food outlet density. Concentration.

• Open green space – mental well being, activity. building green space, municipal space, parks / playgrounds INTO new developments the default – activity, mental well being,

• Play facilities

• Housing standards – trip hazards, cold homes and insulation, housing design

• location issues (mixed developments, not all posh folk enclaves

• Transport / housing / employer links – issues around agglomeration etc Agglomeration - There’s something to be said about building employment zones miles away from residential zones and how this structurally builds in air pollution etc…

• Healthy building standards inc Age and disability friendly housing

• Demographic stuff and planning health care facilities within developments –

• Land use and mix, land density - Social regeneration – and role of planning in this. Not segregated – socially mixed developments. Build on the Glasgow research, referenced at bottom.

• living wage type discussions as a default expectation in applications for new retail or industry developments

• Noise pollution

• Stuff around Retail Offer – not all takeaways

• Stuff around community safety – defensible spaces, planning out crime, reclaim the streets, space for community events and gathering

• Housing growth and impact on other policy objectives

https://gregfellpublichealth.wordpress.com/2017/02/10/planning-processes-healthy-

cities/

How the past defines the future

• Heckman – 20 years ago – “best start = best value”

• Recent work on Adverse Childhood Experiences reinforces

• Long term consequences of ACE – health and disease outcomes.

• Likely to transform our thinking

Lancet editorial - http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32172-9/fulltext?rss=yes

Bellis - https://www.ncbi.nlm.nih.gov/pubmed/25174044

15 minute TED Talk by Nadine Burke Harris for a cogent precise account of the effects of childhood maltreatment on

chronic health outcomes .

https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

Welsh studies

• ACE is correlated

(strongly) with

– rates of chronic

disease

– Low mental well being

– Other harmful

behaviours

• How far upstream do

you want to go –

across sectors and

generations

http://www.wales.nhs.uk/sitesplus/888/pag

e/88517

parks and green space

• We want parks.

• They are in trouble funding wise

• Do we spend our resources on things most likely to achieve our goal?

• Do we build core “health” activity into parks?

https://gregfellpublichealth.wordpress.com/2016/10/01/parks-and-bike-lanes-and-

healthy-folk-on-the-value-of-different-forms-of-investment/

We ARENT short on evidence

202 pages on why green is good

We don’t need more evidence that green = good.

http://www.euro.who.int/__data/assets/pdf_

file/0010/337690/FULL-REPORT-for-

LLP.pdf?ua=1

http://www.euro.who.int/en/health-

topics/environment-and-

health/pages/news/news/2017/05/reviewin

g-the-health-impact-and-effectiveness-of-

urban-green-space-interventions

“Residing in greener areas was associated with healthy weight outcomes possibly through a physical activity-related mechanism.

Green allocation and design may act as upstream-level public health interventions ameliorating the negative health externalities of obesogenic urban environments.

Further prospective studies are needed to identify potential causal pathways and thereby effectively guide such interventions.”

Really? http://www.sciencedirect.com/science/articl

e/pii/S0160412017302416

We DON’T need

more evidence

that green = good

The health select committee report

is state of the art – delivery models

• New models for

protecting the asset

that is “park”

• Do “health” invest in

parks?

• Parks v cancer drugs

and cath labs (again)

http://www.parliament.uk/business/committees/committees-a-z/commons-

select/communities-and-local-government-committee/news-parliament-2015/public-

parks-report-16-17/

Different approaches – 5 elements

of capital. How do we capture and

exploit (in the nicest way)

• decision making tool

which looks to optimise

5 elements of capital

– health,

– natural,

– cultural,

– Financial etc

• We have done this with

Sheffield’s parks

http://wwtonline.co.uk/features/yorkshire-water-s-decision-making-uses-five-

capitals-approach#.WRHpU7pFzoo

“the economy” and health

• The way in which the “economy” works is a determinant of health.

• the “economy” ≠ “what business does”

• Its taken 35 years to get to the current model. Huge power and vested interests.

– It wont go overnight.

• Kerslake – review of HMT functions?

• Inclusive Growth (or sustainable economy)”

Tackling the inequitable distribution

of power, resources and money

1. Market accountability

2. Fair financing

3. Gender equity

4. Political empowerment,

inclusion and voice

5. Equity in all policies

6. Good governance

Re think what really keeps people

well in communities?

http://whatworkswellbeing.org/2017/05/17/a-theory-of-change-for-

community-wellbeing-a-new-call-for-evidence/

• Community support workers who offer brief interventions

– Provide critical support in times of crisis

– Are dependent upon having a system that functions in order to connect clients to longer term sources of support

Janet Harris

Hardest of all? – mental well being

• Medical v social model

• Individual v social policy

• Services vs social environment

• Population and individual level risk factors and assets

• Locus of control

• Welfare net, poverty

• Social exclusion

Framework for Healthy Public Policies Favouring Mental Health

http://www.ncchpp.ca/553/Publications.ccnpps?id_article=1203

But its complex.

Complicated v Complex

Try the same for ALL of the processes and systems that determine our health!

Gotta start somewhere - my “ten”

1. Best start – 1001 days

2. Work (and health)

3. sustainable economic growth

4. City for All Ages & healthy ageing.

5. land use planning; population density and mix, transport planning including active travel by adopting a healthy town framework.

6. Air Quality Strategy and Transport strategy

7. Health and care reform and transformation

8. open space and green space, Outdoor City, parks, Move More

9. housing strategy

10. mental well being In addition to BAU

How…….

Some thoughts on “how” –

you need

• Strong relationships

• Half decent evidence base

• Good narrative – that everyone agrees

with

• To be prepared to streetfight

• Good traction able propositions

• Persistence and presence

• Political support and will

Getting traction – 10 ideas 1. Build health impact assessment into planning processes

2. common monitoring and evaluation tools

3. Ownership - Ownership of a large group of stakeholders matters.

Persistence and presence across all parts of the organization.

4. reconsidering the question of the purpose of "commissioning" in

some areas, what outcomes do we want to achieve

5. Learning across sectors – eg education and health care delivery and

quality improvement

6. change how success is measured in big systems, how ROI is

considered - transport , economic growth

7. Be clear about expectations - should key policy or service areas set

and publish health and well being objectives – Welsh approach to Well

being

8. learn from the successes or failures of other models of change e.g.

recycling,

9. Engaging citizens in this agenda is important, and we could do

better.

10. Supporting community based co-design to define and solve

“problems”.

What are the main processes or

systems that we want to

influence? • Planning, licensing, environment, economic policy etc

• Definable propositions, actionable changes

• How do you influence the natural path.

• Take a chunk – say housing and specifically within that cold

homes / fuel poverty – what the current path, the ideal, the

stretch.

– Evidence, interventions etc etc etc…

– In each area what ARE the outcomes you wants to see.

– What does "better health and well being" look like in THAT context

– What is the logic model for getting from where we are to where we

ought to be

•

Aspects of focus

• In any area, focus on:-

– Resilience – personal and community

– Ageing

– Best start

– Environments that maximize opportunity for health

– Behaviours

– Policy levers, strategies, services we provide or commissioning

– Combination of short to medium term tangible, tractable, measurable stuff & medium to long term narrative, thinking about system type of things

On the future…………..

Think long term – trends and challenges

“mission not a battle”

http://global-systems-science.org/oxford_martin_now_for_the_long_term/

1.Creative Coalitions - climate change, NCDs

2. Innovative, Open and Reinvigorated

Institutions: Decades, not Days, independent,

accountable institutions with long term

horizons,

3. Revalue the Future – people AND tec,

perverse subsidies – hydrocarbons, sugar?

4. Invest in Younger Generations: Attack

Poverty at its Source

5. Establish a Common Platform of

Understanding – collective vision for

society

A “smart city”

• Smart ≠ “tec”

• All types of assets – human, environmental, built, tec

• Smart thinking vs “Smart City” – asking the right long term questions.

• What knowledge is out there that we don’t know

• Seeks new knowledge to answer strategic qs

• Locate “smart” in the context of a real problem

• From a “health” perspective – what are the long term challenges and trends

So you must have a giant

budget and staff then Fell

• 4 staff I’m directly responsible for.

• £5,000 non staff budget.

– PH Grant in Sheffield = £32.5m. Its ALL committed.

– SCC budget = £1.4bn. Its ALL committed.

– Public services in Sheffield = £4.1bn. Its ALL committed.

– Sheffield economy = c£11bn. Its ALL committed.

– What is it that you want to influence? To do what?

Grant - https://www.gov.uk/government/publications/public-

health-grants-to-local-authorities-2016-to-2017

Summing up

Five things that keep me awake

• Our (continuing) failure to redress inequality

• Our (continuing) failure to prevent the

preventable

• Our (continuing) over medicalisation of non

medical issues

• Our (continuing) under implementation of

highly effective and over implementation of

ineffective / marginally effective

• Life expectancy. Gain is slowing. Falling in

USA. Healthy life expectancy falling?

4 critical issues

1. Getting “well being” on the balance sheet. Quantifying

the gain from changed life trajectories of past

investments.

2. Belief and narrative + evidence

3. Making it the CITIES business, getting out of one silo

and into everyone’s silo (eg - Health Inequalities is

NOT a PH responsibility)

4. Are we prepared to say no to todays pressing

demands to invest in the future.

4 key challenges

• Medical model v social model

• The individualisation of policy

• Status quo and vested interests

• Outcomes vs finance

4 take home messages

1. H as an investment for vibrant society and

economy not a cost to NHS & social care

2. Transformation is fundamentally

redefining the job and doing that better

3. You cant be an expert in everything. You

certainly cant control everything, so set

the rules and control the narrative.

4. PH ≠ “a department”. It is an

organisational responsibility.

Back to my job description

redesigning a city for about 570,000

people where health was and inequality

was a key criterion what would it look

like

healthy cities reborn?

More than “commissioning some

services”

more than bananas

Thank you

I’ll stop there and not drone on

about the “how”

Questions

Greg.fell@sheffield.gov.uk

@felly500

https://gregfellpublichealth.wordpress.com/

Reading list – see note page

Some thoughts on implementing

Health in All Policies. Brief notes.

Context – the ask of the leader

• Describe what SCC as a “public health

organization” would look like

• “transform ‘public health’ please, from an

NHS facing model to a local government

facing on.

• “PH” is not “the PH grant”

• goal = 25yr difference in H Life Exp

• write a strategy.

http://democracy.sheffield.gov.uk/ieDecisio

nDetails.aspx?Id=1756

The Strategy….

• Deliberately tipped away from an NHS centric model of public health

• redress the balance in approach to “public health”

• mindful of the large gravitational pull of the NHS

• effect to shift the balance of the discussion and narrative on health away from the NHS and more towards other issues.

Implementing such a strategy

• Its 10 pages long

• no intention to write a detailed action plan.

• Implementing will take many forms.

• No single idea or policy option that will

achieve the goal.

• 4 objectives and 10 starting points –

merely obvious opportunities, easy wins

and areas with significant gain potential.

Health in All Policies……

mechanism to

1) make explicit, get the health impact is on the balance sheet in a visible and tangible way.

2) increase (rather than describe the current), the health gain from policies and service areas that have not been considered as “health” related.

The “public health budget”.

• PH = is an organisational responsibility not a line in a budget, the “Grant” cannot by itself address the public health challenges of the city.

• The ambition in being a public health organization is to optimize the use of its £1.4bn budget, and associated purchasing power, to best improve health and address inequality.

Success – the acid test

• all areas of decisions making and resource commitment systematically consider health and well being outcomes, and inequalities across.

• Success only happens if the approach is institutionalized.

• change the way the organization thinks and does its business.

• Eg transport policy and investments in this area will deliver health gain and that should be led from within that part of the council, for example the licensing or the planning committee.

• “health” becomes business as usual for the council.

• Different methods and challenging or changing cultures, standard operating procedures for a city and challenging the status quo.

Risks and problems in

implementation • Budgets get cut and skewed to demand led services ./

here and now

• framework that’s used for services to describe how what they already did improved health, and how they could do more if they got money (there isn’t any?) so it is not about how they were going to change what they did to better address health”.

• flash points will become where there are choices to be made about resource commitments (do we protect car drivers in effort to address congestion by building more roads, or do we tackle congestion by proportion modal shift; do we prioritise investment in social care or parks and green space).

Success and reasons for failure

organizational competency framework.

•

language is important. Get it

straight.

• The term “health” takes us down a certain

path (NHS),

• At policy level, health is largely still seen

as the remit of health care chiefs.

• the word “health” seen as a bit “narrow”

and “medical”….

• “health imperialism” - HIAP is not a land

grab for “health being at the pinnacle

What is your starting point

• outside government, looking in

– “if only government took its responsibility re the social determinants seriously”

– Starting point = biomedical paradigm

• or starting from the inside

– looking to get better on what's already there, link agendas together, get better value (outcomes) from existing or reducing resource envelope.

– Starting point = social paradigm

Getting traction.

1. Build health impact assessment into planning processes and developments in a practical way and not a techhnical diversion. Needs to be small part of bigger picture

2. develop common monitoring and evaluation tools

3. Ownership - Ownership of a large group of stakeholders matters. Persistence and presence across all parts of the organization.

4. reconsidering the question of the purpose of "commissioning" in some areas, what outcomes do we want to achieve

5. Learning across sectors –

6. In some areas it may be necessary to change how success is measured in big systems, how ROI is considered - transport , economic growth

7. Be clear about expectations - should key policy or service areas set and publish health and well being objectives – Welsh approach to Well being

8. There is much to learn from the successes or failures of other models of change at the population level, e.g. recycling, tobacco, climate change?

9. Engaging citizens in this agenda is important, and we could do better.

10. Supporting community based co-design to define and solve “problems”.

11. Aligning wider policies with improving health - decisions that influence job supply, housing quality, or our ability to lead active lives are going to have more impact on our health than whether or where to build a clinic.

12. Engaging local business and employers

13. Mobilizing wider resources and supporting longer term investment – address the cross sector problem.

14. Developing an inequality and effiiency narrative. How might we react if we were to start viewing health as a finite asset

Learning from other areas • South Australia

– Prep and awareness raising – desktop analysis of strategic plans, what are the

opportunities, analysis of targets and trajectories, development of whole of govt

consensus and mandate.

– Mobilise – then translate mandate into mobilisation and action. Engage

stakeholders, develop collaborations, evidence gathering, policy proposition

development, implement, evaluate (complex system type of evaluation rather

than discrete “interventions ”.

– Underlying values – respect, listen and respond, two way street, humility,

building consensus, mutual gain and collaboration, flexible methods – don’t be

stuck, resources (backbone specialist) to facilitate and enable – this is what you

might call the PH Specialists in vatrious guises ?.

– Build and maintain strong relationships

– Role of “specialists” to nudge it along in a skillfull way, provide fresh

evidence and insights etc

– Shared understanding – if you call it “health” might skew conversation and

direction of work in certain direction. If you call it well being will be entirely

different? Or is that just semantic ?

– Evidence informed vs evidence based - no absolute truth, political org.

– Complex adaptive systems and intangibles

– Surfing the wave – opportunity surfing. When external or internal opportunities

arise let’s put the capacity there.

What are the main processes or

systems that we want to influence • Definable propositions, actionable changes

• How do you influence the natural path.

• Take a chunk – say housing and specifically within that cold homes / fuel pov – what the current path, the ideal, the stretch.

– Evidence, interventions etc etc etc…

– In each area what ARE the outcomes SCC wants to see. What does "better health and well being" look like in that context

– What is the logic model for getting from where we are to where we ought to be

•

• In any area, focus on:- – Resilience – personal and community

– Ageing

– Best start

– Environments that maximize opportunity for health

– Behaviours

– Policy levers, strategies, services we provide or commissioning

– Combination of short to medium term tangible, tractable, measurable stuff & medium to long term narrative, thinking about system type of things

Tools for influence and traction

• HIA or HIA lite

• Whole of government type of approach –

but someone has to “own” it.

• Setting targets for other sectors – cant see

that going down well .

• Strategic use of finance and ROI models

and indicators .

Policy framework for policies where there is risk for health.

McKee . http://thelancet.com/journals/lancet/article/PIIS0140-

6736(17)30122-8/fulltext

Applications re HIAP? HIA made simple?

Propositions

• Eg-

• (i)housing—standards- how we do we prioritise our enforcement efforts for those with poor health / worst conditions ( I don’t think we do, but we keep paying for the service )

• (ii) NICE guidance—how are we going to deliver Cold related illness guidance ( NG6 )

• (iii) Why do we have a policy for adaptations grants for older people with minimum age limit of 75 ?!! – in terms of inequalities, only the healthiest 75 year olds can get house adaptations. ( and we have to advertise it so we can spend the money ( I struggle to believe this, but it’s the story I am getting )

• (iv)How do we plan for ageing population in terms of new housing standards etc—

• (v) tbc by housing colleagues—use scrutiny to help them remove one of their ( probably policy led) issues, provided it helps us too .

Our job?

• Technical skills – evidence, epi, change agent, economic and value, evaluation.

• Technically skilled honest broker.

• See across silos

• Link silos together

• Some things WILL happen anyway, some we may need to alter the course of to maximise HWB as outcome, some may not happen unless we make happen

• assure vs ensure happens etc. guiding, doing, influencing.

• Some tangible stuff.

• Big, in flight programmes

• Impact plan – have we got right people, right strategy, the right high profile / high impact things in flight.

• Some exploratory pieces (for eg economy and health – undoing 30-40yrs of economic thinking isn’t going to happen overnight, quickly or in Sheffield).

• Win win, what's our offer, what leverage do we have (we will take the xxxx $$ away if you don’t sort the xxxx contract out), what sweeteners

https://gregfellpublichealth.wordpress.com/2016/05/06/transforming-public-health-what-

does-public-health-3-0-look-like/

When old meets new

• Use of budget and skills

• 1. use your (tiny) budget wisely and strategically

• 2. use your skills and position to influence others (to do what they largely already want to do – prevent stuff). go play with new people and partners

• 3. use your skills and apply them to any problem that you want. Historically our lot have done this in NHS, now do it in jobs, poverty, housing etc

• 4. Really develop new insights into problems and act on those insights. Use the assets you’ve already got to get those insights.

• 5. Use of behavioural economic techniques to achieve behaviour change at scale.

• 6. Health is an asset to the economy and economic growth. View health through this lens and you will make more friends than “banging on about health” all the time

• 7. Doing more of the same will lead to more of the same. Do something different.

• 8. Use the power of social networks to increase reach.

• 9. Use diffuse leadership – don’t “own” things, but inspire others to. Set agenda and create culture.

• 10. Help people – “the system cant make people healthy, people can make people healthy. The system can help the healthy choice be the default or easiest”

when old PH meets new PH

https://gregfellpublichealth.wordpress.com/2016/06/16/what-does-the-future-of-public-

health-services-look-likeold-world-meets-new/

Old and new

• targets of early thinking

• 1. The key things that are consistently most important we: – Jobs and employment / Homes / Health and well being

• 2. think through what does “prevention” look like from different lenses – police, social care, housing, health, schools etc etc. Remember “health” and “police” are not homogenous – different messages be pertinent to different chunks of that system.

• 3. Translate stuff between systems. Connect different systems together in ways they may not have been connected.

•

• other stuff

• 1. everyone says getting a shared data function for the whole city, as granular as possible. Critical

• 2. digital by default in the design and implementation of behaviour change services. Web offer. Frees up human time to focus on more vulnerable groups. Of relevance to all behaviour change services?

• 3. Quality of relationships matters – esp q of relationships with local communities. Talk to them, be open and transparent.

• 4. What are the early wins. Go and win them. Develop the business cases for big chunks of work you want to see through”

Obstacles/challenges – the

usual stuff, all people related. • “It’s not our job”

• Conversely – “it’s our job not your job, go away/butt out”

• We’ve not got time / we used to have people who did this but they’ve all been sacked

• We’ve knocked our pans in for years trying to do what you’re saying and got nowhere, now we’re really negative about it all (‘computer says no’)

• No we’re not telling you stuff because it’s secret (eg what K lightbulbs the council is putting in to the new street lights)

• People trying to nick money to prop up their pet projects

• it’s a shared enterprise and different way

of doing business.

• Capitalise on the good will – it’s a mission

not a battle. People WANT to do the right

thing. May want help.

• I’ve (deliberately) personalised it, now we

should institutionalise it

• consultants on PLTs – where the business

gets done

Resources The Chris Shaw test

“to be effective its got to influence the

commitment of resources in a way that

squeezes more “health” out of the

commitment than would otherwise have

been the case (compared to alternative of

“yea what we do improves health and we

can do more, if only you give us some more

cash”

Strategy (inc. aims

and objectives)

Translating Strategy

in to Policy

Defining the Policy

and policy into

practice

Policy into

implementation

What we want to

achieve as a Council

The things we need

to do to get there

How we do the

things

Advising/coaching

people how to do it

Cabinet/Cabinet

Members

EMT PLT’s SMT’s

We have one, well

evidenced and

owned.

We have the 10 early

focus – but some are

policy and others are

topics

Needs Developing

across the 10 early

focus

All relevant staff

Take on tour

Discussion with as many stakeholders as possible. That’s not just my job.

A few set pieces

Cabinet, PLTs, Presence and persistence

Develop the proposition - policies, approaches, investable ideas, ways we

would invest new £, ways we'd try to bend current resource commitments,

strategies we'd seek to develop