What do you read to understand what public health is?

Ok, so you want to understand more about public health but you’re a very busy third sector worker, or a very busy local government or NHS officer. Where do you go? The books you find on amazon look thick and daunting. What is going to help you?

Hopefully this blog will give you some top reads for people with little time. My own reading, training, teaching and experience leads me to several core sets of principles, which I hope I continue to learn, revise and change as I learn more. So before we get into the first review, here are a few insights about “what have I learned about the public health toolkit?” If they are useful, I’m glad they help. If they aren’t, let me know.

Firstly, Public Health is, essentially, a mindset. It’s about understanding how health at population level works, identifying issues where we have worse health or more pressing health problems for some populations than others and understanding what can be done about improving it.

Secondly, there is an extent to which public health is a value base, and an ethical stance. (I’d love to get into the utilitarian-individualist debate about philosophical underpinnings of public health, but that’s for another time.) There is, I think, a value base about improving the health of the public, and especially those who bear the heaviest burden of ill health, and the heaviest burden of the causes and determinants of ill-health. We all know public health people with whom we agree and disagree, but I have yet to meet one who doesn’t have a value base I. A colleague of mine suggested to me that might be why people in public health do disagree with each other sometimes over methods or tools, because we do share the same value base.

If you have the mindset and the value base, you are already a long way there. And let’s be honest – there are hundreds of people in Birmingham we all could name without thinking too hard who have a mindset and a value base about improving our City and making it healthier and better, from all walks of life. And if you’re not from Birmingham, just think who meets this criterion in your area. Public Health is often split into “specialist” public health [i.e. those of us who do specialist training, exams and registration] and “wider” public health [e.g. people like housing officers, planners, fire officers, commissioners, councillors, charity trustees] who have a mindset of improving our City and work with each other and sometimes with public health specialists to achieve this. The key thing is getting right what training, knowledge and skills we put into the hands of colleagues. So if you have the mindset of wanting to improve things, then this book blog is for you. Ask me the questions you really want answered, and I will try, honestly, to answer them, or get someone more qualified and wise than I to do so. There are several websites which really help you with this

West Midlands learning for public health network has some good resources http://www.wmpho.org.uk/lfph

East Midlands Public Health Network also has some really good reading

Thirdly, Sir Donald Acheson in 1998 in his Review of Health Inequalities for Government described public health as, essentially “the art and science of promoting and improving the health of the public”. The science is about evidence and other tools we can use to identify what needs to be done and what will work in doing it. The art is about how we work together to do that. The science without the art may not get implmented. The art without the science might get you results you don’t want!

Fourthly, it is about trying to work at different levels. You often need something like a typology or schema of layers/levels of interventions to help you with this. One which has been in the news recently is the Nuffield Council on Bioethics typology. It talks about which interventions you can use for public health gain. Bear in mind though, it’s only one framework or schema, and you may need to use more. You can read the Nuffield Council report here http://www.nuffieldbioethics.org/sites/default/files/Public%20health%20-%20ethical%20issues.pdf



 The Nuffield Council for Bioethics typology happens to be the latest version of frameworks for these, but there are a range of them dating way back to the WHO Interventions Wheel I learned in the 1990s. We’re even trying to create an interventions wheel in Birmingham which helps community agencies understand more about the choice of interventions. This is based on the neighbourhood health action model we developed in 2009. More about this later! The fundamental point is that most public health problems can’t be addressed fully at just one level. You need to work at individual and various population levels. A good example of this is smoking – getting people to quit smoking is really important, but sometimes incentives like the smoking ban in public places really can and do help.

Fifthly, how well you implement something is crucially important, because all programmes can have unintended consequences. Typically, research shows that a really well implemented programme generates much better outcomes for investment than one done badly. There is even a set of methods on how to do this. It’s called Intervention Mapping. I’ve used it, many others have used it. It takes a bit of getting your head round, but it can really work! It even has an intervention mapping website and a facebook page. (I really do think I’m getting old.)

Sixthly, public health benefits from using behavioural sciences, and we need to get better at doing this. Insights from Health Psychology are really valuable and important in helping us understand some key behavioural issues. Next blog I hope to give you more about this.

This list is woefully incomplete, but it’s a start, hopefully of a discussion. And I hope you’ll think it’s an optimistic one. Now, more than ever there is a fantastic set of opportunities for people to use public health skills. This is not just for those of us who train as specialists (like public health specialists, environmental health officers and so on), but for everybody.

When I get my act together I will put my best website reads here, but for the moment,here are three top reads.

TOP READ ON HEALTH BEHAVIOUR: HEALTH (Psychology in Practice Series)
Philip Banyard
Paperback: 160 pages
Publisher: Hodder Education
ISBN-13: 978-0340844960


Right, it’s not exactly recent. But if you are sitting training a bunch of leisure service people on health behaviour and what health psychology can do for them, or you want a quick introduction, this is still a good buy. He also has a fairly similar book called Applying Psychology – Health.

Psychology in Practice is the definitive six-part series on the practical applications of psychology to areas of everyday life, covering crime, education, health, sport, organisations and the environment. Each book in the series examines one unit of the Applications of Psychology section of the OCR syllabus.

This looks at how psychological knowledge can be applied to a wide range of issues. It’s also a very good preparation for my favourite health psychology read of all time Health Psychology by Jane Ogden, from Open University Press/ McGraw Hill, now in its fourth edition. Fantastic Book and if it doesn’t revolutionise the way you develop health programmes, then coffee’s on me.

Psychology and medical students and teachers, doctors, nurses, health and safety workers, professionals working within the medical and caring professions and the interested general reader

Frances Wilson and Andy Mahilba
Paperback: 328 pages
Publisher: Sage Publications
ISBN-13: 978-1412948807

Ok, so this was published in 2008. But, like many a Sage text, it is very good and its value endures. Until someone writes the “Public Health – a very short introduction” for Oxford University Press, this book will do a reasonably similar job. It gives you an overview of fifty key concepts.

The Book is written from a British context, and is a good “way in”. It’s a really good book for anyone who wonders what public health means. For each of the concepts it will give you:

– a quick definition of what the issue is

– a quick discussion of what it means in practice

– some case studies

– a list of further reading.

Grab it and read it over a while.

TOP READ FOR EVIDENCE BASED MEDICINE : Oxford Handbook of Medical Statistics

Janet Peacock and Philip Peacock

Paperback: 544 pages
Publisher: Oxford University Press
Language English
ISBN-13: 978-0199551286

Ok, maybe your inner nerd, if you have one, isn’t jumping for joy at this, and this is probably one for the more nerdy among us. But don’t overlook this book if you are developing a career in public health.

Some folks do get excited at the thought of critically appraising evidence, and actually this book is good reference for them, and a helpful friend for everyone else.

This book, I think, has just superceded the four books I have been consulting regularly for medical statistics hitherto. First, it fits in my briefcase. Second, it is actually quite readable and good for dipping into. Third, it doesn’t assume massive mathematical background.

Why read this book? Well, somewhere in public health, we need people who can understand how research is conducted and appraise papers and evidence. That’s more than ever important in tight financial times.

This book is one I would recommend for anyone doing a Master’s up to anyone practising public health where you work with commissioners or clinicians.

It’s accessible, and actually takes you through a broad spectrum of medical statistics/epidemiology knowledge. Study design, sample size (don’t we all get tied up on that one>) statistical tests, multivariate statistics (who fainted?) and it uses case studies from the literature.

If you are scared stiff of medical statistics, this book is your comfort blanket.