Behavioural and social sciences in Public Health: getting consensus

UPDATE

The Webinar is now  open for registration .  Co-led by PHE, ADPH and HPPHN. 27th April. Register here

In 2014 the Chief Medical Officer Dame Sally Davies and others published a paper in The Lancet which argued we need a new wave in public health improvement – if the first was the improvements in life expectancy brought about by sanitary and water engineering, the fifth is cultural. Much debate has followed.  I am convinced that the nature of our society is such that social, behavioural, environmental and cultural factors are very much part of the challenge we face in improving and protecting the health of the population.  Which is why I believe behavioural and social sciences have an important contribution to make in Public Health.

Some promising starts but need more traction – a quick overview of 16 years’ work

This isn’t a new focus. There have been several attempts to do this before. The American Psychological Association produced a book on this 16 years ago, which is still a good read. A 2005 article also outlined some contributions from psychologists to Public Health. The US CDC produced an outline on its work as early as 2006. There were even special issues of the British Journal of Health Psychology in 1998 and the Journal of Health Psychology on the links between Public Health and Psychology.

More recently Professor Sir Michael Marmot asked the British Academy to produce a series of papers on the contribution of social sciences to Public Health. I was on the editorial group and co-wrote the introduction. I think it was a mixed start: some issues were addressed, many not. Much more remains to be done.

I could produce a bibliography and links list as long as my arm on how epidemiology and spatial criminology, public health and crime reduction, sociology and anthropology and lately operational research professionals have been publishing notable books and papers much more widely on their work around public health issues. I am planning a “rough guide” seminar on this. A webinar for public health people wanting a quick overview of how to navigate this whole world is coming in April 2017. (See the bottom of this blog for more details)

Incidentally, operational research methods – called the Science of better have both an affinity with and much value for Public Health at organizational level, so watch this space for another venture for public health in the next year. I’m also currently working on embedding some of these skills in my own organization through a programme where people who have graduated from our corporate leadership programme undertake a hybrid training programme combining public health skills like problem analysis, evidence-based practice and prioritization and operational research skills like problem structuring, problem analysis and modeling, to have a go at solving some of the challenges we face in the next few years.

Finally, several very useful and straightforward resources I would like to draw your attention to are those aimed at public health professionals by the BPS Division of Health Psychology.

The growing system role and appetite in government

Public Health England has been taking more of a system role in this with some great work shown at their conferences. Amanda Bunten (as of yesterday Dr Amanda Bunten!) one of the PHE team was profiled in The Psychologist with a piece which is great reading for anyone who wonders what a psychologist can do in public health. The work of my own colleague, Michelle Constable, was showcased with that or other local authorities in a recent Local Government Association (LGA) publication on behavioural insights for health used in local government.

But despite this and many other examples I could mention, those of us who have been advocating the stronger integration between the behavioural and social sciences and public health seem to be struggling to get much traction beyond some great work on behavior change, with places like FUSE, and the Cambridge and UCL centres being but a few I single out among many.

The Academy of  Medical Sciences report on the health of the population in 2040 applies, in my view, just as much to the need for social and behavioural sciences to work on this area as biomedical sciences.  Social Sciences will shortly launch its own report on the Health of the People. I for one see this as adding further impetus to the need to develop this work.

Public Health England have good reason to tell us that government is now very open to the inclusion of social and behavioural science in public health and a range of other issues. And this can only be to the good. That means the rest of us – practitioners, researchers, academics and commissioners – have an opportunity to come together and identify a way of how we all go about doing this together.

Perspectives

The barriers to greater integration and use  of social and behavioural sciences in public health remain. From the rich discussions people have given their time and energy to recently,  some of those are cultural, some of those are about training those of us did or didn’t get about different professions (in some EU nations they are much better about breadth of foundation training than we are in the UK), but there are two big challenges for me.

The first is mindset – if you see Public Health as a science in its own right, it doesn’t necessarily follow that you are as open as you could be to the insights other sciences have to bring.  But if you see public health as an integrating mindset which takes insights from a range of fields- epidemiology, sociology, psychology, law, biology, medicine, toxicology and so forth – and integrates them to improve and protect the health of the population – then openness to new insights becomes a critical priority not just an add on.  That brings me to the second set. Even if you have that mindset, how do you learn?  To an outsider, the social and behavioural sciences can look fiendishly complex and confusing, and if you have limited time, how do you navigate to insights, tools and perspectives that can help you in your task. The issue of language itself – what do we mean by social science, what do we mean by behavioural science? can put people off. I still remember from my postgraduate psychology training debates on the difference between social social psychology and psychological social psychology that left me thinking the finer debates of philosophical hermeneutics looked simple and non-contentious by comparison.

These are major practice , policy and training issues which we need to find solutions for. I think our efforts to integrate will continue to falter until we address these coherently.

The need to help policy, practice and research meet

This set of challenges were among the reasons I helped found along with colleagues the Health Psychology in Public Health Network. I kept having people saying to me there was a need where practitioners, researchers, academics and commissioners with an interest in this could get support and help. I was determined to make a contribution to addressing this.  In three years we have provided a place where over 1,000 people from students and trainees to academics and policymakers have come together on LinkedIn and in full membership. We try to model the Public Health – Psychology integration. I have just finished an amazing three years as first chair.  Dr Angel Chater, a health psychologist, has now taken over as Chair.  We have even issued our first awards for research students integrating social/behavioural and public health perspectives in their research. I’m hoping a book will come.

Moving as a system: promising work 

I think we are on the verge of a major step forward. Yesterday, 17th March 2017, around 50 people representing a wide variety of agencies and stakeholders convened for an initial conversation on what we could do; brought together by the Association of Directors of Public Health (ADPH) , Health Psychology in Public Health Network  (HPPHN) and Public Health England.  The aim was to articulate the need for a framework for this work, to make the most of how social and behavioural sciences and public health could work together.

A small group with Public Health England, HPPHN, ADPH, LGA, British Psychological Society and Faculty of Public Health had previously convened to discuss and agree the need for work, produce a short document arguing for this, and then convene the stakeholder conversation yesterday.

It has been exciting working alongside Dr Tim Chadborne and colleagues at Public Health England, with the HPPHN and ADPH folks on this.  And yesterday we had people as diverse as local authorities, ESRC, British Psychological Society, LSE FUSE, NIHR, many universities Society of Social Medicine, NICE and many more in the room.

We shared a co-written prospectus for developing a national framework for the use of behavioural and social sciences in Public Health and we asked people for their views on whether this was a good idea. We asked them to identify priorities and challenges, and what we should do next. We packed all this into two hours of work.  And the day went well, even if the technology kept failing us. We have some rich material to write up, prioritise and turn into a plan.

Suffice it to say that the most important things for me were the atmosphere of consensus and good will in the room, and the fact we got enthusiastic support that we needed to do this. A writing group is being convened with a small number of volunteers and we will start to build more partners into the conversation going forward.

The work is only starting, but I think everyone yesterday shared a willingness and a determination to work together.  We’ll keep you posted.

April webinar Behavioural Sciences for Public Health: the rough guide for busy PH specialists | Registration now open | 27th April

 

 

 

 

 

Advertisements
%d bloggers like this: