Behavioural and Social Sciences in Public Health: the next steps

Today we launch a national strategy Improving Peoples’ Health: applying behavioural and social sciences

Public Health England have published it and it is the result of collaborative work by people from across over 100 agencies, professional bodies and learned societies among them.  It has been a privilege to be part of the team leading and writing this and the work of Michelle Constable, Amanda Bunten and Tim Chadborn has been central to us getting here.

This is the first of its kind. We will be forming a national community of practice to support this work and, among other tools and resources, this will be hosted by the Behavioural Science in Public Health Network (www.bsphn.org.uk)

The first point to make is that this is NOT an individually focused strategy which assumes health is merely about behavior. Those who claim that without having read it do this a disservice. This strategy is about recognising, fundamentally, that our whole life is bounded in systems which influence our health.  Individual, interpersonal, social, political and environmental aspects all affect our health. It is not an EITHER lifestyle OR social determinants it is a BOTH , AND MORE approach.

The Marmot Review[1] showed that socio-economic inequalities have a clear effect on the health outcomes of the population. It confirmed that there is a social gradient in health, and also showed that there is a social gradient in environmental disadvantage. A recent American analysis suggested that as little as 20% of influences on health (access to clinical care and quality of care) were in the gift of clinical health services; health behaviours (30%), socioeconomic factors (40%) and physical environment (10%) – all at least to some extent within the purview of local government – accounting for 80% of the influences on our health[2]. This is not to minimise the important contribution of the National Health Service (NHS), but it is crucial to recognise that health is an issue that has structural as well as lifestyle and genetic/biological determinants.  Again, this is not an either or. Dogmatism that health is all about social determinants with no individual substrate risks falling into fatalism.  Dogmatism that health is all about individual lifestyle factors with no social and structural determinants perpetuates social injustice.

This strategy is an attempt to bring to bear the riches of social and behavioural sciences on this.  We also hope this week’s publication is perhaps a first chapter. We have focused on some and not all of the richness of behavioural and social science. We hope there will be a next one that widens further to include the contributions of Sociology more, of History, of political economy perhaps?

And this strategy sits in a vein of work.  Four years ago, Jane Roberts and I had the privilege of being on the Editorial Group for and then writing the introduction to the British Academy’s If you could do just one thing – nine actions to reduce health inequalities, a report which very strongly included sociological and social policy perspectives on improving the health of the public. This report was one contribution to the importance of social sciences in improving the health of the public. We said then of that document “It is the intention of this report to make a contribution that will help local policymakers improve the health of their local communities by presenting evidence from the social sciences that can help reduce inequalities in health. Indeed, Marmot himself asked for this. In some senses this is a social sciences dialogue companion to the Marmot Review”

Two years ago, the Academy of Social Sciences produced it’s report The Health of the People  Most recently, among many pieces of work, the Health Foundation published A recipe for action  a report which suggests evidence from a range of sources including Sociology and Law must make up part of our action to improve health.

The evidence and guidance on improving the health of our population has often been focused on insights from biomedical sciences, and where  behavioural science has been used it has sometimes been too individually focused.   This does not mean behavioural science is individually focused. For every nudge there is a social psychology of how groups influence health.  But the biomedical model has led us to create paradigms which have often tended to highlight interventions targeted at individuals.  But equally, there has often been a too dogmatic emphasis on the social only.  Both extremes, while valuable,  obscure the complex truth that individual and social factors and perspectives need to be applied.

But it remains true that in much practice and policy the tricky structural issues like housing policy or worklessness have had less focus. The two approaches are not mutually exclusive.  It seems clear from the ongoing work of the Marmot Review that strategies that combine structural/system level approaches with individual approaches are essential if we are really going to make a difference to population health..

The biomedical model of health has its place, but is as we know by no means the whole story. Equally, however, the range of social and behavioural science models and paradigms, tools and techniques being applied in work on public health is sometimes too limited. If we are serious about social determinants and social factors in health, it behoves us to know our stuff about the social and behavioural sciences contributions, rather than rely on what we think we know about social sciences. Some places are really working hard on this.

The rise of systems approaches in public health (borrowed from engineering and other disciplines) and the increased focus on better, more systematic applications of social and behavioural sciences encourages us to work in a trandsciplinary way. Not just taking insights from more than one discipline, but developing a mindset that any issue to be fully understood needs to adopt insights from more than one discipline, and dialogue them.

You may find the powerpoints on transdsiciplinarity and the background to the strategy presented at the Public Health England conference in September this year useful. You can find them here.

This strategy is a contribution to the ongoing work of using the full range of social and behavioural sciences in improving and protecting the health of the population.  It isn’t the last word. It is by no means the first word either. It is an aspiration to a step change.  The long term work starts here.

 

NOTES

[1] Marmot, M. 2010. Fair society, healthy lives : the Marmot Review : strategic review of health inequalities in England post-2010. (2010)

[2] Franklin, D , 2012. Healing Kansas in Scientific American, January 2012 pp 17-18.

[1] Marmot, M. 2010. Fair society, healthy lives : the Marmot Review : strategic review of health inequalities in England post-2010. (2010)

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