Resilient and Resolved : The Next Year in Public Health

This coming week, on 21st March, the Local Government Association and Association of Directors of Public Health will host their joint Annual Public Health Conference, with the theme of Supporting resilient communities.   To my mind this conference is one of the best of the year, and one at which I always learn.  This year I have the privilege of co-chairing it.  This conference is always a landmark for me, because it provides me with an opportunity to look back on what I took away last time, whether I did any of it and a look forward at where next.

The theme this year couldn’t be more apt for me.  Because it provides us with an opportunity to rebalance the agenda from being too focused on the NHS Plan – however needed that one piece of a jigsaw puzzle is, and it is only one piece. It is an opportunity to remind ourselves that clinical approaches alone will not – however needed they are – solve the health problems of our country. It reminds us to focus on place, on wider determinants, and the complex structures within which we live our lives.

And this conference theme is timely because in the last six months, there have been some major pieces of policy work, some from Government, some from elsewhere, which have reminded us that there is a bigger picture to the health of our population than the NHS Plan.

Most recently come two pieces which I commend to you. First, a report on Mental Health: Investing in a resilient generation, from the Birmingham Policy Commission on Mental Health. This timely report reminds us we can never commission or provide enough services to produce a mentally health society and we have to do it a better way – a social determinants, place-based and public health approach. (today’s report on lay people providing more mental health in The Economist backs that up.)

Second, comes a report on a social determinants and public health approach to combatting extremism in this week’s New Scientist.

We’ve also seen significant increases in the interest in public health approaches to knife crime and serious violence, and government’s own clean air strategy takes some significant steps to enshrining such an approach.

Add to this other more recent interventions on public health approaches to persistent challenges from Dame Louise Casey’s news piece this morning to my smaller piece in The Tablet on public health approaches to preventing sex abuse in the church produced for the Papal Summit and the resurgence of place based and social determinants approaches is building.

It’s fair to say there has been a resurgence of interest in public health approaches to complex issues, including resilience. Dispersing the benefits of a public health approach wherever it can add value becomes an approach which can take off in  myriad different directions. We don’t have to own that, we just have to support, inspire and enable it.

But that resurgence seems to remain least energised within the  Department for Health and Social Care where ministers seem to be remain in the thrall – despite all evidence to the contrary – of individualistic narratives on prevention, an over-reliance on NHS structural reform and plans for NHS funding which, though much needed, remain unbalanced by an under-powered focus on prevention and place that is anything more than clinical. The Green Paper on Prevention – when it gets started – provides us with an opportunity to argue to change that, and we can show what we can do.

But most importantly we need to articulate loud, convincingly and clearly that not adopting this kind of place and public health approach will hamper the impact of the NHS Plan. A range of commentators have pointed this out including most recently Richard Humphries of The King’s Fund, writing in the latest LGC. Much of the responsibility for the Long Term Plan’s omissions ought to be attributed to the government’s dismal failure to deliver joined-up policy-making, rather than to NHS England. Continuing cuts in local authority public spending undermine the plan’s ambitions for prevention and health improvement.”  Quite. We need each other.

That said, Public Health teams and colleagues are working resiliently in this space.  There is innovation, there is good work going on across the country on building public health and social determinants approaches, and some of these will be showcased this coming week.

This week provides me with a rallying call, and that call is simply this:

  1. Continue to articulate the benefits of a public health and social determinants approach to complex social problems and issues
  2. Amass evidence of the benefit of doing this to government and the public purse
  3. Be resolved and resilient in pushing these
  4. Find ways of making them happen locally

This will take time to deliver results. But it’s quite clear to me the evidence is there to support it.



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