by Jane South, Professor of Healthy Communities, Leeds Metropolitan University, co-author of People-centred public health
Public health often gets a bad name because it’s seen to be about telling people to how to live their lives – don’t smoke, don’t drink, exercise more, label this and ban that. Beyond the headlines, it is recognised that a moral crusade on lifestyle is hardly going to touch the persistent inequalities that blight UK communities. New solutions are needed and these solutions have to be ones that involve the people who are most affected by inequalities. At an event held on February 15th where our book ‘People-Centred Public Health’ was launched, a different sort of public health was being talked about; one where people are listened to and have opportunities to play a part alongside services in improving health for themselves, their families and communities. Sounds familiar? Well, we would agree that the idea that people should be able to play a part in creating the conditions for good health is not a new one, yet warm words about community engagement have not always been translated into action. In the current policy context, we can’t really claim that the public has a major role in the core business of disease prevention and health improvement. Putting people central to public health action – surely that’s too risky, too difficult to achieve, not evidence based, and a diversion from the real tasks of professionals? People-centred public health is an attempt to answer some of these challenges.
When we set out to write the book, we recognised that things might be changing. There seemed to be a renewed interest in volunteering and the role of civil society in health. The Marmot Strategic Review on Health Inequalities in England put community participation centre stage with the policy objective to ‘create and develop healthy and sustainable places and communities’. Certainly in public health practice, we were beginning to see successful, transferable volunteer models emerging where engagement was happening on a large scale, such as Walking for Health or community health champions. We wanted the book to open up some of the arguments about volunteering and lay involvement in health. We wanted to draw on the rich diversity of UK practice and to use research-based evidence to discuss some of the different perspectives in this field.
Most of all we wanted the book to stimulate debate on why, how and in what ways we could place the efforts of citizens more central to UK public health. That’s why we decided to launch the book with a public event where these issues could be debated. Our two keynote speakers, Dr Ruth Hussey OBE, Chief Medical Officer for Wales and David Hunter, Professor of Health Policy & Management at Durham University, both spoke of the political context for public health and the emerging opportunities for creating stronger and more equal partnerships between professionals and communities. One of the key themes of the panel discussion that followed was the significance of a new localism agenda, combined with the enhanced public health role for local government, that together might create the conditions in which ‘small society’, that is the strengthening the relationships between people, is able to flourish. But there were notes of caution too; the lack of risk taking in the public sector, the need for scaling up efforts, and most critically the profound impact of the economic downturn and welfare cuts on health. The book is clear on this last point, maintaining public services and increasing social action on health is not a matter of ‘either or’, both are needed if health is to improve for all sections of society.
So to the future… Public health is trying to move forward at a time when individuals and communities across the UK are facing difficult and uncertain times. If the concept of people-centred public health catches on, then it has to represent a means of working that addresses real problems, identifies pragmatic solutions, and builds on community assets. It’s not a technocratic fix that’s needed, nor a set of new structures, but stronger local relationships, based on the pursuit of equity.