As Public Health goes through a further spasm following the launch of ‘Healthy, Lives, Healthy People – Update and way forward” (HeLPU&WaF) it would be easy to think that its content describes some of the main business that we need to be focussing on for the rest of this year.
Nothing could be further from the truth – public health is moving to local government (hurray!), there is a bit of finessing around the edges – the relationship with NHS England and where various important but small services should go – but its not where we need to keep focussed. Lets face it the main purpose of HeLPU&WaF is to re-assure the public health professional that they will still be loved, respected and (well) paid in the new world.
HeLPU&WaF speaks to a very small section of the public health workforce. Those organisations who are working on the frontline – the voluntary sector in particular – will feel ignored and dispirited by this inward looking document.
In the same week that HeLPU&WaF was launched the Cabinet Office launched their White Paper “Open Public Services”. It is interesting that health inequalities is well to the fore here.
“In 2003, the Department of Health created 82 ‘indicators’ to measure factors that would contribute to reducing health inequalities: by 2006, departments had met 72 of them, and yet health inequalities continued to widen.
In England today, people living in the poorest neighbourhoods will, on average, die seven years earlier than people living in the richest neighbourhoods”
In part health inequalities is probably mentioned because it suits this government to use areas of previous policy failure to justify the marketisation of NHS and other services. Nonetheless the statements are strong and there is even a reference to how a “local authority could use a local social enterprise to help cut obesity rates.
This White Paper represents the polar opposite of HeLPU&WaF, it sets out a high level direction of travel, is thin on detail and has ambitions to be genuinely whole system. I think it has the potential to be a much more powerful force for good or bad than the over designed machine that will become Public Health England.
In some work that I have been doing with Voluntary Sector North West it is clear that there are a wide range of innovative place based voluntary organisations working who are demonstrating substantial impact on key public health problems – from debt, supporting people manage chronic mental illness to tackling smoking and sexual health problems.
If you want to know more about these check out:
All of these organisations have established powerful relationships with local commissioners, relationships that have often been championed by local public health leads – usually in health promotion. They also have hard earned links to the communities they serve, whole system solutions and strong evidence based interventions.
It is the local systems that have enabled organisations like these to flourish that DH should be promoting in HeLPU&WaF – they have an essential contribution to make to a redesigned public health system that can address health inequalities more effectively.
Instead, DH looks inwards and it is other government departments who are making the running on setting up systems that could impact powerfully – positively or negatively – on inequalities.
Some final scores
| Department | Document | Health Inequalities Mentioned | Voluntary Sector Mentioned |
| DH | HeLPU&WaF |
6 |
0 |
| Cabinet Office | Open Public Services |
4 |
9 |