A presentation at the University of Hertfordshire Future of Public Health Masterclass and Launch Event for the new Herts Public Health Connect Website on what might be next for Public Health Approaches

1. www.hertfordshire.gov.ukwww.hertfordshire.gov.uk
Public Health: Where Next?
What might be the future of Public Health
University of Hertfordshire
PH Connect Launch and Public Health Masterclass
Jim McManus,
Director of Public Health,
12th June 2019
http://www.hertsphconnect.org/

2. www.hertfordshire.gov.uk
Jim.mcmanus@hertfordshire.gov.uk
http://www.hertsphconnect.org/

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Waves of Public Health…where next?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62341-
7/fulltext

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1. Good Start in Life
2. Good Education
3. Meaningful and fair employment
4. Healthy Place
5. Healthy Housing
6. Balance – Physical, Psychological, Spiritual, Interpersonal
7. Sustainable Environment
8. Healthy Living made easy and second nature
9. Connect, Be Active
10.Meaning, Purpose and Hope
The Building blocks of good health

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Persistent Challenges
Variation in Life Expectancy (7.2 years men, 5.4 women)
Untoward Variation in Care
Economic Inactivity and Worklessness
Preventable Mental Ill Health
A system which can’t cope with complex problems
Preventable Disability
Not seeing Human Person as Unity across Life

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Rank Cause % of YLDs
1 High BMI 6.58
2 Smoking 5.38
3 High fasting plasma glucose 5.16
4 Alcohol use 2.22
5 High systolic blood pressure 2.18
6 Drug use 2.16
7 Occupational ergonomic factors 2.15
8 Ambient particulate matter pollution 1.40
9 Diet low in whole grains 1.30
10 Low bone mineral density 1.05
Source: Global Burden of Disease Study, 2017 estimates
Burden of Disease Years Lived with
Disability

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DPH Report 2018-19

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• The prevalence of mental disorder in 5-15 year olds rose from 9.7%
in 1999 and 10.1% in 2004, to 11.2% in 2017 (equating to c.18,600
children and young people in Hertfordshire).
• About one in seven (14.4%) 11-16 year olds have a mental disorder
(equating to c.12,065 children and young people in Hertfordshire).
• Looked-after children generally have greater mental health needs
than other young people.
• 28% of boys and 42% of secondary aged girls in Hertfordshire in
2018 said that they worried ‘quite a lot’ or ‘a lot’ about their own
mental health.
Mental Health and Young People

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Mental Health JSNA, 2015

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Total Population
1,525,147
Mostly Well
1,042,500, (68%)
People with Long
Term Conditions
299,630, (21%)
People with complex
needs
170,468
(11%) - 43% of total
spend
Age 70+
198,269 (13%)
population
47,700 (24%) 231,601 (42%) 79,479 (34%)
Adults 16-69
1,006,597 (13%)
Population
694,800 (69%) 223,421 (22%) 88,376 (9%)
Children & Young
People 0-15
320,280 (21%)
population
300,100 (94%) 21,219 (5%) 2,619 (1%)
HWE STP Population Health Management
Population Health Profile – The Challenge

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• Prevention Vision
• NHS Long Term Plan
• Green Paper on Prevention
• Social Care Green Paper (2 years and counting)
• Clean Air Strategy
• Serious Violence Strategy
• Spending Review – Errr….
– Wanting to get into Genomics, Technology
and Predictive Prevention (whatever that is)
The National Policy Agenda

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Govt says the Green Paper will…
We need to push heavily on this. It’s the weakest section of the Green Paper

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DHSC Slides..what govt says the green paper will contain

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DHSC Slides
DHSC Slides..what govt says the green paper will contain

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But Problems with this,,,
• Nothing on wider determinants or systems
• Very “health” focused
• Trying to be cross-govt but not really
• Simplistic lifestyle narratives
• Very focused on narrative of personal responsibility
• Role of social sciences not articulated
• Lack of coherent lifecourse vision
• Very focused on clinical outcomes
• What about crime, work, sustainability, growth, air quality?

16. www.hertfordshire.gov.uk
Waves of Public Health…where next?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62341-
7/fulltext

17. www.hertfordshire.gov.uk
What might be the future?
• Not a new wave but a more nuanced, varied and
Transdisciplinary approach
• A Public Health which is committed to Human
Flourishing
• A Public Health which can
– Hold individual and social in dynamic tension
– Understand complexity and address it on multiple levels
– Understand and use systems approaches
– Think and act from wider determinants to clinical and back
again
– That thinks Lifecourse
– That thinks of the human person as Unity

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• Population Health
– Wider Determinants
– Sustainability
• Population Health Management
• No Health Without Mental Health
• Complexifying
• Systems Approaches
• Better use of Data and Informatics
Opportunities to deliver this

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A Public Health
Wales take

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• Environmental
• Structural
• Social
• Interpersonal
• Intrapersonal
• Biological
Layers of Complexity – Systems
Working

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Determinants : part of an approach

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• NOT a clinical way of doing public health.
• Population Health Management is ONE subset
of a PH Approach
• Limited without Place and Wider Determinants
Population Health

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MOSTLY HEALTHY DIAGNOSED LONG
TERM CONDITION
COMPLEX NEEDSHigh
cost
Low
cost
Actions:
• have proactive,
meaningful,
personalised care
plans
• prevent people
reaching crisis points
• reduce need for
emergency care
Achievable
curve?
Existing
curve
Actions:
• reduce risk and
keep people well
• prevent need from
arising
• meet urgent care
needs when they
arise
Actions:
• intervene early
to reduce or
delay need
• reduce need
for emergency
care
‘Population health
management’ is an
approach that will help
us to target our
collective resources
where evidence shows
that we can have the
greatest impact.
Local government and
health organisations,
together with the
community and
voluntary sector, will
deliver joined-up
services to defined
groups of the
population. In this way,
we will prevent, reduce,
or delay need before it
escalates; and prevent
people with complex
needs from reaching
crisis points.
Low
needs
High needs
Population Health Management:
Changing the Curve

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• Lifecourse approaches
• Connection between NHS Long Term Plan,
Prevention Vision, Green Paper and Spending
Review
• Impact of Positive Psychology or psychological
science in general
• A personalising narrative on health and
“lifestyle” not determinants or systems
More Missed Opportunities

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• If public health problems are multifaceted, then
surely using a single paradigm (biomedical or
sociological) is insufficient
• How do we “complexify” problems so different
fields and disciplines can eludicate different
aspects of this issue?
Complexifying Knowledge

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Biomedical Psychosocial
Social
Structural and
Environmental
“Knowing” an issue
in its multiple
dimensions
Complexifying Challenges, Solutions
and Knowledge

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thank you
Jim.mcmanus@hertfordshire.gov.uk
http://www.hertsphconnect.org/