Social and Behavioural Sciences and Public Health: Where Next?

www.hertfordshire.gov.uk
Where from; where next?
Social sciences as core to Public
Health
Jim McManus, FBPsS, CPsychol, CSci, FFPH,
FCIPD,FRSB
10th February 2021
Outgoing Chair, BSPHN
Vice President, Association of Directors of Public Health
Director of Public Health, Hertfordshire County Council

Then and now
Then
• One DPH who was also a
Chartered Psychologist
with an obsession about
psychology, apparently
• A network of people who
pushed the boundaries
BSPHN
Now
• Behaviour Change Unit
• Multiple qualified social
scientists and
psychologists,dual-
qualified
• Great partnerships with
UCL and U Herts
• We helped design a
Recycling Centre!!!!!

• ADPH Guidance Preventing communities
• Vaccine Uptake Work
• Coping with lockdown
• Self isolation compliance
• Vaccine hesitancy
• Compliance with combination prevention
• Free evaluation service for vol sector
• Internal consultancy
Some examples

1990s all over again
• The lessons from HIV
for today’s pandemic
– International HIV
Social Science
Convention, Berlin
1994?
– Resilience
• Social science impact
crucial
Epidemiology
Environmental
planning
Systems
Science
Education
Law Epidemiology
Communication
Psychology

Public Health adopts stuff in waves
Waves of scientific models (Biomedical to Social and Cultural)
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62341-
7/fulltext

Are UK BAME populations at increased
vulnerability from COVID-19?
#EvidenceCOVID
Abdul Razaq, Dominic Harrison, Sakthi Karunanithi
and others 05.05.20
Black, Asian and Minority Ethnic (BAME) groups are at markedly higher risk of
developing and dying from COVID-19. Causes appear to be multiple:
Overrepresentation of BAME populations in lower socio-economic groups,
multi-family and multi-generational households, disproportionate
employment in lower-band key worker roles, and co-morbidities (especially
cardiovascular, diabetes, renal and complex multi-morbidities).

• Some
people said
it would
never
happen
The national strategy for social
sciences in Public Health

World Health
Organisation
6 Tests for
Exiting
Lockdown
1. Disease transmission is under control
2. Health systems are able to "detect, test, isolate and treat
every case and trace every contact“ (contact tracing)
3. Hot spot risks are minimized in vulnerable places, such
as nursing homes
4. Schools, workplaces and other essential places have
established preventive measures
5. The risk of importing new cases "can be managed"
6. Communities are fully educated, engaged and
empowered to live under a new normal

Pandemic Milestone Assumptions Summary
This is provisional and subject to revision. Version 3
May June July Augus
t
Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2020 2021
2
Some restrictions
eased
Switch measures on
and off as we regain
some control of curve
and demand .
Systems and planning
enables greater control
and infrastructure runs
better
May into June 2020
1a
Peak of cases.
Deaths
Lag cases by 2-3
week
Late April 2020
First
Peak
1b
Second
Peak
Second peak of cases
sees restrictions
switched back on and
peak of cases and
deaths
Oct 2020
Immunity
Significant increase in
population immunity
Q1 2021
3
Treatment
Candidate treatments
roll out for some cases
Q3-4 2020
4
Recovery Focus
Efforts change to
focus on recovery
Q2 2021
3
Shielding
Ends?
Immunity grows
Q1 2021
Vaccine
Vaccine
starts
population
roll
out
(earliest)
with
frontline
workers
and
clinically
vulnerable
Q2
2021
Full
Recovery
Full return to new Normal
Aug – Nov 2021
Apr
Phase 1 – First Two Peaks
Phase 2 - Control
Phase 3 - Exit
The key drivers of these phases will be
levels of infection, recovery and immunity
Phase 4 - Recovery
Gap between first
peak and second
allows time for control
and planning for
second peak
Sep
4
Rapid + pressure technology hits hospitals and
reduces deaths and ventilator need

Coronavirus Pandemic or Syndemic?
• Singer, 2009
• 1st Wave: Immediate
mortality and morbidity of
COVID-19.
• 1st Wave Tail: Post-ICU
and admission recovery for
many patients.
• 2nd Wave: Impact of
resource restrictions on
non-COVID conditions – all
the usual urgent things that
people need immediate
treatment for – acute.
• 3rd Wave: The impact of
interrupted care of chronic
conditions (people stayed
home).
• 4th Wave: Psychic trauma,
mental illness, PTSD,
economic injury, burnout,
and more.

Influence on Health status
across the lifecourse
© Copyright Hertfordshire County Council Public Health Service, 2013

I’ll skip over next two slides but
they’re here for background if you
want them

Impact
Requires a
collaborative
strategy
between
leaders in
healthcare,
politics,
charity,
education,
and business
Robert Wood Johnson
Foundation, 2014

crucial to a systems approach going
forward…
Employment
Income
Housing Access, Supply, Decency and Quality
Environmental Sustainability
Air Quality
Education and Skills
Local Amenities

These things we hold to be
self-evident
• The Social is as important as the bio-medical
• Solidarity - a covenant of Trust between government,
citizen and agents of civil society
• Subsidiarity
• Vertical – The best person does it
• Horizontal – Participation and Trust
• The Common Good
• The Social Sciences have come into their own – be
confident, be proud

• Multiple dimensions to an issue from the
biological (vaccine) to the social (vaccine
misinformation). No public health approach is
effective without this complexity
• Systems approaches
• A syndemic lens
Multifocal lenses for Recovery

Public Health across the Lifecourse
•
Commissioned
by
the
Local
Authority
Preconception
• Sexual &
reproductive
health services
including
contraception
• Vitamins
• Social
prescribing
• Stop smoking
• Physical activity
• Perinatal mental
health
0-5 Years
• Support from
Health Visiting
• Vitamins
• Breastfeeding
help
• Oral health
promotion
• Stop smoking
• Physical Activity
• Perinatal mental
health
School Years
• Eye checks
• Hearing checks
• School Nursing
• Administering
vaccines
• Mental health
• Weight
management
• Child
measurement
• Oral health
promotion
• Stop smoking
Working Age
Adults
• Weight
management
• Health Checks
• Public mental
health
• Sexual health
• HIV prevention
• Social
prescribing
• Workplace
health
• Stop smoking
Old Age
• Social
prescribing
• Weight
management
• Health Checks
• Public mental
health
• Sexual health
• HIV prevention
• Stop smoking
NHS
Immunisations across the lifecourse commissioned by NHS England but delivered by school nurses in school
Things
you
may
never
see
Statutory advice and guidance to NHS commissioners on service design and commissioning
Quality checks on screening and immunisations
Health Protection and Emergency Planning
Pathways for care services developed by Public Health
Suicide prevention work

A County Council Lifecourse Offer..social
and behavioural science crucial
Culture, Libraries, Sport, Planning, Waste Disposal, Transport,
Road Safety, Economy, Environment, Waste, Sexual Health, ,
Social Care, Addiction Treatment, Carer Support
Perinatal health
Mum’s Vitamins
Health Visiting
Eye and ear tests
Family Centres
Education
CAMHS
Ed Psychs
Fostering
Social Care
Youth Connexions
Youth Justice
Education
Safe and Well
Enablement
Economy
Carers Support

Lessons
• Multifocal Lens
• Resilience
• Complexify then Simplify
• Social Sciences approaches
crucial
• A marathon not a sprint
• Build a movement
• Opportunistic
• Build each other up

Thank You!
Jim.mcmanus@hertfordshire.gov.uk

Social and Behavioural Sciences and Public Health: Where Next?

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Social and Behavioural Sciences and Public Health: Where Next?