This document discusses the complex factors that influence population health and how to improve health at the city level. It notes that health is determined by many social and environmental factors, not just access to healthcare. It advocates taking an approach that addresses the root causes of health inequalities and focuses on prevention rather than just treatment. Some key challenges mentioned include the complexity of issues, competing priorities, and political and commercial influences that can hinder upstream action.
This document summarizes discussions from a Health and Wellbeing Board (HWBB) on health inequalities in Sheffield. It outlines the context of health inequalities, how the city currently addresses the issue, evidence on effective interventions, and next steps. The key points are: the data shows inequalities have not improved in recent years; the current plan from 2014 still aligns with evidence but lacks program management; evidence points to addressing social determinants like poverty, education and employment; and the city needs to focus resources disproportionately to disadvantaged areas and populations to make meaningful progress on reducing inequalities.
This document discusses changes to the Australian workforce over the 20th century and implications for unemployment rates. Key points:
- The workforce has shifted from predominantly male manual labour to one where both women and men can perform most jobs equally. This gender shift was the most significant change.
- As physical strength became less important, more jobs could be performed by women as well as men. However, commentators are still surprised by declining male participation rates.
- Unemployment statistics do not capture the full extent of unemployment, which some estimates put at over 1.5 million Australians who are unemployed or underemployed. The participation rate also influences unemployment rates.
- There are different types of unemployment including
Left always believe that middle to upper class people need to support low income people. The problem with this argument is that you cannot tax people to wealth.
The future workplace will look radically different as employers respond to a growing requirement for a work-health balance. The Well Workplace report considers the global phenomenon of the wellbeing industry.
It asks what the occupational drivers are, what developers and investors need to consider to mitigate risk and it looks to the future of the ‘well’ office.
This document discusses minimum wage increases and their implications. It notes that while raising the minimum wage seems to help the working poor, there are also complex issues involved that must be considered. Both positive and negative consequences of increases are discussed from different perspectives in the research. The document examines factors like minimum wage indexing, effects on poverty levels, differing impacts based on the size of increases, and potential job losses or stimulus to the economy. Concerns are raised about long-term impacts on young workers' education and skills levels. Overall it aims to provide an informed analysis of this complex issue.
Evolution Of American Labor Market PolicyKristin Wolff
The document summarizes the evolution of American labor market policy over three periods: 1) Industrial Transformation from 1913-1946, characterized by high population growth, unskilled jobs, and lack of universal education; 2) Social Policy from 1962-1983, in response to permanent industry dislocation and job/skill losses, focused on disadvantaged groups; and 3) Economic Policy from the 1980s onward, emphasizing education/skills due to global competition. Future labor markets will require increased education levels due to slow population growth, an aging workforce, and most new jobs requiring postsecondary education or training. Industry-recognized certifications will be important portable credentials for economic and social security.
A presentation held by mr Stewart Wallis, head of New Economic Foundation at a seminar with Swedish think tank Global Utmaning (Global Challenge) and Miljöpartiet (Swedens green party
Choosing net zero is
an economic necessity
Australia pays a high price of a global failure
to deliver new growth in recovery. Compared
to this dismal future, Deloitte Access Economics
estimates a new growth recovery could
grow Australia’s economy by $680 billion
(present value terms) and increase GDP
by 2.6% in 2070 – adding over 250,000 jobs
to the Australian economy by 2070.
This document summarizes discussions from a Health and Wellbeing Board (HWBB) on health inequalities in Sheffield. It outlines the context of health inequalities, how the city currently addresses the issue, evidence on effective interventions, and next steps. The key points are: the data shows inequalities have not improved in recent years; the current plan from 2014 still aligns with evidence but lacks program management; evidence points to addressing social determinants like poverty, education and employment; and the city needs to focus resources disproportionately to disadvantaged areas and populations to make meaningful progress on reducing inequalities.
This document discusses changes to the Australian workforce over the 20th century and implications for unemployment rates. Key points:
- The workforce has shifted from predominantly male manual labour to one where both women and men can perform most jobs equally. This gender shift was the most significant change.
- As physical strength became less important, more jobs could be performed by women as well as men. However, commentators are still surprised by declining male participation rates.
- Unemployment statistics do not capture the full extent of unemployment, which some estimates put at over 1.5 million Australians who are unemployed or underemployed. The participation rate also influences unemployment rates.
- There are different types of unemployment including
Left always believe that middle to upper class people need to support low income people. The problem with this argument is that you cannot tax people to wealth.
The future workplace will look radically different as employers respond to a growing requirement for a work-health balance. The Well Workplace report considers the global phenomenon of the wellbeing industry.
It asks what the occupational drivers are, what developers and investors need to consider to mitigate risk and it looks to the future of the ‘well’ office.
This document discusses minimum wage increases and their implications. It notes that while raising the minimum wage seems to help the working poor, there are also complex issues involved that must be considered. Both positive and negative consequences of increases are discussed from different perspectives in the research. The document examines factors like minimum wage indexing, effects on poverty levels, differing impacts based on the size of increases, and potential job losses or stimulus to the economy. Concerns are raised about long-term impacts on young workers' education and skills levels. Overall it aims to provide an informed analysis of this complex issue.
Evolution Of American Labor Market PolicyKristin Wolff
The document summarizes the evolution of American labor market policy over three periods: 1) Industrial Transformation from 1913-1946, characterized by high population growth, unskilled jobs, and lack of universal education; 2) Social Policy from 1962-1983, in response to permanent industry dislocation and job/skill losses, focused on disadvantaged groups; and 3) Economic Policy from the 1980s onward, emphasizing education/skills due to global competition. Future labor markets will require increased education levels due to slow population growth, an aging workforce, and most new jobs requiring postsecondary education or training. Industry-recognized certifications will be important portable credentials for economic and social security.
A presentation held by mr Stewart Wallis, head of New Economic Foundation at a seminar with Swedish think tank Global Utmaning (Global Challenge) and Miljöpartiet (Swedens green party
Choosing net zero is
an economic necessity
Australia pays a high price of a global failure
to deliver new growth in recovery. Compared
to this dismal future, Deloitte Access Economics
estimates a new growth recovery could
grow Australia’s economy by $680 billion
(present value terms) and increase GDP
by 2.6% in 2070 – adding over 250,000 jobs
to the Australian economy by 2070.
Using complex systems thinking to influence the way a city phe2018 gfGreg Fell
This document discusses using complex systems thinking to promote public health at the city level. It notes that health is determined by many interacting factors beyond just healthcare, and that addressing upstream social and economic determinants is important. It advocates taking a complex, long-term approach that considers many stakeholders and trade-offs rather than top-down policies. The goal is to set the system on a healthier trajectory rather than having perfect control or knowing all outcomes in advance.
the social determinants of mental illnessGreg Fell
This document discusses addressing the social determinants of mental illness and flipping the approach to mental health on its head. It makes four key points: (1) Most factors influencing mental well-being are outside the traditional health system; (2) Upstream social and economic factors matter more than downstream interventions; (3) All the proposed determinants are complex systems that interact; and (4) The default is to focus on symptoms over addressing root causes. It argues for a holistic, multi-sector approach to mental health that tackles issues like debt, employment, housing, and education.
the planning function does more for the cities HEALTH than the NHSGreg Fell
The director of public health in Sheffield argues that planning functions have a greater impact on city health than the National Health Service. They discuss how planning can address upstream causes of poor health like inequality, transport infrastructure, housing standards, and community design. The director emphasizes that planning should aim to create environments where health and well-being are the default and easiest options through green spaces, mixed developments, and walkable neighborhoods. They argue planners must consider health impacts and work to reduce health inequities through their decisions.
The document discusses activities of the Global Agenda Council on Ageing from 2014-2016 focused on cognitive decline, financial services, and technology. Key activities included a four-part symposia series exploring these topics across different regions. The Council also published reports, launched the New York City Ageing Alliance, and developed recommendations to link health and wealth, promote planning and cooperation, and regulate for longevity. The document emphasizes the need to address cognitive decline's financial impacts as populations age and live longer.
A presentation to a National Institute of Health Research consultation event on identifying priorities for public health research for the next five years
This document summarizes key issues related to small-scale fisheries in South Africa:
- South Africa's fisheries legislation has historically excluded thousands of small-scale fishers, contributing to overfishing and depletion of stocks.
- New proposed legislation aims to formalize small-scale fisheries by allocating collective rights to fisher cooperatives, allowing them to target multiple species.
- However, most near-shore fish stocks are currently collapsed, so increased fishing pressure from an expanded small-scale sector risks further overfishing unless illegal fishing is addressed.
- Recognizing small-scale fisheries' social and economic roles while ensuring sustainability will be an ongoing challenge.
This document discusses issues related to prevention and return on investment (ROI) in healthcare. It addresses why prevention has not been more widely implemented in the NHS despite the economic case. Barriers include lack of incentives, complex evidence, and culture change. Cost-effectiveness does not equal cost savings. Prevention may release cash in long term rather than short term. ROI tools can oversimplify and make unrealistic assumptions. Obesity prevention is used as an example, highlighting challenges around individual versus population interventions and timeframes for cost savings.
CEI’s Values Based Communications Project
Our Challenge: Make Good Policy Good Politics
Our Question: Just because we’re right, do we have to lose?
CEI’s communication work suggests the answer should be a resounding NO!
Capitalism creates a massive middle class
Produces entrepreneurs and intellectuals
Intellectuals criticize (envy) and de-legitimize entrepreneurs
Culture grows skeptical of business, support for government intervention grows.
Wealth creation suffers, individuals suffer.
Strategy Report on NHS and Recommendations - Gaspare MuraGaspare Mura
The document discusses challenges facing the UK National Health Service (NHS) including an aging population, rising life expectancy, and budget constraints. It analyzes the NHS using PEST and SWOT frameworks to understand external factors and identify issues. Key problems identified are lack of integration between primary, secondary, and community care services; insufficient capacity as demand increases; and need for continued development and innovation. Solutions proposed include optimizing resource allocation, improving preventative care and disease management, strengthening community services, and utilizing low-cost technologies.
Public service and demographic change: an ILC-UK/Actuarial Profession joint d...ILC- UK
Full details of the event are available here: http://www.ilcuk.org.uk/index.php/events/ilc_uk_and_the_actuarial_profession_debate_public_service_and_demographic_c
The live blog for this event is available here: http://blog.ilcuk.org.uk/2013/04/23/live-blog-public-service-and-demographic-change/
The New Shape of Real Estate: Well Workplace by Cushman & WakefieldJohn Farese
Interesting report on the future of the workplace. The well being of employees is the renewed focal point of commercial real estate spaces looking beyond 2017.
Ahead of the marcus evans National Healthcare CXO Summit 2023, Joy Figarsky discusses the link between mental health costs and medical costs, and why hospitals should adopt a whole-person care approach.
Is policy making measuring up: Rethinking how we measure the success of a nation explores how global demands have changed the way we think and measure success and what the results really mean.
This document summarizes the key findings of a report on physical inactivity in the UK. It finds that 1 in 4 people in England are inactive, failing to meet guidelines of 30 minutes of moderate activity per week. Inactivity levels are about 10% higher in more deprived areas. There is also a relationship between inactivity and premature mortality, with more inactive areas having higher premature death rates. However, there is no significant connection between green space availability and inactivity levels. The document calls for a national strategy to reduce inactivity rates by 1% annually, which could save local authorities £1.2 billion over 5 years. It recommends prioritizing inactivity programs and developing evidence-based initiatives to engage inactive groups.
Prevention the final frontier future fit v2David Sandbach
This document discusses strategies for implementing wellness programs in public sector organizations in Shropshire, England to help reduce rates of premature death. It proposes that public sector employees, who number over 40,000, could act as informal health promoters to their friends and families, potentially influencing over 80,000 people. Various digital health tools and on-site health services are suggested that could be offered to employees at low or no cost. Implementing synchronized wellness programs across public sector organizations could help ensure employees are healthier upon retiring than the average UK worker.
This deck describes the work of P2Health Ventures, an early stage venture fund that invests in tech startups aiming to improve health outcomes through preventive and population health
This document provides an overview of a university course on Canadian health policy. It discusses obesity and chronic diseases as a policy issue that will be covered. The topics for today's lecture are introduced, including what policy is, policy tools, and writing a briefing note. Key information is presented on obesity trends, the social and physical determinants of chronic disease, and potential policy actions and the role of government. Government's role in addressing obesity is discussed, with differing views around libertarianism and collectivism.
Paul Young discusses reforming healthcare. He analyzes global healthcare spending and reviews efficient healthcare countries. Several sources of waste and inefficiency are identified in the US and Canadian healthcare systems, including fraud and mismanagement estimated at $11-25 billion annually in Canada. Automation technologies like robotic process automation and artificial intelligence show promise in reducing costs. Performance audits across government and the private sector could help streamline operations and identify additional savings. Comprehensive reform is needed to control costs and curb waste while emphasizing value and improved patient outcomes.
Using complex systems thinking to influence the way a city phe2018 gfGreg Fell
This document discusses using complex systems thinking to promote public health at the city level. It notes that health is determined by many interacting factors beyond just healthcare, and that addressing upstream social and economic determinants is important. It advocates taking a complex, long-term approach that considers many stakeholders and trade-offs rather than top-down policies. The goal is to set the system on a healthier trajectory rather than having perfect control or knowing all outcomes in advance.
the social determinants of mental illnessGreg Fell
This document discusses addressing the social determinants of mental illness and flipping the approach to mental health on its head. It makes four key points: (1) Most factors influencing mental well-being are outside the traditional health system; (2) Upstream social and economic factors matter more than downstream interventions; (3) All the proposed determinants are complex systems that interact; and (4) The default is to focus on symptoms over addressing root causes. It argues for a holistic, multi-sector approach to mental health that tackles issues like debt, employment, housing, and education.
the planning function does more for the cities HEALTH than the NHSGreg Fell
The director of public health in Sheffield argues that planning functions have a greater impact on city health than the National Health Service. They discuss how planning can address upstream causes of poor health like inequality, transport infrastructure, housing standards, and community design. The director emphasizes that planning should aim to create environments where health and well-being are the default and easiest options through green spaces, mixed developments, and walkable neighborhoods. They argue planners must consider health impacts and work to reduce health inequities through their decisions.
The document discusses activities of the Global Agenda Council on Ageing from 2014-2016 focused on cognitive decline, financial services, and technology. Key activities included a four-part symposia series exploring these topics across different regions. The Council also published reports, launched the New York City Ageing Alliance, and developed recommendations to link health and wealth, promote planning and cooperation, and regulate for longevity. The document emphasizes the need to address cognitive decline's financial impacts as populations age and live longer.
A presentation to a National Institute of Health Research consultation event on identifying priorities for public health research for the next five years
This document summarizes key issues related to small-scale fisheries in South Africa:
- South Africa's fisheries legislation has historically excluded thousands of small-scale fishers, contributing to overfishing and depletion of stocks.
- New proposed legislation aims to formalize small-scale fisheries by allocating collective rights to fisher cooperatives, allowing them to target multiple species.
- However, most near-shore fish stocks are currently collapsed, so increased fishing pressure from an expanded small-scale sector risks further overfishing unless illegal fishing is addressed.
- Recognizing small-scale fisheries' social and economic roles while ensuring sustainability will be an ongoing challenge.
This document discusses issues related to prevention and return on investment (ROI) in healthcare. It addresses why prevention has not been more widely implemented in the NHS despite the economic case. Barriers include lack of incentives, complex evidence, and culture change. Cost-effectiveness does not equal cost savings. Prevention may release cash in long term rather than short term. ROI tools can oversimplify and make unrealistic assumptions. Obesity prevention is used as an example, highlighting challenges around individual versus population interventions and timeframes for cost savings.
CEI’s Values Based Communications Project
Our Challenge: Make Good Policy Good Politics
Our Question: Just because we’re right, do we have to lose?
CEI’s communication work suggests the answer should be a resounding NO!
Capitalism creates a massive middle class
Produces entrepreneurs and intellectuals
Intellectuals criticize (envy) and de-legitimize entrepreneurs
Culture grows skeptical of business, support for government intervention grows.
Wealth creation suffers, individuals suffer.
Strategy Report on NHS and Recommendations - Gaspare MuraGaspare Mura
The document discusses challenges facing the UK National Health Service (NHS) including an aging population, rising life expectancy, and budget constraints. It analyzes the NHS using PEST and SWOT frameworks to understand external factors and identify issues. Key problems identified are lack of integration between primary, secondary, and community care services; insufficient capacity as demand increases; and need for continued development and innovation. Solutions proposed include optimizing resource allocation, improving preventative care and disease management, strengthening community services, and utilizing low-cost technologies.
Public service and demographic change: an ILC-UK/Actuarial Profession joint d...ILC- UK
Full details of the event are available here: http://www.ilcuk.org.uk/index.php/events/ilc_uk_and_the_actuarial_profession_debate_public_service_and_demographic_c
The live blog for this event is available here: http://blog.ilcuk.org.uk/2013/04/23/live-blog-public-service-and-demographic-change/
The New Shape of Real Estate: Well Workplace by Cushman & WakefieldJohn Farese
Interesting report on the future of the workplace. The well being of employees is the renewed focal point of commercial real estate spaces looking beyond 2017.
Ahead of the marcus evans National Healthcare CXO Summit 2023, Joy Figarsky discusses the link between mental health costs and medical costs, and why hospitals should adopt a whole-person care approach.
Is policy making measuring up: Rethinking how we measure the success of a nation explores how global demands have changed the way we think and measure success and what the results really mean.
This document summarizes the key findings of a report on physical inactivity in the UK. It finds that 1 in 4 people in England are inactive, failing to meet guidelines of 30 minutes of moderate activity per week. Inactivity levels are about 10% higher in more deprived areas. There is also a relationship between inactivity and premature mortality, with more inactive areas having higher premature death rates. However, there is no significant connection between green space availability and inactivity levels. The document calls for a national strategy to reduce inactivity rates by 1% annually, which could save local authorities £1.2 billion over 5 years. It recommends prioritizing inactivity programs and developing evidence-based initiatives to engage inactive groups.
Prevention the final frontier future fit v2David Sandbach
This document discusses strategies for implementing wellness programs in public sector organizations in Shropshire, England to help reduce rates of premature death. It proposes that public sector employees, who number over 40,000, could act as informal health promoters to their friends and families, potentially influencing over 80,000 people. Various digital health tools and on-site health services are suggested that could be offered to employees at low or no cost. Implementing synchronized wellness programs across public sector organizations could help ensure employees are healthier upon retiring than the average UK worker.
This deck describes the work of P2Health Ventures, an early stage venture fund that invests in tech startups aiming to improve health outcomes through preventive and population health
This document provides an overview of a university course on Canadian health policy. It discusses obesity and chronic diseases as a policy issue that will be covered. The topics for today's lecture are introduced, including what policy is, policy tools, and writing a briefing note. Key information is presented on obesity trends, the social and physical determinants of chronic disease, and potential policy actions and the role of government. Government's role in addressing obesity is discussed, with differing views around libertarianism and collectivism.
Paul Young discusses reforming healthcare. He analyzes global healthcare spending and reviews efficient healthcare countries. Several sources of waste and inefficiency are identified in the US and Canadian healthcare systems, including fraud and mismanagement estimated at $11-25 billion annually in Canada. Automation technologies like robotic process automation and artificial intelligence show promise in reducing costs. Performance audits across government and the private sector could help streamline operations and identify additional savings. Comprehensive reform is needed to control costs and curb waste while emphasizing value and improved patient outcomes.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
The anatomy of a healthy city
1. The anatomy of a healthy city
More than the drains
more than pies and fags
health ≠ the NHS
Greg Fell
Director of Public Health, Sheffield
Greg.fell@sheffield.gov.uk
@felly500
https://gregfellpublichealth.wordpress.com/
3. https://www.rcpe.ac.uk/sites/default/files/burns.pd
“There is no doubt that avoiding health-damaging behaviours
makes sense. However, creating health is a proposition at
least as sensible and as practical as simply avoiding
disease.”
the determinants of well being or
the determinants of health
Townsend Centre for Poverty studies. Bristol, c1980
4. 5 things on my job description
1. Transform PH, from NHS facing to LG facing
2. PH is NOT the PH Grant, but totality of org
3. Stat Duty = to improve health of pop, not to
provide some PH services
4. Job - influence the futures that don’t yet
exist, often influencing other people’s money
5. Metric = the gap in h life expectancy
…..Oh…. And “write a strategy”
6. Or this working forward
Determinants ≠ inequalities.
Inequalities ≠ public health
7. There IS a PH strategy in Sheffield
• I wont bore you with the detail
– Health protection
– Commercial determinants of health
– Inequalities in health
– Health in all policies
• It’s only 5 pages long.
I will tell you a story about context,
reflections and contextualise in complexity
http://democracy.sheffield.gov.uk/ieDecisionDetails.aspx?Id=1756
8. Why is it in a cities interest
• “health” (or lack of) linked to service
demand
• (And economic productivity / social
justice)
• Not addressing upstream risks sets up
demand for our own services
• A long run business case for
investment (or budget cuts? What
outcomes are we prepared to give up)
https://gregfellpublichealth.wordpress.com/2018/08/03/why-is-it-in-the-interests-of-a-city-to-improve-health-and-well-being/
9. Inequalities in health
Why is there a gap in 2018
access to health care, esp primary care. Focus
on services, not risks and populations
tobacco, alcohol, obesity etc
exposure to environmental and social issues –
aka “the determinants
Belief in an economic system based on
trickledown economics.
https://gregfellpublichealth.wordpress.com/2018/06/26/why-is-there-a-20-year-gap-in-healthy-life-
expectancy-between-best-and-worst-in-2018/
https://twitter.com/felly500/status/1014257191933698049
10. Everything is “in”
How far upstream?
Causes of health
inequitable spread of risk
Causes of causes
Inequitable spread of power
Austerity.
Neoliberalism. Global crisis caused by public
debt vs reckless action of financial markets?
Political origins of health inequities: trade and investment agreements
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31013-3/fulltext?rss=yes
Joseph Stiglitz Says Standard Economics Is Wrong. Inequality and Unearned Income Kills the Economy
http://evonomics.com/joseph-stiglitz-inequality-unearned-income/
Ha-Joon Chang | The economic argument against neoliberalism -
https://m.youtube.com/watch?feature=youtu.be&v=ti3rjogF_VU
11. EACH of the “determinants” is a
complex system. And is not fluffy.
They all interact. And have a
bearing on inequality
https://localdemocracyandhealth.com/2017/06/25/the-welfare-benefit-system-is-a-public-health-system/
NHS = £114bn
Welfare = £160bn
“social protection” =
£250bn
12. Adverse Childhood Experiences
How the past defines the future
• NOT screening, and ACE
scoring
• ACE aware v ACE informed
• Meaningful consideration to
primary prevention AND
response.
• Children AND adults
• Whole life course
• Mission to programme
Lancet editorial - http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32172-9/fulltext?rss=yes
Bellis - https://www.ncbi.nlm.nih.gov/pubmed/25174044
15 minute TED Talk by Nadine Burke Harris for a cogent precise account of the effects of childhood maltreatment on
chronic health outcomes .
https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en
13. The most important public health
strategy you haven’t read?
• Danger we will all
focus on “businesses”
and “the economy”
• What IS “the economy”
• Healthy lives are an
economic investment.
A bit like HS2
• GVA vs social value
• Anchor mission
14. Reframing transport policy – bike lanes vs
more roads vs screening and cancer drugs.
How to define “success” in transport policy
https://gregfellpublichealth.wordpress.com/2016/10/17/ten-thoughts-on-reframing-transport-
policy-as-a-health-investment/
https://gregfellpublichealth.wordpress.com/2016/10/01/parks-and-bike-lanes-and-healthy-folk-on-
the-value-of-different-forms-of-investment/
http://publications.arup.com/publications/c/cities_alive_towards_a_walking_world
http://lcc.org.uk/articles/healthy-streets-are-cycling-and-walking-streets
15. Scotland – Its not the pies and cigs,
might be the booze
• What happened in the 1950,
60, 70s - Catastrophic loss of
industry in Scotland -
shipyards
• Gorbels -from close knit
community to large flats and
build new towns.
• Men had no jobs, no
community facilities, no
schools, no shops.
http://www.gcph.co.uk/publications/635_history_politics_and_vulnerability_explaining_excess_mortality
policy recommendations - http://www.gcph.co.uk/assets/0000/5587/Excess_mortality_-_Policy_recommendations.pdf
https://www.theguardian.com/cities/2016/jun/10/glasgow-effect-die-young-high-risk-premature-death
16. We over-medicalise non medical problems
The script for anti depressants and statins
is written before you walk in the door
this wastes resource and does harm
or
17. Lancet June 2012
Some obvious opportunities -
Cholesterol control beyond the clinic
Population wide blood pressure
18. Not just the city, but upwards
• Challenge assumptions at heart of govt.
• OBR assumptions re NHS & social care
costs.
• Fair funding review
• Advocacy for key policies – MUP, fast food
advertising, gambling, welfare system
• Structural condition for funding the things
we need to fund.
19. Reflections to date
• I don’t have “the answer”. No big red button.
• There isn’t a single thing. Complex interplay of many
different things – financial, system, intervention, political. All
at once
• Influence by proposition – cohorts, places,
policies. Granularity of ideas – places, geography, systems
• Writing a big plan wont help.
• “if only we had the resources”. Mainstream vs “new”
• Don’t assume “ROI” evidence will be the thing that swings
it.
• Evidence, data and rational argument vs belief, narrative
and angriness
• political, ideological or commercial influencers
• Visibility is an issue!
https://gregfellpublichealth.wordpress.com/2017/06/20/the-anatomy-of-a-health-city/
20. There’s a powerful downstream pull
We often talk complexity and upstream, but act
differently – empowering parents to address
obesity.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60813-1/abstract
https://gregfellpublichealth.wordpress.com/2018/08/24/complexity-in-public-health-part-1/
• Research, practice,
policy
• Strong pushback
when you try to be
upstream –
commercial,
ideological, other
• “upstream” not
“complex” by another
name
21. But its complex.
Complicated v Complex
Try the same for ALL of the processes and systems
that determine our health!
22. Hierarchy approach or complex
system
• Analytic complexity, decision complexity, political
complexity. All at once.
• Hierarchy & command & control approach wont work.
Ends.
• set broad framework, build in adaptability & regular
review points
• Don’t try to work out every aspect up front. System will
adapt.
• Set system on right trajectory. Path dependence
• Set out what broadly needs to happen
• Capability and capacity of system actors
• System map – 1, 5, 10 year plan. Chess v draughts.
• Don’t assume linearity.
https://gregfellpublichealth.wordpress.com/2018/08/26/complexity-in-public-health-part-2-actions-to-take-responses-to-complex-problem/
23. Trade offs and flash-points.
• Where is one set of values going to clash
with another set. Discuss openly.
• Economy vs well being – GVA vs wider
measure. Reframe “the economy” –
internalise the externality. It changes
things
• Air quality vs jobs - Do the maths
• open dialogue about where the trade offs
are??
24. 6 problems to be mindful of
1. Counting stuff vs having faith
2. Focus on the visible and short term vs the
long term and less tangible
3. Coherent response and “a programme” vs
building a culture.
4. Cant address in silos, but that will be the
default. Complex adaptive systems. No
single idea, no single leader
5. We quickly default to the policy or service
area we are closest to. There is a great deal
going on, that we as individuals might not
know about
6. Austerity
25. There isn’t a pamphlet on this.
This is a different way of doing
the thing called public health
treating places not just health
conditions or patients.
Editor's Notes
Overall aim. Suggestion…..
Land
the notion that MM is a big thing (will be news to some, but not most)
matters well beyond NHS. also matters in social care, econ productivity etc etc
notion that we already have a response in place. Right ingredients in place. How to push harder on it. Any things we really want to get into air. Give people faith in that.
further cement the idea that the analysis John has done is a decent chunk of the business case for “being more preventive”
embed the notion that the number of bike lanes we build, the number of parks we maintain, and further upstream housing, income etc all have a bearing on the endpoint - MM – which has impact on NHS social care and other
whats next in this area
covering
background
Air time to the analytic work done on MM
What & why it matters - NHS demand, social care demand, productive economy, social justics. Put in the inequality context. Onset = 45 in some parts of town 65 in others etc.
Link MM to burden of disease. Chris Bentley has some good slides on this. Treating populations not patient by patient
Why it matters to local govt. Social care demand resulting from MM / Economic stuff - Also land in context of healthy people / economy - onset of MM is 45 in some parts of town. 18,000 people in Sheffield on ESA, weighted massively in poorest parts of town.
Approach to managing multiple morbidity, across the board
Upstream approach , prevent reduce delay. Upstream in locus of intervention (structural policy for population vs treatment for individuals, emptying ocean with teaspoon). Upstream in terms of age - earlier start the better.
Approach in NHS & social care - describe And inequalities. Neighbourhoods , risk strat
Outcome fund. Why doing, what point, where heading
Person centred stuff. Give bit of airtime
https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-1-population-change-and-trends-in-life-expectancy
https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-4-health-of-children-in-the-early-years
Lessons for public policy
If a feeling of being in control of our lives and being able
to make decisions for ourselves is an important
determinant of how individuals create health, then public
policy should, as an underpinning principle, seek to
enhance this sense of being able to control one’s life. Too
often, however, we organise public bodies to do things
to people rather than work with them. Our present
approach to people in difficulty focuses on their
problems, needs and deficiencies. We define them as
being ‘deprived’ and see their health problems as being
due to their health-damaging behaviours. We design
services to fill the gaps in peoples’ lives and fix their
problems. As a result, individuals and communities can
feel disempowered. People become passive recipients of
services rather than active agents in their own lives.
In adopting this approach, we undermine their sense of
control and encourage passivity. This is completely
counter to the evidence that supports the need to
develop the personal assets which individuals and
communities harbour, often unrecognised, and which
allow them to participate fully in the creation of
wellbeing for themselves and their neighbours. This
process has been termed ‘salutogenesis’.8
This salutogenic perspective, therefore, leads us to the
conclusion that it is not enough to improve material
wellbeing in order to improve inequalities in health. We
also need to pay attention to those psychological
resources that allow people to build relationships and
establish social networks. We need to ensure
opportunities for people to feel their lives are meaningful.
Without such internal capacity, attempts to narrow
health inequalities simply by improving external social
circumstances are unlikely to be very effective.
So what is the basic cause of health inequality?
Widening health inequality, then, is a reflection of
inequality in access to those important determinants of
the ability to feel safe and in control of one’s life in
difficult times. Inequality in a society is primarily a
consequence of inequality in the distribution of those
resources in society that allow children to flourish in a
safe and supportive environment. Nurturing environments
for children and the social, economic and environmental
resources that allow parents to create safe and stable
environments for their families are essential if we are to
narrow the gap in health, in educational attainment and
in offending behaviour. By providing such opportunities
early in life, inequalities across many aspects of society
are likely to be improved.
There is no doubt that avoiding health-damaging
behaviours makes sense. However, creating health is a
proposition at least as sensible and as practical as simply
avoiding disease. Perhaps health professionals should
contribute to the search for ways to support the
creation of health rather than simply focusing on treating
or preventing disease.
Why is it in the interests of a city to improve health and well being
LG is at bottom funding wise, now demand pressures.
Summary points
“Health” and “well being” are flip sides of the same coin. There is a whole philosophical debate about the definition of “health” and of “well being”, salotogenesis theory. One for another time
We have an approach to this in the city where we have “health” or “well being” as a theme running through all policies.
Not addressing well being or health simply sets up demand for services. Demand for NHS and social care is a response to failure to optimise this further upstream and is buying back health that we've already lost via policy choices in other spaces.
Social care demand will be the bit that bankrupts any local authority. Thus considering the upstream causes of that demand is a highly legitimate goal. Upstream includes the built environment, green space, transport policy. Thus the role of the Sheffield Plan is critical
"We should have a health in all policies approach", or "we should be more preventive". Both are easy to say and the right aspiration to have.
How we build our environment and city - built places, social neighbourhoods, the services we provide, what the economy looks like and how it develops and includes all. All of this, and much more, matters and matters a lot for how healthy we are.
We underweight the importance and relevance to "health" of changes we make in landing service and policy discussions, we underweight health (by which I don’t mean health care) and inequalities in outcomes in the trade offs we make.
We still aren’t landing the rationale for why PH folk hassle others to build bike lanes, parks, not advertise junk, do progressive licencing etc. Here are some thoughts on linking "how healthy we are" it back to demand for our services.
Defining "health" and why is matters to service demand
Healthy Life Expectancy (HLE) is the standard proxy used for describing years in wellness or illness, or lack of it.
Other metrics are available (activities of daily living, functional ability), there are some distinguishing features but they are all sides of the same coin. All have tricky methodological issues with calculation.
We have broadly accepted that HLE is the measure.
It can be readily linked to NHS demand.
More people with more years of less than good health.
That demand is inequitably spread - affluent / poor, mental illness / not etc.
This leads to demand for NHS and social care (and arguably is THE point of the NHS's newfound enthusiasm for "population health".)
Social care demand is related directly to how poorly people are (that’s a medical model construct) or loss of independence (often related to consequence of decline related to illness or broader social factors)
It is easy to track that back to interventions to reduce or manage risk, and thus delay complications (and thus loss of functional ability, illness etc). This is easy to do re NHS services, easy to track back (or forward) to social care.
These risks are due to well known risk factors. Downstream and upstream risk factors matter. Upstream always matters a lot more.
Not addressing risks sets up demand for our own services.
Thus it IS important to set up an environment where people can be healthy, it is an investment in preventing future demand.
To use an over simplistic example, if we build a city like Amsterdam more people will walk and cycle, there will be less obesity, less downstream complications of obesity - diabetes, cancer, heart disease, joint pain. And all the NHS demand, and loss of function thus social care demand that ensues. The city will be more connected, likely mental health will improve. Some if this is near impossible to prove in modelling terms, though plenty have done this - see here (Pop benefits of Dutch levels of cycling) for an example directly linking active travel, health status and economic productivity via GDP .
Having a healthier set of folk than you would otherwise is probably the biggest, and seemingly as yet untapped by those that "do" the economy, economic lever you can pull at a city level. I’ve written a little on that before – the link between “health” and economy is two way..
Im not only picking on bike lanes here, though there are a neat simple example. The same can be said in almost any area of policy.
Thus it IS in the cities interests that we DO use the various levers available to us to get a healthier set of folk than would otherwise be the case.
Why don’t we do better.
Many obvious reasons.
Austerity has led to us stripping out lots of service to maintain statutory.
Even before austerity, however, this was an issue. “health (or “prevention”) isn’t my job, its done by someone else, somewhere else, leave me alone I’ve got other stuff to do”.
There is something in here about business planning/budget/accountancy
We didn’t want to make severe cuts to any of our preventive services. Circumstance dictated that result – we need to balance this budget NOW, we have these stat services we must deliver, something has to go somewhere, etc. We can’t fix the problem of the amount of money available – so will need to affect that decision process in other ways.
This is the classic Public Service Reform problem of where returns on investment go – and how long they take to accrue.
Given that we cant make the challenge go away, there IS a case to add more information to the frame so it is not just a financial calculation – or can we design a budgeting/business planning approach that exposes the dependencies across the system (so we can model “make this cut now and you will add 5x the pressure to future budgets”).
We probably don’t have the data for this sort of approach, or peraps the capacity (and maybe the capability) for the modelling
A “business case for cuts” process might be an interesting exercise.
Makes it more complex, admittedly. The mechanism/what would need to be in place for someone (cabinet? EMT?) to be able to say “the long-term implications of change x in service y for service z is not something we can ignore – go away and think again” and possibly then look to move some money around the system in response? This might make budget setting even more terrifyingly complex than it is already.
More broadly and away from narrow budget view: application of COM-B to this might be useful
what is the behaviour we want from colleagues on this – need to define this clearly, something like “decision making with full view of the long term outcomes and implications”? Then from this, do they have capability, opportunity, motivation? Suspect capability and motivation might be a problem, haven’t really thought through opportunity.
Knowledge is important but values too.
Who are we delivering for? Eg think the evidence on active travel etc is well understood but we are continually under ambitious.
Ultimately it needs to be a performance issue for Directors/HoS etc?
https://gregfellpublichealth.wordpress.com/2018/06/26/why-is-there-a-20-year-gap-in-healthy-life-expectancy-between-best-and-worst-in-2018/
more“Health” ≠ or better NHS
See Burns on Salutogenesis vs pathogenesis
Determinants ≠ inequalities
Health inequality is therefore about:
The unequal distribution of clinical and lifestyle risk factors (a small part of which is about the NHS)
The unequal distribution of social and environmental risk factors (the determinants)
The determinants of the determinants (power, concentration of wealth, dominant economic model etc.)
Health inequalities ≠ “health” thing, or indeed a “public health” thing.
"Austerity was based on an analysis that what had caused the global recession was the high level of public debt rather than the reckless action of the financial sector"......
How far upstream
Individualisation of social issues
Dominance of market mechanism
Misplaced belief in trickledown economics
Privatisation of profit, socialisation of risk
Concentration of wealth
Neo liberalism
I was thinking about how some of the public health issues have changed since the Ottowa charter and hoping they can be incorporated into whatever we all come up with.
Since 1986 the rise of Neo-liberalism and its effects on inequalities are much better known and of course the effects of Climate Change.
However one of the issues I want to highlight is the growing evidence of the effects on health of abuse and neglect particularly in childhood. I am particularly struck by the evidence from the Adverse Childhood Experiences (ACE) trials.
On line paper from Journal of Public Health (Oxford)
10.1093/pubmed/fdu065
Even though I have retired as a GP I continue to work in the regional CFS/ME (Chronic fatigue / Fibromyalgia) service and come across these issues frequently.
I would like to see them brought to the fore and have cc'd The Director of Public Health, Greg Fell to highlight this as a public health issue
Upstream. “The determinants” - not all nebulous upstream policy wonkery
Running an education system is not nebulous. Ditto housing, ditto planning, ditto transports.
Health policy is more than health care policy
They also need to be on the hook around health inequalities.
The NHS is NOT off the hook
Health Inequality - it’s not (only) an NHS issue.
Health inequalities is not a public health issue.
DH – wrong sponsor agency. Will always focus on end goal, and design solutions with health service in mind first.
This isn’t to let the NHS off the hook. Far from it, but it’s well beyond the NHS.
If we only ever see HI as a “health thing” and people see “health” as = “NHS”, we will only ever have a downstream response. The upstream stuff will not get the impetus…..
So its not so much a case of NHS being let off hook, but those upstream of NHS being put ON the hook……..
https://twitter.com/felly500/status/1014257191933698049
My take is that the NHS does not see itself having a role in health inequality reduction it thinks that’s everybody else’s job. On ‘health’, the public see the NHS’ role but nobody else’s and local govt see a bit of everything. So at risk of being precisely wrong…
Mine for the NHS at the moment is…
Your own work
NHS pull your weight, you need to have inequality reduction at the heart of what you do. You can make a contribution to narrowing inequalities in health quicker than anyone. We know what that looks like (mostly secondary prevention), step up and get on with it.
NHS, if you’re going to do more ‘prevention’ as part of the 3.4%, make sure its inequalities focussed, and not just around specific disease pathways. Focus on preventing premature multimorbidity in poorer populations
Work with others
NHS, integrated care needs to be purposely inequalities focussed, it isn’t
NHS, really do MECC, work with your LA partners through integrated health and wellbeing services to focus holistically around individuals range of behaviours and how that links with wider determinants, psychological wellbeing and ability to undertake sustainable change
NHS, you’re an anchor institution/system, that means you have a massive impact on local wider determinants of health, understand that role and work with others to maximise it
NHS, look at the connections/overlaps where you work with wider determinants, behaviours, community. What are you doing in those gaps? What does it add up to?
NHS mustn’t be left off the hook.
Health policy is more than Healthcare policy
Across policy strategy tactical operational decisions
Healthcare economic housing welfare Leisure transport policy
Post public health professionals including me in my experience I'm only getting to grips with some of these
There’s something about systematically unpacking the complexity that underlies “the determinants of health”. From the outside the Heath care system may look like a big homogenous blob of doctors and nurses. From the inside it is not. Similarly “the determinants of health” are a series of systems, each belie vast complexity.There’s no doubt that the “welfare system” is a determinant. And that changes to it over recent years have had profound detrimental impacts on our mental and maybe physical health, at population and individual level.
Making meaningful intervention in this space requires DEEP understanding of the system to be able to carry credibility and authority and thus to be able to effectively influence.
One might say the same of “housing”, of “education”, of “early years”, or of “planning”. And so on.Each of theses systems is vastly diverse and complex with many different cultures and sub cultures. Many different, difficult and odd incentives with people pulling in many different directions.As a jobbing DPH, I cant be, and am not, expert in all areas. I know a bit about some of them. Definitely, an effort is needed to shift balance of “public health” away from “health” as defined as health care services. Most know my view that “health NHS) and that “lifestlyes” might be better characterised as commercial determinants of health
(As an aside there’s an interesting conundrum there. Should we ignore “smoking” because it is a downstream lifestlye issue, and result of “choices individuals make”…. It causes c12% of illness and 20% of death.)Also I know you’ve given PHE a hard time for being too physical health centric and lifestyle centric….maybe it’s good to expand the range of actors that are involved in the pursuit of “public health” – knowingly or unknowingly, even if those actors don’t call it public health, doesn’t really matter to me if the objective is shared. To be fair it’s my type that need to play into this agenda rather than vice versa Certainly in Sheffield we are clear that PH = organisational responsibility and not a “department” or a line in the budget. This is easier said than done, there’s an element of (my) “personal” responsibility and accountability.But yes, “welfare” is a definitive public health system. Public health types (defined narrowly and with a big P and a big H haven’t engaged in it as well as we might. Let’s put that right?REPLY
•
• markgamsu PERMALINK*June 29, 2017 20:50 Cheers Greg – and welcome to the blog! I agree with you – we have a range of social support systems and others like education that are about personal development and change – yet most of them are tremendously complicated to access for individuals and hard to understand for many professionals. When we met recently I flagged up that I have had a green flag to establish a special interest group on this topic within the Faculty of Public Health and am very keen that we extend an invitation to a number of welfare system experts to work with us – so watch this space. Yes, I have given PHE a bit of a hard time – but only because their role is so important -their position and expertise represents the biggest single chunk of Public Health resource for change in the country it therefore needs to be relevant!
Mark
As resident expert......
is there such a thing as a guide to the welfare system, things you need to know as a busy jobbing frontline clinician
The role of the GP around social determinants
Don't call them determinants - makes them seem a bit nebulous
Individual level
Community level
Population level
Primary, secondary and tertiary prevention
What is it that you're trying to prevent
Consistently point out the obvious, coordinate this at scale
https://localdemocracyandhealth.com/2017/06/25/the-welfare-benefit-system-is-a-public-health-system/
Great blog as ever.There’s something about systematically unpacking the complexity that underlies “the determinants of health”. From the outside the Heath care system may look like a big homogenous blob of doctors and nurses. From the inside it is not. Similarly “the determinants of health” are a series of systems, each belie vast complexity.
There’s no doubt that the “welfare system” is a determinant. And that changes to it over recent years have had profound detrimental impacts on our mental and maybe physical health, at population and individual level.Making meaningful intervention in this space requires DEEP understanding of the system to be able to carry credibility and authority and thus to be able to effectively influence.One might say the same of “housing”, of “education”, of “early years”, or of “planning”. And so on.
Each of theses systems is vastly diverse and complex with many different cultures and sub cultures. Many different, difficult and odd incentives with people pulling in many different directions.
As a jobbing DPH, I cant be, and am not, expert in all areas. I know a bit about some of them. Definitely, an effort is needed to shift balance of “public health” away from “health” as defined as health care services. Most know my view that “health
NHS) and that “lifestlyes” might be better characterised as commercial determinants of health(As an aside there’s an interesting conundrum there. Should we ignore “smoking” because it is a downstream lifestlye issue, and result of “choices individuals make”…. It causes c12% of illness and 20% of death.)
Also I know you’ve given PHE a hard time for being too physical health centric and lifestyle centric….maybe it’s good to expand the range of actors that are involved in the pursuit of “public health” – knowingly or unknowingly, even if those actors don’t call it public health, doesn’t really matter to me if the objective is shared. To be fair it’s my type that need to play into this agenda rather than vice versa
Certainly in Sheffield we are clear that PH = organisational responsibility and not a “department” or a line in the budget. This is easier said than done, there’s an element of (my) “personal” responsibility and accountability.
But yes, “welfare” is a definitive public health system. Public health types (defined narrowly and with a big P and a big H haven’t engaged in it as well as we might. Let’s put that right?
Cheers Greg – and welcome to the blog! I agree with you – we have a range of social support systems and others like education that are about personal development and change – yet most of them are tremendously complicated to access for individuals and hard to understand for many professionals.
When we met recently I flagged up that I have had a green flag to establish a special interest group on this topic within the Faculty of Public Health and am very keen that we extend an invitation to a number of welfare system experts to work with us – so watch this space.
Yes, I have given PHE a bit of a hard time – but only because their role is so important -their position and expertise represents the biggest single chunk of Public Health resource for change in the country it therefore needs to be relevant!
I suspect it is situational. Knowing when to shout, when to whisper. And to whom.
Nearly two decades ago, the Adverse Childhood Experiences (ACE) Study broke new ground, showing a strong relationship between ACEs and health-risk behaviour and disease in adulthood. The findings of this large-scale study have been affirmed by smaller local studies across the world. On Nov 1, Public The Welsh ACE study adds to a growing body of research untangling the link between ACEs and long-term health consequences. The real benefit, however, of a local study is its ability to provide tangible solutions. One of the aims of this study was to understand which communities in Wales are most affected by ACEs to effectively direct existing support services—an aim that could be shared by any country. As a country struggling with loss of industry and the resulting poverty, the approach taken in Wales could be applicable to other transitioning countries in similar straits. With programmes such as Flying Start already in place to tackle child poverty and the political manoeuvrability of devolution, Wales is well placed to act on the results of this study quickly and efficiently—and in doing so, provide an example to other communities or countries wishing to do the same.
Childhood Experiences (ACE) trials.Bellis paper
Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey.
On line paper from Journal of Public Health (Oxford)
10.1093/pubmed/fdu065
https://www.ncbi.nlm.nih.gov/pubmed/25174044
Social value and how we use our institutions/assets – link to inclusive growth, procurement work – but need to think wider than this – eg can employment practices be more supportive?
underplayed.
reconsider this in context of inequality.
aspiration into work and learning – what are the streams into employment and learning.
What role can anchor institutions play in this?
Anchor – role to connect aspiration to opportunity
Create a single approach as a city.
Ten thoughts on reframing transport policy as a health investment https://gregfellpublichealth.wordpress.com/2016/10/17/ten-thoughts-on-reframing-transport-policy-as-a-health-investment/
parks and bike lanes vs cath labs and cancer drugs. https://gregfellpublichealth.wordpress.com/2016/10/01/parks-and-bike-lanes-and-healthy-folk-on-the-value-of-different-forms-of-investment/
http://publications.arup.com/publications/c/cities_alive_towards_a_walking_world
http://lcc.org.uk/articles/healthy-streets-are-cycling-and-walking-streets
Fundamental changes in social structure and patterns
Some obvious opportunities
No single big idea - .
Value of the process
Got to build it with conditions on the ground
Representation of truth, evidence, value of evidence
Clearly establish the direction of change
wider logic models & feeds of “what works”.
Interventions would introduce system learning processes rather than specifying outcomes or targets. Feedback loops.
competencies, capacity, motivations of all the actors in the system
initial conditions which produce a long-term momentum or ‘path dependence’.
Don’t assume linearity
the visibility problem – “but there’s nothing going on”. 1,5,20 year plan. Chess not draughts
The national rules – can you influence, change to make your job easier?
Lets have open dialogue about where the trade offs are??
Recognise flashpoints and trade-offs.
Eg - Cars/ economy/ congestion/ AQ/ Active travel (often a false flag when you REALLY stop to think about it)
Belief sets and national rules may slow progress – eg DfT and travel budget, preference for cars.
Where does “growth” and “economy” clash with “well being” (I often get into reframing the word “economy” at that point)
Where does efficiency clash with equity and or community focused approaches….
Austerity harms, 7 years into a 4 year programme of austerity.
It has forced change, change is welcome.
But we are well beyond trimming fat – now into bone.
Resist single sector and silver bullet answers: all domains need answers and solutions. Resist single sector answers.
Most are unconvinced that “writing plans” will solve or make much progress
No single big idea - Complex interplay of many different things – financial, system, intervention, political. All at once.
Influence by proposition – cohorts, places, policies. Granularity of ideas – places, geography, systems
The one thing – austerity
As per chat – austerity is perhaps the one thing that might prove somewhat silverish in its bullet like status
No doubt that as a result of 7 years of austerity we have stripped out hundereds of millions of spend from our authority. Same story up and down country. That spend we’ve stripped out wasn’t money for old rope – was largely prevention and early intervention services.
Obviously we will have to repay the financial and human cost of that in the future. Depending on your economic lens on the world, it’s a false economy.
There’s little doubt in most DPH minds that austerity is doing harm – both directly to individuals and indirectly via no longer having a range of safety net services.
See the ongoing commentary on the slow down / grinding to a halt of healthy life expectancy and life expectancy – this is what’s driving demand……
It is hard for people to step outside their organisational focus and context and experience.
People view the world from their perspectives and world views. This is understandable. Many specific examples cropped up in the afternoon. Illustrates how we need to overtly flag up this risk to our thinking as we take it forward.
Correct the issue re fragments within a sector, and between sectors.
ROI across agencies, over many years. Standard public service reform problems exist in this space, eg investment by organisation x leads to savings for organisation y
These concerns are set against the impact of austerity on local government budgets and welfare reform, and what they mean for the determinants of health; and met with the response that much activity is taking place.