523911 research-article2014
RSH0010.1177/1757913914523911OtherOther
POLICY
Policy
Health inequalities: mobilising the ‘wider public health workforce’ Over the past century, public health in the United Kingdom has improved dramatically. People are living longer, healthier lives than ever before. However, these improvements mask the serious health inequalities that continue to pervade British society. These inequalities have steadily increased over the past 20 years; research by the Equality Trust estimates that the gap in average life expectancy between different localities has increased by a staggering 41% for men and 73% for women.1 With continued budgetary constraints and the projected staff and skills shortfalls in the National Health Service (NHS) and local government, this trend is unlikely to dissipate without effective action.2 Furthermore, rises in chronic diseases, often the result of lifestyle choices, such as diabetes, heart disease and cancer, increasingly stretch the capacity of the NHS. The Chief Executive of Monitor concludes that ‘the NHS must undergo radical change if it is to survive’.3 To tackle health inequalities and prevent avoidable illnesses, the Royal Society for Public Health (RSPH) asserts that investing in the ‘wider public health workforce’ is a vital next step. We define this workforce as consisting of any organisation or individual who is not a professionally qualified public health specialist, but has the ability or opportunity to positively impact public health. This encompasses a huge number and variety of people, from people working or volunteering directly in a public health capacity, such as health trainers and health champions to people indirectly influencing public health through the course of their work or research, such as architects or teachers. By developing an understanding of public health as a society-wide responsibility, this workforce could ensure that health advice and support reaches far more widely than is currently the case. Some sections of society, particularly from disadvantaged groups, remain largely impervious to primary health care services and consequently, do not receive the help they need. Recruiting health trainers and the more informal health champions from within these communities to provide ‘support from next door’ rather than ‘advice from on high’ could be instrumental in redressing this issue.4 Through effective training, such as the RSPH Level 2 Award in Understanding Health Improvement, community members can be given the skills to motivate and support others in making sustained lifestyle changes. This represents a move away from paternalism towards an approach based on concordance, in which the ‘patient’ is an active partner, empowered to make healthier lifestyle choices.5 The utility of such an approach is supported by a growing body of evidence demonstrating the considerable health benefits for not only the clients, but the trainers and champions themselves. Incorporating public health knowledge into the training for non-health professions could have a similarly significant impact on public health. The work of those employed in areas such as teaching, policing, housing and town planning has a profound impact on public health; while many within these fields are public health aware, providing these professions with public health training would encourage health issues to become an instinctual concern for all. The landmark transition last year of responsibility for public health back to local authorities in England provides the ideal environment for such an approach to be adopted. Many areas are utilising this whole-system approach with demonstrable success. The health inequalities that continue to plague the United Kingdom are a considerable drain on the economy, costing an estimated £31 billion each year in productivity losses and £20 billion in lost taxes,6 as well as being severely detrimental to social justice. Engaging the wider workforce offers a relatively inexpensive way of supporting a far greater number of people to lead healthier lives. The RSPH, therefore, calls for greater utilisation of this untapped resource. Emma Lloyd RSPH Policy Team
References 1.
The Independent. Health Inequality Is Blighting the UK. 2013. Available online at: http://www.independent.co.uk/voices/comment/health-inequality-is-blightingthe-uk-8904398.html (Last accessed 14th January 2014). 2. Imison C, Bohmer R. NHS and Social Care Workforce: Meeting Our Needs Now and in the Future. London: The King’s Fund, 2013. Available online at: http://www. kingsfund.org.uk/sites/files/kf/field/field_publication_file/perspectives-nhs-social-care-workforce-jul13.pdf (Last accessed 14th January 2014). 3. Monitor. Monitor Sets Out How to Secure the Future of the NHS. 2013. Available online at: http://www.monitor.gov.uk/home/news-events-publications/latest-pressreleases/monitor-sets-out-how-secure-the-future-the-nhs (Last accessed 14th January 2014). 4. North West Public Health. Observatory Health Trainers in the North West. Liverpool: North West Public Health Observatory, 2011. Available online at: http://www.nwph. net/nwpho/Publications/healthtrainers.pdf (Last accessed 14th January 2014). 5. Petrie S (ed.). Controversies in Policy Research: Critical Analysis for a New Era of Austerity and Privatisation. Basingstoke: Palgrave Macmillan, 2013. 6. Frontier Economics. Estimating the Costs of Health Inequalities – A Report Prepared for the Marmot Review. London: Frontier Economics, 2010.
March 2014 Vol 134 No 2 l Perspectives in Public Health 63 Downloaded from rsh.sagepub.com at LAKEHEAD UNIV on March 17, 2015
RSH0010.1177/1757913914523911OtherOther
POLICY
Policy
Health inequalities: mobilising the ‘wider public health workforce’ Over the past century, public health in the United Kingdom has improved dramatically. People are living longer, healthier lives than ever before. However, these improvements mask the serious health inequalities that continue to pervade British society. These inequalities have steadily increased over the past 20 years; research by the Equality Trust estimates that the gap in average life expectancy between different localities has increased by a staggering 41% for men and 73% for women.1 With continued budgetary constraints and the projected staff and skills shortfalls in the National Health Service (NHS) and local government, this trend is unlikely to dissipate without effective action.2 Furthermore, rises in chronic diseases, often the result of lifestyle choices, such as diabetes, heart disease and cancer, increasingly stretch the capacity of the NHS. The Chief Executive of Monitor concludes that ‘the NHS must undergo radical change if it is to survive’.3 To tackle health inequalities and prevent avoidable illnesses, the Royal Society for Public Health (RSPH) asserts that investing in the ‘wider public health workforce’ is a vital next step. We define this workforce as consisting of any organisation or individual who is not a professionally qualified public health specialist, but has the ability or opportunity to positively impact public health. This encompasses a huge number and variety of people, from people working or volunteering directly in a public health capacity, such as health trainers and health champions to people indirectly influencing public health through the course of their work or research, such as architects or teachers. By developing an understanding of public health as a society-wide responsibility, this workforce could ensure that health advice and support reaches far more widely than is currently the case. Some sections of society, particularly from disadvantaged groups, remain largely impervious to primary health care services and consequently, do not receive the help they need. Recruiting health trainers and the more informal health champions from within these communities to provide ‘support from next door’ rather than ‘advice from on high’ could be instrumental in redressing this issue.4 Through effective training, such as the RSPH Level 2 Award in Understanding Health Improvement, community members can be given the skills to motivate and support others in making sustained lifestyle changes. This represents a move away from paternalism towards an approach based on concordance, in which the ‘patient’ is an active partner, empowered to make healthier lifestyle choices.5 The utility of such an approach is supported by a growing body of evidence demonstrating the considerable health benefits for not only the clients, but the trainers and champions themselves. Incorporating public health knowledge into the training for non-health professions could have a similarly significant impact on public health. The work of those employed in areas such as teaching, policing, housing and town planning has a profound impact on public health; while many within these fields are public health aware, providing these professions with public health training would encourage health issues to become an instinctual concern for all. The landmark transition last year of responsibility for public health back to local authorities in England provides the ideal environment for such an approach to be adopted. Many areas are utilising this whole-system approach with demonstrable success. The health inequalities that continue to plague the United Kingdom are a considerable drain on the economy, costing an estimated £31 billion each year in productivity losses and £20 billion in lost taxes,6 as well as being severely detrimental to social justice. Engaging the wider workforce offers a relatively inexpensive way of supporting a far greater number of people to lead healthier lives. The RSPH, therefore, calls for greater utilisation of this untapped resource. Emma Lloyd RSPH Policy Team
References 1.
The Independent. Health Inequality Is Blighting the UK. 2013. Available online at: http://www.independent.co.uk/voices/comment/health-inequality-is-blightingthe-uk-8904398.html (Last accessed 14th January 2014). 2. Imison C, Bohmer R. NHS and Social Care Workforce: Meeting Our Needs Now and in the Future. London: The King’s Fund, 2013. Available online at: http://www. kingsfund.org.uk/sites/files/kf/field/field_publication_file/perspectives-nhs-social-care-workforce-jul13.pdf (Last accessed 14th January 2014). 3. Monitor. Monitor Sets Out How to Secure the Future of the NHS. 2013. Available online at: http://www.monitor.gov.uk/home/news-events-publications/latest-pressreleases/monitor-sets-out-how-secure-the-future-the-nhs (Last accessed 14th January 2014). 4. North West Public Health. Observatory Health Trainers in the North West. Liverpool: North West Public Health Observatory, 2011. Available online at: http://www.nwph. net/nwpho/Publications/healthtrainers.pdf (Last accessed 14th January 2014). 5. Petrie S (ed.). Controversies in Policy Research: Critical Analysis for a New Era of Austerity and Privatisation. Basingstoke: Palgrave Macmillan, 2013. 6. Frontier Economics. Estimating the Costs of Health Inequalities – A Report Prepared for the Marmot Review. London: Frontier Economics, 2010.
March 2014 Vol 134 No 2 l Perspectives in Public Health 63 Downloaded from rsh.sagepub.com at LAKEHEAD UNIV on March 17, 2015
