Public health seeks to protect and improve the health of communities, identifying causes of poor health, disease and illness in populations and examining it from the wider social and economic standpoints. The four underpinning tenets of public health are health protection, health promotion, illness prevention and reducing inequalities (Skills for Health, 2008).
The concept of health and, conversely, illness has been the subject of much debate in society, both before and after the inception of the National Health Service (NHS) in 1948. In modern times the association between health and social determinants can be traced back in policy to some of the work of the early social reformers. Edwin Chadwick, one of the more well known, produced a report in 1842 entitled Report of the Sanitary Conditions of the Labouring Population of Great Britain (Chadwick, 1965) in which the relevance of social conditions of the poor and their ability to
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Public Health influence their plight were made explicit in relationship to individuals’ health. This report to the poor law commissioners resulted in the first Public Health Act in 1884.
Since then public health has been part of the United Kingdom’s healthcare provision.
The United Kingdom has seen many different approaches to public health over the past 150 years, each reflecting a more detailed/broader understanding of health and illness in society. Activities have included interventions to address inequalities on a population level, through the provision of state education and increased employment opportunities, to programmes of illness prevention through mass vaccination of children.
Acheson (1988) defined public health as ‘the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society’. The vision of the collective efforts of society, empowering individuals and groups was clearly expressed in the White Paper Saving Lives: Our Healthier Nation (DH, 1999: 3), in which the strategic intent of government was set out as being to improve the health of the population as a whole by increasing the length of life and the number of years people spend free from illness; to improve the health of the worst off in society and to narrow the health gap.
Wanless (2004: 27) defines public health as ‘the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisation, public and private communities and individuals.’ Wanless (2004) and Kerr (Scottish Executive, 2005) took the traditional view of public health further and place responsibility on society, organisations, communities and individuals to implement public health improvement through their organised efforts (Crabbe and Hemingway, 2014).
In 2007, a major criticism of contemporary healthcare provision was made by Lord Darzi, who observed that the NHS was still overwhelmingly concerned with treatment of the sick, and that it should move from a ‘sickness service to a well-being service’ (Darzi, 2007: 37). Importantly, this inclusion of well-being in policy encourages services to place greater emphasis on social health and emotional well-being. The emerging emphasis on personal responsibility also signified the importance of the role of the individual and not the healthcare practitioner when it comes to making lifestyle decisions.
The role of the healthcare practitioner (in this case the community nurse) can be crucial to achieving health-related goals, as community nurses are often in a position to assist individuals to either access services or support individuals, the family, groups and communities in making informed decisions about their health and well-being.
Strategy and policy
As mentioned previously Acheson (1988) and others defined public health and influenced clearly expressed goals. A strategy is a plan of action designed to achieve a long-term or overall goal. Public health strategies exist to improve and protect health and well-being in a population. The UK’s Public Health Skills and Career Framework broadens this purpose and expresses that the purpose of public health should improve health and well-being in the population, prevent disease and minimise its consequences, thus prolonging valued life and reducing inequalities in health (Skills for Health, 2008). Furthermore, they consider that this is achieved
through a culture which ‘mobilises the organised efforts of society’ (Skills for Health, 2008) by empowering individuals and by tackling the wider social, economic, environmental and biological determinants of health and well-being.
Policy is the definition and setting of goals, often made explicit in the form of written legislation. Health policy influences us, as health professionals, in terms of the institutions we work in and the practices we follow in delivering care. To act as persons’ advocate we need to be aware of their rights as clarified in policy. Policy can have either a negative or positive impact on health as it has direct and indirect influence on all aspects of our lives. Public health policy is developed as a result of networks of decisions involving a wide range of people and organisations at local, national and international levels. Social policy traditionally includes public policy in the areas of welfare benefits, unemployment, the NHS, personal social services, education and training. However, despite this optimism and the inequality gap continued to widen (Smith and Eltanani, 2014).
In their UK-wide study, Smith and Eltanani (2015) suggest that knowing what works (significant for the development of policy and strategy) is complex and that there exists little agreement among researchers about to what is effective in reducing health inequalities. However, in their study they stated that there was ‘consensus among researchers about the need for upstream, redistributive and public-service- orientated approaches to reducing health inequalities’.
From the above it is evident that ongoing research and partnership working are critical in the achievement of improving health and addressing inequalities. As the contribution of health professionals to public health is widely acknowledged within recent government policy across the United Kingdom, it is worth reflecting on what this means for your role as a nurse. Governments within the United Kingdom have clearly stated their commitment to public health, health and well-being in documents including, a DoH white paper (DoH, 2010a); Equally Well (Scottish Government, 2008) and Early Years Framework (Scottish Government, 2009), in which they set out strategies for improving the nation’s health by taking preventative measures. They continue to build on these in more recent policies in each of the four UK Nations while staying true to the idea that promoting health and well-being through prevention of illness is achievable through the collective efforts of society.
The idea of health and well-being has been embedded in government policy for many years and continues to be. Additionally, health and well-being were identified in the Key Stage Skills Framework (2004) as a key skill area for all nurses to achieve and is reflected in the NMC Code (2015), for example, within clause 2.2 ‘recognise and respect the contribution that people can make to their own health and wellbeing’
Consider your own government and local policies, as well as the healthcare philosophy where you work and the education you have undertaken to date.
Reflect on how they have been influenced by the concept of well-being and the prevention of ill health from pre-conception of the child until after death.
ACTIVITY 2.3