Two parallel worlds of public health?

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I don’t often use this blog as a platform for a rant, but there’s something I have to get out of my head…

This last week – in my ‘twittersphere’ – two ‘events’ happened, each billed in their own right as a ‘major move’ forward for public health.  But they just seemed like parallel universes.

First of all, the World Health Organisation held its 8th global conference on health promotion in Helsinki, Finland.  The theme of the conference was ‘Health in all policies’.  The twitter tag of #HIAP or #healthinall was used not only be the official communications of the conference but also by the ‘gurus’ of the health promotion movement attending the conference, such as @IlonaKickbusch and @evelynedeleeuw.  The plenaries were broadcast live on the web and an interactive twitter wall fed questions to the speakers.  The conference website – with recordings of all the plenaries is here – (I’ve only had time to look at a few bits). The Finlanders also used their hosting of the conference as a platform to launch a new ‘book’ on ‘Health in all policies’ and used its promotional website to blog about relevant issues –  As has been the ‘tradition’ since the WHO’s Ottawa Charter, the conference led to a Conference statement but also a Health in all Policies Framework for Country Action.

In the meantime, back in England, my taxpayers money was being used by Public Health England to launch a new set of ‘data’ about health in England –  Hitting twittersphere under #LongerLives, Public Health England billed this as an “initiative that allows people to see easily how their areas perform on early deaths from major killers, such as heart disease and cancer, and how it varies across the country” (source press release at – my emphasis).

So with these two events coming at once, I was faced with what felt like two different worlds –

1) Whilst the WHO European Regional Policy Health 2020 and the more recent WHO European Health report 2012 emphasises the importance of embracing measures of wellbeing, England gets all excited about the re-publication and re-hashing of mortality statistics.

2) Whilst WHO language is of the importance of ‘measurement and evaluation’, in England we revert to the language of performance management (Local Area Agreements re-invented?).  That’s in spite of the fact that research has demonstrated that performance regimes can distort the action of those seeking to improve health towards the ‘near and certain results’ (e.g. clinical interventions proven through randomised controlled trials) to the detriment of ‘distant and less predictable results’ (e.g. health in all policies)

3) Whilst WHO talks of the importance of wellbeing, quality of life and equity, England emphasises length of life.

4) Whilst the 8th global conference talks of the importance of multi-level governance and action for health, England publishes data used to ‘judge’ local areas.  I did not see one bit of mainstream press activity highlighting how the national government was going to play its part in addressing these inequalities through health in all policies.  Even the official press release included a quote from Hunt saying ‘I want areas to use the data released today…‘ Shouldn’t the same data lead to inquiry and reflection by national players?

5) Whilst the tweets leaving Helsinki celebrated the fact that there was little mention of ‘behaviour change’ at the conference, most mainstream press activity in England was with a backdrop of either people drinking or smoking OR people in gyms or stop smoking classes.

6) Whilst the tweets from Helsinki spoke of the commercial and political determinants of health and issues of power – ‘big’ tobacco, ‘big’ alcohol, ‘big’ food.  There was NOTHING here about the government’s lack of movement on standard cigarette packaging or minimum unit price for alcohol.  Let alone the growing inequities in the distribution of money, power and resources that are known to be the structural causes of health inequalities.

7) Helsinki highlighted the need to embrace lots of different research and practice disciplines in the pursuit of public health – social science, political science, law, systems, complexity science.  But here felt like the same old, same old ‘contemporary’ medical model (individual biology plus lifestyles).

The government of this country has supposedly signed up to the World Health Organisation’s new European Regional Policy Health2020 but it seems to me our public health capacity development is heading in a completely different direction (could I even go as far to say it isn’t heading anywhere?).  As long as the discourse places emphasis on what Councils and CCGs do and on ‘personal responsibility’ of people we simply won’t get anywhere.  We need a radical change – as Einstein said – ‘we cannot solve our problems with the same kind of thinking we used when we created them’.  We don’t even have to find the new world ourselves, we just need to be part of, take on board, and contribute to, the global discourse.

Amongst all the tweets I’ve skimmed in the last week, I most remember one that told me of a quote by Rudolph Virchow – a 19th century german known for his advancement of public health – he said “Medicine is a social science, and politics is nothing else but medicine on a large scale”.  So maybe this isn’t something all that new – maybe we just have to take it seriously and make it matter.

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