10 Grand challenges for public health

Grand challenges for public health
CDC occasionally write these lists – they are fill of things like healthy ageing, best start in life, climate change, smoking and climacte change. I agree with those.

I especially like the “winnable battles” focus.

Cormac Russell (@cormacrussell – well worth a follow) wrote a great blog in this space earlier – Making Health Healthier 5 Painful Shifts https://worldhealthinnovationsummit.wordpress.com/2015/09/15/making-health-healthier-in-5-painful-shifts-by-cormac-russell/

Again, I agree with him. 
Whilst I was talking the dog I thought of a few of my own. These are a little bit more erethral (I was walking the dog after all)

1. Topic v method

Stop obsessing with topic x,y or z and think how to industrialise a methodology and a mindset, and set of thinking that can be applied to any topic.

Lots of topics we concoct are based on a burden of disease gives us the starting point basis. This is great, but completely misses out the socially, politically and environmentally determinants of health and well being.

2. Policy framework vs more services to rectify the problems

We always want more service to rectify problems rather than thinking of policy environments to stop problems happening. Of course with many things changing the policy environment is probably the most potent modulator of outcomes but also upsets most of the vested interests in status quo. So those who are going to be upset fight hardest against policy changes.

But till we move away from our “must have more services” mindset we won’t get into developing the narrative for policy changes.

3. Where do we focus the effort. How far upstream 

We really need to decide this – causes of causes (neoliberalism etc) vs causes (housing, poverty, jobs) vs lifestyle risks vs consequences 

Hard to focus on causes of causes when 1. It upsets vested interests, 2. It’s a bit difficult and intangible to define and 3. it isn’t going to win financial gain  by next April the 1st 

4. Rethink Heath as something that is about an infrastructure investment and something that is created by the sum total of all that happens in any area or population, across every sector and aspect of society. 

This was a central message of my first DPH report.


Health is not a “health thing”, it is a societal thing. Some for example some changes in the travel and transport will make a contribution to air quality but this is best “sorted” by the travel sector owning the issue not the health sector fighting their way in.
5. Maybe we should try to get outcomes on the balance sheet with the same gravitas as finance. 

Especially inequality in outcomes, whether narrowly defined health and wellbeing outcomes or broader social outcomes (that mostly have a health payback)

6. Monetise the return

Turning the language of investment and return on that investment into something that our orgs (esp the political & financial bits) can respond positively to in a scenario where demand led services are melting everything everywhere

We need to be monetising the return – Wanless did it – 16 years ago. Maybe time to refresh it.

Sad to say that till we monetise the benefit the immediate here and now pressure led things will always win 

7. Challenging the narrative –

For example the 

  • ageing pop will sink the system (wrong); see my earlier blogs
  • inequality is only an issue for poor people (ditto wrong it is a societal issue); 
  • neoliberalism and trickle down – a rising tide lifts all boats (wrong, debunked in the 80s, see this video https://m.youtube.com/watch?feature=youtu.be&v=ti3rjogF_VU
  • Pop wide approach vs high risk approach. Time after time, in policy area after area the narrative is that if only we focused all our effort on the high risk we would reap grand rewards. It has been debunked and disproved again and again, yet it is a narrative that persists.

8. The narrative of nanny – consider the nanny state rhetoric  vs framing it as a savvy state 

The narrative that paternalism is always bad may be just as negative and damaging as being overly paternalistic or even letting the market determine 

One persons paternalism is another’s protection 

Eg smoking in public places law

Such paternalistic interventions are invariably (and proven) more equitable and efficient than what those whose interests may be challenged by paternalism would suggest as alternatives.

9. Cross sector learning

Maybe we might also apply a medical model to social issues and vice versa, also we might get better at cross fertilisation of ideas from sectors – for eg application of health care improvement methods to education sector and vice versa 

There isn’t a 10

Got home and had to make the kids tea


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