What do you actually do then
The question every DPH detests. This is a niche blog (!) to give my answer to a question I get asked a lot.
My answer depends on how much detail folk want. Graham Mackenzie did an excellent primer on what is “in” public health, I often send this to people. What is public health? Some reflections for teaching – #ScotPublicHealth, the slides are also good
In terms of skill sets needed the Faculty of Public Health curriculum is it good as any
1 The short answer
My stock answer is thus – In short, go to meetings. A lot of them, that is basically the currency of the business.
Precisely what meetings this encompasses cover the span of public health practice – from air quality, economic policy, environmental health and housing through tobacco control and obesity to violence reduction and health care strategy. And everything in between. The meetings can range from big set piece partnership meetings such as a Health and Well Being Board, a Community Safety Partnership or the Safeguarding Board through to management team meetings through to 1:1 with a very wide range of people.
2 In more detail – What is a DPH supposed to do
The Association of Directors of Public Health have eloquently described what they think a DPH (and by extension their team) ought to do, link here.
For most us, the role exists in five broad chunks
- The “social determinants” of health. There are many of these, many different systems, actors and constituencies. They all interact. You need to understand and influence how those systems work to create better health
- Lifestyles. Most of us are reframing this in two ways both in a behavioural psychological context (most pertinent to individuals) and commercial determinants (most pertinent to the real drivers). This require some nuanced thinking
- Health protection – screening, vaccination, response to incidents
- The PH grant and how this is used. There are a set of set of mandated services inherent within this.
- Public Health Intelligence. A combination of applied epidemiology and data science. This obviously encompasses things like “needs assessment”, but also evaluation and analytics to answer bespoke questions
I did an interview once for Rachel Steen for the Fair Health blog. And three shorter pocasts for Prof Shickle, here, here and here. I once did a long lecture setting out an approach, it is this blog, the lecture with some linked slides. Save for a rainy day!
All up this becomes about system leadership (whatever that means) and orchestrating many different things. The big idea is that there isn’t a single big idea.
Advocacy for national change remains important, see this RSPH list of 20 achievements of 21st century (so far). None of these things would have happened without a serious advocacy effort, as illuistrated here with the smoking in public places ban.
This is obviously well beyond the expectations of “the grant” per se. Whilst there are a set of statutory requirements of a DPH (see above) many operate in a far wider space. The DPH role is supposed to be about creating and implementing a strategy for improving health and closing the gap between best and worst. Think through that in the context of what determines health and act in a way mindful of this .
3 The full skinny
There’s a lot of legislative expectation
The LA PH Function Act is quite dry, as is the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 . The role of a DPH was also covered in The NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012, this includes in Part 3 the role of the DPH, and a related statutory instrument that covers Dental role
Well, you did ask……
In simpler language, there are within the Act as set of prescribed functions set out in appendix c of the Grant Condition letter, with further detail in the DHSC policy papers on PH in Local Govt. the Statutory Functions include sexual health, NHS Health Checks, ensuring arrangements for health protection, advice to NHS commissioners, the National Childhood Measurement Programme, prescribed 0-5 services. Of course there are a wide range of services that are funded by the PH grant that are not mandated or legislated for.
………………..Try explaining that in a pub, after a drink or two!
4 Im still interested, what should I read
I often send folk a set of reading. It sort of depends who is asking and in what context:
This reading list from Tim Ewell Sutton is excellent and gives a great grounding in most of the basics. The additions from others at the bottom of the thread are also excellent. Ben Jane later tidied it up a little bit and there are a number of other helpful references on his site.
Michael Marmot’s The Health Gap, The Challenge of an Unequal World
Norman Sartorius’ paper The Meanings of Health and its Promotion
The Lancet editorial What is health? The ability to adapt:
Geoffrey Rose’s 1985 paper Sick Individuals and Sick Populations
Health Affairs’ Health Policy Brief: The Relative Contribution of Multiple Determinants of Health Outcomes
Michael Marmot’s 2010 Fair Society Healthy Lives: The Marmot Review:
The Department of Health and Social Security’s 1980 Black Report – Inequalities in Health
Perspective of a jobbing DPH Public health ethics, through the eyes of a front line Director of Public Health
University College London’s Institute of Health Equity:
Lankelly Chase’s Theory of Change – a theory of change that identifies changes at the systemic, structural and cultural level to help improve the quality of life of people most exposed to social harm:
New Philanthropy Capital’s Systems change: a guide to what it is and how to do it – an exploration of the literature on systems thinking: