Better Health For All

We, as a nation, will strive together to build a Culture of Health enabling in all our diverse society to lead healthier lives, now and for generations to come.

You could be forgiven for thinking this bold vision came direct from the mouth of a secretary of state for health, a prime minister, or better still the queens Christmas speech. In fact, it comes from a US thinktank the Robert Wood Johnson Foundation . But it got us thinking at FPH about whether we could build as a compelling a vision to advocate with policy makers, and if so, how we could work with our wider civic society to make this happen.

A big question!

We started by exploring the following (slightly smaller) questions: What do we mean by a culture of health in the UK? Is it helpful terminology? What assumptions are we making? How close are we to a culture of health and how is it different to the status quo?  And finally – what is the role for the Faculty of Public Health?

What do we mean by a culture of health in the UK?

In the UK, recent reflections on a Fifth Wave of Public Health perhaps come the closest to describing a culture of health.  It is emerging as we develop new approaches to complex public health challenges e.g. obesity, social inequalities, loss of wellbeing; all in the context of stresses on population, environment, climate and the economy.

It requires commitments from a range of social actors and structures: government, law, education, business, communities, arts…    However, we know that each of these have the potential to both promote and inhibit a culture of health.

Is it helpful terminology?

We are a long way off from being able to articulate a vision for a UK culture of health with the same clarity and conviction as the RWJF; but the sentiments are present in policy emphasis on systems approaches, integration and reach into the community and voluntary sector.  Additionally, the Welsh Government’s focus on ‘wellness’, NHS Scotland’s focus on fairness and social change and discussion of a ‘social movement’ for health in the recent Prevention paper in England all contribute to a vision of health as a key value in society.  The challenge is 2-fold – how these polices are enacted and interpreted within health and local government structures, and then, how these values are nurtured and developed in wider civic society.

Reflexivity is fundamental as a starting point – being aware of our own paradigms and how they differ from others.  The recent Health Foundation and Frameworks Institute Seeing Upstream report highlighted for me the real differences in expert and public understandings of health and the implications for practice.  At the first meeting I chaired as a public health practitioner, after previously attending in a voluntary sector provider capacity, a colleague told me that I ‘already spoke all the NHS language’.  9 years later, there is no doubt I am completely immersed in public health thinking, writing and speaking.

A culture of health in action

The changing place of smoking in our society provides a good case study and some experience to draw on:

This thought-provoking paper explores the changing culture towards smoking over the last 60 years concluding that change was facilitated by a number of factors interacting over time: the publication of evidence showing the link between smoking and non-communicable disease, a growing non-smokers advocacy lobby, ever-tightening legislation and policy, and the changing image of a smoker from someone who deliberately undertook a harmful activity to someone who is addicted to a harmful substance and needs support (individually and within their environment) to break the addiction.

The caveat, which is recognisable to us, is that cultural perceptions of smoking did not change uniformly across the population, there remains socio-economic and ethnicity related inequalities in smoking.  The authors propose that culture is a product of interactions at a ‘micro-social level’ – in this case smoking is ‘a social behaviour that responds to the convenience or inconvenience of smoking, and this is influenced by legislation, social attitudes and social prevalence in one’s own reference groups’.

Alcohol consumption is another example of an interplay between evidence, values, public opinion and policy, following a similar story arc to tobacco.

What is the role for FPH?

Recent consultation to inform the new FPH Strategy described the role for public health professionals to lead across systems, reframe public health issues to be of relevance to the public and value to policy makers, and to work at community and macro-policy level in the ‘Art’ and ‘Science’ of public health.  This makes us key facilitators in developing and promoting a culture of health.

So, we might be a way off realising a vision like the RWJF quote above, but we know that in public health we work in long story arcs.  For now, the achievable part of this vision is to collectively work through our networks, with awareness of how and when to best influence at micro and macro- level and that is a good start.

Join us in developing these ideas further, through the SIGs and committees at FPH and at the forthcoming workshop on Means, ends, and ethics in the ‘culture of health’ agenda as part of the pre-conference programme at the PHE Conference 2019.

Siobhan Horsley, Specialty Registrar in Public Health on behalf of the FPH Health Improvement Committee. You can follow Siobhan on Twitter @siobhanmari