Celebrating the power of public health
Tom McBride looks at some of the 'greatest hits' of public health policymaking from the past 20 years, and asks whether the approach could be used more effectively to provide support for children and young people facing complex challenges.
Just before Christmas the Royal Society Public Health (RSPH) released their top 20 public health achievements of the 21st century. I suspect that some people may have missed this in the last minute rush to buy presents and make sure you have enough wrapping paper. So I thought I would use my first blog of the new decade to offer some reflections on the RSPH’s list, and the role of public health in improving outcomes for children and families.
Public health can often be a tricky concept to define and explain. The World Health Organization defines it as ‘the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society’, noting that public health focuses on the ‘entire spectrum of health and wellbeing, not only the eradication of particular diseases’ and involves ‘working with other sectors to address the wider determinants of health.’ As such the concept of public health has much in common with early intervention; both have the idea of prevention at their core.
The idea of using a public health approach to tackle complex social issues is becoming increasingly popular. It is at the heart of the government’s Prevention green paper, which was published in July of last year, and the Youth Endowment Fund, which was set up to take a long-term public health approach to tackling youth crime and antisocial behaviour, and in which EIF is a partner.
Top of RSPH’s list was the smoking ban. It came into effect across the UK in 2007 and outlawed smoking in enclosed public spaces workplaces. This was followed by the 2018 levy on soft drinks (the sugar tax) and 2010’s Marmot review of health inequalities. It is notable that none of the top three are specific to children and young people: the first policy specifically for this group was Sure Start children centres, which came in at number four, followed by HPV vaccinations at six.
Clearly this distinction is quite simplistic: children and young people will benefit directly from the smoking ban by being exposed to less second-hand smoke and indirectly through the de-normalisation of smoking; the sugar tax came about as part of the government’s childhood obesity action plan. But on the face of it, there is at least reason to ask if children and family policy has benefited from the same public health focus as other areas.
Another feature of the list is that many of the highest-ranking achievements that the experts have identified are quite blunt interventions, such as minimum unit pricing for alcohol or the congestion charge, which work through legislation or regulation. Initiatives which try to encourage healthier behaviour, such as traffic light labelling of pre-packaged food, are further down the list, while campaigns such as Change4Life and Hungry Little Minds – both of which are focused on improving outcomes for children – don’t feature at all.
Tackling complex social issues will usually require multifaceted responses across multiple sectors and areas of government, yet most of the achievements on the list are focused on a very specific issue. While these are often part of wider initiatives or strategies – the smoking ban, for example, has to be viewed alongside other government policies to reduce smoking, such as advertising bans – the issues that the RSPH have identified as the most powerful are, for the most part, single policy changes. Multifaceted approaches involving several agencies, such as Glasgow’s Community Innovative to Reduce Violence, don’t feature.
While single initiatives are salient, in many cases we might expect that in isolation their impact on the outcomes we ultimately care about will be limited. The sugar tax has been responsible for a considerable reduction in the sugar levels in foods, but I don’t think anyone would argue that by itself it will be sufficient to substantially reduce childhood obesity. We see another key example in the ACEs approach to childhood trauma. With many other complex issues such as poverty playing their part in creating an environment where a child might be at increased risk of abuse or neglect, we know from our own research the necessity of avoiding overly blunt or simplistic interventions. A public health approach to childhood adversity would require action at multiple layers within the system.
I congratulate the RSPH for compiling this list, which highlights key achievements over recent years in using public health approaches to improve health and wellbeing. But 2020 isn’t just a new decade, it is the start of a new parliament. And for the first time in years, we have a government with a large majority, which creates an opportunity for ambitious policymaking. Now is time for us to think how public health approaches can be used to significantly improve outcomes for children and young people.