By Professor Matt Ashton, Director of Public Health for Liverpool, Vice Chair of the Cheshire and Merseyside Directors of Public Health Executive Board, and Lead Director of Public Health for Communications, Strategic Partnerships and Intelligence
Being a Director of Public Health and being an active member of the Collaborative is a genuine pleasure. Working in public health allows me to spend my days with incredibly talented, committed and motivated individuals who are working exceptionally hard to provide the very best outcomes for the populations we serve.
In my role, it is very important that I look towards the future and think about the emerging opportunities we have to improve the public’s health, as well as the challenges that we may face, so that we can put in place the necessary measures to mitigate any impact on health and wellbeing.
Right now, we face many challenges, from the ongoing fall-out of COVID-19, to the cost of living crisis, but our next health crisis or pandemic could be right around the corner.
My first reflection is a positive one; we have an incredibly talented workforce in public health, with a wealth of skills, knowledge and experience, and our next mission is to leverage this talent and think about how we expand our message and our mission on a much, much larger scale. We need to beat the drum for public health and make sure that we are heard across all sectors, from the NHS organisations and hospitals operating in our subregion, to housing providers and charitable organisations, as well as the wide variety of businesses we have across the patch. It is our duty to make sure that health becomes everyone’s business and that individual organisations in the private, public, and third sector take responsibility and leadership for this.
Ensuring that we have the necessary funding to support our population and improve their health is also vitally important. Directors of Public Health across the land will share the frustration sometimes felt due to delays in hearing about the funding we have available for the upcoming year, which really impacts our ability to plan and deliver services. In the 2021/2022 financial year, the public health grant only made up approximately 1.4 per cent of total NHS spend. As my granny always used to say, prevention is better than cure, and we all know about the pressures our health and care sector are seeing, as well as the poor health outcomes our communities are experiencing. These challenges will continue if public health doesn’t get funded systematically and sustainably, it will mean we simply won’t be able to keep up with demand, and of course makes it even harder to plan for the future. As we hear more and more about the widening inequalities gap, how this relates to health and how public health plays a role is tackling this, I hope our communities feel empowered to hold budget holders and those responsible for allocating budgets in the first place to account for how our money is best spent.
The existential threat of the climate emergency is an enormous challenge facing us and one that public health will be getting more and more involved in. Extreme weather events like heatwaves and flooding, the possibility of mosquito-borne diseases becoming endemic, the worsening quality of our air, and impact on food supplies will all be topics that will require public health expertise and input. One example will be how we think more about encouraging active travel, to get people out of their cars, and how we can be more involved in spatial planning to make sure jumping on the bike is an easy option for those who can.
I’m glad that we talk much more about the commercial determinants of health and just how much poor health outcomes are linked to overbearing commercial entities that essentially profit from selling harmful products and substances like processed food and drink, alcohol, vapes and tobacco, which is often more widely purchased and used by those with less money.
We also need to focus on employment and health, and how our own work impacts our health. For the vast majority of us, we need to work to live, but we should all have the right to fair employment that pays a salary we can afford to live on, and treats us with respect and supports our wellbeing, rather than harms it.
We’re just getting over one pandemic, but as a Director of Public Health, I need to be thinking and acting like the next one could be on the way. As well as this, other environmental hazards that impact health also require a plan and we need to be thinking about emerging threats of illegal and illicit substances. When I look across the pond to the US and see how the opioid crisis, which claims the lives of more than 1,500 people per week and has completely destroyed entire communities, I worry.
Our world is more connected than ever before, thanks to technology and a consensus towards achieving globalisation at whatever cost, which means our world is also smaller than ever before. We are deeply connected to what’s happening globally, for example souring international relations with states like China and Russia can cause significant harm at home, and we are still understanding the health repercussions of Brexit and mass migration due to war and famine. With this hyperconnectivity to the world, the pace at which things happen can be lightning fast, and we need to make sure that we don’t blink and miss it.
On the flip side, more data and better technology can also be incredibly positive and helps us understand where our help is needed most. In Cheshire and Merseyside, the Combined Intelligence for Population Health Action (CIPHA) platform was invaluable in helping us understand how quickly COVID-19 was spreading during the height of the pandemic, and the knock-on impact this had on hospital admissions, care home capacity and more. We’ve now built on this success and kept CIPHA going, which – thanks to a new population health dashboard – now allows us to gain a better understanding of the health of our subregion, and how we can improve it. Truly, knowledge is power.
My fellow Directors of Public Health and I speak regularly as the Champs Public Health Collaborative, and recently we set out our five priority areas for the next three years, which we commit to progressing in amongst the ongoing pressures we and our teams face. They are:
- Focusing on prioritising our work to ensure our time and energy is spent on delivering the greatest impact and provides fantastic benefits for our communities
- Understanding how our workforce is currently feeling and introducing new measures to improve health and wellbeing
- Continue to build our relationship with both the Integrated Care Board and Integrated Care Partnership in Cheshire and Merseyside, as we are all members of the same Integrated Care System
- Encourage more and more organisations and workplaces to become anchor institutions, so that they play an active role in improving health and wellbeing
- Shout much louder about the value of public health and the Collaborative, both locally and nationally, so our voice is never lost