Greg Fell, ADPH President and DPH for Sheffield

It takes an army of people to get public health right… 

The public health workforce is vast. Taking the Faculty of Public Health’s definition of public health – “the science and art of promoting and protecting health by the organised efforts of society” – as a starting point, it soon becomes clear just how vast!

Since the Public Health Act 1848, there have been multiple bits of legislation specifically dealing with ‘public health’. One such piece of legislation saw the appointment of Directors of Public Health (DsPH) like me who are tasked with protecting and improving the health of their local populations. In my case, that means the people of Sheffield.

As President of the Association of Directors of Public Health I have an additional role of representing the collective voice of DsPH nationally, advising on policy and supporting work to improve our practice.

However, just as the huge infrastructure investments of the past century that had an enduring impact on health and wellbeing were delivered by many people from many different disciplines, in both my roles, to deliver results, I rely on many different people – most of whom don’t have health in their job titles.

People like me exist to improve health and to close the unacceptable gap in health outcomes. The goal is for everyone – regardless of their education, job, postcode, living conditions, religion, race, gender or any other characteristic, protected or otherwise – to have the chance to live equally long, healthy lives that are free from preventable illnesses.

What this looks like in practice is hard to describe. It is less about ‘doing’ and more about coordinating and leading and is reliant on so many more people than a DPH and their team of specialist public health consultants, practitioners and registrars.

Most people think of public health as delivering commissioned services like school nurses, smoking cessation, weight management, sexual health or addiction support. Each of these services (and more) have a whole workforce behind them. For example, for me as a DPH to know how much to spend on reducing death from tobacco, I first need to know that we have too many people dying from tobacco harm. That intelligence about our population’s health comes from someone crunching the numbers so we know what the prevalence of smoking is, how many people have died as a result, at what age and so on.

Of course, some of those sums are easier than others – what are good metrics for measuring mental health? Defining these trickier metrics requires debate, research and methodical analysis from a raft of academics, practitioners and policy makers.

There is also another category in public health spending which covers anything else that improves public health. In Sheffield for example, public health funding is the main funding stream for the Citizens Advice Bureau, a service which supports residents in all sorts of ways that have a real impact on someone’s quality of life and therefore their mental and physical health.

While some of the services that come under health improvement I'm very much responsible for, some I just contribute to, acting as a dot connecter. Where someone lives for example is a key determinant of health. Planners aren’t ‘public health’ workers but by thinking about health when developing policy, they can ensure that contributary factors to health outcomes like ventilation, insulation or access to transport are considered when new houses are built. Air quality too is a huge health issue but again, the majority of those doing the work aren’t ‘public health’ by trade.

Similarly, as a public health specialist I know that illegal vapes should not be sold to children and young people. I also know that food prepared in unhygienic kitchens is likely to cause illness, but the job of seizing illegal vapes or shutting down dirty kitchens fall to my colleagues in Trading Standards, Environmental Health and the Police – not specialist public health workers.

As well as promoting and improving health, DsPH are charged with protecting their population’s health. This covers outbreaks of communicable diseases, vaccination and screening but also environmental hazards like chemical spills.

If the cause of an outbreak is unknown, we act as medical detectives – what or where do these poorly people have in common? We then have to make sure that people are protected as far as possible. That involves disseminating information to businesses, schools and community groups which means taking ‘science’ and then applying ‘art’ to communicate the facts and risks. There is then another step to ensure that message is heard and a further step to support solutions. All these steps take an army of people to get right.  

Another example of our coordinating role is with vaccines and screening which involves more people than just doctors and nurses. Part of my job is to ensure that we are doing all we can to get people in different parts of town vaccinated and/or screened. However, as we found to our cost during the pandemic, doctors and nurses, or indeed DsPH, aren’t effective enough at doing that. We need to engage with community and faith leaders – people with a real connection with the population we are trying to reach. All people with a huge influence on a population’s wellbeing, yet who are highly unlikely to have ‘health’ in their job title.

Public health is only improved and protected by everyone playing their part. Whether that part has health in their title is completely irrelevant. Each and every one of the people being highlighted in public health workforce week have a critical role in public health and while that may seem obvious to those of us in this line of work, it is a message that we need to spread far and wide.

The health of future generations rests on our politicians and policy makers to truly understand that health is everyone’s responsibility and in everyone’s gift to improve. Sadly, at the moment, levels of preventable disease are increasing as a result of society neglecting our health. Only by considering health at every level in every decision will we be able to move away from associating health with particular people or jobs and start building a society that has health at its heart.