The funding must be available to help achieve public health outcomes

Sean's blogOriginally posted in the HSJ blog Leadership in Mental Health,  27 January 2012

This week, the first Public Health Outcomes Framework was published by the Department of Health. The framework sets out the measures by which the effectiveness of Public Health England will be judged from 2013 onwards. But concerns are already being raised about whether enough funding will be available to achieve these outcomes.

The framework includes many indicators that reflect the mental as well as physical health of individuals and communities. It includes existing measures from the NHS and social care outcomes frameworks such as employment and premature mortality rates for people with mental health conditions. And it adds new measures such as the proportion of prisoners with mental health problems and the emotional wellbeing of looked-after children.

While some of the new indicators are designated as “placeholders” for which robust measures are not yet available, and it is not yet clear how these measures will reflect differences in race, class and other equality dimensions, the inclusion of a range of mental health issues has the potential to bring about a sea change in the way public health professionals act to promote our emotional wellbeing.

The creation of a new public health system, and the move to local authorities for directors of public health, brings about a new opportunity to shift from a focus on preventing physical illness to an understanding of the many influences on our health and wellbeing. But with many local authorities facing major spending cuts there will be considerable pressure on public health budgets and tough choices about how they are spent.

Many items in the Public Health Outcomes Framework require attention to a range of factors that influence health. Domestic abuse, sickness absence and reoffending rates, for example, require a holistic view of health that not only take us beyond the artificial separation of physical and mental health but that also require directors of public health to exert influence over a range of public services such as schools, housing, the police and children’s services and indeed to engage with employers and communities.

Directors of public health can become major influencers in the communities they serve. They can exert a transformative influence on the risk factors for poor health, especially for the most marginalised and disadvantaged. They can help to achieve not just improvements in population health but also in rates of offending, homelessness and worklessness.

Making the Public Health Outcomes Framework an effective tool to measure the performance of public health services nationally and locally will not be easy. Many of the most important indicators need a lot of work before reliable data can be produced to support them. Others will be determined much more by the state of the economy and society than the day-to-day work of public health professionals. And if directors of public health find that they have insufficient resources to fulfil their potential, there remains the real danger that they will retreat to familiar territory and not take on this broader agenda. But the framework at least provides a starting point for a radical new vision of the role of public health professionals and their scope to help to bring about large scale social change.

HSJ Blog

6 thoughts on “The funding must be available to help achieve public health outcomes

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