In last month’s HSJ, Duncan Selbie raised serious questions about the NHS’s record on public health and tackling the causes of ill health and health inequalities.
With public health directors moving to local government, and a new national agency in Public Health England to take the lead on prevention, there may be some who see the NHS’s obligations to promote good health as having been reduced.
The reality, however, is that while lead responsibility for public health will lie outside the NHS’s boundaries, health professionals and NHS organisations remain as key to improving our health and preventing illness as they have ever been. While councils will set the priorities for dedicated public health spending, GPs and the Commissioning Board with its various roles will be important partners without whom some of the most promising and effective interventions cannot be done.
‘Too often GPs and teachers do not know how significant a public health issue behaviour is’
A case in point is parenting. There is now clear and incontrovertible evidence that children with the most serious behavioural problems grow up to be among the most disadvantaged and unhealthy people in our communities.
One child in 20 has a severe behavioural problem while another 15 per cent have less severe problems; between them they go on to commit 80 per cent of crime during their lifetimes.
Feelings of stigma
Yet behavioural problems can be either prevented or managed using simple and inexpensive interventions. In most cases, evidence-based parenting programmes like Triple P and Incredible Years can in a short time support parents to manage their children’s behaviour and dramatically improve their health and life chances.
Such programmes, however, are not widely available. Where they are provided, they are not always targeted towards the families who need them most. And not all such programmes are run faithfully to the programme’s design by staff with the right skills to deliver them most effectively.
Key to the success of parenting interventions is the ability of universal health services to identify the families who could benefit from them and make referrals successfully.
Research shows that most parents who struggle with their children’s behaviour ask for help. Most often they ask their GP or their children’s schools. Yet too often GPs and teachers do not know how significant a public health issue behaviour is or what programmes exist locally to address it or how to refer in to them in a way that doesn’t make parents feel stigmatised.
General practitioners, health visitors, midwives and mental health professionals are all ideally placed to identify families where behavioural problems are either emerging or already causing distress.
If they are aware of the support that is available and have the know-how to encourage parents to make use of it, health professionals can bring about a major improvement in the life chances of some of the most disadvantaged children in their communities.
It is in the relationships between the new public health system and the NHS, alongside their wider links with schools, housing providers and the police, that this major public health issue can be tackled successfully.
As the new systems take shape and learn to work together, providing parents with the support they need to give their children the best possible start in life can be a marker of what they can achieve and the difference they can make to the people they both exist to serve.