In 2013, directors of public health (DPHs) in England moved from the NHS to local authorities. This has many advantages in terms of how easily we collaborate with various local government departments and agencies. However, while our colleagues in the rest of the UK and its Crown Dependencies have different reporting lines, their day-to-day practice remains similar to our own: to protect and promote public health.
For example, improving mental health is a fundamental public health issue for everyone, particularly in the aftermath of the pandemic's restrictions and isolations. Within NHS Highland, which covers the two local authorities of Highland and Argyll and Bute, there has been concern about mental health for many years and work continues to promote the importance of good mental health just like good physical health.
Suicide – a tragic event for family, friends and the wider community – is a specific concern with rates higher in Highland, compared with Scotland and the UK.
NHS Highland's authorities have slightly different suicide prevention strategies, but both are focused on the same core priorities of ensuring all workforces and communities are suicide aware and able to identify those at risk. There is also a commitment to providing support to people left behind after a suicide and understanding that practice can only be improved by learning lessons from past deaths.
The team have worked with the police, local authorities and third sector to develop a suicide app which provides a range of information and contact details and, by identifying particular locations of concern, they have improved signposting for support and even recommended structural changes to reduce risk.
This type of preventative approach – fundamental to our day-to-day work – can be hard to implement when competing against initiatives that support current need. As a result, unless there is a specific requirement, or ring-fenced resources, preventative programmes are often overlooked.
Promoting the effectiveness of collaborative, preventative approaches is therefore an important system leadership task for DPHs. Annual reports are one way to do this, and last year's Highland DPH report highlighted the benefits of successful schemes such as the infant feeding programme and the introduction of smoke-free environments.
Sometimes though, DPHs have to respond to completely unavoidable situations and, between 2022-23, Jersey's residents experienced five major incidents, involving loss of life, evacuation and property destruction. Although such incidents are naturally chaotic, the way we react can be organised, and given the impact multiple major incidents have on a community's health and wellbeing, Jersey's experience gives a unique insight into incident response.
In addition to practical measures needed to recover from the incidents, which ranged from an explosion to a sunken trawler, the public health team helped develop a new service offering health and psychological (post-trauma) support.
Teams across the UK were consulted to learn from previous incidents, including the Somerset floods and Grenfell Tower fire. Residents affected were consulted, a budget was secured and new data sharing agreements, which required cross-government working, were arranged.
This highly valued service has now been in place for over six months and provides early intervention when needed and can identify longer-term health needs.
They also plan to start long-term monitoring of the incidents' impact on health to mitigate longer-term risks, including psychological distress among the general population.
Another core purpose for DPHs is to tackle health inequalities and, in line with national targets to eliminate Hepatitis and HIV transmission by 2030, practitioners in Newport, Wales have been working with communities who have traditionally found screening programmes harder to access.
In collaboration with Muslim Doctors Cymru, two testing events were held in a local mosque and community centre for people from South Asian communities.
To reduce any perceived stigma associated with blood borne virus screening – and due to poor health outcomes associated with cardiovascular disease and lower uptake of preventative cancer programmes – the events included a range of interventions covering cardiovascular risk assessment, Covid-19 and flu vaccination, as well as signposting to weight management and smoking cessation services and wellbeing support.
Following the initiative's success, a programme of similar sessions, that will also include screening for TB, has been planned in partnership with all the main mosques in Newport.
This commitment to work with community leaders to reach all residents is a priority for DPHs, who also strongly advocate for those with lived experience to ensure services address real (as opposed to perceived) challenges.
Jersey offers another example of how important this role is. Historically, residents living near the airport were exposed to pollution from fire-fighting foams (PFAS), with some feeling their health has been severely affected.
Funding was secured to investigate the local problem with blood testing and, following confirmation that some residents' PFAS levels were higher than expected, an independent panel of international experts was established to make recommendations on health impacts, potential treatments, further testing and environmental management.
As in Wales, the partnership with residents was crucial in establishing trust between the community and authorities and ensuring initial recommendations were fully informed. Without developing this level of trust, solutions are unlikely to be relevant or gain the necessary support.
We have seen this again and again, not least during the Covid-19 pandemic, and it is at the heart of what DPHs and their teams do: work together with those that really understand the issues involved to protect and promote public health so that local residents have the support they need to live longer, healthier lives.
Greg Fell is president of the Association of Directors of Public Health
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With thanks to Peter Bradley, director of public health/medical officer of health at Government of Jersey, Tim Allison, a director of public health and policy at NHS Highland, and Tracy Daszkiewicz, executive director of public health and strategic partnerships at Aneurin Bevan University Health Board
