From COVID to Cola: how public health services take on population-wide health challenges
Healthy populations depend on oversight from public health services, which protect and improve the lives of people on a ‘big picture’ scale. Let’s take a look at the world of public health and what it does for us.
What is public health?
Public health is the science of protecting and improving people’s health at the scale of populations. That might be the people living in a local neighbourhood, a whole country or an entire region of the world. Public health work includes encouraging people to live healthier lives, carrying out research into preventing diseases and injuries, and detecting, preventing and responding to infectious diseases such as HIV, the COVID-19 pandemic or seasonal ‘flu.
The National Health Service explains that:
“It is about every single person out there. It’s about ensuring that people understand the choices they are making and the impact they are having on their health in the long term. But it’s also about making sure that when they do come into contact with healthcare services that those services are appropriate and of a good standard and that evidence-based healthcare is used wherever possible,”
Public health is also about looking at the wider health inequalities there are in society, whether that is people living with debt or on very low incomes, poor housing or mental health problems. Public health services’ work to tackle challenges like these is essential for securing healthier futures for populations of people.
The ‘three Ps’ of public health
The field of public health is sometimes divided into three main areas which overlap with one another. These are the so-called ‘three Ps’ of public health, which are:
Protection
Protection against diseases involves detecting, preventing and reducing the effects of infectious diseases and of environmental, chemical and radiological physical threats. Central to health protection is collaborating with decision-makers at local and global levels.
Prevention
Prevention is a fundamental principle of modern health care. Disease prevention in public health includes primary and secondary prevention, i.e. stopping a disease from gaining a foothold in the body and counteracting and limiting its effects after diagnosis. It also includes efforts to minimise the harms and complications that diseases cause.
Promotion
Health promotion is the process of giving people more control over their own health so that they can improve it. It’s one of the aims of the World Health Organization (WHO), which works to improve overall population health by helping people reduce the risks posed by smoking tobacco, consuming alcohol and not doing enough physical activity. The WHO’s health promotion goals, widely adopted across the world, were laid out in the 1986 Ottawa Charter.
What does the World Health Organization (WHO) do?
The WHO works globally to promote health, keep the world safe, and serve vulnerable people everywhere. Its goals are to:
Achieve universal health coverage for a billion more people by helping more people to access essential primary healthcare and medicines, making the cost of healthcare more sustainable, training the public health workforce and supporting people’s participation in national health policies.
Protect a billion more people from health emergencies by identifying, mitigating and managing risks, preventing emergencies and supporting the development of tools and interventions needed to fight outbreaks, spotting and responding to urgent health emergencies and helping health agencies and providers to deliver health services in difficult to reach and vulnerable parts of the world.
Provide a further billion people with better health and well-being by addressing social determinants of health, promoting approaches that cross different sectors, and prioritising health in all policies and healthy settings.
Who oversees public health in the UK?
UK government public health services are managed by the UK Health Security Agency (UKHSA) and the Office for Health Improvement and Disparities (OHID), which replaced Public Health England in October 2021.
The UKHSA is an executive agency sponsored by the Department of Health and Social Care and collaborates with relevant agencies in Scotland, Wales and Northern Ireland. It’s responsible for protecting every member of every community from the impact of health threats, including infectious diseases as well as chemical, biological, radiological and nuclear incidents. The agency leads public health science and operations at national and local levels, as well as on the global stage. Some of the UKHSA’s specific responsibilities include health protection and planning and carrying out the UK’s response to external health threats such as pandemics.
The Office for Health Improvement and Disparities (OHID), on the other hand, focuses on reducing the pressures on the healthcare system and on society of preventable illness and disease. It has a particular focus on the places and communities where there are the biggest disparities in health.
As part of Department of Health and Social Care, OHID brings together expert advice, analysis and evidence to develop and roll out health policy that improves the health of people in the UK. Its priorities include:
- identifying groups and areas within the UK where ill health is worst
- taking action on the biggest preventable risk factors for ill health and premature death including tobacco, obesity and harmful use of alcohol and drugs
- working with the NHS and local government to improve access to the services which can help, as early as possible
- working closely with government, communities, industry and employers to act on the wider factors that have an impact on people’s health, such as work, environmental health, housing and education. One example of this is profiling sexual and reproductive health across the UK to support local authorities and public health leads in monitoring the sexual and reproductive health of their population
- drive innovation in health improvement, harnessing the best of technology, analytics, and innovations in policy and delivery to help deliver change where it is needed most.
Sugar, cervical cancer and smoking: three successful public health initiatives
Stoptober
An annual NHS campaign that takes place in October, Stoptober aims to persuade smokers to give up cigarettes for one month. The idea is that if smokers can give up for October, they can continue to go without cigarettes and ultimately live smoke-free. The campaign is underpinned by robust evidence from University College London which shows that if a smoker can quit for 28 days, they are five times more likely to stop smoking long-term.
Key to the campaign’s success is that it motivates and encourages smokers along their journey towards giving up for good through the official Stoptober app, daily emails, access to online communities of other people trying to stop smoking, and a personalised quit plan. These resources even give smokers insights into how much money they are saving by cutting cigarettes out of their lives. Over the 11 years it has been running, the campaign has helped over 2 million people to give up smoking.
The ‘sugar tax’
Research carried out in 2018 showed that British children were on average consuming double the recommended amount of sugar each day. Sugary soft drinks (for example squashes and fizzy drinks) are the top source of children’s sugar intake; not surprising given that a single can of cola contains nine teaspoons of sugar. Eating and drinking too much sugar can lead to obesity and decayed teeth. Research also shows that children who are overweight are more likely to remain so as adults, increasing risk of preventable diseases like diabetes and heart disease.
As part of the UK government’s plan to tackle childhood obesity, a Soft Drinks Industry Levy (SDIL), also nicknamed the ‘sugar tax’, was introduced in April 2018. Soft drink manufacturers must now pay a charge for drinks containing over 8g of sugar. At the time the levy was launched, nearly half of the soft drinks market had already reformulated their products to reduce levels of sugar in order to avoid charges. This public health practice has also signalled a shift towards greater recognition of the role to be played by the food and drink industry in enabling healthier choices. Revenue from the levy is being invested in programmes to encourage more exercise and balanced diets in school-age children.
Vaccinating young people against cervical cancer
Human Papilloma Virus (HPV) is a group of common viruses that are passed on through sexual contact, certain forms of HPV cause abnormal changes in the cells that can sometimes turn into cancers, including cervical cancer.
A public health programme to protect young people against HPV with the aim of reducing cervical cancer rates was launched in England in 2008. Girls aged 12-13 years began to be offered routine immunisation with the Cervarix vaccination against HPV, with a catch-up programme for girls aged 14 to 18 from 2008 to 2010. A study published over a decade later in The Lancet showed that the immunisation programme reduced cervical cancer rates by 34% in girls vaccinated at age 16 -18 and a massive 87% in girls vaccinated at age 12 to 13 compared with girls who had not been vaccinated. Now, all children aged 12-13 are routinely vaccinated, not just girls. Overall, the hugely successful HPV immunisation programme has almost eliminated cervical cancer in women born since Sept 1, 1995.
Skills for a healthier, more sustainable world
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