Introduction

Public Health

There are different definitions of public health. We like the definition used by the UK Public Health Association . They believe that public health:

• is an approach that focuses on the health and well being of a society and the most effective means of protecting and improving it.

 

• encompasses the science, art and politics of preventing illness and disease and promoting health and well being. It addresses the root causes of illness and disease, including the inter-acting social, environmental, biological and psychological dimensions, as well as the provision of effective health services.

 

• addresses inequalities, injustices and denials of human rights, which frequently explain large variations in health locally, nationally and globally.

 

• works effectively through partnerships that cut across professional and organisational boundaries and seeks to eliminate avoidable distinctions.

 

• relies upon evidence, judgement and skills and promotes the participation of the populations who are themselves the subject of policy and action.

Public health encompasses a number of different activities, including health protection, measures to prevent ill-health, and health promotion.

The World Health Organisation defines health as a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity .  

This sounds virtually unattainable by most people.  However, it does introduce the wider concept of wellbeing, which itself has been defined as -

A subjective state of being healthy, happy, contented, comfortable and satisfied with one’s quality of life.

Draft Commissioning Framework for Health and Wellbeing , DH 2007

This definition sounds much closer to something that people can relate to in their daily lives.

Public health is based on a social model of health, which recognises that the health and wellbeing of individuals and communities is determined by a wide range of social, economic and lifestyle factors in addition to heredity and health care (Figure 1).

Factors such as the education system and labour market, or ‘social structure of society’, help shape peoples lives.  An ‘individuals social position’, based on socio-economic position, gender, ethnicity, and sexuality, affects their access to resources and relative exposure to health risks. ‘Intermediary factors’, including personal behaviour or lifestyle, environmental factors such as poor housing, and the provision of health and social care provision impact on ‘health outcomes’, or a person’s health and well-being.

Figure 1 Model of health and its determinants

Deprivation and health inequalities

If people and communities lack the positive resources which they need to thrive, this can be referred to as ‘deprivation’.

Deprivation can influence health and wellbeing in many ways, such as lack of social support and low satisfaction with the neighbourhood, feelings of financial strain, low self esteem, unhealthy lifestyle choices and risk taking behaviour, poor access to health information and quality services.

It is fairly easy to establish the characteristics of a neighbourhood and the people who live there, for example, through the 10-yearly Census.  Deprivation can therefore be ‘mapped’ to geographical areas.  Death certificates also record where someone lived before they died.  It is then a relatively simple process to look at the effect of deprivation on age and cause of death. 

The relationship between deprivation and premature mortality (death) is now well recognized, both when comparing large areas, such as Local Authorities, with each other, and small areas within Boroughs. 

As well as where you live, even wider differences, or ‘inequalities’, in patterns of health, wellbeing and life expectancy exist by social group, gender, and ethnicity.

The 2006 North West Public Health Observatory report Where Wealth Means Health provides detailed examination of deprivation and its effect on inequalities in health and wellbeing across the Region.

Joint Strategic Needs Assessment

The Local Government and Public Involvement in Health Act (2007) places a duty on upper tier local authorities and PCTs to undertake Joint Strategic Needs Assessment (JSNA).  This duty commenced on 1st April 2008.

Based on guidance released in December 2007, JSNA is a process that should:

• identify the current and future health and wellbeing needs of the local population; over both the short term (three to five years) to inform the Local Area Agreement and PCT Strategic Plan and longer term (five to ten years) future planning.
• lead to agreed commissioning priorities that will improve health and wellbeing outcomes and reduce health inequalities.
• reflect the competencies of a world class commissioner, being underpinned by:
  • partnership working;
  • community engagement;
  • evidence of effectiveness: identifying relevant best practice, innovation and research to inform how needs will best be met.

The Council and PCT have developed, with partners, a JSNA process for Blackburn with Darwen, including a JSNA website for the Borough.

The 2008 Blackburn with Darwen Public Health Annual Report incorporates, for the first time, the Joint Strategic Needs Assessment stock-take for the Borough.