Health and Well Being – view from the Town Hall

Greg FellDirector of Public HealthSheffield City CouncilGreg.fell@sheffield.gcsx.gov.uk@felly500

Exam question:

• how wellbeing is being taken forward practically• opportunities for politicians and policy-makers? • What are the challenges for wellbeing in politics

and policy? • What is the role of evidence in policy-making? • What are the lessons for collaboration/co-

production between academics and policy-makers?

Firstly some language and terminology

Health

• …. “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

WHO

Well being

• The state of being comfortable, healthy, or happy

• high levels of well-being mean that we are more able to respond to difficult circumstances, to innovate and constructively engage with other people and the world around us

(er…. Top link on google)

Public health

• The science and art of promoting and protecting health and well-being, preventingill-health and prolonging life through the organised efforts of society

Faculty of Public Health

Overlapping circles in a venn diagram?Competing definitions?Co-existing definitions?Different lenses on the world?Does is matter?is trying to draw distinctions pyric?

Locally

• Shape and size of Sheffield• A few stats. Not many• Do we want???

25 year difference in healthy life expectancy

Not just geographic – but also populations – those with severe mental illness, learning disability etcDo we have good data on “well being”

How is wellbeing is being taken forward in a practical sense. Structures a plenty• Health and Well Being Board – “health”, “health care”,

“health and social care” or “well being”. Or all of the above.• Transforming Sheffield Board• Public Service Reform Board• Sheffield Executive Board• Fairness commission • The boards / gov bodies of countless organisations large

and small.• The actions of the city contribute to “well being” across all

sectors.

(remember the point about “organised efforts of society”)

Challenges around money/ resources and its deployment• SCC = £1.4bn, NHS = £1.1bn, Public sector =

£4.4bn, economy = £11bn. • Which of these matters most.• Hospitals v not in hospitals • “statutory services” vs “VCS” in many shapes

and guises• Downstream (reactive and responsive) vs

upstream (supporting and enabling)

We have a strategy

Objectives of our institutions

• As an institution what’s the point of the £1.2bn of NHS spend - Keeping Mrs Smith alive for another 3 weeks or optimising well being for a broader social purpose.

• Meeting health needs vs enabling the best outcomes for a population as a whole.

This is a session on “politics and health”

politics

• Politics (from Greek: πολιτικός politikos, definition "of, for, or relating to citizens") is the process of making decisions applying to all members of a group.

• More narrowly, it refers to achieving and exercising positions of governance — organized control over a human community, particularly a state. Furthermore, politics is the study or practice of the distribution of power and resources within a given community (a usually hierarchically organized population) as well as the interrelationship(s) between communities.

Some “well being challenges”

Some “political” conundrums in the “well” being space

• (Health) inequality is a political choice. Marmot. Discuss

• Austerity is a political choice. Piketty? Discuss • ……different zeitgeists and interpretations of

the available evidence filtered through political and ideological lens

“All this fluffy well being stuff is great, but there’s no point as we cant match it to the money”

“prevention and promoting well being is futile as everyone will just end up getting dementia and it will be more expensive overall”Discuss

Our approach to “obesity”

• Is “obesity” important to well being• How far down or upstream do you go • from empowerment poverty, food choices +

sugar levy etc, activity enabling environment through to diabetic stroke and amputation.

Mental health

• Is this a “well being” issue• Where on the continuum do we intervene –

from acute psychiatric admission through antidepressants & IAPT through to mental well being

• “prescribe pounds not pills” – the living wage will do more to improve mental well being than the total volume of anti depressant prescribing. Discuss.

Housing.

• Right supply of homes to meet society need vsaddressing consequences of acute homelessness

• Long term well being consequences of social regeneration and housing stock / housing quality, the way in which we “plan” neighbourhoods.

The “economy” and the way in which we peruse economic growth• The way in which economic growth is shared• Financial inclusion / exclusion• Jobs at any cost vs secure, stable and

meaningful jobs• Interplay between the “informal econ” and

“corporate” econ and “public econ”• Healthy folk as a core component of a vibrant

economy – infrastructure investment

Subjective well being – where does it fit• The Cameron Happy questions

– real world relevance? – Robustness of data? – Do they inform policy and practice

• Evidence on what works– Extent to which the “What Works” centre is

known about• What lens we look at the world through

– Health, education, life satisfaction

What opportunities does wellbeing offer for politicians and policy-makers?

“health”& “well being”:– for its own sake– To reduce care costs – Broader social purpose – core infrastructure for

vibrant economy, – the “right” thing to do

What are the challenges for wellbeing in politics and policy?

• Medical or social model• Can they co-exist.• Different roles and functions• Asset v need (deficit) based approaches• What matters to you vs whats the matter with

you.• The here and now / in your face vs

investments with a long term pay off.

What is the role of evidence in policy-making?

• We like “evidence” when it gives us the answer we want.

• Powerful vested interests in status quo. Path of least resistance?

• Most “evidence” never even gets close to influencing policy or practice.

• Strongly held prior beliefs – focusing on the “high risk” will yield massive gains –troubled families.

• Lack of counterfactuals, poor use of RCTs, lack of economic appraisal

• Biomedical v social science paragigm of evidence

What are the lessons for collaboration/co-production between academics and policy-makers?

• Insiders• Contacts of contacts• Think tanks• “proper” evidence• Pre appraised

evidence

http://blogs.lse.ac.uk/politicsandpolicy/proximity-and-trust-are-key-factors-in-getting-research-to-feed-into-policymaking/