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Public health efforts must focus on six areas to 'make biggest difference'

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Public health initiatives need to focus on six key areas in particular to improve the nation’s wellbeing, according to the head of England’s national public health body.

The chief executive of Public Health England said evidence proves that “we can make the biggest difference” if efforts were focused on tobacco, alcohol, dementia, child nutrition and education, and tuberculosis.

In a speech last month, Duncan Selbie noted that tobacco remained the “number one killer” and said he was “delighted” with the move to consult on introducing plain packaging for cigarettes.   

“It’s going to make a difference for 14 and 15 year olds,” he said. “Adults don’t start to smoke, children do. It’s a child protection issue.”

Public Health England

Duncan Selbie

However, he highlighted that admissions for alcohol-related issues were on the increase and the link between alcohol consumption and domestic violence. He said he was favour of minimum unit pricing to reduce the consumption of cheap, high volume alcohol by young people.

“Minimum unit pricing is something we haven’t yet achieved but I’m convinced we’ll get there,” he said, citing the need to tackle situations where “it’s cheaper to buy cider than it is to buy water”.

He also said that every hospital needed “to have expertise in alcohol”. “We see the patchiness of that around the country,” he said at a national public health nursing conference in Birmingham.


Thirdly, he noted the impact of dementia and the importance that hypertension played in its prevention and development, as well as highlighting the potential for schemes such as Dementia Friends to provide support.

“Essentially it’s about blood pressure and we know what to do about blood pressure, we just need to do it as a nation,” he added.

At the other end of scale, Mr Selbie said efforts needed to focus on reducing the calory intake of children, especially from sugar, and encouraging them to be more active.

Sugar lumps

“If we got our children – if we got the entire population – back to the weight they were in 1993 we could knock 1.8 million type 2 diabetics off the future books of the NHS,” he said.

Sticking with children, he highlighted the importance of a good start to life through the SureStart and health visiting programmes, so that “every child is ready to learn when they start school”.

Finally, he warned that the country was in a “shameful position” regarding the return of tuberculosis.

“In the next year we will overtake the whole of the US in new cases of TB,” he said. “We’re actually exporting cases of TB to Pakistan, so we’re going to have to deal with this.”

Mr Selbie, who became chief executive of Public Health England on 1 April 2013, used his speech to say how much he respected public health nurses and how their role “makes a difference every day”.

He said they had “a lot to be proud of in the last year and the last 10 years”.

“The single biggest difference that we can make to improving the health of an adult is to help them get into work”

Duncan Selbie

For example, he noted improvements in reducing mortality from cardiovascular disease – especially stroke – and many cancers, and also a fall in adult suicide rates.  He added that there had been a “stunning reduction” in teenage pregnancies.

He also noted that the “great majority” of causes of poor health were factors outside the healthcare system itself. For example, he highlighted the key importance for health of having a “decent job”, somewhere “decent to live” and companionship.

“Jobs are good for your health. Having somewhere to live is a vital part of having a healthy life, and having friendship and companionship and affection in your life are mutually important,” he added.

He said the work of public health nurses was vital in helping patients beyond the normal reach of contact with the NHS.

“It’s about helping people, real people living in real places, living lives that sometimes we wish they weren’t but they are and reaching them in meaningful and relevant ways,” he told delegates at the conference, which was hosted by Public Health England and the Department of Health.

“The single biggest difference we can make for the health of a child is a good start to life”

Duncan Selbie

“Health is not synonymous with the NHS,” he said. “We need to be as involved about economic prosperity and decent housing… and we need to be concerned about social isolation.”

He added: “The single biggest difference that we can make to improving the health of an adult is to help them get into work. The single biggest difference we can make for the health of a child is a good start to life.”

Mr Selbie also touched on the health of the NHS workforce itself, something also highlighted in a recent newspaper interview by NHS England chief executive Simon Stevens.

Mr Selbie noted that the NHS had “a lot to learn” from the attention the big four supermarkets put into helping their staff remain well and recover from health-related problems.

“It improves morale, it improves productivity and it’s the right thing to do,” he said.

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