What is public health?
This explainer outlines the fundamental principles of public health and its strategic management within the NHS in Wales. It explores how public health operates as both a science and an art, dedicated to protecting and improving the wellbeing of entire communities. It details the central role Public Health Wales NHS Trust plays, with its core functions in health protection, health improvement and healthcare public health.
By examining these responsibilities and the collaborative actions of NHS bodies and their partners, the explainer provides an overview of the proactive approaches being taken to address health challenges across the nation.
What is public health?
Public Health Wales defines public health as both the science and art of keeping people healthy, preventing disease, extending lives and promoting wellbeing through organised societal efforts. It is built on principles of social justice and fairness, aiming to protect and improve health for everyone, ensuring no one is left behind. This means public health is dedicated to tackling health inequalities, including those caused by racism and discrimination.
Instead of focusing on individual health, public health works to safeguard and enhance the health of entire communities and populations, from local to global levels. Public health thrives on collective action and is a shared responsibility. While there is a specialised public health workforce, governments, charities, community leaders and businesses can also drive efforts to improve public health.
What is public health management?
In NHS Wales, public health management is primarily the responsibility of Public Health Wales. It acts as the central body for public health expertise and leadership.
Public health management in NHS Wales is about the strategic planning, coordination and delivery of services and initiatives to address health challenges at a population level. It's an approach that goes beyond treating individual patients to focus on prevention and the wider determinants of health.
What are Public Health Wales’s core functions and responsibilities?
The core functions and responsibilities of public health in NHS Wales are primarily carried out by Public Health Wales, in conjunction with public health teams in local health boards. Its purpose is to protect and improve the health and wellbeing of the population and reduce health inequalities. These responsibilities are categorised into three main areas:
What are the core functions and responsibilities of public health teams within Local Health Boards in Wales?
Public health teams within Local Health Boards (LHBs) in Wales have a crucial role in planning, commissioning, and delivering healthcare services to improve the wellbeing of the population. Their core functions extend beyond treating illness to a more proactive, preventative approach.
This includes improving health outcomes, promoting wellbeing, reducing health inequalities, planning and commissioning services and working in partnership with a variety of partners, including local authorities, other NHS trusts (like Public Health Wales), and the third sector, to deliver a coordinated approach to public health.
What actions are being taken by NHS Wales and its partners to improve public health?
In Wales, a significant effort to address health equity is underway through the Welsh Health Equity Status Report initiative, a collaboration between the Welsh Government and the WHO. This has led to the development of a solutions platform offering extensive resources beneficial for NHS bodies.
A crucial aspect of this effort involves NHS bodies acting as anchor institutions. This means they leverage their substantial local presence as major employers, purchasers, landowners, and holders of fixed assets, coupled with their inherent mission and local ties, to contribute to community wellbeing.
Anchor institutions can help by:
- purchasing more locally
- using their buildings to support communities
- widening access to quality work for local and disadvantaged groups
- working with local partners and
- reducing environmental impact.
This is also known as community wealth building. Beyond their anchor role, NHS organisations actively promote local workforce participation and facilitate the return to work for individuals experiencing ill health. They also wield influence over local licensing decisions related to tobacco, alcohol, food and drink.
What is prevention?
As defined by Public Health Wales, prevention is an approach that aims to improve public health and reduce the need for acute healthcare services by proactively addressing the root causes of illness and promoting wellbeing. This approach shifts the focus from a traditional reactive model of treating sickness after it occurs to a more proactive model of preventing it in the first place.
Prevention is a key part of the Welsh Government's health and social care plan, A Healthier Wales, and is central to the work of Public Health Wales. The Future Generations Commissioner has made several recommendations to help prioritise it. It is seen as the collective responsibility of health services and requires collaboration with other sectors, such as social care, education and local government, to address the wider determinants of health like poverty, housing and social support. By working together, the aim is to create a healthier, more equitable society and reduce the long-term strain on healthcare services.
How are preventative services being delivered to improve public health?
The NHS is struggling to manage the current burden of preventable disease amidst increased demand on acute and primary care services. We must prioritise preventing avoidable ill-health, or these pressures will worsen year on year as need and demand continues to outstrip capacity.
The latest NHS Wales Performance framework sets out important performance indicators on a range of preventative programmes, including smoking cessation, immunisations (childhood, HPV, influenza and Covid-19), substance misuse treatment, healthy weight systems and screening programmes as part of the new national framework. All of these can make an important contribution to tackling health inequalities.
Wales has implemented several strategic approaches to prevention:
Why is prevention a priority for public health in Wales?
As highlighted within the Wellbeing of Wales report, Wales faces significant population health challenges that stall life expectancy and widen inequalities, including high levels of obesity, unhealthy alcohol consumption, smoking and poor levels of physical activity. Also, with the challenge of an ageing population and a growing prevalence of chronic diseases, a healthcare system focused solely on treating illness is not sustainable.
Prevention is an important part of the solution to achieving sustainable health and care services, particularly in the face of growing pressures on the NHS, as it aims to reduce the need for expensive, high-acuity care by keeping people healthy and independent for longer.
The emphasis on prevention in NHS Wales is driven by several factors:
Summary
Public health within NHS Wales is a proactive and collective endeavour, with Public Health Wales driving efforts at its core. It extends beyond the confines of individual patient care to encompass population-level protection, improvement and the strategic management of health services. Prevention, delivered across primary, secondary, and tertiary levels, is now a crucial priority. This focus is not only essential for addressing persistent health inequalities and improving life expectancy, but also for ensuring the financial sustainability and long-term sustainability of the Welsh healthcare system. Ultimately, the success of this strategic management hinges on a cross-government and cross-sectoral approach, fostering collaboration among all public, private, and third-sector bodies to empower communities and secure a healthier future for Wales.
