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Public Health Policy and Practice NUR 261
Discuss what is meant by policy and how it affects nursing practice.
Explain how healthy public policy is formulated and how this impact upon the NHS and other organisations.
Discuss relevant healthy public policies that have been published within the UK and how effective they have been.
Analyse the effect that public health policy has upon nursing practice.
What is policy?
‘ Policy is a vague term used in different ways to describe the direction of an organization, a decision to act on a particular problem, or a set of guiding principles directed towards specific goals.’
(Titmuss, 1974, cited in Naidoo and Wills, 2005)
The policy process is influenced by:
Ideological beliefs and values
Evidence based research about ‘what works.’
(Naidoo and Wills, 2000)
Why should nurses be interested in policy?
Discuss the following statement – why is it relevant to nursing?
‘ Health policy is nursing practice.’
(Gebbie et al. 2000, cited by Toofany, 2005)
Influencing policy development
Policies are also formed in areas of multiple interests – where stakeholders exert influence and help to shape policy.
Stakeholders are individuals or groups ‘that can affect or will be affected by the achievement of an organization’s purpose.’
Who do you think the stakeholders are within public health?
(Naidoo and Wills, 2005,p.69)
Public health policy or healthy public policy?
‘ Public health policy’ focuses narrowly on health care and frequently illness management
‘ healthy public policy’ has a broader remit is concerned with the role of government and the public sector in creating the conditions that support health and should be:
Ecological in perspective
Multi-sectoral in scope
Collaborative in strategy
Tones K. and Green J (2004) Health Promotion: Planning and Strategies London, Sage Publications
Healthy public policy
The World Health Organization have strongly emphasised the importance of healthy public policy as a significant factor for health promotion to succeed.
Healthy public policy is concerned with health and equity in all areas of policy and accountability for health impact of policy.
Therefore healthy public policy does not just involve ‘health policy’ but any policy as they can all impact upon health….
(World Health Organization, 1988)
In the pursuit of healthy public policy government departments concerned with:
Need to take into consideration the effect on health that their policies may have- these should be just as important as economic considerations.
(World Health Organization, 1988)
What about us?
Prior to 1997 (Conservative administration) Public Health seen to be the preserve of the medical profession.
Following election of Labour govt. in May 1997 first ever appointment of Minister for Public Health appointed (England only).
It was recognised that improving health and narrowing the health gap between social groups involved the policies of several departments not just one!
Acheson Independent Inquiry into Inequalities in Health (1998)
Labour government commissioned the above inquiry.
Identified three key priorities:
All policies likely to have an impact on health should be evaluated in terms of their impact on health inequalities.
High priority should be given to families with children.
Steps should be taken to reduce income inequalities and improve the living standards of the poor.
Key events in public health since 1999 (adapted from Hunter, 2007)
1999 - Saving Lives: Our Healthier Nation published. Launch of Health action zones, healthy living centres, and Sure Start.
2000 – Health Development Agency formed; one of it’s priorities is to strengthen the evidence base of public health.
2001 – National targets on health inequalities published. Responsibility for health care changed – to a ‘front line’ approach – the Primary Care Trust.
2002 – Wanless Report published. Supports public health action for economic and health benefit. Recommends that public are ‘fully engaged’ to gain maximum benefits.
Public Service Agreement (PSA) target on health inequalities published – by 2010 to reduce inequalities in health outcomes by 10 per cent as measured by infant mortality and life expectancy at birth.
2004 – 2 nd Wanless Report: critical of progress made by NHS to go from a ‘sickness’ to a ‘health’ service. Workforce development planning advised to prepare workforce in contributing to public health.
Choosing Health published. See next slide.
New PSA targets announced – main theme improving health and tackling health inequalities. Targets achievable by ‘joined up’ working only.
Choosing Health: Making healthier choices easier. (DH 2004)
Public Health white paper - response to Wanless Report
Emphasis from ‘Nanny State’ to one of enablement of people to make healthier choices.
Close partnership working between NHS and Local Government advocated.
Informed choice for all
Personalisation of support to make healthy choices
Working in partnership to make health everybody’s business
Choosing health: key priorities
Tackling health inequalities
Reducing the number of people who smoke
Improving sexual health
Improving mental health and well being
Reducing harm and encouraging sensible drinking
Delivery based upon more people making more healthier choices.
2005 – Choosing Health Delivery plan published. 171 targets identified.
The HDA is no more and its work is transferred to NICE . NICE now has a division called the Centre for Public Health Excellence.
A report published demonstrates that health inequalities are continuing to widen when measured by infant mortality and life expectancy at birth.
2006 – New health strategy: Our health, Our care, Our say published. Emphasis on ‘local’ care and more attention to long-term conditions and public health.
2006/2007 Operating framework for the NHS in England identifies health inequalities and sexual health as 2 of the 6 priorities for action.
2007 – ‘Smoke free legislation’ implemented. Smoking is banned in public places (England).
Contemporary healthy public policies
Contemporary policies encourage practice that is thought to be effective in public health.
This involves tackling health inequalities; partnership or ‘joined up’ working; participation and involvement; and information, education and communication.
(Naidoo and Wills, 2005)
What might the problems be with implementation of these policies?
How do you think nurses can influence healthy public policy?
Evans, D. (2007) New directions in tackling inequalities in health, in Orme, J., Powell, J., Taylor, P. and Grey, M. (editors) Public health for the 21 st Century. New perspectives on policy, participation and practice. (2e) Maidenhead: The Open University.
Hunter, D. (2007) Public health policy, in Orme, J., Powell, J., Taylor, P. and Grey, M. (editors) Public health for the 21 st Century. New perspectives on policy, participation and practice. (2e) Maidenhead: The Open University.
Naidoo, J. and Wills, J. (2000) Health promotion: foundations for practice. (2e) London: Balliere Tindall
Naidoo, J. and Wills, J. Public health and health promotion: developing practice. London: Balliere Tindall.
Toofany, S. (2005) Nurses and health policy. Nursing management. 12(3)p26-30.
World Health Organization (1988) Extract from the report on the Adelaide Conference. Healthy public policy. In Adelaide recommendations on healthy public policy. 2 nd International conference on health promotion, Adelaide, South Australia, 5 th – 9 th April, 1988 . Available [online] http://www.who.int