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Public health

Key Points Background Implications News Resources Action Points References

Key Points

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting health through organised efforts of society" by the Faculty of Public Health.(1)

Public health falls into three main areas: health improvement, health inequalities, and health protection.

Physiotherapy has the scope to play a key role in each of these areas, especially with the growing emphasis on prevention, chronic disease management and health inequalities.

  • The CSP is running a long term 'Move For Health' programme and is working to engage members and the public more widely in the prevention of illness and promotion of good health, particularly by encouraging regular physical activity.
  • Public health seeks to understand and address the determinants of, and trends in, health across a population. It is well established that our health is affected by a range of factors, including where we live, our gender, income, education and social status. Public health is about promoting physical, mental or emotional well-being by inspiring, educating and empowering the public to stay healthy. Physiotherapists can play a key role in improving public health.
  • Over the past 50 years, there have been impressive social economic and health improvements in the UK. People from every class and region are healthier, and living longer than ever before. However, not everyone is able to share the benefits of these improvements. Inequalities in health start early in life and persist not only into old age but through subsequent generations.
  • A major aspect of public health involves tackling social inequalities in health. The major killers, such as stroke and chronic heart disease, are linked to socio-economic inequality, with risk factors such as smoking being much higher among people in deprived areas. An estimated 30 per cent of cases of coronary heart disease in under-65s, and 25 per cent of all cancers, could be prevented through public health measures to encourage healthier lifestyles.(2)
  • Key public health issues include physical activity, childhood obesity, work health, and the health of older people. Physiotherapists can play a key role addressing many of these issues – for example, by raising awareness of the links between a musculoskeletal condition such as back pain and contributory factors such as poor diet, lack of exercise and obesity, and helping people set goals and follow-up advice.
  • Public health initiatives draw on epidemiology – the branch of medical science that studies the factors that affect the health and wellbeing of populations – for their evidence base. This area of research investigates how specific health conditions may feed into wider health concerns (for example, how wider access to physiotherapy for lower back pain can affect overall levels of obesity).
  • There is a general acceptance that the NHS must play a greater role in preventing ill-health and maintaining and promoting good health if it is to be sustainable in its current form 
  • There is a growing emphasis on the need for all health practitioners to contribute to the public health agenda. Physiotherapists, as allied health professionals are key members of the wider public health workforce.

Implications

  • Public health involves education, preventing illness, empowering individuals to make health choices, and redesigning services to support all of these. Individual physiotherapists and practice managers can embrace these principles within every aspect of their daily practice.
  • Physiotherapists need to be aware of the latest advice on lifestyle issues that affect health. The most obvious issues within the physiotherapy scope of practice include obesity, levels of exercise, diet and injury prevention. But it is also important to be well informed about other factors, including smoking, diet, drug and alcohol misuse, and to offer motivation in these areas where appropriate.
  • Physiotherapists should engage with the epidemiological findings within their area of work to ensure that they are following the latest evidence-based practice.
  • Working with patients to set up activity programmes (such as the activity action plans set out in Choosing Activity), can help patients address a range of issues relating to their health and well-being. It can also help improve musculoskeletal health, decrease the risk of osteoporosis and back pain, and reduce the effect of arthritis.
  • A key part of the work for physiotherapists is to educate, encourage, inspire, and lead by example on ways of promoting well being and preventing ill health. This should be complemented by work to adapt services to respond to the challenge – not only within primary care, but also within secondary care and specialists' centres too.

Background

Physiotherapists have not traditionally identified strongly with public health. However, the philosophy of care of physiotherapy (and the other allied health professions) is a biopsychosocial model underpinned by enabling service users to learn how to manage their own health and sustain new, positive health behaviours more effectively. In this way, physiotherapists have in fact been contributing to this area of work for some time.

In the 2002 report Securing Our Future Health(3) and the follow-up review on investing in public health Securing Good Health for the Whole Population(4) (both commissioned by the then Chancellor of the Exchequer rather than the Secretary of State for Health), Wanless concluded that the health service must focus on prevention in order to be sustainable. Linked to this was the need for increased self-care, in which:

the health services can support a pro-active public… for example, helping people to empower themselves with appropriate information, skills and equipment or supporting people to take a more active role in the diagnosis and treatment of a condition followed by rehabilitation and maintenance of well being.(5)

There is still a need for physiotherapists to engage further with the public health agenda in order to have a broader impact on people's lifestyles and health and well-being. The CSP has its own public health initiative, the Move for Health campaign, which aims to support members to engage in the public health agenda and  promotes messages about physical activity to the general public.

Action Points

  • Access member resources on public health, through Move for Health for Members
  • Take some time to understand the key drivers in this field and how they impact on physiotherapy in your country.
  • Read up on the epidemiology in your area of work. See, for example, the Association of Public Health Observatories website (www.apho.org.uk/) which has live data on various health issues and the Journal of Epidemiology and Community Health – the official journal of the society for Social Medicine.
  • Find out more about the Move for Health campaign
  • Sign up to the iCSP Move for Health network
  • Consider registering to be a Move for Health champion
  • Help your clients to make their own informed decisions about the choices that affect their health, drawing on the recommended targets for physical activity, calculating their Body Mass Index, and using the 5aday web tool.
  • Improve awareness of wider public health messages by promoting government targets for healthy lifestyles – for example, by displaying leaflets around your practice.
  • Educate and promote exercise and activity in programmes to patients with long-term conditions. Enable patients to manage their condition and to improve their fitness levels and their overall quality of life.
  • Find out about local health promotion projects or services and refer individuals, or make recommendations, if appropriate.
  • Collect key data about health inequalities in your area, and think about how you can address them through the way you promote your services and enable access to them.
  • Follow the nationally agreed standards to support your practice around the public health agenda set out in the Public Health Skills and Career Framework (PHSCF) (link to add www.phru.nhs.uk. ) These useful tools will help you articulate your practice within the wider public health workforce, and can be used alongside other recognised standards and guidelines.

References

  1. Acheson D. Committee of inquiry into the future development of the public health function. Public health in England. Cmd 289. London:  HMSO; 1988.
  2. Wanless D. Securing our future health: taking a long-term view. Final report. London:  HM Treasury; 2002.  p 47
  3. Wanless D. Securing our future health: taking a long-term view. Final report. London:  HM Treasury; 2002.  p 47
  4. Wanless D. Securing our future health: taking a long-term view. Final report. London:  HM Treasury; 2002.  p 47
  5. Wanless D. Securing our future health: taking a long-term view. Final report. London:  HM Treasury; 2002.  p 47
  6. Department of Health. Choosing health: making healthy choices easier. Cmd 6374. London:  Department of Health; 2004.
  7. Department of Health. Choosing a better diet: a food and health action plan. London:  Department of Health; 2005.
  8. Department of Health. Choosing activity: a physical activity action plan. London:  Department of Health; 2005.  URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
  9. Darzi A. High quality care for all: NHS Next Stage Review final report. Cmd 7432. London:  Department of Health; 2008
  10. Department of Health. Let's Get Moving - introducing a new physical activity care pathway. London:  Department of Health; 2010
  11. Department of Health. The ten keys areas of public health practice.
  12. Scottish Government. Health of Scotland's population - life expectancy. Scottish Government
  13. Scottish Office. Towards a healthier Scotland - a white paper on health. Cm 4269. London:  The Stationery Office; 1999
  14. Scottish Executive. Partnership for care: Scotland's health white paper. Edinburgh:  Scottish Executive; 2003.
  15. Scottish Government. Healthy eating, active living: an action plan to improve diet, increase physical activity and tackle obesity (2008-2011). Edinburgh:  Scottish Government; 2008.
  16. Crombie IK, Irvine L, Elliott L, Wallace H. Understanding public health policy: learning from international comparisons. Edinburgh:  NHS Health Scotland; 2003.
  17. Department of Health Social Services and Public Safety. Investing for health. Belfast:  The Department of Health, Social Services and Public Safety; 2002.
  18. Department of Health Social Services and Public Safety. Investing for health. Belfast:  The Department of Health, Social Services and Public Safety; 2002.
  19. Office of the First Minister and Deputy First Minister. Our Children, Our Pledge: a 10-year strategy for children and young people in Northern Ireland 2006 -2016. Belfast:  Office of the First Minister and Deputy First Minister; 2006
  20. Department of Health Social Services and Public Safety. A healthier future: a twenty year vision for health and wellbeing in Northern Ireland 2005 - 2025. Belfast The Department of Health Social Services and Public Safety; 2004.
  21. Northern Ireland Assembly. New Targeting Social Need (New TSN). Belfast:  Northern Ireland Assembly; 2001
  22. Department of Health Social Services and Public Safety. Investing for health. Belfast:  The Department of Health, Social Services and Public Safety; 2002.
  23. Welsh Office. Better health, better Wales. London:  TSO; 1998.
  24. National Assembly for Wales. Promoting health and well being: Implementing the national health promotion strategy. Cardiff:  National Assembly for Wales; 2001.  URL:
  25. Welsh Assembly Government. Health, social care and well-being strategies: policy guidance. Cardiff:  Welsh Assembly Government; 2003.
  26. Welsh Assembly Government. Healthy ageing action plan for Wales. Cardiff:  Welsh Assembly Government; 2005
  27. Skills for Health. National occupational standards for the practice of public health guide. Bristol:  Skills for Health; 2004

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The Chartered Society of Physiotherapy (CSP) is the professional, educational and trade union body for the UK's 50,000 chartered physiotherapists, physiotherapy students and support workers. Find out more about us.

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