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Public health - Northern Ireland

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

  • Investing in Health refers expressly to the health professions, including physiotherapy, as having: "an important and specific public health role to play in the promotion of physical, mental health and social well-being within local populations and with existing service users. Through the opportunities presented in direct patient/client assessment and treatment, members of the Health Professions are uniquely placed to convey key health promotion messages targeted to individual needs by virtue of face to face contacts."(22)
  • 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 should engage with the epidemiological findings within their area of work to ensure that they are following the latest evidence-based 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.
  • 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.

News & Comment

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.

There is a strong emphasis on public health within Northern Ireland's health policy arena – particularly in terms of reducing health inequalities, promoting active lifestyles and increasing well being, and improving health within the workplace. Key public health concerns in Northern Ireland include:

  • mental health such as anxiety and depression, related to levels of local trouble-related violence
  • conditions related to diet and lifestyle, such as heart disease, stroke and cancer, which are the main causes of death
  • air quality, which has been flagged up as a possible cause of increased levels of asthma in some parts of the country, and affects an individual's ability to exercise
  • shelter and fuel poverty, especially among older people.

The Northern Ireland Executive published its public health strategy, Investing for Health (17), in 2002. This document contains a framework for action to improve health and well-being and reduce inequalities, with a strong emphasis on partnership working among the various stakeholders:

The success of the Investing for Health (2002) process will depend on effective partnership working between departments, the voluntary and community sectors, public agencies and statutory bodies. Good Health is everybody's business. We all have an interest, and a part to play, in achieving the vision of a healthy society.(18)

The two key aims of the strategy are to improve health, in terms of life expectancy, and to reduce health inequalities. One of its main objectives is "to enable all people and young people in particular to develop the skills and attitudes that will give them the capacity to reach their full potential and make healthy choices" – an aim in which physiotherapists can clearly play a key role.

The strategy underwent a review in 2009.

Investing for Health complements other policy initiatives including the equality agenda, the ten-year strategy for children and young people(19), A Healthier Future (20), and the New Targeting Social Need policy. (21)

Since 1 April 2009 public health has been the responsibility of the Public Health Agency for Northern Ireland. The agency is supported by a range of bodies, including the Northern Ireland Public Health Alliance (NIPHA) and the Queens University Centre of Excellence for Public Health – one of five UK centres set up by the UK Clinical Research Collaboration (UKCRC).

It is also supported by two Ireland-wide public health bodies: the Institute for Public Health in Ireland, which produces information and monitoring, initiatives to enhance public health capacity, and policy advice; and the all-Ireland Population Health Observatory, which focuses on improving health, and reducing health inequalities, and promoting North–South cooperation.

A key priority within Investing for Health is tackling health issues and health inequalities within the workplace, resulting in the strategy Working for Health. For more information see Work health.

The CSP has its own public health programme, our Move for Health campaign, which is designed to promote messages about physical activity and the expert advice that physiotherapists can provide on exercise and movement.

Action Points

  • Take some time to understand the key drivers in this field and how they impact on physiotherapy in your area:
  • Read up on the epidemiology in your area of work. See, for example, the Association of Public Health Observatories website (http://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.
  • 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.

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