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Public health - Wales

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

  • Physiotherapists have a significant contribution to make within the public health agenda, working in partnership with other agencies and organisations, to promote exercise and well being in all stages of health.
  • 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 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.

There is a strong emphasis on public health within the Welsh health policy arena – particularly in terms of reducing health inequalities and promoting active lifestyles. Key public health concerns in Wales are similar to those in the rest of the UK, such as obesity, smoking, and diseases of the circulatory system, but include high levels of respiratory problems (which account for 13 per cent of all deaths in Wales) and high levels of farm injuries, which are a major cause of death in Wales.

In 1998, the then Secretary of State for Wales Ron Davies published Better Health – Better Wales, which set out the health challenges facing Wales and proposed a range of strategies to improve public health and well being. It argued that: "Many agencies have a role to play in providing information, advice and cultural change programmes aimed at improving health… Health professionals in many settings are important sources of advice and support on aspects of a healthy lifestyle".(23)

The key principles of this paper were underpinned by subsequent policy documents, including Promoting Health and Well Being: Implementing the National Health Promotion Strategy(24), Health, Social Care and Well-being Strategies(25), Healthy and Active Lifestyles in Wales: A framework for action, and Healthy Ageing Action Plan for Wales.(26)

Public health in Wales is co-ordinated by the National Public Health Service for Wales (NPHS). NPHS is part of NHS Wales, and delivers its services through and Infection and Communicable Disease Service; resource teams, which provide services directly to stakeholders; and a team within each of the 22 public health boards. The 22 public health teams have the flexibility to reflect both nationwide and local needs, and place a strong emphasis on partnership working, including with local authorities, NHS trusts, voluntary organisations, the police, private sector organisations, leisure centres, and multidisciplinary groups and other networks.

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.
  • Follow the nationally agreed standards to support your practice around the public health agenda set out in the National Occupational Standards for the Practice of Public Health. These will help you follow the same benchmarks as other healthcare workers, and can be a useful tool to sit alongside the National Knowledge Skills Framework.

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