Public Health in York - an insight
Mike Sullivan reports...
On September 8th we continued the series of health-related topics, this week considering the role of public health: Peter Roderick, Deputy Director of Public Health for York presented an informative and thought provoking assessment of how public health develops and informs health policy and practice, and how we all can contribute to managing our health.
Starting with some definitions, public health as a discipline is the “art and science of preventing disease, prolonging health life and promoting good health”, whilst “health” is “not merely the absence of disease, but rather the complete physical, mental and social well-being of the individual”.
Having reminded us that John Snow, who identified in the 1850s how cholera spread, was born in York, Peter set out how public health offers direct interventions such as immunisation, and develops policy and broader societal actions to ensure the health of the whole populations is safeguarded.
To do this, it’s essential to understand where “health” comes from: some statistics were startling, for example, 40% of what makes us healthy is determined by socio economic factors such as education or employment, and only 20% from the presence or absence of illness, and a further 20% through direct clinical therapies or interventions.
And how this works in York is demonstrated through, for example, that 10% of all deaths in York are smoking related, 30% of 11 years olds do not have a healthy weight, and child immunisation in York is too low to avoid the risk of measles.
Peter talked about the huge societal challenges for public health: reduced levels of healthy food in the diet; reduced adult physical activity since Covid; the problems of air quality; and how precarious employment models lead to stress. Overall, the higher the level of wealth, the higher both the level of overall health and higher uptake of health screening and health management. Conversely, the most economically deprived in York, when mapped by home postcode, are the most frequent users of A&E.
Possibly the most interesting point for those of us who feel ourselves creaking from time to time is that age alone is not automatically equated with ill health: the real problem is multiple illnesses; in York 30% of all hospital admissions are of people with more than one long term health condition. In York, and across England generally, life expectancy is declining slightly, as is the age to which one now expects to live without illness. These are worrying trends.
What may be done? Peter explained that there are policy approaches, such as restricting fat/salt/sugar in foods or supporting good public transport, and there are also individual actions: York has developed Health Trainers, 12 staff working across 15 venues in York offering advice on e.g. diet, exercise and up to 6 free sessions of support https://www.york.gov.uk/CYCHealthTrainers, and debt advice sessions, particularly important during a period of costs-of-living increases https://www.livewellyork.co.uk/information-and-advice/money-legal/money-and-benefits-advice/
This presentation was well-received, and offers us all some (healthy) food for thought in how we can support a healthy population in York