Leadership for Health Innovation:Public Health Education and

Entrepreneurship

Professor Richard Parish

Chief Executive

Royal Society for Public Health

Today’s PresentationToday’s Presentation

• Focus on us – the public health community• Consider why public health is so often at the

margins of political commitment• Why have we not made more progress?• The role of public health leaders and how we

make the best use of the knowledge resource• Challenging and provocative – stimulate a

debate

The Royal Society for Public Healthwww.rsph.org.uk

The Royal Society for Public Health is an independent, multi-disciplinary organisation,

dedicated to the promotion and protection of collective human health and well-being.

Through advocacy, mediation, empowerment, knowledge and practice,

we advise on policy development; provide education and training services;

encourage scientific research; disseminate information; and certify products, training centres and processes

The Royal Society for Public HealthThe Royal Society for Public Health

Royal Society for Public HealthRoyal Society for Public Health• Newest and the oldest PH

body• National Awarding Body• 100,000 students• 1,450 education centres• ISO Certification• NGO Forum• National health promotion

support• IUPHE, APHA, WFPHA• John Snow Society

Future Health ChallengesFuture Health Challenges

• Modern day NCDs and so called ‘lifestyle’ issues

• Re-emerging communicable diseases

• Multi-resistant hospital acquired infections

• Emergency and disaster responses

• Impact of climate change• Emerging communicable

diseases

Health in the FutureHealth in the Future

1. Economic growth and sustainable development

2. Health care provision versus action on the fundamental determinants of health

3. Potential adverse effects of the media and IT and the obvious advantages of better communication

4. Energy demand versus environmental impact

5. Improvements for the affluent at the expense of the worst-off

Unresolved Dilemmas and ChallengesUnresolved Dilemmas and Challenges

• Growing inequalities• Social injustice• Governance and public

accountability• Ethics• Multisectorality – partners and

‘unethical enemies’

“If we don’t succeed this, we

run the risk of failure”

Ottawa and Beyond: 22 years of success?Ottawa and Beyond: 22 years of success?

• Five action areas – progress?

• Three functional responsibilities – competent?

• Pilots projects and demonstration areas

Successes and FailuresSuccesses and Failures

Successes – Yes!

But too often a failure in

• Political commitment• Programme implementation• Replication

Implementation and replication?

• Limited capacity/Not enough staff?

• Inadequate resources?

• Lack of skills?

• Unsupportive policy climate?

• Wrong policy instruments?

REASONS FOR FAILUREInternational Standards Organisation

• inappropriate standard

• low level of resources

• inadequately trained personnel

• organisational constraints

• unclear objectives

• poor communication

• inaccurate audit methodology

Real progress depends upon:

• Using the full range of policy instruments (fiscal, legislation, regulation, organisational development, funding, accountability, human resource deployment, pooled resources)

• Capacity, capability and infrastructure

• Communication and co-ordination

• New research and evaluation paradigms

Why are the policy-makers not begging public health to help?Why are the policy-makers not begging public health to help?

Better health benefits:

• Education• Economic prosperity and

wealth• Social welfare• Environment

ASPHEREuropean Public Health Core Competencies Programme

• Flexible competencies• Populations change• Different countries; different needs• Infrastructure• Labour market• Social norms• Economic and environmental

circumstances

ASPHEREuropean Public Health Core Competencies

ProgrammeMethods in Public Health

Epidemiology Data collection

Data analysis Evaluation

Surveillance Biostatistcs

Qualitative research

ASPHEREuropean Public Health Core Competencies

Programme

Social Environment and Health Physical, Chemical and Biological Environment

Social research methods Health risk assessment

Health risk management

Health risk communication

ASPHEREuropean Public Health Core Competencies Programme

Health Policy, Organisation, Management & Economics

Health Promotion and Disease Prevention

Application of theories and models

Health determinants and risk factors

Monitoring and evaluation Theory and principles

Management (resources, budgets, grants

Strategy and programme development, management and evaluation

Public Health Training?Public Health Training?

Problem definition and evaluation

V

Change agents and implementation management

Key QuestionsKey Questions

• Should we better differentiate between public health ‘scientists’ and ‘implementation managers’?

• Is the current curriculum too crowded?

Implementing the Ottawa Charter

• Enable

• Mediate

• Advocate

Asset mapping Disease profiling

Market research and intelligence

Epidemiological research methods

Media management Curriculum development

Economic and environmental assessment

Health services provision

Organisational change management

Community development

Policy development + policy impact assessment

Negotiating skills

Advocacy techniques

Social marketing

Management monitoring Outcome evaluation

Workforce planning

Quality Management for Quality Public Health

What can we learn from other sectors and

services?

What should we measure?What should we measure?

INPUTS PROCESSES OUTPUTS OUTCOMES

We tend to value the things we measure

rather than

Measure the things we value

Is something missing

in the DNA of Public

Health Practitioners?

The art as well as the scienceof public health

The art as well as the scienceof public health

ProblemDefinition

Priorities

Intervention Strategy

ProgrammePlanning

Implementation

Impact andEvaluation

Replication andMainstreaming

We learn from what we document

But

Do we document everything we know?

The Art not just the Science!The Art not just the Science!

• Public health in Wales

• Tesco

• Wanless Review

• Child and Adolescent Health and Development Strategy

The Assessment Tool• Identify current policies and strategies that contribute to

child and adolescent health• Clarify the goals and objectives for which these policies

and strategies have been formulated.• Map the existing policy provision• Assess the extent to which these are based on evidence.• Identify any gaps in policy provision.• Enable policy-makers to determine whether they have

utilised the full range of policy possibilities

Professor Richard Parish, Chief Executive, Royal Society of Health, United Kingdom

The Assessment Tool• Identify whether the necessary information systems are

in place to assist in policy formulation, implementation management, and outcome evaluation.

• Identify the sectors and key players involved in planning, implementation, evaluation and accountability.

• Assess the extent to which national policies and strategies have been implemented in practice.

• Determine the adequacy of the existing infrastructure required for the successful implementation of national policies and strategies, and identify any additional measures that might be required

Professor Richard Parish, Chief Executive, Royal Society of Health, United Kingdom

Policy Options

Professor Richard Parish, Chief Executive, Royal Society of Health, United Kingdom

LEGISLATION(e.g. smoking in public places, wearing seat belts, environmental

improvement, maternity leave, child rights)

REGULATIONS(e.g. consumer protection, food labelling,

industrial and vehicle emissions, speed limits)

ORGANISATIONAL CHANGE(e.g. new services, improved access)

PUBLIC EDUCATION(e.g. mass media campaigns)

PROFESSIONAL DEVELOPMENT(e.g. training of health professionals, professional regulation)

BUDGET ALLOCATION(e.g. increased health or education budget)

FISCAL MEASURES(e.g. taxation, corporate subsidies, financial penalties, investment

funds, tax exemption)

WELFARE POLICY(e.g. food coupons, welfare benefits, housing support)

RESEARCH(commissioned research, information dissemination)

PERFORMANCE RELATED PUBLIC SERVICE FUNDING(e.g. funds follow targets)

CURRICULUM DEVELOPMENT(e.g. primary and secondary school knowledge and skills development)

ENVIRONMENTAL CHANGE(e.g. transport planning, water and sewage supply, playground design)

OTHER(please specify)

OTHER(please specify)

Go to 1.13

The Assessment Exercise

• What?

• Why?

• Where?

• How?

• When?

• Which?

Professor Richard Parish, Chief Executive, Royal Society of Health, United Kingdom

Human Resources

• Skills• Location and

deployment• Recruitment and

training• Is there a Plan?

Planning and evaluation Implementation

Health indicators Management indicators

Outcomes Process

Epidemiology Asset mapping

Science Art

What can be documented What must be experienced

Map the Community’s Assets

• facilities

• networks

• community organisations

• communication structures

• local identity

• media

Half empty

Half full

“I have a vision for the future as well

as the past!”

Supporting PractitionersSupporting Practitioners

Professional development, skills and competencies

Organisation and system support - accreditation

National/International learning networks

Evidence-based tools

You must learn from the mistakes of others –

you will never live long enough to make

them all yourself

Most of the pieces, butwe don’t yet havethe jigsaw!

• Competencies

• Science

• Differentiation and specialisation?

• Art of public health?

The Missing LinksThe Missing Links

• Leadership development• Mentorship• Better use of existing leaders and

those who have recently retired• Draw on other disciplines• Learn the language and culture of

others – recruitment, secondment, etc

• International Journal of Public Health Failures

If you always do what you have always done, you will always get what you have always had

One ship sails east and another sails west

With the self same wind that blows

T’is the set of the sails and not the gales

That determines the way we go

Like the winds of the sea are the winds of fate

As we journey along through life

T’is the set of the soul that determines the goal

And not the calm or the strifeElla Wheller Wilcox