Lindsey Davies: Q&A - Royal College of Physicians

Lindsey Davies: Q&A
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directors and DPHs, talking about how
they can help each other. Quite often new
insights and pathways of care develop – it
is a great opportunity for a public health
specialist to work alongside a clinician.
What lessons can we learn about
Q major reforms from the past such as
the 1990 health reforms that introduced
GP fund-holding
AThat’s huge. I think I’d go back to
relationships. In any big change you
lose experienced people because they
find it one change too many. We have
to try and avoid that. But if you disrupt a
relationship it could take years to re-build.
If you want to take staff, professionals
and the public with you in any programme
of change you have to paint a compelling
vision – and they have to want to do it. The
problem at the moment is that nationally
the picture is not very clear. People don’t
feel that they are behind a clear vision.
Hopefully, after this discussion we will have
something that we can really sign up to and
move forward with enthusiasm. But we are
not there yet.
QWhere do you think public health
should be focusing its efforts over the
next decade
ABasically, the health needs of the
population and we know what they
are – huge chronic diseases, infection,
new diseases emerging, and disasters
around the corner for which we need to be
ready. We also know that there are huge
inequalities in health and inequalities
in access to health services. One of the
challenges for public health is to go back to
those three domains [protecting people’s
health, improving health, and making sure
that the right health services are in place]
and make progress in these areas in the
next couple of decades.
I’d like to think that we have got really
good surveillance in place across the
country to spot nasty things before they
happen. I’d like to think that every health
service and social care provider has really
good emergency plans in place.
QSo do you think that we responded
well to the recent flu pandemic that
we had last year
ALast year’s flu pandemic – I think we
responded quite well, I was in charge!
[smiles] I was the flu tzar at the DH before
becoming president of the Faculty of Public
Health. For three years I was planning for
a pandemic and then suddenly, just when
plans were nearly in place, one arrived! We
got a great test of whether our plans were
right or not – including the flu line, which
was my idea – and I think we did do pretty
well. We learned some good lessons and
that’s looking really strong now.
It is so important that we get that
[health protection] right, whether it’s for a
pandemic or not. We need to keep looking
hard at health services and ask if they are
meeting the needs of the population or
not. We need to be prepared to make big
changes. Look at diabetes, for example.
Most diabetics are not in hospitals and yet
most diabetes consultants are in hospitals
– well that’s not right is it A lot of them
are in the community, but we would like
to see more of those who understand and
can treat the disease working where the
patients really are. There are lots of things
that we can do to improve health services.
Mental health is one I haven’t
mentioned at all, but that is huge. I’d love
to see better mental health services – public
mental health services and prevention
as well as cure. We also need to look at
lifestyles – smoking, obesity and alcohol
are the major health challenges. If we
can get a focus on those three that would
make a real difference. That means eating
healthily, more exercise, less smoking and
less drinking.
QWhat is your view on the current
government’s focus on ‘nudging’
people into healthy behaviours
AWell, I think they have all got a place.
Any serious campaign or action to
make a difference to public health needs
a holistic approach. You are never going
to make an impact on a health issue –
tobacco, alcohol, eating – by just sending
out a bit of information or by providing
nice parks. You need to have a range of
things in place. I think smoking is a good
example. People need information that
helps them understand that smoking
harms. They also need support to help
them to stop smoking and regulation to
adjust their environment to make it more
difficult for them to smoke, or for people to
be affected by that tobacco smoke.
Information, regulation and nudging
in the environment all have a role to play.
Healthy eating, for example – I would ban
transfats tomorrow. If there were a germ
or a bacterium in food that was killing
as many people as we think are killed by
eating transfats in a year then people
would be hysterical about it!
QIs there cause for optimism in the
public health community
AI think there is. We have a government
which is saying that public health is
important – and they are saying it louder
than any government has before. They are
saying that they really care about public
health and that they really want to make a
difference. That’s brilliant. They have made
more people more aware, not least across
the health professions.
Our ambition as a public health specialty
is to do ourselves out of business! We want
everybody doing public health things and
then there would not need to be so many
of us. But I shouldn’t say that, should I!
We see public health as something that
everyone can do. n
Read more online...
Read and comment on our full-length
interview with Professor Lindsey
Davies online at Commentary
Community, including her views on
social determinants of health and
on epidemiological research. n
www.rcplondon.ac.uk n June 2011 n Commentary 13