When the National Health Service was founded, the vision was ““a comprehensive health service designed to secure improvement in the physical and mental health of the people … and the prevention, diagnosis and treatment of illness”¹.  Since then, it has been recognised that health professionals must acquire skills to reach out to the whole of society where the significant determinants of health are located, including working conditions, education, and the environment.  Helping people improve their health and well-being or preventing the deterioration of their health. With a shift to an increased focus on public health, encompassing the entire spectrum of health and wellbeing, not only the eradication of diseases.  

In July 1842, a report titled ‘the Sanitary Condition of the Labouring Population of Great Britain’² was published and turned out to be the most important 19^th Century publication on social reform. The report was the result of documenting frequent cholera epidemics suffered by the lower classes. The report resulted in the passing of the Public Health Act in 1848³ and was instrumental in introducing sanitation. Thus, it was the first step to the improvement of public health.  Improvements in nutrition, hygiene, housing, and the control of infectious diseases further increased life expectancy to 56 years for males and 59 years for females by 1920⁴. The introduction of public health measures such as childhood immunisations, universal health care, medical advances in treating adult diseases such as heart disease and cancer, and a reduction in smoking meant by 2019, life expectancy in England had increased to 79.9 years for males and 83.6 years for females⁴.  Although ‘healthy’ life expectancy has also increased, it has not been in line with life expectancy, with up to 24 per cent of years not spent in good health⁴.

While we are much healthier than we were a century ago there is still much work to do. Resulting in a plethora of strategies and reports aiming to tackle public health and healthy life expectancy^5–9. The Marmot Review¹⁰ in 2010 examined health inequalities in England. Reporting that health inequalities have social determinants and outlining the importance of health and wellbeing as a societal measure. This was a pivotal report which changed the narrative around determinants of health and established a political urgency to tackle inequalities from a health perspective.

The local picture

Wolverhampton is ranked 24th out of 317 using the indices of deprivation measure¹¹. The city also has high levels of child poverty, 31.6% in 2019 compared to a national average of 19.1%¹¹. People living in deprived areas on average have poorer health and shorter lives¹². See figure 1.

The power of words

Language evolves with time, context, and experience. Dictionaries add thousands of new words every year to keep up with changes in the English language¹⁴.  The new word entries in the Oxford English Dictionary often reflect new things and possibilities in everyday life that were not there before¹⁴. Societal realities may require new word combinations to deliver a message far more powerful than each word in isolation, such as ‘Black Lives Matter’¹⁴. One such powerful word is “equity,” which became part of our professional vocabulary, increasing our understanding of the dynamics of social determinants¹⁴. Inequities in health put groups of people who are already socially disadvantaged at further disadvantage with respect to their health¹⁵.

The discourse around public health is essential in communicating evidence and ensuring public awareness. Understanding which messages promote or reduce people’s awareness of public health campaigns is an important first step in developing effective ways of framing the evidence. When assessing validity, research indicates that people will ask at least one of four questions¹⁶. Is it compatible with my beliefs? do other people believe it? do I see sufficient evidence for it? do I believe it comes from a credible source? In Wolverhampton, smoking is the biggest preventable cause of inequalities and accounts for over half of the difference in risk of premature death between social classes¹¹. However, there are disparities in smoking prevalence within the city.  Potentially indicating the need for different messages for different groups of people within our local population. We must also subsequently consider the medium of communication for different groups.  Even the most carefully crafted public health messages will be ineffective if they do not reach the target audience.

To ensure that all our local population groups have an equal opportunity to be healthy we must use resources in ways that will move toward equalising the health outcomes of our disadvantaged social groups with those of our more advantaged social groups¹⁵.  With this in mind, we must ensure that our health professionals are equipped with the right information, training, and evidence to effectively communicate important public health messages to their local populations.

References

1. National Health Service Act (England and Wales) 1946, National Health Service Act (Scotland) 1947, Health Services (Northern Ireland) Act 1948.
2. 1842 Report on the Sanitary Condition of the Labouring Population of Great Britain – UK Parliament. Accessed May 30, 2022. https://www.parliament.uk/about/living-heritage/transformingsociety/livinglearning/coll-9-health1/health-02/
3. The 1848 Public Health Act – UK Parliament. Accessed May 30, 2022. https://www.parliament.uk/about/living-heritage/transformingsociety/towncountry/towns/tyne-and-wear-case-study/about-the-group/public-administration/the-1848-public-health-act/
4. Veena Raleigh. What Is Happening to Life Expectancy in England?; 2021.
5. Dougall D, Buck D. My Role in Tackling Health Inequalities A Framework for Allied Health Professionals.; 2021. https://www.kingsfund.org.uk/publications/tackling-health-inequalities-framework-allied-health-professionals
6. Public Health England. PHE Strategy 2020-25.; 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/831562/PHE_Strategy_2020-25.pdf
7. Hindle L, Charlesworth L. UK Allied Health Professions Public Health Strategic Framework 2019-2024. Public Heal Engl Allied Heal Prof Fed. Published online 2019. http://www.ahpf.org.uk/files/UK AHP Public Health Strategic Framework 2019-2024.pdf
8. Kaufman W.A. Lunsford T.R. Lunsford B.R. Lance L.L. Comparison of Three Prefabricated Cervical Collars. Published online 1986:1-8. http://www.oandplibrary.org/op/pdf/1985_04_021.pdf%5Cnpapers3://publication/uuid/E9387F9C-C882-4EFB-9391-C1F43F140735
9. House of Commons Health Committee. Public Health Post-2013. Second Report of Session 2016-17.; 2016. https://publications.parliament.uk/pa/cm201617/cmselect/cmhealth/140/140.pdf
10. Marmot M, Bell R. Fair society, healthy lives (Full report). Public Health. 2012;126(SUPPL.1):S4-S10. http://dx.doi.org/10.1016/j.puhe.2012.05.014
11. Relight S. Wolverhampton Health Inequalities Strategy 2021-2023 Supporting Relight and Recovery for the City.; 2021. https://wolverhampton.moderngov.co.uk/mgConvert2PDF.aspx?ID=189660
12. NHS England. Equality and Health Inequalities Pack: NHS Wolverhampton CCG.; 2018.
13. City of Wolverhampton Council. The Vision for Publich Health 2030: Longer, Healthier Lives.; 2018. https://www.wolverhampton.gov.uk/sites/default/files/pdf/The_vision_for_Public_Health_2030.pdf
14. Roe K.M and Mata H.J. The Power of Words. Heal Promot Pract. 2019;20((2)):153-156. doi:10.1177/1524839919827900
15. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Heal. 2003;57(4):254-258. doi:10.1136/JECH.57.4.254
16. Claire Greszczuk. Making Messages Work. The Health Foundation.; 2020. Accessed May 30, 2022. https://www.health.org.uk/what-we-do/a-healthier-uk-population/thinking-differently-about-health/making-messages-work