|Keith Reid, chair of the South Island Public Health Partnership, and Clinical Leader, Public Health South.|
Across the South Island, there is much talk and activity aimed at reducing the burden on our hospital services – providing ‘the right care in the right place at the right time’ or ‘care closer to home’. Comparatively, there is little talk about addressing the root cause of this demand, by making our population healthier. But, there is important activity going on. It’s only by generating health in our people where we live, learn, work and play, that we will tackle the long-term demand on health care services. So, why is there less of a focus on this aspect of demand reduction, than on health care services?
A number of studies demonstrate that the quality of health care services and ease of access to them accounts for only about 10 percent of the overall ‘health’ of a community. If we examine variance in health status between communities, most of that variance is determined neither by the quality and accessibility of clinical care, nor by the genomic characteristics of the population – each of which accounts for only 10 percent of the variance. Most of the variance in health status is accounted for by factors not under the direct control of the health care sector. About 30 percent is determined by individual behaviour (i.e. physical activity, diet, smoking) and about 40 percent arises from social and economic factors, such as community cohesion, income inequality and meaningful employment. It’s vital that we look outside the health care sector for solutions if we’re serious about health. In public health, we interpret such studies as demonstrating that effective action on health needs to be focused on building healthy communities, which is sometimes seen as denigrating or devaluing the work of clinicians. We are not advocating for an ‘either/or’ approach, but for a ‘both/and’ way of working. Both public health approaches and health care are important in maximising human capital: the first by creating the conditions for people to flourish and the second to mitigate the effects of illness, disease or injury.
Concepts of return on investment are important here. The benefit of ‘public health’ approaches is not always directly attributable at an individual level. There remains the misconception that return on investment from public health initiatives only occurs over several years, decades or generations. However, there is a growing body of evidence that public health interventions not only represent an excellent return on financial investment, but also deliver measurable results over comparably short periods: months to years. That’s why the South Island Public Health Partnership (SIPHP) is working together with partners from other sectors across the South Island to establish a Public Health Alliance. This is a project the SIPHP began work on last year and has now expanded to include members of other sectors, as we seek to define a common purpose, identify shared priorities and map out new or expanded ways of working.
Although this initiative began within the ‘health’ sector, the Public Health Alliance is being created jointly by the sectors it contains. Health will be one among many. The expectation is that work undertaken on behalf of the Public Health Alliance might include cross-sector work initiated by health, with a direct payback for health care budgets and work initiated by other sectors where health is both a contributor and a beneficiary of the activities. We hope that in time it will also be an overarching body for work undertaken outside the health care sector, which will nonetheless also provide a very direct benefit through its contributions to well-nourished, well-housed, well-educated, active and engaged communities across the South Island. We look forward to supporting the work of our clinical colleagues through this initiative. But mostly, we look forward to helping the whole population live longer, happier and more fulfilled lives, wherever they work, learn or play.
History: The South Island Public Health Partnership comprises the clinical leaders and managers from the three Public Health Units of the South Island and Maori public health specialist, and the Ministry of Health. The partnership pre-dates the South Island Alliance arrangements, but now works within the South Island Alliance framework.