Public health challenges are often behavioural and sociological
Many public health challenges – including preventable diseases, smoking, and mental ill-health – are more often behavioural and sociological than medical in nature. The reason behind this is that they often arise from behaviours that are underpinned by social and structural determinants.
For example, obesity and Type 2 diabetes often arise as a result of the poor diets that we have, which are influenced by the obesogenic environment that we live in. Although these behavioural and social factors are often the leading influences on our health outcomes, they attract only a fraction of the attention or resource that goes into clinical treatment.
Public health in action entails preventing poor health and wellbeing, alongside improving and protecting the health of the public. Prevention is essential in tackling the prevalence of long-term chronic conditions, which now account for 70% of total health and social care spending in England, and preventative interventions that encourage and enable positive behaviour change are an important component in this. For example, up to 80% of premature heart attacks and strokes, 75% of Type 2 diabetes, and 40% of cancers can be avoided through changing health-related behaviours.
In order to effectively prevent poor health, we need an approach that takes account of the whole person, social context, and wider aspects such as education, employment, social norms, and the built and online environment. This would be a comprehensive systems approach that draws on multiple behavioural and social sciences, including psychology, behavioural economics, sociology and anthropology.
As Professor Jim McManus, Director of Public Health for Hertfordshire County Council, said at the recent PHE Conference, “public health is a mind-set” and “you can’t do public health without having a range of different perspectives.”
Behavioural and social sciences in public health – a new strategy
PHE’s Behavioural Insights (PHEBI) team has led the collaborative development of a behavioural and social sciences strategy in partnership with the Association of Directors of Public Health, Faculty of Public Health, Behavioural Science and Public Health Network, the Local Government Association and many others.
Improving people’s health: Applying behavioural and social sciences to improve population health and wellbeing in England is the first strategy of its kind. It aims to better enable the public health system to maximise the contribution of behavioural and social sciences to improving and protecting the public’s health and wellbeing, improve value to the public purse, and reduce health inequalities. As a high-level guide, it provides a framework and brings together a suite of relevant resources from a range of disciplines in one place.
Before the development of this strategy, there was a strategic demand for a systems leadership approach to embedding the behavioural and social sciences in public health.
To initiate this process, a broad stakeholder engagement event took place in early 2017, at which partners emphasised the need to draw on a number of social sciences to deliver health improvements. It was agreed that this initiative should take the form of a collaboration amongst academics, researchers, policy makers, and practitioners. That agreed initiative has come to fruition with this strategy.
A transdisciplinary approach to public health
There is a fundamental problem around addressing long-term health outcomes in complex and adaptive systems in England. The issue is that the evidence for population-level action to deliver long-term population health benefit, as well as the support to produce such evidence, is limited.
In order to produce this evidence and translate it into improvement, the public health system needs to further develop and engage behavioural and social skills, and go beyond the traditional biomedical approach to tackle social, economic, political and cultural phenomena.
We need to take a transdisciplinary approach to public health, where we focus on issues rather than disciplines, and people with diverse disciplinary backgrounds come together to work on public health problems.
In recent years, the contributions of behavioural and social sciences to improving the health of the public have gained more prominence. However, they are still underutilised in practice and insufficiently integrated when applied to public health, and the workforce that is qualified to provide this behavioural and social science input remains small.
The strategy marks the start of a process, not the conclusion. PHE joins all stakeholders in a commitment to use this strategy to encourage further collaboration and put the transdisciplinary approach into action across the public health system.
The next steps include:
- The Behavioural Science and Public Health Network and PHE establishing a community of practice to spread and embed the strategy. This will include a panel of behavioural and social science experts who are willing to provide timely advice to public health policy-makers and practitioners, and a live online list of behavioural and social science models of practice and case studies.
- Health Education England (HEE) building capability with the development of their Behaviour Change Framework and a supporting toolkit for workforce development.
- HEE and PHE, in partnership with Solihull, Croydon and Hertfordshire Councils, and Warwick and Coventry Universities, are holding a Free Behavioural Science Conference on 10th October 2018, which will support the launch and implementation of the national behavioural and social science strategy across the Midlands and East.
- Local Government Association, Association of Directors of Public Health, Behavioural Science and Public Health Network, and PHE conducting an initial survey of the behavioural and social sciences in practice across local government so that we have a baseline from which we can measure increases in behavioural and social science activities in public health over time.