A public health approach for a wellbeing-centred recovery

How we feel about our health, both mental and physical, is the most important determinant of our subjective wellbeing – that is, how happy we are and how we feel about our lives in general. As such a central tenet of our wellbeing, we often see ‘health and wellbeing’ lumped together. 

Covid-19 presents a very real threat to the wellbeing of people in the UK, in the first instance due to the direct health threat from the virus. 

But the pandemic also demonstrated quite clearly that:

• Health and wellbeing is a shared issue, requiring a society level response, across multiple government agencies to contain the virus. It also requires a collective response to support and protect those most at risk, from protecting livelihoods to managing the education and emotional wellbeing of our children. 
• Underlying wellbeing inequalities in the UK have been exacerbated by the pandemic. While some people and regions have been hit hardest by health impacts, and rising levels of anxiety and depression that compound broader wellbeing impacts, other people have been protected from the worst outcomes, through good underlying health, stable jobs, financial security and supportive relationships.

A wellbeing-centred recovery 

The appropriate Covid-19 response and recovery plan should be both joined-up across government, and well targeted to support those most in need. This is no different to what a wellbeing approach to policy making proposes, even prior to the pandemic. 

‘Public health’ is a term used to describe how societies protect and improve people’s health. It explicitly recognises the value of improving underlying health,  preventing ill health, and improving healthy life expectancy.

It is also about strengthening health and wellbeing systems that intentionally go beyond direct health care interventions. A ‘public health approach’ improves the evidence base to make improvements in the most effective way. As such, it is an approach that:

• recognises the importance of the wider social determinants of physical health and mental wellbeing
• provides us with many of the tools to improve wellbeing
• supports communities to improve both health and wellbeing, and reduce inequalities in a place.

Prof. Kevin Fenton highlights the importance of a “robust, integrated and well-resourced public health national to local system is the foundation for ending the COVID-19 pandemic, tackling its growing health & wellbeing consequences, recovering our economy and addressing pervasive inequalities”.

The role of a public health body in advising and supporting thriving people and communities is as important as ever. Public Health England was set up “to protect and improve the nation’s health and wellbeing, and reduce health inequalities.” Now it is transforming, although the full details of the changes ahead are not yet known. It does so at a time where the focus is on coping with the current health and economic crisis, and the development of technology and tools to manage the outbreak.

Yet it is important to keep sight of another goal: improving underlying health, wellbeing and reducing inequalities, beyond avoiding contagion of the virus.  This means providing conditions for health and wellbeing to thrive. It means supporting people through challenges of deprivation and poor mental health. 

Three ways to strengthen the new public health agency 

Taking a longer-term approach and thinking about investing in public health cannot be achieved without a twin focus on building resilient health improvement and health protection systems. These enable us to weather future storms, for wider community wellbeing, now and in the future.

1. Work across government and sectors. This remit goes beyond a single body tasked with responding to the health impacts of Covid. A wellbeing approach needs the agencies  that replace Public Health England to work explicitly with other government departments, communities, and third sector bodies. 
2. Keep strong links between the organisation and local government. A key part of PHE’s success has been strong links between PHE Centres and local government – and it is really important we don’t lose this. There are legitimate concerns about how a national, centralised organisation can work in a way that delivers nuance, with an understanding of the wider context on the ground. This is where some of the most effective public health work takes place,  
3. Use data and evidence to understand what works, where, how, and for whom. It is also vital that it uses data and evidence to tell us what works; where needs are greatest; and how to highlight the importance of health behaviours and individual circumstances.