Public Health – the ‘weight’ of a Nation upon its shoulders

We all that know that Public Health England (PHE) is creating some fantastic campaigns around encouraging people to take their health seriously. The Government and its think tanks know that the current evidence pointing toward an obesity epidemic in the UK and the worrying increase in poor mental health could pose a huge risk to an already over-stretched NHS.

That’s not forgetting diabetes, reduced life spans and the array of health conditions and diseases associated with our modern day lifestyles. The question is how can it be slowed down, or even better stopped? Prevention we know is better than the cure.

Good public health is a long term vision and demands sustained investment to produce results that are often not seen until years after the health programme or intervention has took place. This is the very reason cuts to public health budgets are made by Governments who don’t see the value in committing to a long term health strategy.

This short sighted approach to a long term problem will never yield results and inevitably costs more money. A long term approach with sustained investment is the key to producing measurable public health outcomes. Each elected Government acknowledges the problem associated with the Nation’s poor health, spends millions on departmental reshuffles, creates new structures and follows the same public health approach in a rebranded package. Fail.

This is often why such health programmes fail- Governments trying to measure the immeasurable whilst basing success on short terms goals or quick wins that can never change a culture of bad lifestyles developed over decades. It took quite a while for us to become an overweight Nation and thus to reverse this demands the same amount of time and consistency.

Even more importantly learning from past failings and developing new health approaches should be a key Government priority and at the heart of any new National Health Strategy.

Remember, the very nature of health programmes are based on behavioural change, breaking bad habits instilled in families over what is now generations. Investment in breaking this cycle relies on consistent funding by Government, PHE and local delivery partners across the Private, Public and the very important Third Sector. But there are still many questions.

How do you reach this audience of people and support them to achieving their health goals? At one end of the spectrum you have clever advertising campaigns used by corporate business to push their ‘fast food’ ‘high sugar’ products onto consumers. It’s disguised as fun, convenient and is seen by many as a treat, but not a balanced treat a overindulged treat.

Then we have the boring health advice – the fun police knocking at our door – ‘eat 5 a day’, exercise for 30 minutes 5 times a week, all things that take our time. Can we really be bothered?

Can you see where it is going wrong? Where is the fun and convenience? The sexy, sweet and sugar hitting chocolate bar, or that strange looking ginger root that looks almost alien sat on a cold market stall in the middle of town? Then there’s fitting in that 30 minutes of physical activity, but not before picking the children up. Before you know it it’s bed time!

You see where health campaigns are going wrong? They need to be fun, not aimed at already sporty types but involvement that resonates with as many people as possible and fits in with our lifestyles. The Change4life programme is a good example of what can be achieved. Simplicity is key.

Locally there are great health projects going on across our towns and cities. But often these are fragmented across our regions and based upon local decision makers. Best practice isn’t necessarily shared as it should be against a solid National health strategy that Local partners deliver against. This would ensure a more joined up approach.

I have worked in many public health programmes with families on a 1-2-1 basis and often people really want to change and become healthier, but despite all the advice and support out there, they don’t know where to start. If their concern is weight, often they feel too embarrassed to even be seen walking in their area.

Those on low incomes don’t have access to a car and struggle to travel out of their area to access such activities. Fruit and vegetables are more expensive than the equivalent unhealthy snack. It doesn’t appeal, it’s boring and time consuming to adopt this healthier lifestyle.

And so the spiral begins, embarrassment brings about isolation, comfort is sourced in poor food, weight increases and confidence drains away leading to all sorts of mental and physical health conditions. This is by no means a definite pattern, but I have seen this with many different families I have worked with. So what can public health campaigns do better to help break this cycle?

One of the answers lies in the branding of such health programmes. Pinching the best bits from the private Corporations that have done such a good job of influencing people’s choices to consume / purchase their products over the years. Public Health programmes need to wise up. Change4life has led the way with its fun characters, funky colours and its simple messages around eating well and moving more. But more needs to be done.

Physical activity needs to involve strands that are not just sports based, or portraying images of Lycra clad ‘fit’ individuals exercising. Nor are the images of overweight people particularly helpful. The everyday person is the audience. The couple balancing work with childcare responsibilities, the person dealing with the care of elderly parents, the unemployed person struggling with confidence and the isolation it can bring. The ‘real’ wider determinants of health.

The often ‘juggling’ nature of our lives is a major barrier. Often people are well aware of how they can improve their health. I have spoken to many clients who have had a comparable knowledge to me in terms of nutrition, physical activity and how to practice good mental health. Information alone isn’t enough – it’s the practical implementation of it in our lives that matters and more importantly how to sustain it.

So back to the solutions. Habitual physical activity. A simple and clever approach that enables public health campaigns to target the selling points of their advice to people. Wrap health advice around a fun brand, focus on the personal benefits to adopting health advice, and much like ‘selling’ tactics by companies – use a clear call of action to make people act.

Investment in our built environment. We have heard it all before. Make using the stairs funky. This could be multi-coloured stairs, stairs that light up as you tread on them, or have simple messages on each step i.e. 0.5 kcal burned on each step etc. Just ideas. In my current workplace I am launching an innovative project to gauge encouraging staff to use the stairs through a completely different approach to previous ones in a three storey building.

Other solutions could be ‘walking’ meetings at work, better cycle and walk infrastructure for those willing to try active travel, or shopping centres using painted trails in malls detailing distance, or steps taken whilst shopping. Stealth Health is the name of the game here.

What are the benefits to the individual around adopting a healthy lifestyle? Not just the health benefits of changing to a more active lifestyle but the time saved to spend on other past times, or the money saved by dropping a bad habit such as alcohol or smoking. Better sleep, more energy to play with the kids etc.

Advice such as taking the steps instead of the lift, parking in the furthest car parking space away from the supermarket or getting off the bus a stop earlier may sound ridiculous to some, but are the very first steps to changing behaviours. Behaviours shaped by the convenient lifestyle we now lead due to transport choices, the built environment around convenience and the ‘sit down’ technology we have access to.

I think of these small changes in the same context as saving pennies and loose change in a money jar. What is the value of 1 pence on its own? Pretty pointless huh. However a collective amount of 1 pence, 20 pence and 50 pence’s over a year adds up. Exactly the same as those extra steps in the car park, or using the stairs instead of the lift – the long term benefits accumulate. It isn’t just about the gym – that’s further down the line for most of us and is a choice. It isn’t for everyone.

Even better these small changes will become part of peoples thinking and can take place in their day – no extra time required to go to the gym, or join a class just a little alternative thinking and creativity. Health strategy take note.

Ask yourself this – why do most of us brush our teeth? Quite obviously to prevent tooth decay right? Most of us have a routine last thing at night and first thing in the morning. If exercise can achieve the same level of importance in people’s lives as brushing teeth– problem very much solved. The critics will point out that brushing teeth is a couple of minutes as opposed to 30 minutes of exercise and so on. But the principle remains the same. Embed a different thought pattern and exercise could become part of a routine.

Exercise is by no means the answer to all the Nation’s problems, but it provides a foundation. Once people see the visible benefits of their increased physical activity, they take more note of how they are feeding themselves. Suddenly new thoughts on what nutrition or food could improve their 30 minutes of walking or using the stairs start to materialise. Could I improve they ask – suddenly it becomes quite addictive.

Then comes the confidence, feeling more energetic, that lower dress or waist size or the compliments from friends and family. More importantly this healthy lifestyle is being adopted by the individual, not the doctor dictating advice but their own goals whatever that may be. That feeling of self – worth and feeling good helps negate negative thought patterns associated with low level anxiety or depression. Big societal benefits.

So indeed the weight of the Nation on the NHS, PHE and Government could be relieved by key figures making some smart decisions on how to approach a major National challenge in terms of our citizen’s health. Decisions based on a long term strategy, focusing on realistic changes that acknowledge peoples busy lives.

A Nationwide commitment to deliver programmes based on learning and an evolving programme that resonate with the everyday person. Programmes that learn from the corporate giants and promote health brands based on the same elements. Fight fire with fire.

So it could be with a National strategy and joined up approach light work could be made of a heavy burden.


Andrew Picken

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