• Opinion
  • March 15, 2019
  • 6 minutes
  • 1

Public health approaches alone won’t solve today’s health crises

Opinion: Tackling obesity, depression and diabetes takes more than the health sector

A row of treadmills with a solo runner to the right of the frame

This opinion piece was written by Sophie Hawkesworth, Senior Portfolio Developer at the Wellcome Trust. For more like this, see our public health newsfeed. 


Public health has generated huge health gains for society — from vaccination programs to recognising the harms of tobacco smoke — but today’s biggest health problems stem from issues far beyond the traditional remit of the world’s health systems.

The discipline of public health has been defined as “the science and art of preventing disease, prolonging life and promoting human health.” To do that effectively, we need a new approach, which some are calling the “Health of the Public”.

Conditions such as obesity, which is a leading cause of ill health across the globe, have very complex and interconnected causes.

At the individual level, obesity is caused by an imbalance between energy in and energy out. But countless “upstream” factors influence that seemingly simple equation. Asking an individual to change their behaviour against a background environment that is actively promoting the opposite is setting everyone up for failure.

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The upstream drivers of obesity often sit in food, economic, urban and transport systems. The levers for effective change are therefore often outside of the public health sphere. If we want to re-design environments so that they facilitate healthy behaviours, we need to bring in other areas of expertise and empower other professions with an understanding of how their actions impact on health.

Some 10 years ago, the UK government understood these issues and mapped them, but only now are we beginning to see a real drive to consider upstream policy actions when it comes to prevention of disease.

In 2012, the UK Health and Social Care Act placed public health under the power of local authorities, providing an opportunity for much closer alignment between public health teams and other areas of local authority responsibility including urban planning, education and transportation. In response, local governments have adopted a “health in all policies” approach, which systematically and explicitly takes into account the health implications of the decisions they make.

There are many challenges to fulfilling this agenda. But there have been important steps forward too. One aspect of the local food landscape shown to be important for unhealthy diets is the density of fast food outlets. Some councils have taken on this challenge by developing Supplementary Planning Documents that allow health to be considered in planning decisions relating to fast food outlets.

Elsewhere, research has shown that transport policies can be adapted to prioritise health. In Cambridge, a new bus network and cycling lane have increased cycling in the town.

It is naïve to think that local decision-makers will be able to put health at the heart of all decisions, or that infrastructure changes on their own are sufficient to change behaviours that have such complex causes. But being more aware of the health implications of policy decisions outside of the health sector is an important first step.

The major opportunity of the Health of the Public approach is also one of its biggest challenges. Working in multi-disciplinary teams at both the research and policy coal-face brings with it the challenge of understanding and valuing other approaches.

For public health professionals trained in a predominantly biomedical tradition this can mean valuing different types of evidence in addition to the randomised controlled trial. The UK Prevention Research Partnership is one attempt by research funders in the UK to explicitly support Health of the Public research by funding large multi-disciplinary consortia to produce actionable evidence on the prevention of non-communicable diseases.

The complex and diverse health issues that face the world’s population today include rising rates of obesity, diabetes, cancer, dementia and depression. Effective prevention strategies will require actions that cross disciplinary and geographical boundaries and transcend biomedical traditions.

A “health of the public” approach integrates aspects of natural, social and health sciences, alongside the arts and humanities. It’s time to adopt this radical shift and realise the roles we can all play in improving the health of both our own and future generations. — Sophie Hawkesworth

(Picture credit: Pexels)

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