What is public health anyway?

Physiotherapy IS Public Health

I’m a physio and  several years ago I went on a public health (PH) training course, the public health professional on the registration desk said "But you're a physio.....why are you here?"  Whilst we have made some progress in raising our profile in this area we are a long way from being recognised as an integral part of the PH workforce.  This seems strange to me when so much of what we do is about keeping people well, keeping people in work and maximising independence and quality of life.  Surely these are key PH outcomes too?

Last week I attended a public health conference for nurses and AHPs and one of the key things that I took away from it was the realisation that public health is not someone else’s job, if you work in healthcare then public health is part of your job.  Yes, there are people who work exclusively in PH, but PH approaches will only work if they are embedded broadly in a way that can influence the health of populations rather than just individuals. 

The new "Framework for Personalised Care and Population Health" has been developed to help maximise the impact of AHPs (and nurses, midwives and health visitors) in improving health outcomes and reducing health inequalities.  The framework identifies 6 key areas of population health activity, one thing that struck me was just how much we do as physios in these areas already.

 

          Supporting Health, Wellbeing & Independence

       Physios eat your hearts out, this is our bread & butter, show me a physio that isn’t doing this every day!

 

     Healthcare Public Health

This term basically means delivering PH interventions to those who are already in the healthcare system (sometimes called secondary health promotion).  This is something we do a huge amount of, think physio for people with LTCs, people with co-morbidities etc..  Think about our skills in treating a presenting complaint but also advising, managing  & preventing secondary issues.  This is a key area for physios and one that we are firmly recognised as being key players in. 

 

Health Protection

This isn’t traditionally thought of as an area that physios would have a major role in, it usually relates to pre-emptive measures put in place to avoid/limit future problems.  This might include breast screening for women over 50 or immunisations for children.  We do have a role in health protection though, we use valid, reliable measurement tools to predict those at risk of falling and we target treatment based on the results.  We are being encouraged to routinely screen older adults for fraility for example, by using tools such as the 4 meter walk test.  At present we screen as & when we see fit rather than having mass screening programmes.  One screening programme that I would really like to see introduced is routine screening of physical activity levels as part of every Physiotherapy assessment, it would be lovely to think that this might happen in the next 10 years.

 

Making Every Contact Count

This is an important one for us; MECC is an initiative that encourages us to use every healthcare contact for maximum benefit.  This means looking at our existing practice and thinking about how we can integrate key health messages.  The big 4 health messages are about alcohol, tobacco, nutrition and physical activity.  I’d be pretty confident that most physios regularly advise about physical activity but how many of us are confident broaching weight issues, giving nutritional advice or advising on alcohol and tobacco?  Whilst we don’t need in-depth knowledge on these issues we do need some knowledge and we need to know where to send people for more information.  I think this is a real area of potential development for our profession.  And before I jump down off the old soap box I’ll briefly add in that the whole Physical Activity agenda offers massive opportunities for us, we are so well equipped to lead on this (more to come on this too)!

 

Improving the wider determinants of health

      There are still huge inequalities in healthcare and this is something that we all have to work hard to address, it is simply not fair that someone should have poorer health and poorer outcomes based on their postcode.  It surprises me that this doesn't feature more in the design of our services, it's relatively easy to get affluent people better so we should really be targeting hard to reach/hard to treat populations.  I did a systematic review a while ago to see whether deprivation, or socioeconomic status, influenced outcomes in musculoskeletal physio.  It did, unsurprisingly, but what was surprising was the fact that I only found 3 articles to include in the review.  Deprivation can be ranked based on postcode so this data will be collected routinely but it is almost never used, even for secondary analysis in physiotherapy research.

 

     Lifecourse

 

       We do work with individuals over their lifecourse and we have specialist physios for every stage.  With the changing demographic of the UK population I think we will see Physiotherapy for older adults become less of a speciality and more the main stay of what most physios do.  When I say "less of a speciality" I'm not suggesting deskilling, I'm suggesting that more of us will need the specialist skills required for working with older people.  So much amazing PH work in falling for example, this is an area that we are recognised as leaders in, it would be great to think we can emulate this in other areas too.

I think it's fair to say that as a profession we have been slow to engage with PH agendas, I think this might be because there has been a feeling that it’s someone else's job and also that it is additional work that an already stretched physio workforce will be required to do.  I feel pretty confident that neither of these statements is correct, PH principles are already deeply embedded within physiotherapy practice….we just haven’t realised that what we are doing is "public health".

There are very strong messages coming through that we need to engage with PH agendas and I think the first step in this might be thinking about our own practice & identifying the bits of PH work that we are already doing….step two is shouting about them!