When we talked with directors of public health for our research into their experiences of the Covid-19 pandemic, one topic we wanted to hear about was its indirect impacts. From their position in local authorities, directors have a broad view across not just the roll out of health protection measures, but also the wider implications of the pandemic and the response to these for the populations they serve. They raised a breadth of issues with us: in particular, negative impacts on children and young people, growing mental health need, and the wider economic impacts, such as reduced wages for people on furlough, or redundancies in some sectors and localities.
If any good can come out of Covid, it’s shining the light on inequalities and that they are really, really important, the causes of the causes. And that's really good... if you talk about inequalities, it also brings in the economic impact, the issues around skills in our young people, employability, social mobility, as well as the mental and physical impacts of the pandemic as a whole.
Their accounts highlight that many of the challenges people were facing before the pandemic have worsened. Research shows that those with pre-existing mental health issues have experienced worse mental health impacts, that children already living in poverty have fallen further behind, and that the impacts of unemployment have bitten hardest in areas already experiencing significant economic deprivation. While current debates are dominated by the need to manage and reduce NHS waiting lists, these broader factors also have significant consequences for people’s health and wellbeing and need to be addressed as England recovers from the pandemic.
Our work on recovery and resilience after disasters highlights the need for a community-led approach, and directors of public health are well placed to galvanise this in their local area. We heard about new or improved relationships between public health teams and local communities, such as the Covid-19 health champions schemes that bloomed around the country. There’s an opportunity to continue to nurture and develop these relationships alongside designing longer-term plans to address the pandemic’s wider impacts. And directors’ profile within local authorities and their communities has also grown during the pandemic, offering new opportunities to make links across diverse sectors including health care, private businesses and voluntary organisations. These relationships are even more important when issues like unemployment and supporting children’s wellbeing and development stretch far beyond traditional health and care interventions. Directors in our research shared a range of examples of building relationships and collaborating with these different stakeholders during the pandemic, and some were already, or beginning to get, involved in plans around their local economic recovery. It was encouraging to hear these early signs of areas re-emphasising the links between economic recovery and the health of local populations.
But, like all staff working in health and care organisations, directors of public health and their teams have been working at a relentless pace over the past 18 months. Directors were frank with us about the limits of their ability to manage more ‘business-as-usual’ health promotion and prevention work, alongside the ongoing pandemic response – especially after years of cuts to public health budgets. As the public health reforms and development of integrated care systems take shape, there are likely to be even more asks of them. Directors we spoke to were already facing challenges recruiting to their teams, and there’s an urgent need for a plan to grow and strengthen the wider public health workforce. For now, directors face difficult choices about where to spend their political capital and focus their teams’ energy – reinforcing the need for this to be a whole-system effort.
We know that the rhetoric comes quick, but moves on just as quickly. And so the challenge for us, as public health, is how we can keep that stuff going, even when much of the political, and policy, and wider narrative, rhetoric, momentum, moves into the next, other places, or back to the status quo.
Much has been made of the 'spotlight' that Covid-19 has shone on health inequalities. The key question, as articulated by one director, is how to keep the focus on the wider impacts of the pandemic after this attention fades. Supporting workforce capacity is a vital part of this. But our work with them over the last year convinces us that directors of public health have an important role in maintaining this focus in local systems. Through direct leadership and the influencing roles they have developed during the pandemic, they will continue to be a critical part of the response to inequalities facing their local populations, now and into the future.