Every nurse has the capacity to directly and indirectly influence the health and wellbeing of people, communities and populations. Public health is the business of every nurse, all nurses are public health nurses, ensuring that every contact counts. Public health impacts us all, as service users or health and social care providers. When provided with the right opportunities and appropriate support people can, and often wish to, take responsibility for their own health.
The practice of public health is defined as:
‘The science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society.’
This definition resonates well with so many principles that make up our own Code (Nursing and Midwifery Council, 2018).
Public health practice is population-based, emphasising collective responsibility for health, health protection and disease prevention. It recognises the role that the state has to play as it is linked to a concern for the underlying socio-economic and wider determinants of health, as well as disease and the absolute need to ensure that people and communities can access public health interventions. Partnership working between all those who contribute to the health of the population is vital.
Public health is concerned with creating the conditions in which people can live a healthy life for as long as possible. It is about accepting that economic prosperity, a good start in life, quality education, good work, good and affordable housing and strong, supportive relationships (at various levels) all have a very important part to play.
Good public health that is responsive to the needs of diverse populations requires a system-wide commitment to improve quality in all areas. The health and care system cannot deliver an improvement in health outcomes on its own, this has to be done in partnership with others, otherwise it is destined to become nothing more than empty Whitehall rhetoric.
There have been several success stories in public health over the past 10 years, for example, smoking prevalence is now at an all-time low, conception rates in teens have been reduced by over half since 2007, there have been improvements in health behaviours in younger people and, since 2015, we have seen a 31% reduction in new HIV infections. There are, however, still a number of long-term challenges. These include a population that is ageing; an increase in complex long-term conditions; overweight or obesity in two-thirds of UK adults; and increases in health inequalities between people living in poor and affluent areas.
Further challenges include the difficult decisions that have to be made about the prioritisation of public health and preventive interventions and where the funds are to come from to support these interventions. Workforce challenges in the health and care system are a reality that will seriously impact on key public health functions and their successes.
The framework produced by the Public Health System Group for England (2019) highlights the role we all have to play and the collective effort in shaping and delivering policies and interventions that aim to protect and improve health outcomes and to reduce health inequalities. Key stakeholders include national and local government, our NHS, the voluntary and community sector, and industry as well as the wider public sector.
Public health can no longer be seen as the domain of a few professionals—it has now become central to all nursing practice. We are ideally placed to affect health outcomes and this needs more recognition if we are indeed to protect, promote and improve the nation's health and wellbeing.