POLICY IN THEORY AND PRACTICE

Policy in Theory and Practice

Policy in Theory and Practice

This is agreat a honour for me to be here with all prestijous personalities my senior managers and leaders of our organisation. Before I start my speech I would like to thank them and thanks again for their presence.

In the UK? the Labour Government from 1997 signalled intent to take a broad approach to public health (PH) policy. Across the UK? the publication of white papers ([Department of Health? 1999a] and [The Scottish Office? 1999]) marked a departure from PH policy generated by previous Conservative administrations where discussions of health inequalities were notoriously stifled (Baggott? 2000). In particular? the documents explicitly accepted the impact of structural determinants of health? and pledged to target inequalities. Furthermore? reviews of the PH function ([Department of Health? 2001] and [The Scottish Executive? 1999]) advocated PH as the responsibility of a range of multi-disciplinary players operating in different organisational contexts.

In this paper? I consider how changing PH policy was operationalised and implemented in the context of one health demonstration project - Starting Well - which aimed to use health visitors (HVs)? working as PH practitioners with families living in disadvantaged areas? as a route to improved child health. First? I briefly describe the policy context for PH work within the UK since 1997 and consider the implications for HVs. I then report on a process evaluation of Starting Well aimed at identifying the challenges of implementing PH policy.

The policy context for public health practice

Since coming to power in 1997? the Labour government was keen to be seen to take PH seriously and? in the early years? their acceptance of the impact of relative poverty on health was one means of demonstrating clear blue water between the government and its main opposition within the UK (although rhetorically this water has been muddied with the current Conservative leader's pronouncements on the relevance of relative poverty - Cameron? 2006). Across government? policies were established to tackle the determinants of ill health and the inequalities therein (Asthana & Halliday? 2006).

Within the National Health Service (NHS)? the broad boundaries of PH were emphasised. Reviews of the public health function named health improvement (including reducing health inequalities) as one of three key domains ([Department of Health? 2001] and [The Scottish Executive? 1999]). It is within this domain that Hunter? Marks? and Smith (2007) argue the debate over the nature of PH has been most heated.

In parallel? the PH workforce has been expanded beyond the NHS to include: specialists working strategically to manage change; practitioners delivering services directly related to health; and generalists - those working within the public? community and voluntary sectors whose work impinges on health.

At the practitioner level? policies have emerged to inform the PH remit of community nursing staff (for example? [Department of Health? 1999b] and [The Scottish Executive? 2001]). These encourage population level health improvement work and community development practice.

In summary? PH has climbed high on the political agenda and policy space has been made for ...