1. www.hertsdirect.org
Population Health is everyone’s
business
better outcomes for Communities and Workforces
Jim McManus, CPsychol, CSci, AFBPsS,
FFPH, FRSPH, MCIPD, FCIEH
Director of Public Health, Hertfordshire County
Council
Representing the Association of Directors of
Public Health

2. www.hertsdirect.org
Coverage
• Public health - one year on
– From closing brothels to changing places
• Shared ownership of community outcomes
• Applying public health skills across local
government
• Common ground between public health and
people managers for the future?
• Workforce wellbeing - keeping people healthy
and resilient

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Public Health – one year on
Opportunity
•The Big epidemiological
challenges ahead
•PH Skillsets adding value
•Mainstreaming public
health work
Challenge
•workforce challenges
– Leadership
– Market
– Person-Organisation Fit
– Redesigning roles and
jobs
•Service challenges

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Crucial Situational Factors
• Leadership doesn’t happen in isolation
• Multiple environment and collaborative (Getha-
Taylor,2013)
The factors
determining
which style you
need for which
Public Health
challenge
The Personality of the Leader
The issue itself
Pandemic or health improvement?
Organizational
Culture
Strategic and
Partnership
Environments
Team and
Organization

5. www.hertsdirect.org
Crucial Situational Factors
• Leadership doesn’t happen in isolation
• Multiple environment and collaborative (Getha-
Taylor,2013)
The factors
determining
which style you
need for which
Public Health
challenge
The Personality of the Leader
The issue itself
Pandemic or health improvement?
Organizational
Culture
Strategic and
Partnership
Environments
Team and
Organization

6. www.hertsdirect.org
Crucial Situational Factors
• Leadership doesn’t happen in isolation
• Multiple environment and collaborative (Getha-
Taylor,2013)
The factors
determining
which style you
need for which
Public Health
challenge
The Personality of the Leader
The issue itself
Pandemic or health improvement?
Organizational
Culture
Strategic and
Partnership
Environments
Team and
Organization

7. www.hertsdirect.org
What does that mean for Public Health?
The variety of challenges
1. The Strategic Challenge across our agency and geography
2. The distributed Challenge across agencies and
stakeholders
3. The Professional challenge across domains of PH practice
4. The practice challenge to remain competent and practice
well
5. The protective challenge of planning and responding to
health protection incidents
6. The managerial challenge of tasks and resources
7. The personal challenge of resilience during this
Agile Leadership Styles!
See for example Lutz Allan et al, 2013

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Work still to do – finding the new sewage?
What is high impact public health today?
• Transformation not transition
• Multi-Dimensional public health
– Phasing across the lifecourse
– Layering across the real world
• Colonising local government
• Using PH as a babel fish
• New applications for public health

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The Challenges
• Misery and Pain due to avoidable disease and
poor resilience/happiness
• What kills most people early is diseases of
lifestyle
• Seeing the wood for the trees in the midst of
clinical detail

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The Challenges – Living in a System

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The challenges - busting the economy

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The Challenges - the Lifecourse
• Phasing across the lifecourse and layering
across time Working age
Accumulation
Of risk in
Late working
age
Good early
Years
outcomes
For lifetime
Mental
health

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Core Public Health Skill Sets – ppma
can help unlock this
• The population mindset
• Problem Definition
• Needs Assessment
• Evidence of What Works
• Generation of Outcomes and Priorities
• Generation of Interventions
• Testing and refining

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Health
Improvement
Health
Protection
Commissioning priorities,
Evidence, acting when
evidence is silent, making
it work, supporting
implementation
Protecting people from threats
and hazards
Long term, medium term,
short term impacts
Take any example and use the three domains model
Service
Improvement
& Quality

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Applications
• Housing
• Leisure
• Social Care
• Workforce
• Behaviour Change – from driving behaviour to
council tax payments and channel shift

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Health
Improvement
Health
Protection
Commissioning
priorities, Evidence,
acting when evidence is
silent, making it work,
supporting
implementation
Protecting the workforce from
hazards and threats
Long term, medium term,
short term impacts
Applications in H R Terms – Phasing and
Layering
Service
Quality/
Improvem
ent

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Common ground – our workforce health
• Increasing non-communicable disease
– Smoking, obesity
• Increasing mental ill health
• Increasing sickness absence
• Increasing loss to business productivity and
performance from sick pay
• Avoidable cost of managing and replacing sick
and absent staff

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Early and avoidable deaths
• Most of them preventable
• Problems start in working age life with sickness absence
• Common causes: inactivity, MSK problems, diet,
alcohol, smoking
• Significant avoidable stress and mental health costs
• The human side of resource depreciation because it
isn’t looked after
• WE REALLY MUST DO SOMETHING! BUT WHAT?

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Mental Health
• Biggest single cause of sickness absence
• Mostly avoidable or remediable at early stages
• Significant cause of ET claims and workplace
disputes
• Area most employers feel least prepared for
• 1 in 4 of population have in lifetime
• 1 in 3 of workforce report sickness absence
around it
• Behavioural sciences relatively under-utilised

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What is the root issue?
• There is a flow from low risk to high risk to
disease for the working age population
• This leads to:
• Diseases of lifestyle
• More risk, more absence
• Compound risk, compound absence
• Low productivity

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What does this mean for you as
employers?
• Chronic disease related deaths account for 56% of all deaths in the
working-age population in the world (World Health Organization).
• High prevalence of major modifiable health risks contributes to the
epidemic of chronic disease.
– Elevated BMI (BMI ≥25kg/m2
) Obesity (BMI ≥ 30 kg/m2
)
– Inactivity Smoking
– Stress Elevated blood pressure
– Elevated cholesterol High blood sugar
– Alcohol
• Places an increasing burden on employers: decreased productivity,
increased absenteeism, increased health and worker’s
compensation claims.

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Productivity Decreases with Number of Health Risks
Excess
Productivity
Loss
Productivity
Loss (%)
Base Cost
Number of Health Risks
(Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))

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Absenteeism Increases with Number of Health Risks
Number of Health Risks
(Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))
Base work
loss days/yr
Excess
Work Loss
days/yr
work loss
days/yr

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Root causes
One of the root causes of unsustainable
increases in costs is natural flow of individuals
from
low risk → high risk →disease →higher
employer costs
natural flow estimated at 2% - 4% per year.
• (Edington et al, 2009).

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What can be done
• An effective Workplace Wellness strategy is to
stop migration of people to higher risk and keep
low risk people at low risk.
•
• Employers costs go up as people age, regardless of their
health risk status and as health risk status gets worse, costs
go up regardless of age.

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Three Examples

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Our Offer
1. Workplace health champions (North Herts College)
2. Mental Health First Aid (Bourne Leisure)
3. Health Checks and Mini-MOTs (HCC)
4. Physical Activity (ServiceLine)
5. Weight Management
6. Stop Smoking
7. Alcohol and Drugs
8. Active Travel

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A common Agenda
1. A Healthy, resilient population is a workforce
sustainability outcome and a public health
outcome
2. The Psychological Contract and Happiness
3. Public Health skills embedding across our
agencies can help us understand new
challenges
4. Public Health being effective in new world is a
key shared outcome for us

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Thank you!
Jim.McManus@hertfordshire.gov.uk
www.adph.org.uk