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Harry Evans: public health must focus on the whole person, not single risk factors

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Since responsibility for many public health services was transferred to local government in 2013, there has been a welcome focus on the role councils can play in promoting healthy lifestyles.

Despite budget cuts in recent years, councils across the country have done great work developing services to support people to make healthy choices, whether that is stopping smoking, eating more healthily, drinking less, or exercising more.

But these services tend to address these risk factors in isolation when in reality – as we showed in ground-breaking research published in 2012 – they tend to occur together. In other words, if you smoke, then you’re also quite likely to drink too much, have an unhealthy diet or be physically inactive.

So if these risk factors tend to group together, then it stands to reason that services should be able to address them together. It is about which intervention is best-placed to help improve that person’s health at that time.

This is starting to happen. Our new report on tackling multiple unhealthy risk factors shows that across England, we are increasingly seeing integrated health and wellbeing services. Livewell Dorset, for example, works with people to identify barriers to healthy choices, while the Well-being Service in Blackburn with Darwen has a focus on the wider context of people’s lives and how this might impact people’s lifestyle choices in the round.

These integrated services take different forms. Some are single services that support people to address more than one risk factor, while others comprise specialist services working together in an integrated way. Some focus on the wider determinants of health – linking up with housing support, for example – while others have a stronger focus on psychological support.

But they all share a common characteristic – they look at the needs of the whole person rather than just focusing on a single risk factor.

They also share an understanding that risk factors do not respect organisational boundaries, and so they must capitalise on partnerships between local government and the NHS.

The areas we talked to for our report are all exciting examples of innovation focused on making a real difference to people’s lives, and they should be celebrated. But their challenge now is to make sure they rigorously evaluate what they are doing. This is especially important because the evidence on supporting people with multiple risk factors remains weak and so these areas are effectively real-world laboratories.

The challenge for other areas is to make sure they are open to learning from what the integrated health and wellbeing services are doing. While each area has its own population with its own unique needs, everywhere will be able to take lessons that can help them develop their own services to try to make sure they can best support their own community stay healthier for longer.

Harry Evans, researcher, The King’s Fund

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