Here’s to a healthy future: Q&A with Shirley Cramer

At the end of October we announced the winner of our dystopian short story competition Health: From here to where?, which we ran in partnership with the Royal Society for Public Health (RSPH). The competition challenged writers to create a dystopian future in which society had failed to act on the social and commercial determinants of health.

We spoke to Chief Executive of the RSPH, Shirley Cramer, about the competition and how we can take action to avoid the sort of future the winning story describes.

Where did the idea for the story competition come from and why did you decide the stories should be aimed at young people?

The RSPH has long championed the link between arts and health, both in influencing people’s views and in actually delivering services to improve health. We thought a writing competition would shine a light on the lack of choice and control young people face around the factors that shape their health and wellbeing. In order to prevent ill health, we really need to be focusing on the next generation. We need to inspire the leaders of tomorrow to change things.

We were really pleased with the competition, and we think the winning story will make a great teaching aid, and really help young people engage with some important issues, so we’re also now working with the PHSE Association, the national body for personal, social, health and economic (PSHE) education, to develop lesson plans for UK secondary schools.

Tim Byrne’s winning story, What you want, portrays a fairly bleak outlook for the future. What do you think needs to change at a system level in order to avoid fiction becoming reality?

We need to make a cultural shift from thinking about the NHS as a health service, when it is in fact our illness service. We can see just from the recent Budget that NHS spending is all focused on short term issues and not about prevention. Instead, we need to think about health and wellbeing across the life course and plan what kind of society we’d like to see in 10 or 20 years’ time. This means tackling the social determinants of health, and creating healthy environments to live and work in.

This approach underpins a lot of the work we do because, as you know, the poorer and more disadvantaged you are, the more likely you are to die younger and have protracted ill health in later life. So, this is clearly a social justice issue, and we really need to level the playing field.

In an ideal world what would the future public health landscape look like?

There’d be a lot more government support around legislation, the kind we’re now seeing in Scotland around minimum unit pricing on alcohol. In England, we could also be learning from Wales and their Future Generations Bill, which has made sure that all Welsh legislation has to consider its impact on the health and wellbeing of future generations. This helps policymakers to think long-term, and consider health in all departments – transport, education etc.

Nationally we could also do more to help people make better decisions by providing the right kind of information. Using activity equivalents labelling on high calorie food for example, so somebody can clearly see that it will take them 19 minutes to walk off that bag of crisps, and can make an informed choice.

We’d also like local authorities to have real control over the local environment, so that they can promote healthy lives much more, through influencing early years, nursery school, family support… all of those areas are vastly important.

What specific things are you working on that will contribute to a healthier future population?

We’re currently working on something called the Wider Workforce for the Public’s Health. So instead of thinking about public health as a department, we think of the public’s health –  something that is everybody’s business. We think we should be improving the capacity and capability of the wider workforce, but particularly people working in the public sector, to support prevention and wellbeing. The work’s already been picked up really well by the fire service with their safe and well checks, and now the police, ambulance services, allied health professionals, pharmacy are all looking at how they could do more.

There are up to 15 million people already out there working, who if given permission and training, could be doing a lot more around prevention as part of their jobs. We all know there’s no spare money at the moment, so in terms of austerity Britain this is a great model.

We’ll also be running our Health on the High Street campaign again next year, where we look at high streets across Britain to figure out which are the healthiest and unhealthiest. Last time it really highlighted how the poorest people find themselves living near the worst high streets. This time we hope to look in a bit more detail at what makes a really good, healthy environment.