Public health priorities in a pandemic Q&A with Christina Marriott

How has the pandemic affected your new role and the day-to-day work of RSPH? 

The COVID-19 pandemic has impacted every plan I had and it has dramatically changed the context we work in. The pandemic is what all of our stakeholders are working on, of course, and I’ve put to one side the kind of stakeholder engagement I was planning. Leading an organisation where I haven’t met most of the people is incredibly strange for me, but the team have been fantastic and they’ve moved to working remotely really well.

Everything RSPH does has been impacted. We are a regulated qualifications awarding organisation for public health and many training centres we work with closed during lockdown. We had to rapidly respond, bringing in e-assessments. We’ve also moved to running webinars from our previous programme of conferences.

The context we’re working in is not just the pandemic, but what it has led to in terms of public perceptions and public policy. We’ve just seen the government’s decision to abolish Public Health England. It is clear we are going to have to advocate very strongly for the health improvement and health promotion aspects of public health. 

We have had real public and media recognition of the social determinants of health and how they relate to COVID-19. For the first time, we saw a national health inequalities conversation move beyond individual behaviour, and the public understood the impact of things like occupational risk and overcrowded housing. But in the last few weeks, that perception has weakened. Local lockdowns were always going to be more likely in more deprived areas, often in ethnically diverse areas. I’m already hearing punitive messages coming through and, as a sector, we need to think fairly rapidly about how we challenge that.

Before coming to RSPH, you were Chief Executive at Revolving Doors Agency, which aims to break the cycle of crisis and crime. What learning for public health have you brought with you from that experience?

I had previously worked in health inequalities in academia and the NHS and I brought the model of primary, secondary and tertiary prevention to Revolving Doors. That allowed us to redefine our purpose and it led us to a strategy of preventing young adults from being drawn into the revolving door of crisis and crime. 

I took several key lessons from my time there. The first is that policy and practice is best when it’s co-designed with the people it is for. The second is the importance of thinking about lives as whole lives and the cumulative effects of inequalities and disadvantage. And thirdly, in thinking about the life course, we have to expect life to be messy. That means we need to deal with co-morbidity and co-occurring public health challenges. Public health is in danger of falling into the same trap that health care services fall into, which is that of single morbidity services. 

What are your priorities for RSPH over the coming year?

My immediate priority is a strategic review. We’ve commissioned stakeholder research to inform it, and we’ll be working with our members and the wider public health sector to develop a strategy that makes our priorities clear. 

Given the abolition of Public Health England, we urgently need to have conversations about where health promotion, health improvement and health inequalities fit in the new system.

Our existing work continues. We lead the Gambling Health Alliance, which has been really important under COVID, looking at the extra challenges for individuals under lockdown. We have our work on vaccinations and, again, public attitude to vaccinations feels highly relevant. And our third priority in terms of policy work is supporting and challenging the national obesity strategy, recognising that this is not about individual behaviour change.

We also want to think about how we can support place-based public health. In areas that are really challenged, can we support new or different workforces around health, public health or social care, and what effect does that education and employment have on the place we’re working in? 

Different organisations and sectors have worked together in response to the pandemic. Do you think collaborative action will play a greater role in efforts to address health inequalities?

Most people who work in health inequalities are collaborative, because if you understand the wider determinants, you know you have to be collaborative. At RSPH, our challenge is to work out where we fit, where we collaborate, and where we work in partnership with communities, the statutory, academic and voluntary sectors, around health inequalities. This includes being part of developing the Collaboration for Wellbeing and Health, led by the Health Foundation, to tackle health inequalities and improve health with others across sectors. It’s important to me that we’re clear about what we bring – our strong and vibrant membership and our independence. We should leverage that power. 

I also think we have to acknowledge the role of the Black Lives Matter campaign. People now have a better understanding of wider institutional and structural inequalities. Something about Black Lives Matter has driven a humility into some organisations, to think about their forms of collaboration.

If you could take one key learning and one key positive from the public health community’s response to COVID-19, what would these be?

My key positive is the public health workforce and the phenomenal work they have delivered. My key learning would probably also be about public health practitioners, because I think we need to support them. 

They need a settlement in the spending review that is medium or long-term and most importantly is sufficient. Just a fortnight before the new financial year, Directors of Public Health still hadn’t had their budgets settled. To successfully fight a pandemic, public health practitioners need clarity over their supporting budget and resources. 

Public health has been underfunded and underacknowledged for too long and this needs to change. 
 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.