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ICS jobs ‘devaluing public health’, say directors
Integrated care system population health lead roles are causing “inefficient working” and sometimes “poorer care and outcomes”, public health directors have claimed.
A King’s Fund report, shared with HSJ and published Tuesday, found ongoing “tensions and a lack of engagement” in some areas between integrated care board population health staff and public health teams in local councils. Public health directors shared “major concerns” about ICS population health posts, it said.
Since their establishment in 2022, ICBs have introduced numerous population health leader roles, often known as population health directors, which rarely existed in predecessor clinical commissioning groups.
Directors of public health are almost always employed by local councils, which have legal public health duties.
The King’s Fund report, which is supported by the Health Foundation, says “for the most part, DPHs’ relationships with their population health colleagues were reported as being relatively positive”, but goes on to list several pointed concerns.
According to some public health leaders, the new, often better-paid population health posts can duplicate work of their teams and create a “confusion about responsibilities”, which leads to “inefficient working” and “poorer care and outcomes” in the worst case scenario.
Some even saw the new roles as a “drain on the public health profession”, with “highly qualified people taking knowledge away from where it was perceived to be most needed”.
Some public health directors were concerned the new roles often did not require formal public health training or accreditation, meaning the individuals are not as “effective and competent” as they should be, particularly in areas like infectious disease.
The report states: “[Some DPHs] thought that the language of population health can be perceived to ‘mask’, misinterpret the role of, or devalue, the skills of public health professionals.
“Other areas of worry related to relative pay (between the NHS and population health roles, and local government and public health roles), the status, and the competencies of those in population health roles, without formal public health training or accreditation.”
One public health leader cited said: “A whole load of people who used to be directors of public health have gone on to be population health specialists… there’s less stress involved. There’s more money. There’s greater independence.”
The King’s Fund also spoke to ICB population health directors, many of whom argued these concerns were misplaced — saying their roles increase “resource availability and capacity”, bring public health into core decision-making, and mean it can impact across a bigger patch.
The population health leads did warn of other concerns, however, with one saying they were often “lonely voices” in their system, with their work “slipping back down the agenda”. Some are worried about short-term funding and positions on short contracts, and a concern the subject “may be a short-lived area of attention for the NHS”, which they see as more focused on downstream healthcare activity than prevention.
King’s Fund senior fellow David Buck told HSJ the “effectiveness” of public health and population health leaders “could be enhanced by greater clarity on definitions and guidance on roles, sharing examples from good practice and greater investment in capacity and capability”.
He added: “The government and national bodies will have an important role to play in creating an environment conducive to their success, including by providing clarity on role definitions and a clearer framework for these leaders to operate in.”
Source: HSJ, 8 October 2024
See also: The King’s Fund - Public health and population health: leading together
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Quit smoking at 35 for 8 years more life – but what if you're 75?
A new study has found that, whether you do it at 35 or 75, quitting cigarette smoking will add years to your life. The findings go to prove that you’re never too old to reap the benefits of stopping smoking.
For as long as cigarette smoking has been linked to cancer, stroke, and heart and lung disease, quit-smoking campaigns have urged people to kick the habit as a way of improving their health. But the focus has predominantly been on getting younger folks to stop smoking ‘before it’s too late’. New research by the University of Michigan School of Public Health has found that you’ll live longer regardless of the age at which you quit.
“We have seen a remarkable decline in young adult smoking over the past decade,” said Thuy Le, PhD, who conducted the study with co-investigators David Mendez, PhD, and Kenneth Warner, PhD. “However, rates among older adults who smoke have remained stagnant and to our knowledge, no research had established benefits for them of quitting. We wanted to show that stopping smoking is beneficial at any age and provide [an] incentive for older people who smoke to quit.”
The researchers calculated age-specific death rates by smoking status – people who never smoked, those who currently smoked, and those who’d smoked previously but quit – using the relative risks of all-cause mortality, using data from a range of national US sources. This information was used to create ‘life tables’ that showed peoples’ life expectancies in 10-year intervals between the ages of 35 and 75.
They found that compared to people who’d never smoked, those who currently smoked and had smoked through adulthood up to age 35, 45, 55, 65, or 75 will lose, on average, 9.1, 8.3, 7.3, 5.9 and 4.4 years of life, respectively, if they continued to smoke for the rest of their lives. However, if they quit smoking at each of these ages, they’d avoid an average loss of 8.0, 5.6, 3.4, 1.7, and 0.7 years, respectively. Among those who quit at 65, the chance of gaining at least one year of life was 23.4%; for quitting at 75, the chance was 14.2%. Those are pretty decent chances.
Additionally, the data showed that almost 10% of people who quit smoking at 65 gained at least eight years of life compared to those who kept smoking, and 8% of those who quit by 75 gained at least four years.
“The cessation benefit is not limited to young and middle-aged adults who smoke; this study demonstrates its applicability to seniors as well,” said Warner. “While the gains from quitting at older ages may seem low in absolute terms, they represent a large proportion of an individual’s remaining life expectancy.”
The researchers hope that clinicians can use the study as scientific evidence to convince their patients, particularly their older patients, who smoke to quit.
Source: New Atlas, 8 October 2024
See also: American Journal of Preventative Medicine – The benefits of quitting smoking at different ages
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