Public Health Outcomes and the Big Society?

The consultation on the Public Health Outcomes Framework was published on Monday and closes on 31 March 2010.

A smaller set of indicators, than in the recent past, are proposed to measure  the local performance of Council’s. In some cases they will be paid a ‘health premium’ – a financial incentive to encourage them, as the new lead bodies on public health, ‘to make progress on health improvement priorities and reduce health inequalities.’ Much of this is very positive and shows the broader political consensus on tackling this that did not exist 30 years ago.

What is interesting, when looking at the government proposals elsewhere, is that almost all the proposed indicators are “Big Government” and about the role of professionals. Very few could be described as “Big Society. Indeed the only two that did not require automatic leadership by paid professionals are:

• Cycling participation
• Social Connectedness

Some might argue that the other indicators do at least require co-production by individuals with professionals to achieve those outcomes, however the challenge is that if these are to be achieved with limited resources how does one prioritise this and identify those communities with values that are least likely to respond to behavioural change, rather than spread proposed interventions too thin.

What the proposed Outcomes currently seem to miss is that many of the separately recorded indicators all involve the same communities and target groups. Perhaps a more effective approach is engaging with lifestyles holistically and not produce yet another set of separate strategies for individual problems are likely to substantially overlap at a time when money is tight?

Behaviour change theory tells us that a lot has been invested in ability. In other words “bring the horse to water”, or more likely in the toughest cases “bring the water to the horse”. Yet many of those behavioural approaches also make the point that one has address motivation too.  In that case “get the horse to want to drink”!

We have argued through many other postings on this blog that a modern approach to this needs to include targeted values segmentation, network mapping, and using a range of behavioural and influence techniques to build and reinforce new social norms. These cannot simply be about presenting objective facts that people sit in workshops and consider in a rational way. We also need to frame things in such a way as to address the needs, emotions and values of a targeted community in order to motivate it!

Thus the consultation on the Public Health Outcome Framework should not be seen as just a menu of indicators for practitioners to make short-list of, but also an opportunity to debate the most effective ways we can deliver behaviour change for a pro-social benefit.

Charlie Mansell is the Research and Development Officer at The Campaign Company.