Like many people in public health of my generation, John Ashton and Howard Seymour’s book, The New Public Health was an inspiration. It plotted a path of public health from its Victorian roots to the 1980s. Many people I speak to who have read the book, are particularly impressed by a series of photos from a class of schoolchildren in Liverpool going back 100 years. From stunted, adenoidal faces in the late 19th century to the smiling, white-toothed, well-looking children of the 1970s the pictures are a graphic illustration of the progress made in public health over that time.
The Health For All ambition of the 1980s and the Ottawa Charter on which it is based, and which are described in detail in the book, saw public health building on that legacy by making cross-sectoral alliances at all levels in society. Working in settings such as the school and prison, working with partners in the voluntary sector, local government and health services at district, city and national level and forging alliances across nations we could fashion a future which would achieve this lofty goal of Health For All by the year 2000.
But the dream has gone sour. A countervailing current of neo-liberal economics has played out across the globe since the 1980s creating greater inequality between people within and between nations than ever before. Furthermore, as our industrial culture expands and consumes ever-increasing amounts of material resources, chickens are coming home to roost, not least in the guise of climate change and other major environmental challenges.
These major shifts in society and culture leave no-one untouched. Every day and in cities, towns and countries, these challenges have tested the resilience of many – in Australia, Japan, New York, China, the list goes on. In Britain, we have witnessed a rapid rise in inequality in the last twenty years. Environmental challenges have multiplied with drought and floods, pressure on landfill and costs of dealing with waste, rises in food prices as a result of poor harvests etc. There is a widening social gradient in health, with, for example, a boy from the poorest parts of Scotland living 14 years less than a boy born in the most affluent areas.
How does public health respond to these deepening inequalities? Do we have a hopeful story for our time that might help us navigate these challenges?
To address these questions, a group of pioneering public health practitioners from the North West of England came together for a series of dialogues, using Three Horizon thinking, beginning with the Marmot report on inequalities. From these discussions, a new story of our time emerged. We called this the “New New Public Health” or N2PH for short, in recognition of the debt this work paid to Ashton and Seymour and our public health predecessors who have worked so hard for so long to combat health inequalities.
I am re-visiting this work today because universal social security, or welfare as it is more loosely described, is under a great threat. With this comes a loosening of the common ties, which bind us together as a nation. Yet clearly, what worked for the post-war generation is in need of reinventing for the 21st century. The tensions, which we describe in the N2PH story, are all too much in evidence. A division between the deserving and non-deserving poor, a shallow engagement with the real challenges by mainstream media and a re-asserting of old assumptions, which were under threat following the financial crash of 2008.
Now the public health network in the North West of England have produced a video to tell this story. Using Three Horizon thinking, we can begin to understand the context of our work better and use innovation both to “keep the lights on” during this turbulent transition to a different world and to nurture the Third Horizon – an Equal Society, valuing everyone’s contribution, with multiple currencies in circulation, not just money. This is a massive culture shift, like oak trees, has to start small. All around the NW region and Scotland, pockets of the new culture are growing, seeding the hope that we can leave the world in a better shape than how we found it.