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There is a crisis of public health in the UK. Although public health measures are known to be effective and cost-effective, UK government has shown a reluctance to adopt those measures. Reasons for this reluctance include: the wide-ranging agenda involved in dealing with the social determinants of health; a governmental decision bias against prevention; a similar bias against precaution; the problems of interorganisational collaboration and cross-government working; and the need for political leadership. However, the reluctance also reflects a dominant libertarian way of thinking about the role of the state, which needs to be replaced by a new social contract for responsible government.
A public health crisis is gripping the UK. Improvements in life expectancy have stalled, health inequalities have widened, obesity and alcohol misuse are placing an increasing strain on health services and urban air pollution is now widely recognised as a serious health hazard. COVID-19 revealed the weaknesses of the UK's public health system, once thought to be among the best in the world.
Against this background, this book examines the organisational and political barriers to an effective public health system showcased through the UK. It urges that what is needed is a new social contract, in which health policy is truly public.
The fundamental question at the heart of public health policy is how it can be that cost-effective measures to promote the health of the population are not more vigorously implemented. The question has become more urgent as the pressures on the NHS have increased. Behind the implementation deficit, this chapter examines the role that a dominant public philosophy of libertarianism has played. That public philosophy is plagued with a number of problems, and in its place this chapter argues for a philosophy of social individualism in which the role of government-provided public goods is central to creating the conditions for effective individual choice and fulfilment. The chapter concludes with a manifesto of practical public health measures.
With the demise of Public Health England came the establishment of the UK Health Security Agency and the Office for Health Improvement and Disparities. This new settlement poses issues of process and policy. Separating health protection and health improvement poses its own problems, given the association between poor health status and susceptibility to infection. More generally, the new bodies will have to cope with the complexity of public health evidence which is essential to scientific integrity, as well as the need for independence from politically partisan control. Political leadership will be essential, and there needs to be a ruthless focus on implementation.
Devolution is a notable constitutional change in the UK. The devolution of health responsibilities has been associated over time with the establishment of public health responsibilities in the home nations other than England. Public Health Scotland, Public Health Wales and the Public Health Agency in Northern Ireland have acquired responsibilities, though the precise configuration varies among them. These differences suggest that there is no one right way of organising public health responsibilities, although it is notable that all the devolved governments have brought together health protection and health promotion. Important policy initiatives, like the minimum unit pricing of alcohol, are independent of organisational questions.
This chapter explores the organisation of public health responsibilities in England between 2013 and 2020. The establishment of Public Health England was widely welcomed in bringing together health protection and health promotion. During its lifetime, Public Health England encountered problems in addressing some health promotion issues, like vaping, as well as ensuring cross-departmental working in government and forming relations with local government. Its funding was also cut. At its abolition in 2020, long-standing issues about the lack of priority to be given to public health to protect the NHS and promote the health of the population remained unresolved.
This chapter examines strategies for addressing power imbalances, bias and disempowerment in the research process from the perspective of both care-experienced and non-care-experienced researchers. Also, this chapter reflects on practical advice for those engaging with care-experienced people in research and doing so can create more authentic, empowering and meaningful experiences for care-experienced participants in ways that reduce fear of shame, stigma, tokenism and re-traumatisation.
Street-involved children are recognised as a social concern worldwide. In South Africa, there are an estimated 250,000 street-involved children, living mostly in the larger centres of the country. Street-involved children’s lives are characterised by hardship and stigmatisation; they live on the very edges of society. However, street-involved children demonstrate considerable resilience in their daily lives as they navigate and negotiate their way to accessing resources necessary for their daily lives and future goals. This study entailed qualitative interviews with nine young adults who had lived on the streets prior to coming into care, and then been taken up into the residential care of a children’s home and had since aged out of care. The study examined the accounts of the resilience of these nine care-leavers while living on the streets. The findings show that, while on the streets, participants demonstrated resilience in building family-like connections, networking people for resources and reflecting on their learning through life experiences. The authors argue that recognising and celebrating these resilience factors when working with former street-involved children in care will enable them to incorporate these resilience processes into a repertoire of resilience enablers for life.
This book has aimed to conduct research about edgy facets of leaving care – understudied groups of care-leavers, and fresh methodological approaches and innovative theories. In this concluding chapter, we draw together key findings regarding these three facets, highlighting what has been learned collectively through this project. The research has been conducted and chapters written by authors from all over the world who are, mostly, on the edge, transitioning between postgraduate student and scholar. Spring-boarding from their new insights, the chapter attempts to imagine what leaving-care research will look like in the future and where the new edges might be. It will draw attention to the many gaps and edges that remain and suggest possibilities for ongoing research that pushes the boundaries yet further forward.
To assist care-leavers in navigating transitional challenges, developmental and environmental resources are essential. Additionally, informal support is pivotal to the transition of care-leavers into adulthood. A small qualitative study conducted from 2016 to 2019 in Victoria, Australia, provides the basis for this chapter. The research used an analytical framework based on the core concepts of social capital and social support. It helped explore how social support actions and social capital functions interact to allow young people to harness and access developmental and environmental resources to help meet their transitional needs. Social support and capital have been found to contribute to meaningful relationships, normative social experiences, resilience, positive self-identity and progressive responsibility. Policy and practice implications are also discussed in the chapter.
