Here in Morecambe Bay, thanks especially to the excellent work of Marie Spencer, David Walker, Jane Mathieson, Hannah Maiden and Jacqui Thompson, we have together developed a way of thinking about population health, which we call the ‘Pentagon Approach’. It draws on learning over a number of years from Public Health England and the World Health Organisation, and synergises nicely with the vision and approach of our excellent Directors of Public Health in Lancashire and Cumbria. It forms part of our overall population health strategy, which I want to give some focus to over a few short blogs. In this blog I will focus on the Pentagon and what we mean by each bit of it!
Population health means different things to different organisations, groups and individuals. However there is agreement that population health is determined by a complex range of interacting factors e.g. social and economic, lifestyle, access to services, including health, as well as our genes, age and sex.
Most of these factors lie outside of the health care system but have significant impact on individual and population health. Lord Darzi recently wrote in the 2016 WISH report (https://www.kingsfund.org.uk/publications/articles/healthy-populations) that we have talked about making a difference to population health for decades, but no-one has really grasped the nettle to make the changes we need to see, particularly around health inequalities. Responsibility for addressing these issues are fragmented. Therefore we need to ensure that we work with a multitude of partners to:
- Understand the problem and set clear goals for improvement
- Focus on the determinants of health and not just health care
- Generate shared accountability
- Empower people and communities and develop their capabilities
- Embed health equity as a core element.
Therefore Population Health in Morecambe Bay is defined as:
“The health outcomes of our citizens as a group, including the distribution of those outcomes across the geography of Morecambe Bay.”
In Morecambe Bay, we have developed a way of thinking about Population Health through the means of five key strands, namely – Prevent, Detect, Protect, Manage and Recover.
Various definitions currently exist around these words, but in Morecambe Bay, the definitions will be used as follows:
Prevention
Prevention means preventing disease or injury before it ever occurs. This is done through:
- Working with communities and other partners to tackle the underlying social determinants of health (e.g. living and working conditions, social isolation, health literacy etc.)
- Encourage the development of health in all policies
- The promotion of positive behavioural choices which improve a person’s health and wellbeing (e.g. stop smoking, reduce alcohol, take regular exercise, eat healthily)
- Preventing exposures to hazards that cause disease or injury (e.g. through hand hygiene, health and safety )
- Increasing resistance to disease or injury, should exposure occur (e.g. immunisation programmes)
Prevention can be primary (before a diagnosis) or secondary (after a diagnosis), but always refers to creating an environment that supports healthy choices, lifestyle changes, rather than medical intervention.
Detection
Detection means early recognition that:
- a person is developing increased risk factors which may predispose them to a more serious condition (e.g. obesity, rising cholesterol, high BP, low mood)
- a person has developed a chronic condition, for which they will need further protection (e.g. COPD – chronic obstructive pulmonary diease, Type 1 Diabetes Mellitus)
- a local population are more at risk of developing a particular condition/set of conditions (e.g. detection of childhood obesity rates, high rates of smoking, high rates of alcohol use, poor housing or air quality )
- a local population has worse health outcomes than another, requiring appropriate resource allocation (e.g. poor cancer survival rates, high rates premature mortality, low access to preventative interventions)
Protection
Protection means:
- to protect someone from developing a condition of which they are at risk, through medical intervention (e.g. starting antihypertensive medication) – this would also go hand in hand with some further prevention measures
- to reduce the impact of a disease or injury that has already occurred (e.g. ensuring protection after a first MI of having a second MI through strict treatment of BP, cholesterol and kidney function, smoking and dietary advice)
- to soften the impacts of an ongoing illness or injury that has lasting effects (e.g. helping a person to understand a chronic condition they are living with, through structured education and ensure best evidenced treatment, to help them live at optimal health)
- to protect someone from developing a more serious condition, through surgical intervention (e.g. prophylactic bilateral mastectomy)
Management
Management means:
- to provide appropriate advice, treatment or referral for a single episode of a health complaint (e.g. minor ailments )
- to intervene at the time of a medical or surgical emergency with best evidence-based practice (e.g. transfer to a cardiology centre for management of a STEMI – [heart attack])
- to treat an exacerbation of a chronic condition through a best evidence-based intervention (e.g. an acute exacerbation of COPD)
Recovery
Recovery means:
- helping people manage long-term, often complex health problems and injuries in order to improve as much as possible their ability to function, their quality of life and their life expectancy (e.g. through cardiac/pulmonary rehabilitation, community integration, support groups, social care provision, vocational rehabilitation programmes, links to financial advice)
- recognising where people will not recover and enable good palliative care and a good death
This Pentagon describes our ‘population health approach’, but is not the complete picture of how we think about population health. More on this in some follow up blogs and vlogs.
This situation exposes something far deeper than just an argument between Jeremy Hunt and the BMA and is far more important than discovering who has the strongest will power. Infact, the BMA have made a major error in targeting Jeremy Hunt so vindictively, because in the final analysis, this isn’t about Hunt at all. Jeremy Hunt can be replaced in a moment, and is likely to be succeeded by a far more robust 
Boris Johnson, who will simply pound his fist more visciously. To make Hunt the scape goat narrows this debate to something far too insignificant and actually strengthens the government’s ability to do exactly as they please.
place, the goverment could instead have said to all the hospital trusts across the country what their hopes and intentions were and then waited to see if this was workable, in what way and how much it would cost. But you cannot simply act like Pharoah and expect the brick makers to make ever more bricks with less and less resource available – otherwise, you face an exodus!
The system, to which we must all bow doesn’t care for the needs of the people who work within it. It will force them to submit. Why should doctors (many of whom work for less than the minimum wage, when on call) be allowed time to rest at weekends? Why can’t everybody have routine care through the weekend, just as from monday to friday (even though most of our top clinicians think we need better emergency care and not routine access)? Surely our economy needs this kind of health service? And actually, whilst we’re on it, isn’t it a waste of time, allowing teachers to have weekends off as well? Don’t we need our children to work harder, or at least be given some sort of babysitting service, so we can get more for our pound of flesh from their parents? If we are to have a 24/7 health service, why not a 24/7 education service? Our shops are already open practically 24/7. In this commercial world – shouldn’t everything else follow suit? No, no and NO!!
This is why we need a revolution of solidarity and resistance. We need a people movement who will stand together and be brave enough to say that there is a different way to see the world and a new way to live within it. Our naked life itself, although currently abused, can become for us our greatest power. Our naked life can expose the truth of just how abusive our systems have become. Our naked life, when combined with the indestructable force of kenotic love, becomes the very agent of change that we need.
really demonstrate the power of naked life……how about naked marches?!! (I grew up in Coventry, and so the story of Lady Godiva is in my blood – nakedness overcame oppression once before!). Or maybe the staff of the NHS should all turn up to work with no clothes on?!! How about people stripping off at least to their underwear to expose both the fragility and the power of naked life?!
