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Themes of the 14th EPH Conference

Public health futures in a changing world

European public health has not had a good COVID. Across Europe the public health response to a pandemic has been largely unsuccessful. This is despite an enormous amount of very hard work in public health units all across the EU. This reflects a weakness within the profession, which has been manifested in the curious phenomenon of dual strands of public health advice, official and unofficial, in several EU countries. Politicians were placed in an impossible position by this. This needs to be openly and constructively faced. By and large, public health has had limited impact on the design and implementation of a core public health policy.
So. The world of public health changes, but many key pieces remain the same. A key part is to hold to that which we value, and to build on that, and extend out from that, to meet new and pressing needs. A focus on where we are, and where we want to go might be helpful for clarification. The relevant word is ‘futures’, and not ‘future’. We expect an even more diverse public health, with the public health workforce delivering in new and more traditional arenas.

Public health futures in a changing world
‘Times change, and we are changed with them’, as the 16th century phrase has it. Public health has changed a lot in the last thirty years. Whole subdisciplines, for example health informatics, and genetic public health, have grown up in that time. Has the core practice of public health changed? Does it need to? Should it? 
If so, we need to lead and shape the changes. We need to identify futures for our discipline, and figure out how to get there. If we don’t, others will, and that is not necessarily for the benefit of our practice, our practitioners, or the public. If we are to be more than well trained technicians (which is not in itself a minor accomplishment) perhaps we need to articulate more forcibly who we are, why we are, and why we are relevant?

Public health praxis, training and workforces for the future
What is is that distinguishes us? What is that we do well, that others do not? Future public health, as at present, will have people doing many roles, communication, policy design and evaluation, service planning, monitoring, and delivery, health data, health protection, environmental health, evidence analysis, and more. In all of these areas we work with people from different backgrounds. What value do we bring? Who are we? What skills do we need for now and for the future?

Communications and public health
Communications have always been a key part of public health, especially when we felt it advisable for people to change what they do. Communications about the benefits and safety of vaccines date back to the first organised opposition to Jenner’s vaccination in 1805. Communication of key public health messages led to the building of systems to bring clean water and remove sewage form our cities in the 19t century. Florence Nightingale largely revolutionised both nursing and public health by targetted communications, and a keen awareness of the value of her personal brand. Public health needs to look back at some of the tools used by our founders, and bring these to a new media market, led by social media, but still reliant on high quality journalism.

Digital health – person centred?
Digital health has promised health system transformation, and universally failed to deliver. They are many reasons for this, but one key issue is that the data are usually organisation centred, and not person centred. A range of challenges, including the interests of many current vendors, have inhibited this. A combination of the smarter use of standards, open api’s, and GDPR rules has the potential to change all of this. Is public health going to be at this table?

Climate change and public health – a dual role
COVID19 is a challenge for public health. Climate change is an existential threat for our civilisation, and possibly our species. Does public health have a part to play in meeting the challenges of climate change, and if so what? Is there a public health of information and lies? Should there be? How do we use the tools and methods of public health to explore futures?

Learning from the pandemic, and getting ready for the next one
In many ways the world was fortunate with SARS-CoV-2. Much pandemic planning had focussed on a more lethal, and more infectious pathogen, which may yet land. While certain features of SARS-CoV-2 made it a serious public health challenge, notably the high prevalence of infectious people with few or no symptoms, it could have been much worse.
However, no reasonable observer could argue that Europe dealt with this well. Governments of a wide range of levels of competency, and covering much of the political spectrum, all failed to respond effectively to the pandemic, as witnessed by the second wave of infection in most of Europe. What can we learn from what went well, and from our failures?

Public health, equity and justice, going back to go forwards
Public health is one of the older medical specialities. It has developed in very different ways in different countries, but there has always been a tension between a more focussed view on health, on public health practice within state and health care organisations, and a wider view looking at the ways in which societies, and the power relations within societies, construct health. Both perspectives have value. Is there a way to integrate these, and move into a refreshed vision of new futures for public health?
COVID19 has shed a cold light on many of our societies. Health and social inequalities within societies and between countries, have led to enormous extra costs. Public health has along tradition, dating back to the time of Engels and Chadwick, of interrogating the way our societies are structured, and both the winners and the losers from this. As we deal with the complex challenges of COVID19, and climate change, how we choose to structure our societies will matter more than ever.