Public health needs to fully embrace the life satisfaction agenda that governments are slowly moving towards and make it their own

Public Health re-imagined
 

 The Wizard of Oz is a story about the importance of intellect, emotions and connection for human happiness. I believe that
these are key components of public health too

Why bother?
Why bother trying to engage the public with popular culture? What is the purpose of public health anyway? What idea of future human society should it aspire to? How could it get there? What can it learn from outside the profession?

This section is more personal. You can accept or reject it whilst still finding the other sections of the website useful. 

A multiplicity of public healths
I have written it partly as a response to my fear of a monopoly developing in the UK around who defines what public health is about. When I started in what was then health education in the late Eighties there was less joined up thinking than there is today. Since then successive governments at the centre have told local health services what they should be doing. In addition, local councils and the health service have been encouraged to work in partnership. The most recent step is the move towards the NHS commissioning the voluntary sector to  do work for it. I am also told by colleagues that charitable funds are also now tending to fund projects that  meet government guidelines. I can understand the thinking behind all this

joined up working and can see its benefits. The potential downside however, is the loss of a plurality of views. If only one perspective is presented and funded and especially if the voluntary sector loses its independence, isn't something lost? Aren't there some advantages in having radically different views about what health and society is about discussed and potentially funded and tried out? 

Commissioning also makes it more difficult for either providers or purchasers to try out a new approach that looks worthwhile quickly. Instead it has to be considered for commissioning and a tender produced.

Some companies, I believe, allow employees to suggest new 'out of the mainstream' ideas. More importantly they have money put aside to pilot them. I think it would be useful if the Government did something similiar. The Exchequer could put aside a set percentage of funds, however small, for ideas not in current government policies to be tested out in each council area. Perhaps some of them may not even need to be put out for tender. (Though of course if the people commissioning always come from the same backgrounds and have the same perspectives, problems may still persist.)

I would also encourage workers in public health to network their own websites and blogs where non-mainstreamed ideas can be discussed.

Life satisfaction should be a goal of public health
The Public Health Skills and Career Framework says that the purpose of public health is to
* Improve health and wellbeing in the population
* Prevent disease and minimise its consequences
* Prolong valued life
* Reduce inequalities in health

 It is true that over the years we have seen a change of emphasis in public health. There was for example much more focus on the wider determinants of health e.g. how transport policy links to health. However, this hasn't changed the fact that policy is still dominated by illness prevention. 

This is obviously important but I think wellbeing has been under valued. By wellbeing I mean more than physical fitness or freedom from illness. Postive psychology has put a new slant on wellbeing. It has fed into the life satisfaction debates that both some academics and governments are becoming interested in. Life satisfaction is about looking at what makes people content with their lives and how to develop policy that reflects this. The Cabinet Office produced a discussion paper on it in 2002. This however does not seem to have fed into public health debate in the UK.

So what does the discussion paper say? It seems that after a certain point, merely increasing people's income does not lead to greater happiness. Education is important in terms of helping achieving this income but does not bring happiness in its own right. Good relationships are important to life satisfaction as are a good relationship with a partner. Joining in with social activity is also linked to happiness. Inequality in society is linked to unhappiness. Direct democracy e.g. having a say in how your community is run, also seems to be linked to life satisfaction

Wellbeing as freedom from conditioning, oppression and fear
I am also interested in humanistic psychology. In the Eighties it informed much health education practice, with approaches such as assertiveness, self-esteem and 'Be all you can be'. It tended to be a very individualistic approach. However it actually has profound implications for both how organisations and society are organised if its tenets are carried through. It is important in tackling health inequalties. Self esteem in particular is tied up with how society is organised and how people see themselves and are treated by others. Sexism, ageism, racism, class and the routine denigration of children impact on all of these. These oppressions are held in place by conditioning and external power. Both are tied up with our feelings. In particular the fears we learn early in life, such as the underlying message that if you behave differently from how society expects, you are punished. We then act out these messages embedded with emotion without us being aware of them. They run much of our lives.  The feelings are held in place in the body. As children we learn not to let them out as we are punished physically or verbally if we do. So we tense our bodies to stop healing tears and other recovery mechanisms. 

Humanistic psychology then is concerned with the emotions and their relationship with the body, as much as the rational mind. It is also closely connected to the human potential movement. This movement encourages people to connect both with their own needs and other people. This means learning new skills in coping with our own emotions and other people's i.e. it isn't about just dumping your feelings on other people. It is more sophisticated than that. (Click here to see my personal, social and health education curriculum based on all this.)

CCI: An alternative model to bureaucratic hierarchy
Humanistic psychology has long fallen out of fashion in public health. Even when it was in vogue, the version practiced by health professionals was generally watered down. This was because it was not very well understood in my experience. I was lucky to get involved with it outside of work, mainly through Co-counselling International (CCI). CCI showed me the importance of having new structures and processes if people are to feel safe enough to confront the negative feelings that modern society creates. These limit who we can each be as human beings. They also damage our relationships with each other. (And all this in turn is bad for our physical health.)

Co-counselling is an approach where after 40 hours of training a person is able to be both a counsellor and a client. Indeed for half the time you are a counsellor and then you change over roles. This itself is empowering and gets away from professional ideas of us and them. The focus tends to be on releasing emotions physically e.g. though tears or anger, as well as searching for new insights and making plans for how to behave differently in the future.

CCI also organises cheap workshops. These again are a challenge to professional ideas of hierarchy and bureaucracy. Although a planning group may well organise bookings, after that everyone is equal. There are processes to structure this equality e.g. a morning opening circle. This often involves group activities such as dance, singing or celebration. This is then followed by a discussion of any problems and offers of workshops. 

Workshops  can be by anybody on any topic e.g. work, masculinity, sexuality, health etc. Part of the beauty of co-counselling is that it is a tool to access your feelings about a subject. Academic debate and study, although very useful, is weak in this area. This needs to be addressed as it is often feelings rather rationality that drives human behaviour. Co-counsellors all have a common set of processes and structures to work within. This creates a freedom to explore feelings and relationships more safely than in the everyday world. Indeed safety is a key issue within co-counselling. Without it no self-learning and connection with others is possible.

I have been involved in CCI  for over 20 years now. In my initial excitement I was keen to get others involved in it, but it isn't for everybody. It is mainly a white, middle class organisation and many people will put off by its unconventionality around emotions etc. In many ways it is the opposite of what most of this website is about i.e. working from within popular culture. It is a product of the counterculture of the 1970s. However, it has taught me that there are other ways of operating than hierarchical bureaucracies. Also that the distinction between education and therapy is unhelpful. They are both part of learning, which ideally should take into account the emotional as well as the intellectual. Finally, for me CCI has let me see what the purpose of life is, in terms of connecting with others and accepting one's self.

To find out more about CCI click here

Public health: Take the lead in discussing what wellness really means
To summarise I will try to partially answer my own questions at the top of the page. I had several  hopes in developing this website on using popular culture. One was that these techniques would not only be used to tackle issues such as smoking, vital though they are. I would also like to see them used to engage people around what it is to be human and what we really want for ourselves and our society.  I believe that this is the purpose of public health as much as preventing outbreaks of disease. I have a hope that public health will lead the debate on what wellness and life satisfaction could mean. I am not dictating how society should develop. However, I do believe that part of the answer lies in institutions addressing issues around feelings and power more awarely. To do this I would encourage colleagues to learn from techniques and experiences from outside the profession. This would give a wider view of what human wellbeing entails and how individuals can learn together. I believe educators and policy makers need to embrace emotions. They are a way of understanding what is going on for them and the people they work with. 

It might also mean that public health and other organisations might also genuinely focus more on the wellbeing of staff. Although I no longer have the reference, I was once moved by a piece I read about an American social enterprise. Their mission statement was something like

We have only three goals.
We want to create good lives for the people in the community we serve.
We want to create good lives for the people who work for us.
We want to be successful enough commercially to achieve these first two goals.
We believe all three goals are interrelated.

It is a rapidly changing world. Commissioning will raise issues for many providers of the need to be customer focused and market driven. This not necessarily a bad thing. However, I still like the added perspective given by the mission statement.

A good place to start with all of the above would be for public health to tie in more with the life satisfaction agenda. This at least is concerned with issues of personal happiness, relationships and democracy. Who knows in what direction it my develop.  My fear is that what will actually happen is that a well meaning monolithic state bureaucracy will funnel what health and wellbeing means along an illness route and miss this opportunity.

(For references click here and links click here.)

To download the whole 180 page report on using popular culture to tackle health  inequalities click here
http://www.sexanddrugsandrockandhealth.com/userimages/newPCTotalDocument.pdf

To download the PDF software to be able to view these files click here
http://www.adobe.com/products/acrobat/readstep2.html