Dona Milne on being NHS Lothian’s DPH

People often ask what a typical day of a Director of Public Health looks like – and, of course, it depends what day it is and where you work. In Scotland, there are 14 Directors of Public Health who are also Executive Directors of their respective Health Boards, which means that we have both public health and corporate responsibilities. We have responsibility for all public health functions locally: population health (health improvement), healthcare public health and health protection, all underpinned by a strong health intelligence function. This is what makes every day different. Last week for example I spent time looking at housing, poverty, immunisation, racialised inequalities, screening, emerging infectious disease pathways and how to increase our focus on prevention across the health and care system.

I started my public health work specialising in reproductive health and children and young people, but developed expertise across the determinants of health and improving life circumstances. I am convinced this work requires place-based, partnership working with non-NHS colleagues. In Lothian, we have created Partnership and Place teams who take a health in all policies approach to work in our four local Community Planning Partnerships addressing priorities such as education, employment, housing and income. These are, as we know from the work of Marmot and others, the fundamental building blocks for good health outcomes.

One of the things I enjoy most about my role is the multi-disciplinary nature of public health. And, in response to the need for breadth and depth of public health skills, our staff come from all walks of life; there are educators, scientists (of all kinds), medical doctors, political theorists, social workers, youth workers, nurses, administration and management experts and arts graduates in our teams. All have a passion and commitment to addressing inequalities. Our diversity hopefully contributes to more creative responses to local needs using our public health expertise with a range of collaborators.

Addressing inequalities requires long term effort and sticking with those programmes that are evidence based and we know will make a difference. For example, the IFS have recently reported that children from low-income families who grew up near a SureStart centre performed better than their peers at GCSE. There is, to my mind, no doubt that children’s centres help to give all children, particularly those from disadvantaged backgrounds, a good start in life.

We have placed a significant focus in our local plans on children and the early years as the evidence is clear that this will make the biggest difference longer term, as highlighted in our recent Director of Public Health Annual Report. It can seem attractive to start a shiny, new project but sustaining the evidence informed actions – across all domains of public health — that we know will improve population health should be our priority. It is fair to say that perseverance and tenacity are key public health attributes alongside the specific skills developed in training.

Directors of Public Health in Scotland work alongside Public Health Scotland and our colleagues in the Convention of Scottish Local Authorities (COSLA) and Scottish Government to try and build a whole system approach to public health. But we also benefit hugely from being part of ADPH UK and looking to and learning from our colleagues across the UK and further afield. We can share evidence, examples of good practice and support cross country and cross government activity on key priorities such as the forthcoming tobacco control legislation. When you are trying to achieve change within structures and with tricky subjects that are intransigent, insights from what others have achieved can make all the difference.