With an ever expanding population and people living longer but not more healthily, the demand on health and care services is increasing. This, coupled with the fact that there is a big squeeze on the amount of money available for health and care from central and devolved budgets, has meant that all four countries in the UK have decided to focus on ‘prevention’, public health and tackling health inequalities.
In the UK, there are currently not enough people working specifically in public health to tackle our major public health issues alone. This means that more people from a wider workforce need to be engaged with the public health agenda so that we can address more of these challenges.
AHPs are ‘early adopters’
Allied healthcare professionals (AHPs) have been recognised as ‘early adopters’ in the wider workforce because they are already engaged with the public’s health, are active, and interested in doing more. The RSPH recognised AHPs as one of the key parts of the wider workforce in their 2015 report "Rethinking the Public Health Workforce".
A survey of a sample of all of the 12 AHPs conducted by PHE and RSPH in 2015 revealed that there is an appetite for AHPs to engage in lifestyle health promotion activities:
- 87% AHPs agree that their role should include prevention of ill health.
- 76% agreed that their role gives opportunities for healthy conversations.
- 81% said that they already incorporate health improvement into their daily practice e.g. healthy eating advice.
- 86% of the public said that they would trust health promotion advice if it came from AHPs.
These results are reinforced by the results of a national survey of the general public in which 86% said that they would trust health promotion advice if it came from AHPs.
Dietitians as 'early adopters'
In early 2016, Public Health England conducted a survey of all Allied Health Professionals including dietitians. 171 dietitians (mainly from England) responded of whom 36% were from the acute sector. The survey showed that 76% of dietitians regarded health promotion and public health as part of their role. 43% of dietitians said that they were interested in becoming public health champions.
Dietitians are already having ‘healthy conversations’ and offering brief interventions with their patients, but mainly about diet, malnutrition, weight management and alcohol. This is not unexpected as dietitians are trained to do this and many (but not all) have behaviour change and motivational interviewing skills. It is also not unexpected that fewer dietitians have conversations and offer brief interventions about the following public health priorities (in descending order of frequency):
- mental health
- social isolation
- smoking cessation
- falls prevention
- pain management
- substance misuse
- domestic violence
- developmental delay in children
Barriers to healthy conversations
One of the most common barriers to having healthy conversations is time. Dietitians also indicated that there are a few other barriers to delivering healthy messages and these including:
- Lack of knowledge of local services
- Lack of knowledge and expertise
- Lack of access to patient education materials
- A perceived lack of interest by patients
Managers can help by including public health in job descriptions and appraisals
The results of the 2016 survey suggested that it would help if there was greater support from managers:
- Appraisals to include healthy conversations and public health objectives.
- Job descriptions to include healthy conversations and public health.
- NHS organizations can help by including public health in dietetic service contracts.
Although the survey found that 53% of organizations expected dietitians to focus on prevention only 37% wrote this into the dietetic service contracts. Organisations can help to embed public health in dietetic services if more were to include public health specifically in dietetic service contracts.