Duncan Selbie: the new face of public health in England

Abstract

Duncan Selbie is the Chief Executive of Public Health England, a new organisation tasked with protecting and improving the nation's health and reducing inequalities. His appointment was not entirely expected, and he admits that public health is a new area for him. “I am that well known international expert”, he jokes. “You can fit my public health credentials on a postage stamp, but this is what I want to do for the next number of years because it matters so much.” Although he does not have a track record in public health, Selbie brings a depth of knowledge about the UK's National Health Service (NHS) to his new role. Selbie's experience of the NHS began early on in his life. Born in the Scottish city of Dundee, Selbie was one of four children. His mother died when he was 13 years old and he left school at 15. After a year at college, he took a job as a clerical officer in the NHS at North Tayside and later moved to London working in the NHS. “I have worked at every level and grade in catering, engineering, community services, family planning, and care of the elderly. You name it, I have done it!” he says. Indeed, Selbie's career has been remarkable considering he has no medical or substantial academic qualifications. Between 1997 and 2012, he moved up the ranks to become the Chief Executive of three major NHS organisations: South West London and St George's Mental Health NHS Trust, South East London Strategic Health Authority, and Brighton and Sussex University Hospitals. He also spent 5 years at the Department of Health and became the first Director General of Commissioning. But his outlook is not confined to managerial expertise. Having spent much of his career in clinical and academic settings, he knows the value of research: “Whenever you invest in academia, you see an improvement in service.” And he firmly believes that the key factors to good health lie in tackling the underlying social determinants: “Jobs, homes, and friends are what will make the biggest difference to improving people's health. Did you know that isolation in the elderly affects quality of life to the same extent as smoking 15 cigarettes a day?” As he takes the helm at Public Health England, Selbie acknowledges that not being a public health professional means “I need to listen. That is the strength I uniquely bring.” He thinks that public health in the NHS has not had the attention or investment it deserves. “For decades we've conflated health and the NHS as the same thing. We don't have a system that is premised on prevention and early intervention, but instead relies heavily on hospital-based care. We have had a very fragmented public health system distributed across different organisations, which is why we have not had a coherent strategy for health.” Public Health England aims to integrate health protection, health improvement, health care, and public health. Since April 1, public health has come under the jurisdiction of local government. Public health teams will be embedded into 152 upper-tier local authorities that will have a budget of £5·45 billion over 2 years disbursed by their health and wellbeing boards, and have a legal duty to improve the public's health. Selbie hopes the profession will embrace this change: “I believe in the public heath profession and I have great confidence in the leadership that local government will bring. I am seeing a passion, this is their moment, but they have to stand up and take it.” What Selbie will bring to the job, says Aidan Halligan, Director of Education at University College London Hospitals and Chief of Safety at Brighton and Sussex University Hospitals, is “his superb skills as a proven leader, and his ability to engage, inspire, and energise health leaders. In previous administrations, successive Secretaries of State for Health came to rely on his ability to tell the truth to power, his compelling honesty (even against himself at times), and his ability to bring warring partners together and achieve productive purpose.” Selbie points out that despite the vast body of evidence about what works in public health, “we have not acted on it and to scale”. He is determined to change that. “Public Health England will support and work alongside local and national governments and the NHS, providing them with advice, knowledge, and evidence, and help people to make healthier choices. In addressing inequalities, attention will be focused on the poorest, and making the fastest progress for them.” Reducing preventable deaths from non-communicable diseases and increasing healthy life expectancy by tackling poor mental health, substance misuse, and musculoskeletal disorders are among the key priorities for the organisation in the next 3 years. Those priorities are, he says, informed by evidence from the Global Burden of Disease Study 2010; Selbie sat on the panel at the launch of GBD 2010 and remarks that “it is the best of public health science and the timing is just phenomenal”. Commenting on the new body, Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, says that “Public Health England has the opportunity to become an extremely important organisation, despite its challenging environment, but, to do so, it should ensure that it learns from the experiences of those who share its goals in other countries, for example, the Centers for Disease Control and Prevention in Atlanta, the National Institute for Health and Welfare in Helsinki, and the Robert Koch Institute in Berlin”. With his listen and learn approach to life, Selbie looks ready to respond to the challenges facing public health. For Public Health England see https://www.gov.uk/government/organisations/public-health-england For Public Health England see https://www.gov.uk/government/organisations/public-health-england Raising the pressure on hypertensionCardiovascular disease is not exclusive to the modern era. 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It is a political analysis and requires a political response—from UK politicians and from the body politic of the health professions. Full-Text PDF