Public Health

Wellbeing theories are utilised to better understand and frame current health promotion approaches. The World Health Organisation’s definition of wellbeing is first evaluated in terms of its merits, potential interpretations and its relationship to health promotion. The reorganisation of the public health agenda to local authorities within the UK up to current policy directions will be outlined, to set the context for this study. The current public health agenda will be evaluated in relation to the theoretical underpinnings as connected to eudaimonic and integrated wellbeing theories. This focus does not presuppose that eudaimonic wellbeing theories are superior in any way to hedonic wellbeing theories, rather in seeking potential synergies between public health and tourism, these types of wellbeing theories may catalyse longer-term wellbeing and ultimately enhanced levels of social sustainability.

Legislation Empowering Local Authorities

The UK Local Government Act (2000), empowered local authorities to encourage economic, social, and environmental wellbeing within their jurisdictional area, where they

now have a statutory duty to improve the health and wellbeing of their local population (UK House of Commons 2015). Additional changes included the Local Government and Public Involvement Act 2007 and the Duty to Involve 2009 that allowed local authorities to devolve power to local communities. More recently, the UK Public Health White Paper (2010) proposes responsibilities for local council in regards to public health. The concept of wellbeing becomes increasingly salient in light of the UK government’s empowerment of local authorities to promote wellbeing (Local Government Act 2000). Moreover, it is suggested that local government is now experiencing an unparalleled opportunity to carve out a new role. The UK government is in the process of pursuing a "localised" policy where functions of health improvement shift from regional to local council responsibility (Davies et al. 2014; Hartwell 2011). Instruments of local government, which include planning, transport, education, leisure, and housing, represent many of the fundamental levers for improved wellbeing (Hunt 2012; Aked et al. 2010).

Additionally, it is acknowledged that local government plays a significant role in building greater capacity for material and psycho-social wellbeing and nurturing conditions for citizens to reach their potential and enjoy a good life (HM Government 2010). This shift presents an opportunity for local level decision makers, aware of local conditions, to effectively enhance general levels of health and wellbeing (Hartwell et al. 2012). Furthermore, there is a growing recognition of the importance of multi-stakeholder collaboration in marrying policies for more effective outcomes towards community wellbeing (Hartwell et al. 2013; Aked 2010).

Increasingly, health research suggests that health promotion and prevention needs to be linked to individual responsibility and accountability for their health (Hunt 2012). Researchers recommend the creation of new models for positive health which reflect WHO’s slogan, health is our real wealth (Hunt 2012; Shaw and Marks 2004). Shah and Marks (2004) recommend that any good, democratic government ought to promote a good life and a flourishing society to facilitate a happy, healthy, capable and engaged citizenry and wellbeing. From this perspective, wellbeing contributes to a person’s development, their fulfilment and their ability to contribute to their community (MacKean and Chapman 2012; Shah and Marks 2004; Cuthill 2003). There is now a recognised need for the integration of all sectors, both locally and nationally, to work together to be fully engaged to encourage a scenario where citizens understand their health and how to protect it (Wanless 2002).

Historical context of public health policy and health promotion

Research suggests that historical interpretation could be used as an analytical tool to better understand public health decision-making and policy (Berridge 2000). Historically, public health policy has been conceptualised as four distinct waves of health activity that

bridge a connection between societal situations, thinking, and associated public health policy interventions (Davies et al. 2014; Hemingway 2011; and Hanlon et al. 2011; Lyon 2008). Further, it is proposed that each of these waves since the industrial revolution is associated with shifts in thinking around society and health (Hanlon et al. 2011; Szretzer 1997). Notably, research suggests that it is possible to connect links between the public health waves and notions about society, health and wellbeing (Hanlon et al. 2011). The historical trace of public health policies reveals the predominance of reductionist and reactionary approaches, traditionally responding to curing rather than preventing disease. Increasingly research supports the need for a fifth wave in health policy that would represent a shift to a proactive approach to health promotion (Davies et al. 2014; Hemingway 2011).

Fifth wave of public health policy

With the additional complexity accompanying the twenty-first century, the reductionist and reactionary approaches employed within public health seem to no longer meet current health challenges. There is growing recognition that current public health models, ideas and interventions seem inadequate when faced with the complex issues of the 21st century (Lyon 2008). Increasingly, research indicates that public health is an ineffective body based on the false assumption that the human body is a machine protected from disease and infirmity through interventions (Naidoo and Wills 2015).

Research indicates that a distinct ‘fifth wave’ of development is needed to address the current societal health challenges (Hanlon et al. 2011), where public health is not just supporting public health policy but is prompting the approach (Whitehead 2010). Public health has moved past being merely the science of identifying and removing infectious diseases. Current epidemiology is more complex as there is an interrelationship between genetics, environmental situation, and lifestyle choices. Researchers have acknowledged the limitations of reductionist thinking in healthcare for unravelling clinical and organisational challenges (McDaniel and Driebe 2001; Plsek and Grenhalgh 2001; Waldrop 1992). There is currently a recognised need to abandon past linear models to better respond to emerging patterns and prospects (Plsek and Grenhalgh 2001). Some have argued that a main challenge is that there is no conceptual model to guide the identification of social and political processes to either encourage or discourage public health policy development (Berridge 2000; Nathanson 1996).

It is suggested that the particular challenges around issues of obesity, inequalities, and the loss of wellbeing are not able to be mitigated through earlier or current strategies despite central government efforts (Hanlon et al. 2011). Additionally recent statistical analyses suggest that ill-health accounts for annual UK government spending of £10.4 billion where £4.2 billion is related to obesity, £3.5 billion to alcohol misuse, and £2.7

billion to smoking (HM Treasury 2015). Obesity rates across England are continuing to rise, particularly amongst disadvantaged children, further widening health inequalities (Health Survey for England 2014). While smoking rates have declined, one in five adults are smokers; and one in four are smokers in disadvantaged communities (ASH 2015). Excessive drinking is also most prevalent within the lowest socio-economic groups (UK House of Commons 2015). These are examples of challenges that are currently being faced, that if tackled effectively could improve the function of public health and lessen health inequalities (UK House of Commons 2015). This situation is further compounded by recent evidence to suggest that the current Conservative and Unionist government have been criticised for not developing effective strategies and policy to address health challenges of obesity, and smoking (Bosely 2016; Wallaston 2016). Recent evidence further emphasising that current models, ideas, institutions and interventions are now deemed to be ineffective in tackling the complexity in life within the 21st century (Naidoo and Wills 2015; Lyon 2008).