I love working in Public Health and am proud to work alongside so many dedicated, highly skilled and intelligent colleagues. The Public Health workforce is richer for our diversity and people coming from a range of different backgrounds. Although there are many routes to this career and no single training path, what we all have in common is unity around shared values and morals, and a commitment to improve lives. We are unrelenting in our desire for social justice, evidence-based practice, reducing inequalities and critical thinking and we bring heart and soul to what we do. Our standard of practice is as high as our work ethic, but most of all we care about what we do.

However, the scale of ill-health, inequality, unmet need and adversity is now so great across the communities we serve that we can no longer rely on our tried and tested approaches. The time has come for us to reflect very carefully on how we work and what we do.

The Public Health approach tends to be methodical and iterative which seems at odds with the measure of what we need to do. Public Health teams are a safe and reliable bunch of people. Apart from the odd maverick, we are diligent and disciplined; we are generally middle class; and we most definitely do not rock the boat or upset the status quo. And although we do advocate for reducing inequalities and improving the rights of people, groups and communities who experience disadvantage, we do this in a very reasoned and considered manner. We hope making our point with academic rigor and commitment will convince others in the same way that this style compels us.

But maybe the time has come to harness and release our inner maverick in order to challenge the status quo, for the current system is failing and at risk of collapse. It is also unfair and unjust. Remembering the purpose of Public Health is to improve the health and wellbeing outcomes across our whole population, it is worth re-iterating the current level of this need:

• Life expectancy stopped increasing for the first time since the second world war after 2008 and this is largely down to austerity. In recent years we are seeing a decline in life expectancy meaning children born now will live shorter lives than their parents and grandparents.
• The levels of ill-health in the population are at an unprecedented high and this burden of disease is detrimental on an individual level, but also on society as many people are no longer able to work or participate in their communities and family life.
• Our health and social care services are stretched and underfunded.
• Adding to the layers of concern, the volume of people waiting for treatment for these ailments is also at an all-time high with many languishing and even dying on waiting lists.
• There are unprecedented demands on the health service with new drugs and technology putting more pressure on finite budgets. What we see in these developing fields is some are better at articulating their want to access these services than others are which leads to more inequality.
• Record numbers of children don’t know where their next meal is coming from and go to bed hungry. This is but one social ill amongst trauma, addiction, homelessness, fuel poverty, isolation and the cost of living crisis.
• The wider public and third sector continues to be eroded with many community based services once seen as essential, now judged a luxury and facing decimation.
• Our staff are burning out and weary of giving of themselves to ever increasing demands, whilst at the same time facing cost of living and other social problems themselves.

All this is grim, and I don’t see any light on the horizon. Yet, we live in a country rich in natural assets and resources. It is important to recognise the causes of the ill-health and unmet need described above do not come about by chance, nor are they just down to bad luck in the lottery of what country you happen to live in. In other words health problems are politically driven; whether this is due to a lack of consideration by politicians of the impacts of their decisions or if there are more malevolent forces at play is a matter for personal opinion.

The compelling need for system change puts fire in my belly, but if I am honest, it also makes me feel overwhelmed and at times impotent. It is very difficult to rebel against a system while at the same time being completely immersed in it. Even with a wide-angle lens, the constituent parts that contribute to a failing system are very difficult to disentangle.

The Covid pandemic brought the Public Health profession centre stage and increased our profile. Arguably we have failed to capitalise on this opportunity. The collective amnesia of 2020 to 2022 might even be returning us to being met with glazed expressions when we tell people what we do for a living. Yes, we were exhausted by Covid and it is not clear how we should prioritise our efforts now the ask is so great, but we have big work to do.

So my challenge to you, my very dedicated and hard working colleagues is this – you have to zoom out from where you currently work and look at the bigger picture and you might have to work in a more generalist way as opposed to being specialists in your field. You have to allow that anger at injustice and inequality to rise to the surface and you have to become a bit less conventional in how you channel your energy. The old Public Health approach will not serve us in the future in the same way as it did in the past. You will also have to be brave and join forces with others to form a collective voice to call out the discord between Scotland’s wealth and Scotland’s health. Set daily reminders that social democracy is inextricably linked with health and wellbeing. You will have to roll up your sleeves and get better at working with your communities and helping people in these communities to have their voices heard.

If I were to choose the most important step change we must make as a profession, it is this – we must put community and people at the heart of everything we do and focus on how we are present rather than what we deliver. From strong and trusted relationships great things can happen.

The climate emergency is in our peripheral vision, and for the next generation of Public Health staff will likely dwarf all the other challenges we have ever faced. Therefore we must change now to ensure we are a sustainable workforce to meet both current and future demands. Public Health teams have a unique contribution to give, and we are in this for the long haul, we need to stay well ourselves, for our colleagues and our families. Inner reflection and a focus on our own health and wellbeing needs are essential so we don’t burn out.

I’m asking a lot, but I have a lot to give, for example, as a networker and cheerleader to enable us to work together and as a collaborator to cast our net wide and bring new people in. Please get in touch so we can build bridges from tried and tested approaches to new and innovative ways of working. Together we can harness the passion that brought us into Public Health in the first place and create a new vision for Public Health from within.

Radical spirits rise up with me for this challenge, for in every caring heart there is a hidden roaring lion.