"I know things are going well when we make a real difference to the health of the most disadvantaged people."
Bruce worked as a junior doctor in Paediatrics before starting a ten-year career in international medical relief work. It was here that he developed his interest in public health and moved away from clinical medicine.
It was my experience abroad, working for Médecins Sans Frontières, Oxfam and Merlin that first led me towards a career in public health. I saw at first-hand how many factors beyond health services affected people in emergencies. Back in the UK, with a young family in tow, I began training in public health in Berkshire and Sheffield. I became less focused on clinical work and increasingly interested in the distribution and causes of ill health in communities, and in strategies for improving and protecting health.
Initially I became the director of a public health team for a small primary care trust – ‘High Peak and Dales’. This later became part of Derbyshire PCT, where I was a consultant, deputy director and finally acting director. In 2013, having led the team’s transition from the NHS to the County Council, I moved to Bath and North East Somerset (BaNES).
The nature and interest of the role of director of public health is that it isn’t routine; in fact it’s extremely varied with many different elements: strategic planning, management, commissioning, leadership and networking. I have a general responsibility for the health and well-being of the population of Bath and North East Somerset and, overall, the role is about trying to prevent illness, promote good physical and mental health and reduce health inequalities through any possible means.
One way of describing the scope is through the three broad areas of health improvement (promoting healthy lifestyles), health protection (reducing hazards to health for example through vaccination, screening and emergency response), and healthcare public health (providing information and support to the NHS, particularly the local Clinical Commissioning Group). I also supervise public health trainees, lecture in global public health and teach on the Master’s in international health at Bristol where I run a session on health in refugee camps. So there really is no typical day.
I have a significant commissioning remit, and a £9 million budget for services, including: health visiting, school nursing, NHS health checks, weight management, exercise referral, smoking cessation, sexual health and drug and alcohol treatment. I also provide information and evidence on the health and population of Bath and North East Somerset to the Council and NHS. I or my team lead local strategies including those for active lifestyles, healthy weight, sexual health, tobacco and alcohol control and suicide prevention.
We seek to influence a wide range of Bath & North East Somerset Council departments and to have an impact on some of the wider determinants of health, such as transport, housing, leisure and regeneration, and we work with partners across other public services like the police and schools. Finally we engage with some of the local businesses, for instance on workplace health or improving the nutritional quality of foods in local restaurants and takeaways. One of the most striking things about my job is that I have a perfectly legitimate reason to meet with any of the 190,000 residents of the area.
As well as my local work I am on regional and national groups. For example I am a regional representative on the board of the Association of Directors of Public Health and part of a national group developing links between health and housing sectors.
This role demands technical knowledge, management skills and a fair amount of diplomacy since a significant part of the work relates to influencing others over whom I have no direct control. I need to be able to communicate effectively with Councillors and council officers, with local NHS leaders and sometimes the local media.
I know that things are going well when we make a real difference to the health of the most disadvantaged people in the area. I enjoy the variety each day brings, working with a very dedicated team, and helping to start new collaborations between different groups that will bring benefit to the population. One example of this is my chairing the Bath and North East Somerset domestic abuse partnership and overseeing its strategy.
My family consists of a wife, a dog and two boys at university. I keep fit by going to the gym and running. I have an interest in motorcycling and have recently become a volunteer ‘Blood Biker’ to courier medical supplies. I’m also a trustee of ENN, a small Oxford-based charity that works in the field of improving nutrition in developing countries.
Bath is an excellent place to live, I have a great job, work alongside some fantastic people and I’m happy to be here for the foreseeable future.
Public health is a fascinating career, working to secure people’s health in a variety of ways to create a fairer society in which health and life-chances are spread more equally. Its breadth encompasses young children, families, our growing elderly population, and areas such as transport, housing, economic development and clean air. It’s both a technical and a more personal task to understand, assess and then try to improve the health of the population. Whilst I have limited direct power and only a modest budget, there’s great potential to influence results locally through partnerships and collective collaborative work.