Building the voice of citizens into public health evidence – the view from NICE’

1. Building the voice of citizens into public health evidence – the view from NICE’ Putting the public back into public health, Leeds Metropolitan University, 16th January 2014. . Professor Mike Kelly, Director of the Centre for Public Health, NICE and the Institute of Public Health, University of Cambridge.

2. Key ideas. • Practical steps at citizen involvement. • Theoretical implications for Public Health Guidance.

3. NICE needs YOU

4. Stakeholder involvement • Scope of the work drawn up by the NICE team. • Scope published on the web. • Public stakeholder meeting. • Stakeholder comments received and responded to on the web • Scope amended and final version published.

5. Who writes the guidance?

7. Guidance developed • Evidence reviewed. • Evidence appraised. • All committees have lay and community members on them. • Draft recommendations published. • Stakeholders comment on the draft recommendations. • Recommendations revised. • Guidance published.

9. The Public Involvement Programme at NICE • Recruits lay members to committees. • Inducts the lay members. • Provides on going support to lay members. • The importance of the lay and community perspective. • Meetings held in public. • http://www.nice.org.uk/getinvolved/patientsandpublic/patientandpublichome.jsp

10. The Citizens’ Council • 30 members of the general public. • Deliberates on complex problems. • Presents independent reports to the Board. • Its views help to frame the production of NICE guidance.

11. A methodological and theoretical departure.

12. The discourse of risky behaviours • Tobacco

13. The discourse of risky behaviours • Tobacco • Alcohol

14. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity

15. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food

16. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs

17. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs • Travel

18. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs • Travel • Sex

19. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs • Travel • Sex • Age

20. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs • Travel • Sex • Age • Being alive

21. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs • Travel • Sex • Age • Being alive

22. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs • Travel • Sex • Age • Being alive

23. The discourse of risky behaviours • Tobacco • Alcohol • Inactivity • Food • Drugs • Travel • Sex • Age • Being alive

24. Social practice. • Social practices not behaviour. • Acknowledges agency and structure. • Non–determinist.

25. Theories of Social Practice and Public Health Conventional methods of understanding and influencing non communicable disease and smoking, obesity, alcohol Something missing Behaviour and lifestyle choices Nudge, getting messages across, enabling people to make better choices for themselves. “wider determinants”

26. materials (objects, consumer goods, infrastructures); • competence (including understandings of the situation; practical know-how) • meanings (including embodied understandings of the social significance of the practice; past experiences of participation etc.).

28. X Y

30. X D A Y X1 C B

31. X4 P O X2 N H G M F E X1 D C B A Y I J K Q L R X3 S T X5

32. 4 P O N H G M F E X1 D C B A Y I J K Q L R X3 S T X5

35. How practices change Practices depend on the active integration of elements. Practices emerge and change when new links are made Practices disappear when links are broken. competence competence meanings meanings materials materials An ex-practice - In which links between elements are broken A practice – in which elements are linked

36. Tobacco smoking How has the practice has evolved? How the elements of the practice have changed? Who is captured by the practice? How does smoking relate to other social practices? Smoking has changed significantly during the course of its 2,000 year ‘lifetime’. What are the materials, the meanings, the skills involved? Who smokes, social class associations, gender, age? Drinking, relaxing, taking a break, eating.

37. Smoking depends on an integration of materials: not only, cigarettes, matches and lighters; but also tobacco plants, factories, transport systems, retail infrastructures, an economy.. competence: to know how to smoke, not only practically how to light a cigarette and inhale; but how to smoke in the ‘correct’ manner for a given social situation e.g. in a beer garden, during a break at work meaning: understanding that smoking is a normal and socially acceptable thing to do, variously associated with relaxation, sociability, masculinity, glamour and toughness. http://www.morguefile.com/archive/#/?q=cigarette&sort=pop&photo_lib=morgueFile

38. Practices make and use social networks? People are linked by practices, practices recruit through networks Example of social network from Nick Crossley

39. Social practices interact – links are made and broken between one practice and another

40. “wider determinants” Impasse Social practices that persist across space and time That have lives of their own That are constantly on the move Behaviour and lifestyle choices Nudge, getting messages across, enabling people to make better choices for themselves.

41. Conclusions

42. 'Many of the triumphs of public health in the past ...relating to infectious diseases have been brought about by primary prevention. Similar victories over those modern maladies , the chronic degenerative diseases seems however far from grasp. ....[T]he strategies of preventive medicine do not seem to have come to grips with the sorts of behavioural and societal manipulations necessary to allow these conquests to be made' (Donaldson & Donaldson, 1983:130).[ Donaldson, R.J. & Donaldson, L.J. (1983) Essential Community Medicine (Including Relevant Social Services) , Lancaster: MTP Press.]

43. Implications • We need to understand the lived experience of citizens in their lifeworlds. • We need to eschew predictive causal models. • We need to understand the relational nature of social life.