Measuring Health and Wellbeing


John Harvey & Vicki Taylor

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    Foreword from the Series Editor

    The publication of the Public Health Skills and Career Framework in April 2008 provided, for the first time, an overall framework for career development in public health in the UK. Prior to this, the focus had been primarily on the public health specialist workforce. The development of the framework itself was a truly collaborative enterprise involving a large number of organisations and stakeholder groups and was designed to enable individuals at any stage of their career to identify a pathway for skills and career progression.

    Within the framework, public health is divided into nine areas of work. There are four core areas that anyone working in public health must know about and have certain competences within. There are five non-core or ‘defined’ areas, representing the contexts within which individuals principally work and develop.

    Core areasNon-core (defined) areas
    Surveillance and assessment of the population's health and wellbeingHealth improvement
    Assessing the evidence of effectiveness of interventions, programmes and servicesHealth protection Public health intelligence
    Policy and strategy development and implementationAcademic public health
    Leadership and collaborative workingHealth and social care quality

    This new series, ‘Transforming Public Health Practice’, has been developed as a direct response to the development of the framework and has a book dedicated to each of the four core areas of public health. Measuring Health and Wellbeing; Assessing Evidence to Improve Population Health and Wellbeing; Policy and Strategy for Improving Health and Wellbeing; and Leading for Health and Wellbeing are all featured.

    The framework defines nine levels of competence and knowledge. Level 1 will have little previous knowledge, skills or experience in public health, while those at level 9 will be setting strategic priorities and direction and providing leadership to improve population health and wellbeing. This series is aimed at those who want to develop their skills and knowledge in public health at levels 7–9 (which broadly equates to Master's level), although the series will be relevant to a wider group with the publication of the Public Health Practitioner standards and opening of the Public Health Practitioner Register (UKPHR). This will include those interested in acquiring or developing their public health competences and knowledge and, in particular, those who are seeking to demonstrate their public health skills and knowledge (and may be considering putting together a portfolio to demonstrate this, at specialist or practitioner level).

    This series will also be useful for anyone whose work involves improving people's health and wellbeing, or has a direct impact on the health and wellbeing of communities and populations – this encompasses a wide range of work areas and of organisations and agencies.

    Individual books in the series outline the key knowledge and skills in the core area and through case studies and scenarios show how these competences can be used in practice. Activities and self-assessment tools are provided throughout the book to help readers to hone their critical thinking and reflection skills.

    Chapters in each of the books follow a standard format. At the beginning a box highlights links to relevant competences. This sets the scene and enables readers to see exactly what will be covered. This is extended by a chapter overview, which sets out the key topics and what readers should expect to have learnt by the end of the chapter.

    There is usually at least one case study in each chapter, which considers public health skills and knowledge in practice. Activities such as practical tasks with learning points, critical thinking and reflective practice are included. Each activity is followed by a brief commentary on issues raised. At the end of each chapter a chapter summary provides a reminder of what has been covered.

    All chapters are evidence-based in that they set out theory or evidence that underpins practice. In most chapters, one or more ‘What's the evidence?’ boxes provide further information. A list of additional readings is set out under the ‘Going further’ section, with all references collated at the end of the book.

    In summary, this series will provide invaluable support to anyone studying or practising in the field of public health, in a range of different settings.

    Vicki TaylorIndependent Public Health Consultant and Director The Roundhouse Consultancy, MK Ltd Associate Lecturer, The Open University Previously Senior Lecturer, London South Bank University Senior Lecturer, Kings CollegeLondon

    Author Information

    Claire Bradford graduated from Nottingham University Medical School in the 1980s and pursued a clinical career as a haematologist. She subsequently trained and worked in Public Health in the North East of England. Her appointments have included Director of Public Health in Newcastle upon Tyne and deputy director at the North East Public Health Observatory. Her professional interests include knowledge management, maternal and child health and reduction in health inequalities.

    John Harvey is currently a director of a limited company providing public health consultancy. He trained as a public health consultant after working for nine years in the Yemen doing mainly maternal and child health programmes. He has experience as Director of Public Health in three different settings – Newcastle upon Tyne, Jersey and the London borough of Havering, where he was a visiting professor of public health at London South Bank University. He is an honorary Fellow of the Royal College of Paediatrics and Child Health. He was the co-chair (for the Faculty of Public Health) of the Child Public Health Interest Group for several years.

    Mike Lavender currently works for NHS County Durham and Darlington. After medical qualification and junior doctor posts, he trained as a general practitioner. For the next 8 years he worked for different health programmes in Nepal, initially as a clinician but with increasing involvement in community health projects. On his return to the UK he trained in public health. He has been a consultant and doctor of public health in the North East since then, apart from another recent 2-year spell in Nepal.

    Vicki Taylor has worked in public health since 1985 in a range of different roles at local, regional and national levels, and is now Director of the Roundhouse Consultancy MK Ltd, which offers consultancy in public health and leadership and management. She has a strong interest in public health development and, in particular, the development of public health leadership and management. She has substantive experience of public health and public health practitioner development in a number of geographical areas, spanning a period of more than 25 years. Vicki is Vice Chair of the UK Public Health Register (UKPHR) Registration Panel and is also an assessor for the UKPHR with experience of assessing public health portfolios at consultant (generalist specialist and defined specialist) and practitioner level. Currently she is providing learning sets and support for the West Midlands Public Health Practitioner's Assessment Scheme and the Surrey and Sussex Public Health Practitioner's Assessment Scheme and provided Commentary Writing Workshops support for the Public Health Practitioner Portfolio Development scheme in Wales.

    Vicki provided learning sets to support the Kent and Medway Public Health Practitioner's Pilot Assessment Scheme and was the project manager for the NHS South Central public health practitioner development scheme from March 2007 until November 2009. In these roles Vicki has influenced and championed the development of public health practitioner schemes.

    Rhonda Ware is a registered nurse who has worked at a senior level in the commercial, charity, local authority and health sectors, including private and the NHS. Rhonda was a senior manager in public health, having previous expertise in children's health and education, learning disabilities and care of the elderly. She is now Co-Director of Tiger Health Limited, which offers consultancy in healthcare and public health. Rhonda has a particular interest in leadership and change management, governance and quality improvement.


    The editors would like to thank Rhonda Ware, Claire Bradford and Mike Lavender for their contributions to the text. Chapter 2 was written by John Harvey with contributions to the activities from Vicki Taylor. Chapter 3 was written by Mike Lavender with contributions from Vicki Taylor who wrote the sections on ‘A five step approach to HNA and Rapid participatory appraisal’ and activities 3.3 and 3.4.

    The editors and publisher would like to thank the following for permission to reproduce copyright material:

    Stockholm Institute for Future Studies for Figure 1.2; from Dahlgren and Whitehead (1991) Policies and Strategies to Promote Social Equity in Health.

    Dr Rida Elkheir for Health Needs Assessment: A Practical Approach (2007).

    The British Medical Journal for Wright, J, Williams, R and Wilkinson, JR (1998) Development and importance of health needs assessment. BMJ, 316:1310–1313.

    The British Medical Journal for Murray, SA (1999) Experiences with ‘rapid appraisal’ in primary care: involving the public in assessing health needs, orientating staff, and educating medical students. BMJ, 318:440.

    Every effort has been made to trace all copyright holders within the book, but if any have been inadvertently overlooked the publisher will be pleased to make the necessary arrangements at the first opportunity.


    This book explores the knowledge and skills required to undertake meaningful measures of health and wellbeing.

    One of the most important tasks we have as a society is to promote the health and wellbeing of our population, looking to improve their long-term quality of life. To do this we must understand two main issues: what determines health and wellbeing and how that influences the needs of any given population; and what impact interventions, whether a public health programme, a new social policy, a housing development or a health and social care service, have on individuals and the population – so-called outcomes. This understanding is informed by measuring health and wellbeing.

    This is a vital aspect of public health practice. The practitioner must be able to plan and undertake straightforward need assessment for a local community or wider population. This requires a knowledge of how different measures are produced, the competence to give relevant interpretation of those measures and the skill to present the information in a compelling way.

    Is This Book for Me?

    This book is one of a series of four books aimed at addressing the core standards for public health practice as set out in the UK Public Health Skills and Career Framework (2008). It covers the first core area in the Public Health Skills and Career Framework: ‘Surveillance and assessment of the population's health and wellbeing’.

    Bringing together a basic understanding of need and measures used to express need and methods for doing health needs assessment (HNA) this book provides a practical resource that can be applied to public health and health promotion practice. It aims to make accessible from the vast health surveillance and population assessment literature some key concepts that may have relevance to measuring health and wellbeing. Through the use of case studies and activities, this book seeks to support the achievement of health improvement and health promotion goals. It is hoped that the approach taken gives the reader an opportunity to consider ways of contributing to the surveillance and assessment of the population's health and wellbeing.

    The primary aim of the authors is to create a practical resource to support anyone preparing a portfolio for submission for registration as a defined specialist (at level 8), or registration as a public health practitioner (at level 5) and for those who are interested in the standards for measuring and surveying population health.

    How the Book Works

    This book is organised into six chapters. A consideration of the links between, and relative importance of, the various determinants of health and wellbeing is at the heart of Chapter 1. Chapter 2introduces different types of measures and methods of measuring health and wellbeing and considers the difference between a measure and an indicator. Chapter 3 explores the notion of HNA as a means for identifying and prioritising the health needs of a community or population group. The chapter goes on to set out different approaches to carrying out an HNA, in particular the epidemiological approach and a five-step method. In Chapter 4 the emphasis shifts to health surveillance and what is required to establish an effective system for carrying out health surveillance. Health outcomes measurement and assessment are considered in Chapter 5.

    The final chapter aims to provide the reader with a practical view of the use of measures of health and wellbeing to influence decision making, whether by commissioners or in a local strategic partnership. The chapter aims to provide models for practice and brings several strands together in a focus on tackling health inequalities.

    How to Use this Book

    You may be using this book to help prepare a portfolio for registration as a defined specialist (at level 8), for registration as a public health practitioner (at level 5) or as part of your studies. Once you are clear about the focus or standard you wish to consider, whether (for example) it is knowledge of methods for undertaking an HNA, look at the table below, which gives you a quick guide to the chapter titles and the standards (UK Public Health Skills and Career Framework (Department of Health 2008) and National Occupational Standards) and Public Health Practitioner Standards covered within the chapter. A chapter overview, at the beginning of each chapter, augments this information and sets you in the right direction.

    Table 0.1 Chapters, Uk Public Health Skills and Career Framework (Phscf), National Occupational Standards (Nos) and Public Health Practitioner Standards (Phps)

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