Introduction

If there is to be success in addressing the major health challenges of today, in tackling the social gradient of health and in promoting well-being in all sectors of the population, then public health needs to be done differently. The current public health system, the way the workforce is organised and the downstream focus on lifestyle interventions is evidently not up to the task in hand. Debate about public health capacity continues to focus almost exclusively on the capabilities and resources of professionals, rather than recognising the capacity of citizens and communities to make a significant contribution. Despite all the aspirational policy statements on citizen empowerment (Secretary of State for Communities and Local Government, 2008; Cabinet Office, 2010), and the importance of a fully engaged society (Wanless, 2004), the lay contribution is still not harnessed in any systematic or mainstreamed way. Knowledge about how to involve people has not been translated into the creation of an infrastructure to sustain that involvement in order to bring about long-term improvements in health. Yet the potential benefits that would result from ‘putting the public back into public health’ (Heller et al, 2003, p 62) would be enormous. This final chapter revisits the major themes of the book, bringing in some fresh perspectives that shift thinking on lay engagement. The chapter ends with a manifesto for change based on the value of active citizenship for public health.

The focus of this book has been the involvement of members of the public (lay people) in the delivery of public health programmes, one of the ways communities can play a larger part in public health efforts (see Figure 1.1 in Chapter One). The book has looked at why, how and with what support people can move from being passive consumers of services to active citizens who make a valued contribution to health improvement. The major themes for policy and practice explored in the book are topical, not least because of the current fiscal crisis and the threats to the welfare state. The authors have argued that the public health community needs to redefine the way people and communities are involved, in a way that does not erode hard-won rights.