Dr Fiona Sim, RSPH Chair

Dr Fiona Sim, Chair of RSPH, reflects on the American Public Health Association’s annual meeting: an "enormous forum with such a clear common purpose".

Earlier this month I was very fortunate to spend four days at the American Public Health Association’s annual meeting, which this year was held in Boston.

I have attended this conference, which, with about 13,000 delegates, is many times bigger than anything we attend in the UK, several times before; but having not been for the past three years, it was great to return to that enormous forum with such a clear common purpose – I can only hope that working together with other public health leaders in the UK, we shall be able to achieve some genuinely shared goals in this country, too.

It has become a RSPH custom to host a parallel session during the APHA meeting, which has been badged by the APHA executive as the RSPH Lecture. For those thinking of attending the meeting in future, you might like to know that there is also a RSPH Tea (Party), at which English tea is served and hosted for us by the APHA Executive – the kind of tradition to which we have no objection, though the poignancy of this happening in Boston was not lost!

As the RSPH lecturer this year, I decided to speak on the topic of health reform and the potential for reform to impact on population health, with a ‘Think global, act local’ context in keeping with the theme of the whole meeting. I was delighted to be asked a few weeks before the meeting if our session could accommodate a visiting speaker, one Howard Koh, MD: in addition to having a Masters in Public Health he is Deputy Secretary for Health in the current US administration.

Naturally, I was delighted to share the platform with Howard, whom I had heard speak a few years ago: not only is he knowledgeable on his brief, but the timing was such that he was able to update the Meeting on the progress of the Affordable Care Act (ACA known as Obarmacareand how the challenges that had arisen in recent weeks were being handled by Federal government.

Despite my contention that the recent NHS reforms in England were large and hugely complex – and given that David Nicholson, the current NHS CEO, described the changes as being visible from space – by the end of Howard Koh’s description of the ACA, I was convinced that anything we in the UK can do, the US can manage to make their emerging health system even more complex and considerably more massive – though maybe not better.

I had done a lot of reading around the ACA prior to the session, so none of this was a surprise to me – but, by contrast, many of the mainly US-based audience seemed really shocked that the English system, which they view as a well-established and well-respected one, had undergone such radical reform in recent times. I shall write about my talk another time and place, but a key message was to explore the extent to which such major reforms may actually impact on population health – for better or worse - and to reflect on the many reorganisations to which the health system in England has been subjected since its introduction in 1948.

I referred in my talk on 4 November 2013 to the words of Aneurin Bevan in 1948, who said of the new NHS: “This is the biggest single experiment in social service that the world has ever seen undertaken”. Many of us feel that we – and indeed the Americans – are still living and working through this experiment.

What is now incumbent upon all of us, I believe, is to heed another quote of his: “It will last as long as there are folk left to fight for it”, so we continue to ensure our UK health care and public health systems are maintained and nurtured to achieve steadily improving population health and reduced inequalities.