All Directors of Public Health across the country write an annual report on the health of their local population. It aims to both inform and challenge with a combination of narrative, health intelligence and recommendations. Historically, some have been accused of being rather dry but the move of public health into local government has seen a renewed emphasis on innovative approaches and creative ways to engage both partners and the local population. For example, last year the Director of Public Health from Barnsley asked local people to complete a diary on the 7 November 2017 and to tell her about their day, including how they were feeling physically and mentally and what they felt made this better or worse. This resulted in a report called ‘A Day in the Life of…’. based on 260 diary entries by local residents.
My annual report came from a collaborative process with a small team of public health staff, a graphic artist and 250 local children. The novel starts on 5th July 1948 with the birth of the NHS and Wakefield resident, Janet Crofton and follows both of their fortunes over the next 70 years revisiting them every decade on her birthday. It includes a wide cast of characters and weaves a huge variety of strands together including social issues, healthcare and changing attitudes to gender, disability and sexuality. The graphic novel also includes input from local children including their own cartoons picturing how they view health and wellbeing. These provided us with some unexpected insights, alongside the usual points about eating healthily and doing exercise. For example, a number of children felt that their parents were working too hard and that this was having a negative impact on the whole family’s health whilst a protective factor was spending time together as a family. It was also interesting that even children as young as 11 recognise that it is easier to be healthy when you have more money.
I had decided to do a graphic novel for a number of reasons. While I did wonder a number of times, occasionally at 4am, whether I had made an error of judgement, I believe that stories can reach people in a way that facts and figures alone can’t. I wanted to do something different showing how health and wellbeing is influenced by the way that we are born, live, work and love. The complexity of this is captured much more subtly when you see all of these factors played out in somebody’s life rather than just pages of graphs and tables. I wanted people to read it and I had heard that children (and no doubt adults) absorb concepts more effectively in cartoon form – this is particularly important in a district like Wakefield where there are low literacy rates.
When you see 70 years of public health laid out in story form it does throw some things into stark contrast. One of the biggest reflections for me was how whilst social issues have moved on dramatically health inequalities remain entrenched. In 1948 ‘a woman’s place was in the home’, mental health was stigmatised and being homosexual was illegal. We still have a long way to go but women now make up almost half the workforce, mental health is openly discussed and gay marriage has been legalised.
One of the facts we came across when researching the novel was that it was John Wolfenden, who grew up in Wakefield, who wrote the 1957 report recommending that homosexuality was decriminalised. It took another ten years before this was enacted but in 2017, just fifty years later, my three children attended their first gay wedding. However, this huge social shift has not been replicated when it comes to social justice. Although life expectancy has increased overall, 11% of households in Wakefield can’t keep warm at a reasonable cost, almost one in four children are living in poverty, and a child born in the most deprived area can expect to live almost ten years less than those in the least deprived area.
In the end, despite my concerns, the graphic novel concept was welcomed by everyone with our leader even joking that in the future all council reports should be produced like this. Taking a collaborative approach and getting local children to be an integral part of both the process and the end product made it feel fresh and relevant. On a personal level I have been delighted by the much bigger reach the annual report has had this year sparking both corridor conversations and Twitter traffic. In conclusion, I would encourage others to be brave too and adopt innovative approaches to communicate with staff, partners and citizens - it works!