Introduction

This chapter focuses on public health in Wales and the context within which it is delivered. As a devolved service, health policy and the wider public policy legislative framework are the responsibility of the devolved Welsh Government tasked under the Government of Wales Act 2006 with developing and implementing policy, exercising executive functions and making subordinate legislation. Focusing on public health, part two of the chapter outlines the organisations involved and the context of the policy in Wales. It also explores the political drive for more collaboration between different organisations as a mechanism for the delivery of better services. Part three examines a unique piece of legislation in Wales, the Well-Being of Future Generations Act 2015 (WFG Act), and identifies how this may influence the work of local authorities and other organisations in relation to health and its social determinants. In part four, we draw on the available evidence on how this is working so far and focus on two key policy areas jointly driven by the Cymru Well Wales partnership – ‘Adverse Childhood Experiences’ (ACEs) and ‘The first 1,000 days’. Finally, our conclusions indicate that regardless of where public health is located, the policy context in Wales is quite different, and the key issue is whether this will lead to improved public health outcomes for everyone in Wales.

Public health in Wales

The onset of devolution of health services across the United Kingdom (UK) has seen significant divergence through an asymmetric process where distinctive national characteristics of public services delivery have emerged (Bevan et al, 2014). Prior to this, as McClelland (2002, p 325) states, the National Health Service (NHS) in Wales was perceived as ‘forming an adjunct to the English health service’. Since 1999, legislative and policy frameworks have been viewed by the predominantly Welsh Labour-led devolved governments as a mechanism to assert political demarcation from Westminster. This was famously encapsulated in the term ‘clear red water’ set out in a speech delivered by the First Minister Rhodri Morgan in December 2002 (Morgan, 2017). While this philosophy was originally constructed in differentiating Welsh Labour from the marketisation strategies of New Labour in London, it grew in contextual importance.