From Aspiration to Action: Becoming a Director of Public Health in Local Government

Stepping into the role of Director of Public Health (DPH) is not just a career milestone it’s a commitment to shaping the health and wellbeing of entire communities. As one of the most influential positions within local government, the DPH leads on everything from tackling health inequalities and managing public health emergencies to influencing housing, education, and economic development strategies. It’s a role that sits at the intersection of policy, leadership, and compassion.

The journey to becoming a DPH requires more than technical expertise. It demands strategic vision, political acumen, emotional intelligence, and the ability to lead across complex systems. You’ll be expected to navigate competing priorities, build trust with elected members, and deliver measurable improvements in population health often with limited resources and under intense scrutiny.

This guide is designed for those who aspire to take on this challenge. Whether you're a public health consultant, a senior manager in the NHS, or a local government officer with a passion for prevention and equity, this roadmap will help you understand:

• The core skills you’ll need to develop to succeed in the role.

• What to focus on from day one to build credibility and momentum.

• The common pitfalls to avoid as you transition into leadership.

If you’re ready to move from aspiration to action, read on.

1. The Skills You’ll Need to Develop

According to the NHS Health Careers framework, Directors of Public Health operate at levels 8 and 9 the highest tiers of leadership within the public health system. These roles are not only senior in status but also in complexity, requiring a blend of technical expertise, strategic thinking, and emotional intelligence. To thrive in this space, aspiring DPHs must cultivate a diverse and robust skillset:

• Leadership and Diplomacy

You’ll be expected to lead with vision and integrity in politically sensitive environments. This means balancing the needs of elected members, senior officers, NHS partners, and the public often with competing priorities. Effective DPHs are not just managers; they are system leaders who inspire trust, navigate ambiguity, and make decisions that stand up to scrutiny.

You must be able to “lead without authority” influencing others through credibility, relationships, and shared purpose.

• Financial Management

Public health budgets are often constrained, and the ability to do more with less is essential. You’ll need to understand commissioning, procurement, and return on investment. Whether it’s allocating funding for smoking cessation or negotiating contracts for sexual health services, financial literacy is key to delivering value and sustainability. A DPH must be able to articulate the economic case for prevention not just the moral one.

• Project and Change Management

Public health is dynamic. You’ll be leading programmes that span multiple sectors from tackling obesity to improving air quality. Change management skills help you bring people with you, manage resistance, and embed new ways of working. You’ll also need to be comfortable with programme governance, risk management, and evaluation. Transformation is not a one-off event it’s a continuous process of learning, adapting, and improving.

• Numerical and Analytical Skills

Data is the lifeblood of public health. You’ll be expected to interpret epidemiological trends, assess population needs, and evaluate interventions. Whether it’s analysing mortality rates or modelling the impact of a new policy, your decisions must be grounded in evidence. You don’t need to be a statistician but you do need to know what good data looks like, and how to use it to tell a compelling story.

• Collaborative and Systems Leadership

Public health doesn’t operate in isolation. You’ll need to work across boundaries with housing, education, transport, and the voluntary sector to address the wider determinants of health. This requires humility, curiosity, and the ability to build coalitions for change.

“Successful leaders affect change through influence, share resources and power, and collaborate with diverse groups.” Aspiring Directors Programme, ADPH

2. What to Focus on From Day One

Your first 100 days as a Director of Public Health are critical. They set the tone for your leadership, establish your credibility, and lay the groundwork for long-term impact. This is your opportunity to listen, learn, and lead with intention. Experienced DPHs consistently emphasise the importance of starting with clarity, humility, and strategic focus.

• Listen Before Leading

Before making changes or setting new priorities, take time to understand the culture, context, and people around you. Meet with your public health team, senior council officers, elected members, NHS colleagues, and community stakeholders. Ask questions, seek feedback, and show that you value existing expertise. Listening builds trust and trust is the currency of effective leadership.

• Understand the Local Health Landscape

Familiarise yourself with the key documents and data that shape your area’s public health strategy. This includes the Joint Strategic Needs Assessment (JSNA), the Health and Wellbeing Strategy, and the Public Health Outcomes Framework. These resources will help you identify priority issues, understand demographic trends, and align your work with local needs. A strong grasp of local data ensures your decisions are relevant, targeted, and defensible.

• Build Relationships

Your success will depend on the strength of your relationships. Invest time in building rapport with elected members, NHS partners, Integrated Care Boards (ICBs), voluntary sector leaders, and other council departments. Be visible, approachable, and collaborative. These relationships will be essential when navigating complex challenges or driving cross-sector initiatives. Public health is a team sport and your influence grows through connection.

• Clarify Your Priorities

You can’t do everything at once. Identify a small number of high-impact priorities that align with local needs and national policy. Focus on prevention, reducing health inequalities, and place-based approaches that address the wider determinants of health. Be clear about what success looks like and how you’ll measure progress. Early wins build momentum but only if they’re meaningful and strategic.

• Communicate Your Values

Your leadership style will shape the culture of your team and influence how others perceive public health. Be transparent about your values whether it’s equity, evidence-led practice, or community empowerment. Use every opportunity to reinforce these principles in your communication, decision-making, and partnerships.

“Your plan is the signal to your team around your style and priorities.” NHS Leadership Academy

3. Common Pitfalls to Avoid

Even the most experienced leaders can stumble when stepping into a new role and the Director of Public Health position is no exception. The early months are filled with pressure, visibility, and expectation. Avoiding common pitfalls can help you build credibility, maintain momentum, and protect your wellbeing.

• Trying to Do Everything at Once

Public health is a vast and complex field. From mental health and substance misuse to air quality and active travel, the scope is enormous. New DPHs often feel compelled to tackle every issue immediately but this can lead to burnout, diluted impact, and confusion among stakeholders.

Prioritise ruthlessly. Focus on a small number of strategic goals that align with local needs and deliver visible value. Use your JSNA and Health and Wellbeing Strategy to guide your choices.

• Neglecting Political Awareness

Local government is inherently political. Your ability to navigate council dynamics including party politics, cabinet priorities, and scrutiny committees will shape your success. Failing to understand the political landscape can result in missed opportunities, miscommunication, or resistance to your initiatives. Build relationships with elected members early. Understand their priorities, language, and concerns. Position public health as a solution to their challenges, not a separate agenda.

• Overlooking Workforce Morale

Public health teams have endured years of funding cuts, restructures, and rising demand. Morale may be fragile, and staff may be stretched thin. Ignoring this reality can lead to disengagement, turnover, and reduced performance. Invest in your team. Celebrate their achievements, support their development, and create a culture of psychological safety. A motivated team is your greatest asset.

• Ignoring Data

In public health, data is not optional it’s essential. Decisions must be evidence-based, and your ability to interpret and communicate data will underpin your credibility. Failing to use data effectively can lead to poor outcomes, wasted resources, and reputational risk. Use tools like Fingertips, Local Knowledge and Intelligence Service (LKIS), and Office for Health Improvement and Disparities dashboards. Make data part of your narrative not just your reports.

4. The State of Public Health Leadership Today

The landscape of public health in the UK is shifting and Directors of Public Health are at the forefront of that change. The challenges are complex, the expectations are high, and the need for bold, compassionate leadership has never been greater.

• Life Expectancy Is Stalling and Inequalities Are Deepening

Recent data shows that gains in life expectancy have plateaued, and in some areas, even reversed. The gap in healthy life expectancy between the most and least deprived communities is stark up to 19 years. This isn’t just a statistic; it’s a reflection of systemic inequality, and it demands urgent, place-based intervention. As a DPH, you are not just managing services you are shaping the conditions in which people live, work, and age.

• The Economic Impact of Poor Health Is Growing

In 2021 alone, 149 million workdays were lost due to illness or injury. This has profound implications for productivity, economic growth, and social cohesion. Public health is not a cost centre it’s a driver of economic resilience. DPHs must be able to make the case for prevention in terms that resonate with finance directors, chief executives, and elected members.

Every pound invested in public health generates multiple pounds in return but only if it’s targeted, evidence-based, and sustained.

• Leadership Is No Longer Confined to the Council

Modern public health leadership is system-wide. DPHs are increasingly expected to lead across Integrated Care Systems (ICSs), influence NHS commissioning, and collaborate with housing, education, transport, and the voluntary sector. The ability to operate beyond organisational boundaries and to do so with humility and authority is now essential.

You are not just a departmental head you are a strategic leader for place.

• The Role Is Demanding But Deeply Rewarding

Despite the pressures, many DPHs describe the role as the most fulfilling of their careers. It offers the chance to make a tangible difference, to advocate for the voiceless, and to shape policy that improves lives.

“Being DPH for Newcastle in spite of the very difficult time of the pandemic was the best job I have had.” Professor Eugene Milne, former DPH, Newcastle City Council

5. Final Thoughts

Public health leadership is not for the faint-hearted. It requires resilience, strategic clarity, and a deep-rooted commitment to equity and prevention. But for those who are ready to take on the challenge, the role of Director of Public Health offers a rare opportunity: to shape the conditions in which people live, to advocate for the most vulnerable, and to lead change that lasts.

The DPH is more than a technical expert they are a system leader, a trusted advisor, and a public servant. They must balance political nuance with scientific rigour, and short-term pressures with long-term vision. It’s a role that demands courage, compassion, and clarity especially in times of crisis.

As Professor Jim McManus, former President of ADPH and now National Director of Health and Wellbeing at Public Health Wales, once wrote:

“Directors of public health form part of the infrastructure of keeping our country functioning, for the long term, not just for Covid.” Professor Jim McManus

If you’re ready to lead with purpose, to challenge injustice, and to build healthier communities then the role of DPH might just be your calling.