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Unlike most visits to Ghana, this trip was particularly special and a “mission” rather than a reunion with friends and family. My yearning to make this a success had me constantly refreshing myself on the terms of reference and action plans for the trip, which, I guess, was the culmination of a partnership ‘journey’ that started in the latter part of 2018 involving various emails, teleconferences, text messages and phone calls!

My first day (and first time) at LEKMA hospital, started with some personal observations (and to have a moment to myself).  Afterwards, on the way to see the Medical Superintendent, Dr. Ameh, I saw one of the pharmacists that I recognised from one video conference call. I called him by his ‘English’ rather than Ghanaian name, thereby giving away who I was, but more reassuring was when he mentioned they were expecting me (as did Dr. Ameh when we met).  This bode well for the visiting team.  With initial introductions over, I went into planning times for the Global Point Prevalence Survey (GPPS) which took place over subsequent days with two Pharmacist colleagues.

Samantha arrived a few days later. The rest of the team arrived after Samantha, but the excitement made me go to the airport. Waiting like it was Christmas!  The next morning, we all met for the first time and were driven to LEKMA Hospital.

Our first day LEKMA was extremely pleasant with the usual warm Ghanaian hospitality.  The enthusiasm was apparent from the get-go.  We ran through the agenda for that day and duration of the visit followed by ward/departmental visits.

 

pic1FPH Africa SIG Ghana Visiting Team (left to right)

  • Mr Edwin Panford-Quainoo, Public Health Pharmacist, Liverpool School of Tropical Medicine
  • Dr Rajesh Rajendran, Consultant Microbiologist, East Cheshire NHS Trust
  • Dr Valérie Decraene, Consultant Epidemiologist, PHE Field Service
  • Dr Sam Ghebrehewet, Head of Health Protection, Public Health England, North West (FPH Ghana Visiting Team and Partnership Project Lead)
  • Dr Saran Shantikumar, Clinical Lecturer in Public Health, University of Warwick
  • Ms Samantha Walker, Lead Nurse – Infection Prevention and Control, Countess of Chester Hospital NHS Foundation Trust
  • Mrs Indu Das, Antimicrobial Specialist Pharmacist, East Cheshire NHS Trust

 

The second day had workshops on Antimicrobial Resistance (AMR), Antimicrobial Stewardship (AMS) and Infection Prevention and Control (IPC), with a fully engaged hospital team who gave frank and honest opinions about their hospital IPC practices and improvements needed. Workshop evaluation provided invaluable information that was consistent with observations.

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On the Saturday, we visited the hospital to get a sense of the out-of-hours services [accident and emergency and out-patient departments (OPD)]. We used this opportunity to review OPD antibiotic prescriptions of the day (revealing interesting findings).  We visited three community pharmacies within walking distance of LEKMA Hospital who had been informed of the project and were fully engaged in completing a knowledge, attitude and practice survey.

We spent the Sunday recapping and reflecting on the previous days’ events in the idyllic setting of Sogakope. Even on our day off, the team could not help but be productive and were able to record a podcast, prepare a WHO grant application for implementing delayed/back-up prescribing at LEKMA Hospital and learn about Ghanaian music.

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Monday was the advisory committee meeting, chaired by Prof. Afari. The morning of Tuesday 18th June, was feedback session with the LEKMA management and Ghana Public Health Association (GPHA).

In summary we were able to deliver:

  1. Agreed and signed off a Memorandum of Understanding and ToR;
  2. Established an AMS Advisory Committee;
  3. Completed a Global Point Prevalence Survey;
  4. Completed a healthcare workers Knowledge, Attitude and Practice survey;
  5. Initiated IPC guidelines review based on the WHO infection prevention control and hand hygiene assessment tools;
  6. Initiated discussion around prescribing guidelines (national) with the view of having simpler and more accessible local prescribing guidelines, i.e. within the context of the National AMR Plan and Prescribing Guidelines;
  7. Initiated the discussion around laboratory data surveillance processes and regular production surveillance outputs, with a focus on drug-resistant organisms;
  8. Agreed to implement delayed/back-up prescribing in the out-patient department of LEKMA Hospital.

We left Ghana with nothing but fond memories of a magnitude that we could not put into words and look forward to our next visit to Ghana.

Blog written by Edwin Panford-Quainoo, Liverpool School of Tropical Medicine

The Faculty of Public Health Part B Membership exam is the final stage of the route to membership of the Faculty through examination, but by no means the last step of becoming a Specialist in Public Health. Examiners from across the UK and from all domains of Public Health develop scenarios to test candidates’ abilities to understand and explain public health concepts and respond appropriately to questions and challenges in various settings (examples are available on the Faculty website). As examiners, we are committed to maintaining the standards set by FPH, but also committed to developing the next generation of Public Health leaders as excellent communicators and experts in all aspects of Public Health.

I was asked to write this blog, on behalf of my fellow examiners, after I had tweeted some tips based on reflecting on performance in the exam. One of my Registrars wrote a blog on how to prepare and pass the exam – this blog gives the examiner perspective.  As examiners, we wrote an article to help highlight how best to approach the exam. We had become concerned that some candidates are developing an approach to the exam which structures their answers but reduces their chance to succeed. These tips below, buidling on the tweets, are offered to all candidates with the reminder that, as examiners and colleagues: we want you to pass!

  1. Prepare to listen, hear the question, answer in a way that makes sense to that person, be it Director of Public Health (DPH), journalist or MP.

Too many candidates enter the room with their first answer prepared- forgetting to listen to the question. In a role play, examiners are keen to see that you are responding appropriately to the audience and answering the issues they raise. It is better to focus on listening to the question and answering the way you would in real life. Candidates are sometimes so determined to introduce themselves (which is not necessary) that they miss the first question altogether.

  1. Be ready to present/explain tables and charts – it’s what we do – but remember your audience. Don’t treat the DPH like you would a lay person.

If there are tables and charts in the pack, it’s likely you will need to understand what they say, and demonstrate this. This is a core skill of Public Health and we expect this to be done well. A trap some candidates fall into is in guessing the next question: “would you like me to explain confidence intervals” to which a reasonable reply might be “of course not- I’m your DPH!”

  1. Let the role player ask their questions. The pack doesn’t give you the structure, the questions do. Let us lead you through.

There are significant numbers of candidates who struggle because they don’t understand the format of the exam. The role player has a list of questions that they ask in order. These should elicit the information we need to mark the candidate. In general, scenarios are designed to build – so that the role play makes sense. Offering to give a speech, trying to tell us information that has not been requested, and answering questions you wish had been asked are all ways to run out of time and fail to complete the station.

  1. Don’t be just anyone – speak with passion about public health principles. Care about outcomes, inequalities and efficiency.

This is a “show’s how” exam where we are looking to see you have internalised Public Health concepts. Great candidates engage with the role play and come across as advocates for Public Health. This is far better than the trite “This is an important public health problem” statement repeated at every station by some candidates. There are no marks available for this.

  1. Have a good look at any data. Is it numbers, rates, percentages?  Be clear when explaining or answering questions.

Sometimes the scenario makes clear that the data has come from a poor quality source; a student project or similar. Might this mean that there are errors in the data? It’s vital that we use the right terms; confusing number of deaths with death rates is a sign a candidate hasn’t studied the material. Be accurate – the difference matters.

  1. Check the role player is understanding you. Keep eye contact- sometimes role players will look confused or upset- this is part of the station.

There is little scope for conversation in most scenarios- sometimes we really have to rush to get through the questions. Taking notice of how role players respond is an important part of the exam. Picking up on responses is a key skill in the “listening” competency. If you are asked the same question twice, it usually means its important and you did not answer it correctly the first time. Don’t try and skirt round it or just repeat what you said the first time.

  1. If you have to explain a table or graph – share it, show me, point it out.  Be sure I understand your explanation.

Great candidates really do this well. Positioning themselves in a way that allows them to share their papers, point at the information they are describing, and looking at the role player to see if they are understanding the explanation. Done badly, it can appear that candidates are just hoping not to be asked about it.

  1. Be ready to say if you don’t know. No “I’ll email you” or “I’ll get back to you”, sometimes you just don’t know – that’s ok.

The issue with the answer “I’ll email you” or similar is that the question has been asked and needs to be answered. If asked “Do we need to close the shop?” the possible answers are Yes, No and I don’t know. All can be valid, and the mark scheme will make this clear. The questions are scripted to last 8 minutes and the role player strives to complete the station within that time. Sometimes a scenario runs faster and most candidates finish a station a minute or so early. It will be obvious from the role player that the scenario is complete. It is quite okay to use this spare time to look at your next scenario.

  1. Remember to make eye contact. It’s a conversation.  The examiner role players are willing you on. 

Some candidates have clearly not prepared the “acting” side of the exam. Great candidates have a real conversation and engage the role player. This means they pick up on the mood and responses as well as the substance of the questions. Comments like “I know this must be difficult” and “I can see why you might think that” often reflect an understanding of the other point of view.

  1. Be yourself. You have got this far because of who you are.  Serious people think you are amazing.  Show us why.

We really do want you to pass. Many examiners are also Educational Supervisors, they are all involved in training and want to give candidates the chance to shine. We don’t want an act – just you being your best you. Read the material, listen to the questions, engage in the scenario and show us why one day soon, you will be a consultant.

 

Links:

Do you want to complete some of your CPD and learn about Health and Climate Change and Sustainable Development (SD) at the same time? Well now you can.

The FPH Sustainable Development Special Interest Group (SD SIG) has put together a series of fact sheets. Each resource is a two-page introductory summary of a major topic in sustainable development, with references and signposts to more detailed information. The resources explain the relationships between the work of public health practitioners, the causes and effects of climate change, and health. You can read these fact sheets, learn more about sustainable development and log this activity in your CPD diary.

The topics cover areas of knowledge such as ‘Principles of Sustainable development’, ‘Health benefits of action on climate change’ and ‘Sustainable food systems’ which includes issues such as the contribution of agriculture to greenhouse gas emmissions (GHGE). There are also some ‘action’ resources e.g. ‘Adaptation to climate change’ which gives examples of health impacts and the adaptation required and how the built environment can be more climate resilient.

At the end of each resource there are specific CPD questions as well as the general CPD diary questions and there are model answers so that you can learn as you go and get credits in your CPD diary.

These resources are useful to everyone; whether you are a specialist trainee addressing competency 5.7 or you are a specialist or educational supervisor who wants to learn more about climate change and health or you are supervising your trainee. A survey of both SpRs and educational supervisors showed there was some good work in this area but that SD needed to be more embedded into routine placements and projects and that SpRs should be empowered to be leaders in SD.(1)

We’ve made this link between the resources on the FPH website and CPD as in the last membership survey it was identified that members wished for more CPD support from FPH. CPD is something we all do every day; we learn as we go and don’t always need to go to a specific training course. Over time the aim is for other SIGs to similarly make the explicit link between their intelligence and resources and your CPD.

Why is health and Climate change important?

  • Lancet commission identified in 2009, that ‘Climate Change could be the biggest global threat of the 21st Century’.(2)
  • Climate change science is real, but it is often difficult to get our heads round. The impacts of climate change can seem like a long way off, and we know that politicians and all of us find it hard to recognise this and take action on threats that are in the more distant future.
  • The co-benefits of addressing health and climate change together are clear, for example increasing active travel is good for your health and good for the planet.
  • Health brings home the real story of the impact of climate change; imperative, immediate and life changing. People’s health is being damaged today by climate change through effects ranging from deadly heatwaves in Europe, (I write this on what is being anticipated as the hottest July day in UK ever!) to rising dengue fever in the tropics, major floods and devastating fires.
  • “We cannot delay action on climate change. We cannot sleepwalk through this health emergency any longer.” (3)
  • For trainees and educational supervisors don’t forget the FPH Curriculum competency 5.7 – “Demonstrate leadership in environmental sustainability with a focus on the links to health and climate change”

So click this link, read these resources and chalk up some CPD credits as well as getting yourself up to speed on SD, health and climate change.

References

  1. UK Public Health Registrar Sustainable Development Network. Embedding Sustainable Development in UK Public Health Training: Update Report. November 2018. Available at: https://www.fph.org.uk/media/2268/sdn-report-final-2017-2018-nov1-1.pdf
  2. Lancet Commission. 2009. “Managing the health effects of climate change”. Lancet and UCL Institute for Global Health Commission. April 2009.
  3. Lancet Commission.2018. “Health and Climate Change: shaping the health of nations for centuries to come” Lancet. December. 2018

No 1. The European National Anthem

There was always going to be music in my presidency. We were still in the EU before the 2016 EU referendum when I played the European National Anthem, ‘Ode to Joy’ at John Ashton’s leaving party.  There’s a taste of it from my leaving party, three years later, still just in Europe here:

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No 2. I almost lost my mind

At the Brighton Conference 2016 where I became President, David Stuckler in his keynote presentation gave me the licence I needed to play, when he said he had the ‘Brexit blues’ , when opinion polls showed Brexiteers in the lead.  Seeing Muddy Waters and Bruce Springsteen on the walls of the conference syndicate rooms, I needed no more excuse to play the Brighton Dome and played a blues with my closing speech.  So, I played my ‘go to’ blues number., the one I learned from Shakey Walter Horton, one of the giants of Chicago blues harmonica,  he called it ‘Easy’, and Dr Harp’s Medicine Band version of it is here . He borrowed it from Ivory Joe Hunter, a blues crooner and piano player; he called the song ‘I almost lost my mind’. His words were sadly prophetic for the Brexit experience.

“Well, I can tell you, people, the news was not so good 
She said, “Your baby has quit you, this time she’s gone for good”

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No 3. Freedom come all ye! 

Scottish colleagues had already booked me for their Autumn conference, but now they expected me to also play the mouthie.  I said I would if they could find me someone to sing the great Scottish anthem, ‘Freedom come all ye!’ in Scots.  And they did: the wonderful Josie Murray stepped up to the mark. ‘Freedom come all ye’.  It is wonderful song, written by Hamish Henderson at the time of the Polaris CND protests at Faslane in 1960. The ‘Come all ye’ is a rallying cry used in political protest, forever, I called my talk to the Scottish conference ‘Health Come All ye.’ , and recounted my time in Dundee, by the silvery Tay. I spoke also to great Scottish public health work, the campaign for rights to health and the Scottish beacon and conscience for health. Henderson saw his anthem as a world anthem, overcoming Imperialism, where ‘no more would our bonnie callants march to war’, instilling fear as the bagpipes played ‘Scotland the brave’.  The tune was ‘The bloody fields of Flanders’, Henderson had heard on the beach of Anzio in the allied invasion of Italy in 1944.  The poetry of this song is important, elegant and worth the effort.

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No 4.  Please see my grave is kept clean

One of my saddest, but ultimately uplifting duties was to commemorate the life of Alwyn Smith, one of our best regarded presidents, which we held at the Christie Hospital in his beloved Manchester.  But he was, at least, a proper Yam Yam, like June Crown, they were  born in the Black Country; I was only adopted ‘Honorary Black Country’. In amongst the remembrances, I performed Blind Lemon Jefferson’s  ‘Please See my Grave is Kept Clean’  more symbolic than literal, the words are a celebration of living, and a plea to remember the achievements of those gone before. I also gave the Faculty Grace that Alwyn composed, passed on to me by John Ashton.  I hope my successors will keep up alive this lovely, simple statement which I say at family meals and now, in European public health gatherings.…

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No 5. Watermelon man

Another great hero of my public health history was Peter Draper.  Peter Draper invented ‘upstream factors’ the things we carelessly talk about not realising this is internal jargon that few outside public health will get without an explanation.  He also compiled the definitive text ‘Health through public policy’ to which we all owe an enormous debt for our pious thoughts on health in all policies. His forensic analysis of how media predicts and hijacks our efforts to communicate health messages, was visionary. It pre-dated anything anyone is trying now with social media and we need to develop this kind of surveillance of media – fortunately Martin McKee and colleagues are on the case.

Peter was a great humanist and a great jazz lover, so when we came to celebrate his life, it was fitting that we went to Conway Hall, home of British humanists, and also a venue in which Humphrey Lyttleton had recorded one of his great jazz live albums. Herbie Hancock’s jazz classic is a blues tune I love to play wherever I get the chance. So where better than Conway Hall?  I also got to play it at the 2016 Gastein conference with the house band. Thanks guys!

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No 6. Juke

Little Walter was the Hendrix of the Chicago blues harmonica. I would take his songs to a desert island hoping I might practice and learn how he did it. I played my version of ‘Juke’ at the brilliant Oxford Registrars public health conference in September 2017. Thank you, Emily Dobell and colleagues.

It was a joy to perform overlooked by Sir Richard Doll, and in the company of the brilliant and chilling presentation of Nigel Hewitt, conscience of the care of homeless people in the UK.

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No 7.  The songs of Ewan McColl

I talked about ‘Dirty Old town’ in my presentation to the Salford University conference on social prescribing in November 2017. I also talked about ‘Kind of Loving’ and Kitchen Sink drama, somehow I didn’t get my organ out though!   But Ewan McColl has been with me since I first learned a few words of the Manchester Rambler in about 1971. McColl was the British equivalent of Woody Guthrie, an extraordinary chronicler of UK working lives and communities, and able to put himself into their heads to sing songs of their experience. We should try to do the same- bringing stories into the tapestry of statistics and policies. So I’ve sung ‘Manchester Rambler’ at the 2017 conference in Telford,  and on my leaving do  It is a song which celebrates the triumph of working class people for the right to roam- started with the Trespass trail in 1934, the ‘Battle of Kinder Scout’; and finally won in 1998 with the Ramblers Association victory in England (Scotland knew the right to roam was there’s!).

I also got to play ‘The Shoals of  Herring’ at the East of England  Conference in October 2018. It is a truly beautiful song, celebrating herring fishers and fishing fleets from Yarmouth to Peterhead: a life, and an industry long gone. Although post Brexit, we will all have to revert to eating the most healthy oily fish, the Herring!

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No 8.  Irish tunes

The Irish have the best tunes.   It’s a fact.  Tunes I’ve been able to play on my travels have been  Dingle RegattaRaglan Road,  the Fields of Athenry, Star of the County  Down, and Tell Me  Ma., though I’ve not recorded that one!   The Green Fields of France, is probably the greatest ever song about war, written by a Scot, Eric Bogle, who became an Australian, about a could be, Scottish, could be Irish, Soldier in WW1, Willie McBride. The Fureys made the greatest version I’ve heard and I commend it to you, but our version, featured in the  November 2018  FPH bulletin, is here.

No 9. Notable public health tunesmiths and the song of the month

In our number are many outstanding songsters and musicians.  Apologies, Alison MacFarlane, but I only learned just after I had passed on the President robes that you have a public health music review- something like ‘the cholera blues’ I believe?  I’d like to sit in on that one!  I tried to get more public health participants into my song of the month feature in the bulletin. So far only had the great Gabriel Scally’s ‘Public Health Call’ and Carole Wood’s  ‘Five in a bar’ acapella piece, ‘Let every spirit fly’.

To mark Fats Domino’s demise in November 2017, I put up the previously unreleased  version of ‘Walking to New  Orleans’ by  Dr Harp’s Medicine  Band.  I also put up the brilliant piece of stand up by John Denver- not a song in sight- and I know, hijacked by the US temperance movement. But this version of Joseph Mallins’ poem- ‘The Ambulance down in the Valley’ is a parable of the plight, and the need for public health.

We had ‘Down to the Doctors’ at the Christmas  bulletin – to remind me of the greatest band to come out of the East of England!

No 10.  Hearts and Minds

I first met Lady Nade, performing for my daughter’s café’s 1st year anniversary party in   September 2016 in Bristol.  I was on stage playing ‘Back to Black’ with her in minutes and we have been working on an album ever since.  Nade is a talented singer songwriter who has just completed her second album launch and tour. We have been cooking the album ‘Hearts and Minds’  over three years. I commend it to you.  We are selling the CD for young people’s mental health and older people’s dementia charities. You can find us on Apple Music, Spotify, Amazon, CDBaby.com, or you can buy a CD form me.  Bill Wither’s great soul anthem, ‘Lean on me’ is also a long-standing favourite of mine. It is a great statement for community development and public mental health. I first heard it played for a health audience by Jackie Lynton at Sandwell’s first public mental health event in 1997!  We featured it on the World Mental Health Day issue of the FPH bulletin in October 2018. Enjoy!

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Written by Professor John Middleton,
Immediate Past President, United Kingdom Faculty of Public Health,
President, Association of Schools of Public Health in the European Region (ASPHER)
Honorary Professor, University of Wolverhampton,
Visiting Professor, University of Chester.

Life expectancy has gone down in my term of office. I am the first President of the UK Faculty of Public Health who has had to admit that, in 47 years.

Why beat about the bush? Austerity kills. We can now be clear that the – “un-‘natural experiment’”–austerity, has indeed made poor people poorer, made inequalities in health wider, and killed people.  Economic depression is a phenomenon, ‘austerity’ is a political policy. Austerity policies have killed large numbers of people in Britain who would otherwise still be with us.

Austerity kills. There has been a flood of reports in the last six months alone, and their links are buried in this blog – please do them the courtesy of clicking on them and bringing them back to life -they deserve and need it! On overall life expectancy, the Society of Actuaries reported in March that life expectancy had gone down on average by 6 months, Close on its heals, the Office of National Statistics reported widening inequalities in mortality for women, with women from poor areas dying years before women in rich areas.

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To quote ONS: ‘The gap in life expectancy between the richest and poorest areas of England and Wales has widened during the past decade. Women living in the most deprived parts of England lived an additional half a year less than women in the most affluent parts of the country in 2015 to 2017 compared with 2012 to 2014. The corresponding figure for men was four months. Men in the most deprived areas could expect to die 9.4 years earlier than counterparts in the richest places, while for women the figure was 7.4 years. “We’ve found a large fall in life expectancy at birth among women living in the most deprived areas in England,” said Ben Humberstone, deputy director for health analysis and life events at the ONS. “This has led to a significant widening in the inequality in life expectancy at birth in England. Wales mirrored this pattern, although significant changes were not detected,” he said.’

A review of recent trends in mortality in England, acknowledged that life expectancy has levelled off, and indeed decreased for women. They point to a range of factors which are contributing to this- not a single issue, but effects of drug-related deaths, infant deaths, deaths from flu? dementia, lower respiratory disease, a rise in strokes, and cardiovascular disease no longer going down as fast as it should be. However, between 2010-12 and 2014-16, life expectancy in the more deprived areas in England increased more slowly than in the least deprived areas. In addition, female life expectancy in the most deprived decile areas has decreased since 2010-12 and inequality in life expectancy has increased. Inequality in male life expectancy has fluctuated over time but increased since 2011-13.

This analysis indicates that whatever is causing the reduction in the rate of improvement, it is affecting the most deprived areas more than the least deprived areas, and that widening health inequalities has exacerbated the slowdown in improvement. There is also some recognition that social care cuts might be a factor.

In a damning editorial in the BMJ David Taylor-Robinson and colleagues described our child health unravelling.  The rise in infant deaths and the widening of inequalities between rich and poor is alarming and should be a wakeup call that not all is well in the public health world. Infant mortality is this most fundamental of public health measures and a marker for a new public health emergency. More babies dying should not happen in a rich country, but it is. Our infant death rate is now higher than Cuba’s. It cannot be attributed to worsening behaviours, or poorer treatment; the causes are upstream in the advance of child poverty and destitution and the worsening conditions and services in our poorer neighbourhoods.

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Nearly 200,000 more children live in poverty now than in 2010 & more than half are aged under 5. At a population level, fewer children are likely to get the best start in life & more are at risk of poor lifelong outcomes. Other manifestations of our neglect of young people’s health can be found in the Nuffield Trust report on international comparisons of adolescent health, and a warning from Britain’s head teachers, describing schools as the unofficial emergency service for the victims of Britain’s poverty, This is a crisis & must be urgently addressed.

Between 2004–05 and 2017–18, the share of those in headline poverty that are in working households grew by 10 percentage points (from 48% to 58%), and for severe poverty it grew by 26 percentage points. In May, ONS data showed ‘an astonishing difference in the risk of avoidable death between the rich and poor.

We are letting down the next generation. Leaving them potential victims of destitution, knife crime, modern slavery and homelessness. We owe our children more.

The politics of austerity is the politics of cruelty. On an average day in the UK, 3700 people are forced to visit a food bank, 5400 suffer domestic violence, 4750 sleep rough on the streets…There are daily stories of children being hungry in school and in school holidays. Food bank usage continues to rise.

Food charity cannot be the answer. We continue to ignore the root causes of poverty and suffering in favour of short-term charitable relief? Baby equipment banks are now springing up, catching up with food banks. Long recognised problems of fuel poverty are now joined by stories of period poverty. Universal credit changes will hit the poorest hardest. In my BMJ Editorial with Alex Bax, President of the Faculty of Homelessness and Inclusion, we described the escalating problem of homelessness and the health care crisis it is creating.

The word destitution has been brought back into use- conveying a sense of extreme and absolute poverty. 1.5 million people, including 365,000 children, were destitute in the UK at some point during 2017. They could not afford to buy the bare essentials that we all need to eat, stay warm and dry, and keep clean. There is no longer a welfare safety net- national and local government, and utilities, are the biggest creditors on the least able to pay. And people are being sent to prison for civil debt. 

UN Rapporteur, Professor Phillip Alston returned to the UK in May and compared British government policies to the era of the Victorian workhouse. 14m people live in poverty despite the UK being 5th richest economy in world; 40% of children in poverty within 2 years; millions in work dependent on charities, people joining gangs to avoid destitution and a shocking rise in food banks. And, in a reprise of 17th Century philosopher Thomas Hobbes famous quote, the UK’s poorest facing “nasty, brutish, solitary, and short” lives.

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What to do about it?

There is an owners club in reports on the ‘wider determinants of health’ and rightly, a clamour for health in all policies approach from our governments.

Poverty is bad for the nation’s health and also for its economic efficiency. Ten years after the Marmot report, it is completely clear that we have gone in exactly the opposite direction, in policies and in investments, that would have continued to reduce inequalities in health. Worse still, the national policies have gone completely in the opposite direction, wilfully creating more inequality. Following Acheson report recommendations in1998, health inequalities narrowed in the years to 2010, with real political will and local implementation of national policies. It is notable how much progress was made narrowing the gap between rich and poor areas on childhood mortality during the 2000s. The policies implemented were reinforced by Marmot in 2010. Early years support was a key and central recommendation of Acheson and Marmot. I attributed improvements in past pieces for FPH, to the ’Surestart Generation’ (a better name than ‘Millennials’?) There was a raft of evidence-based policies implemented from 1997: Surestart, Surestart-Plus services for teenage mothers, Surestart maternity grant, but also the minimum wage, working families tax credit, new deal for employment, Decent Homes Standard and a reduction in child poverty of half a million. And when we talk ‘millennials’- they are no longer smoking, drinking, having babies as teenagers- might that not also be a ’Surestart effect’? Ben Barr, Clare Bambra and colleagues  have now provided some evidence to back up this view, and so has the Institute of Fiscal Studies, in its evaluation of Surestart programmes.

Marmot also highlighted a need for tax policies reducing inequalities in income. The poor pay more proportionately, in tax than do the rich. Reform of tax systems and the overall national and local provisions for taxation need urgent review.  As major corporates and the super-rich avoid tax, the case for property, land and location taxes  become more compelling. Danny Dorling’s book ‘All that is solid’ describes the nightmare of UK housing policy and some of the remedies; buried in them, fair and proportionate property tax for high value properties.

England spends less on social care per person than Scotland and Wales, and the gap has widened since 2010/11. Today, England spends £310 compared to £445 in Scotland (43% more) and £414 in Wales (33% more). For many eminent public health authorities this is a driver of inequalities in health and the observed reductions in life expectancy.

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Cuts in local government budgets have fallen disproportionately on the poorest local authority areas. I share the view that we must redress the cut in social care- I would go as far as to say we should fully fund social care from taxation. We must also rebuild public health investment in local authorities in England and in all health systems. And there must be place in our comparatively wealthy country, for greater investment in an NSH – a National Service for Health.

Throughout my presidency I championed the Welsh Wellbeing of Future Generations Act. This visionary piece of legislation seeks to take political thinking beyond its usual ‘my term of office’ and ‘my back yard’ and offers Public Health Wales the chance to scrutinise all policies for their health and health inequalities impact. All health systems in every political administration need this provision.

Climate change is a health issue, and an inequalities issue, a cause and consequence of violence and conflict, and interconnected with environmental degradation, loss of biodiversity, creation of trafficking, refugees and slavery. I am pleased that FPH divested from fossil fuels investments last year. But our efforts have been given greater urgency. There has never been a greater need for public health expertise. We need to be resolved and stand together in the fight against darkness and destruction.

Written by Professor John Middleton,
Immediate Past President, United Kingdom Faculty of Public Health,
President, Association of Schools of Public Health in the European Region (ASPHER)
Honorary Professor, University of Wolverhampton,
Visiting Professor, University of Chester.

In 2017 I was in ST5 and getting ready for my first consultant interviews. This blog follows on from my earlier blog sharing my top tips gathered for Consultant job applications during the final stages of Public Health Specialty training.

After a great application, you will get your invitation to attend interview. Generally, those I was invited to attend contained details about the interview panel and format, e.g.  situational judgement/ psychometric test, role play with actors (memories of Part B!) or a presentation.

Research the interview panel through online searches, particularly if you are applying outside of your training zone and you don’t know them. Knowing that a Councillor on the panel has an interest in smoke free playgrounds and e-cigarettes is softer intelligence that can give you an edge over other candidates.

Real-life Consultant experiences

The biggest preparation that you can do for a job interview is consultant level on-the-job learning, shadowing and experiences in the year beforehand. You will collect examples and stories which you can use to answer interview questions. Use these real-life experiences to show that you are ready and capable to be a Consultant and hit the ground running.

Interview Questions

Use the library of interview questions you gathered earlier in the year from recently qualified Consultants. Think about themes from Job Descriptions and Person Specifications e.g. Leadership/ Change Management/ Commissioning/ Media/ Collaboration/ Continuing Professional Development or Learning Needs. Develop two to three examples using a simple answer framework (Situation Action Outcome Reflect).

Don’t forget the Part A and Part B frameworks from years gone by – you might get asked a technical question or a ‘how would you?’ question.

Look at some useful online resources too: –

https://www.healthcareers.nhs.uk/i-am/working-health/information-doctors/medical-specialty-training/consultant-interview

http://careers.bmj.com/careers/advice/Great_answers_to_tricky_consultant_interview_questions

Have a sensible question to ask of the panel at the end, but never ask a question that you could have found out in the recruitment pack or clarified beforehand (e.g. terms and conditions). You want to leave the panel with a positive impression as you exit the room.

Interview Presentation

Be prepared to deliver a presentation on the day – this might be sent out to you in advance or might be on the day. Either way, make sure you know and can talk about the organisation’s values, local & regional challenges and aspirations.

Consider the wider stakeholder context through websites, public health indicators and reports, plus any recent local press or social media. In one interview, knowing that there had been a recent avian flu outbreak meant that I had read up on outbreak responses and considered wider migrant worker health needs in my response.

Don’t be scared to ditch PowerPoint, unless you are specifically asked to provide one. I know some interviewees that have arrived with flash cards and props, making their point very effectively and memorably.

Clearly describe what you know about the role and organisation, what experience you have and what you can do for them.

Practice makes perfect!

Invest your time in interview preparation and presentation practice with buddies and Consultants to get feedback and ‘test’ examples. Set yourself interview questions when driving or making a cup of tea and talk out loud; it will help you refine your answers, being clear and succinct.  I tried recording myself; awkward I know, but this helps refine the waffling.

Unique Selling Point

You have worked hard training to become a Public Health Consultant, so what makes you special and stand out? What are you going to say about you? What is your ‘unique selling point’? Ask your colleagues and peers for informal feedback to boast your confidence and give ‘live’ examples for interview regarding personal qualities, leadership style and what makes you a good Consultant.

On the day

Arrive in good time, breathe, do your best and good luck!

Written by Hayley Mercer, Screening & Immunisation Lead – Public Health Consultant, Public Health England, North West

You can follow Hayley on Twitter

 

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I joined the Faculty of Public Health a year ago. I work across health and transport sectors but hadn’t ever joined a professional body before. Going to the Faculty of Public Health conference in Peebles in 2016 and 2018 broadened my interest in Public Health.

I joined FPH and attended an Introduction to Pubic Health event in London and then a training day in Manchester, led by Professor Gurch Randhawa from University of Bedfordshire on evaluation of joint interventions.

I was really enthused by the course run by FPH and liked the idea of inviting Professor Randhawa to Aberdeen and it was a very enjoyable experience working with FPH to arrange delivery of the course.

We had 25 attendees on the day and the event was held in the Beach Ballroom, a real Ballroom by the beach if you ever visit Aberdeen. The event took place on May 16 and the feedback has been extremely positive. Many of the attendees felt it should be re-run for the benefit of my Health & Transport Action Plan Steering Group members.

My advice to anyone thinking about joining the Faculty is to do so, it will certainly introduce you to new colleagues. Personally, I’ve found it helpful to belong to something collective as my role can be isolating at times.

I’ll end with thanking Nikol and Gurch for helping arrange the event and support my work around adding strategic value to partnership working across health and transport issues. I also thank CIVITAS PORTIS and Nestrans for funding the event, making it free for attendees.

Written by Andrew Stewart, Aberdeenshire Council (post jointly funded by NHS Grampian and Nestrans)