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By Andy Beckingham FFPH, Fernandez Hospital, Hyderabad

Giggling Girls!

The scope of our profession gives opportunities to branch out. These may not always look at first glance like ‘public health’.

In 2010, working in India on maternal mortality, someone asked over dinner if I thought UK-style midwifery might be useful in India where doctors provided all the care. “Perhaps if you try the bits that work for women,” I said. “And avoid the bits that the NHS got so wrong.” My dinner companion turned out to be the MD of India’s most famous maternity hospital, and I found myself designing her midwifery pilot programme.

The midwife who had run the UK’s most woman-friendly midwifery service (the Albany Practice, which achieved great outcomes for disadvantaged women) was inveigled into joining us as a mentor. Eight anxious trainees found themselves becoming India’s first evidence-based woman-centred midwives (pictured). They began to develop their own profession, promoting choice about labour and supporting and empowering women to have more natural births. They had to challenge established obstetric practice. Our hospital’s maternity care began to change. Babies had been routinely separated from the mother at birth, although this impedes attachment and breastfeeding. The midwives worked with paediatricians to change that. Now most mothers have immediate contact and breastfeed their babies in the first hour.

Now leaders in their own right, those first eight have since mentored other trainees to become strong professional midwives, supporting thousands of Indian women to have better births.

Like most countries, India has unnecessarily high rates of intervention in childbirth. A local public hospital’s c-section rate is 52%. A local private hospital’s is 90%. But thanks to the midwives, ours has come right down. Instead of epidurals being routine, midwives ask women what pain relief they want. They offer choice. Women get continuity of care. The outcomes are better. Satisfaction rates are high.

In 2017, the state government invited us to train midwives to work in their hospitals too. They want c-section rates to come down. But they also want compassionate, respectful maternity care for the large numbers of women who are mostly ‘below poverty line’. So maybe, just maybe, this could become a model for wider public maternal-health improvement in lower-income countries. I have to assess its impact.

Designing a midwifery programme and curriculum doesn’t at first look like a public health role. But it is starting to address unmet needs, inequalities and disadvantage, improve care quality and effectiveness, show that Indian women and their choices matter. Of course, it will need to be part of wider action on social and economic determinants of maternal health.

And now, this alternative to the medical model is available, and the state government is actively promoting compassionate, effective midwifery care and supporting us to roll out professional midwifery more widely, among very disadvantaged women.

Public health, in disguise.

By Dr Justin Varney, National Lead for Adult Health and Wellbeing, Public Health England

Public Health England estimates that between 2-5% of the population identify as lesbian, gay, bisexual or other – comparable to many ethnic minority and faith populations. Despite legislative reform many LGBT people continue to experience discrimination, marginalisation and harassment.

  • 38 per cent of trans people have experienced physical intimidation and threats and 81 per cent have experienced silent harassment (e.g. being stared at/whispered about)
  • One in five (19 per cent) lesbian, gay and bi employees have experienced verbal bullying from colleagues, customers or service users because of their sexual orientation in the last five years
  • Almost 1 in 4 trans people are made to use an inappropriate toilet in the workplace, or none at all, in the early stages of transition. At work over 10% of trans people experienced being verbally abused and 6% were physically assaulted.

The impact of this discrimination on mental health is easy to understand, however the stark data on suicide and self-harm demonstrates the depth of the impact that this discrimination can have:

  • 52% of young LGBT people reported self-harm either recently or in the past compared to 25% of heterosexual non-trans young people and 44% of young LGBT people have considered suicide compared to 26% of heterosexual non-trans young people
  • Prescription for Change (2008) found that in the last year, 5% of lesbians and bisexual women say they have attempted to take their own life. This increases to 7% of bisexual women, 7% of black and minority ethnic women and 10% of lesbians and bisexual women with a disability
  • The Gay Men’s Health Survey (2013) found that in the last year, 3% of gay men have attempted to take their own life. This increases to 5% of black and minority ethnic men, 5% of bisexual men and 7% of gay and bisexual men with a disability. In the same period, 0.4% of all men attempted to take their own life
  • The Trans Mental Health Study (2012) found that 11% of trans people had thought about ending their lives at some point in the last year and 33% had attempted to take their life more than once in their lifetime, 3% attempting suicide more than 10 times.

The impacts aren’t limited to mental health, and the level of inequalities in lifestyle behaviours such as smoking and substance misuse will almost certainly play out in a great burden of chronic disease and premature mortality over the life course.

The evidence base of inequalities affecting LGBT populations continues to grow as we get better at incorporating sexual orientation and gender identity into the demographics of research and population surveys. Positively, as the NHS rolls out the sexual orientation monitoring information standard this year, this understanding will no doubt continue to grow.

As public health professionals we have a responsibility to advocate for the populations in our care, and this should include advocating for LGBT populations. Lesbian, gay, bisexual and trans communities are diverse, vibrant and varied and have many assets, although the LGBT community sector has faced fiscal challenges due to the economy there remain many small local LGBT organisations that are keen to work with public health teams to address these inequalities.  This is population who clearly need our professional expertise, advocacy and support to co-produce solutions for change and one where we could have a real impact.

So during this lesbian, gay, bisexual and trans Pride season please take up the opportunity to engage, empower and partner with your local LGBT community.

FPH is committed to improving the health and well-being of the LGBT population. If you would like to join us in our work please consider joining our Equality & Diversity Special Interest Group or our LGBT Health Special Interest Group. To express an interest in joining please email policy@fph.org.uk and we can help you get started!

Dr Alisha Davies, Head of Research and Development, Public Health Wales

We understand the importance of good quality, sustainable employment for health. We also recognise that economic shocks, such as the loss of a high number of jobs in a localised area, can have a detrimental impact on the health, social and financial situation of individuals. In the years following a mass unemployment event workers can experience double the risk of death from heart attack or stroke and even greater increases in problems such as alcohol related disease, alongside detrimental effects on mental health. The impact can extend beyond those directly made redundant to families, local communities, and the effects endure over many generations.

Preparedness to address the health consequences of mass unemployment events is of national and international importance – yet there is very little information on how to better prepare and respond to such events. The public health discipline has emergency planning response frameworks for other events, such as flooding, which have a significant impact on individual and community health, but not mass unemployment.

Working with academic experts and those previously involved in public health responses to mass unemployment events across the globe – from the motor industry in Australia, to mining in New Zealand, Public Health Wales have developed a basic framework to support public, voluntary and private sectors with prevention, planning for and reaction to mass unemployment events.

The recently launched report provides an eight-step framework to support public, voluntary and private sectors with prevention, planning for and reaction to mass unemployment events. Key priorities where public health approaches can help are highlighted including early identification of areas at risk; ensuring the reactive responses address the health and wellbeing needs of all those affected alongside financial and re-employment advice; providing accessible support for families, and the wider community – in particular vulnerable groups, such as the long term unemployed; and increasing awareness through community and third sector links.

Preventative measures identified by those interviewed included longer term consideration of skills development, investment and diversification, social responsibility of employers announcing redundancies, and increasing individual and community resilience.

This report is an important tool to inform action to help prevent and minimise the consequences and harms of mass unemployment events (MUEs) to population health. The work was taken forward following events in Wales, but has national and international reach across many European and International countries.

NOTES:
The report and info-graphic will be available on the day of launch in English and Welsh, and it will be announced on our Public Health Wales website on Friday 30th June (www.publichealthwales.org).

By Hannah Dorling, Helen Walters and Tara Lamont

How can alcohol licensing decisions impact upon alcohol-related crime and health issues? Does turning street lights out at midnight cause more accidents? How does a new bus service impact upon physical activity levels?

Front-line public health professionals need relevant evidence in formats that reach them and are digestible by them and those they work with. At this year’s FPH conference we are running a session on just this issue. The National Institute for Health Research (NIHR) spends £10m a year on its Public Health Research (PHR) programme and we are one of the main funders of public health research in the UK. We support research which may not be funded by others – from studies of impact of alcohol licensing to evaluation of urban motorways. NIHR also runs the Dissemination Centre whose specific role is to get research findings to the front line.

We want to fund research that evaluates public health interventions that happen outside the NHS – that will provide new knowledge on the benefits, costs, acceptability and wider impacts of interventions that impact on the health of the public and inequalities in health. We want this research to be multi-disciplinary and broad, covering a wide range of public health interventions. Funding comes from the Department of Health in all four UK countries. A key aim of the programme is to deliver information to allow practitioners and policy makers to improve services, rather than simply improving scientific knowledge. A challenge for the programme is finding the questions that most urgently need answering.

We also need to help decision-makers get hold of the evidence they need. Every day, about 75 new clinical trials and 11 new systematic reviews are published, many of which will be relevant to public health. The NIHR Dissemination Centre filters new knowledge and produces a wide range of publications. We want to know more about what kinds of evidence and formats work best for front line staff.

This is where we need you. This interactive conference session is aimed at front-line public health professionals (though academics are welcome!) who want to talk about how you use research in your daily work. Where do you find your research? What do you do with it? What would you like more of? Do you have challenges linking to the academic world? What questions would you like answered to help you in your work? Come along to our session and tell us what you think. We are keen to hear and to use your wisdom as we reflect on 10 years of public health research funding and make plans for the next 10 years.

In the meantime if you have an idea for research that needs doing please do contact us on phr@nihr.ac.uk or use the programme’s online mechanism for submitting suggestions.

Join the session at the FPH conference on Tuesday 20 June in Telford:
11:30 – 12:30: Public health need – filling the evidence gaps in local government
Location: Wenlock Suite 1&2
Presenters: Helen Walters, Consultant in Public Health Medicine / Consultant Advisor, NIHR NETSCC, University of Southampton
Tara Lamont, Deputy Director of the NIHR Dissemination Centre
Closing comments: John Middleton, President of the Faculty of Public Health

By Elizabeth Orton

The Faculty of Public Health’s Transport Injury Prevention Network will be holding an inaugural workshop at the FPH conference in Telford on 20 June.

As well as introducing the aims and objectives of the network, the session will focus on speed reduction as a key road danger reduction strategy. We will be looking at how to improve collaboration in local government between public health and transport teams to encourage active travel and reduce road danger. We will review the evidence around 20mph zones and limits and discuss strategies for their implementation, sharing examples of good practice, tools and approaches.

Please come along and share your ideas, experiences and views with us.

By FPH’s Sustainable Development Special Interest Group

There are many good reasons to prioritise sustainability for the health of future generations. Protection of key planetary boundaries such as climate change, air quality, ocean alkalinity and land forestation are crucial to whether our children and grandchildren can survive and have a tolerable quality of life.

However, this can be a hard sell to those making key political and economic decisions internationally, for electorates, consumers and shareholders who have come to accept excessive consumption and unequal concentration of wealth.

Therefore, we need to emphasise the benefits of sustainability to those alive today. Fortunately, these benefits are many both to individuals and to communities. Unfortunately, these benefits are rarely discussed in political and economic discourse.

Let’s start with the benefits of sustainable nutrition. These were well summarised by Barak Obama at a recent Global Food Innovation Summit (and a Guardian article on 27 May 2017). More sustainable food means more locally sourced fruit and vegetables and less processed food and meat from ruminant animals. Not only will this reduce greenhouse gases (especially methane) and protect forests but it will also mean more food security for poorer nations and less chronic disease for those in richer countries.

Another win-win opportunity is in sustainable travel. This means more walking and cycling but also better public transport (which always involves a contribution from walking or cycling). This reduces carbon emissions, improves air quality in urban areas and improves health and wellbeing in travellers (see, for example, the PHE and LGA Report ‘Obesity and the physical environment; increasing physical activity’ in November 2013 and PHE’s ‘Working together to promote active travel’ in May 2016).

There are many other direct benefits to public health from energy efficiency, urban green space and reducing waste. Public Health professionals need to publicise this evidence and advocate for action on sustainability at local, national and international levels. This is not just good for the planet but good for the health of the public and the effects will be immediate.

 

Learn more about the work FPH is doing on behalf of our membership on the General Election.

 

By Professor Simon Capewell, FPH Vice President of Policy 

Next week, voters across the country will head to the polls to determine the make-up of the next Government. The outcome may be uncertain, but this much is clear: we cannot allow the public’s health to be side-lined over the course of the next Parliament. At FPH, we are committed to ensuring that policy-makers embed health in all policies. Following the announcement of the snap-election, we therefore rapidly produced our short-list of priorities for the next Government. They are:

1) Realising Brexit’s ‘health dividend’
2) Shoring up and increasing public health funding
3) Making sure the specialist public health workforce is adequately staffed and supported

We’re doing all we can nationally to advocate for these issues. But we cannot do it alone.  We need your help to deliver our message to your local parliamentary candidates and get them to commit to our asks. As an FPH member, you are well-placed to do this because Parliamentary candidates are much more likely to listen to the concerns of their constituents- especially when those concerns are presented against the backdrop of local data or case-studies- than they are to national organisations with no concrete links to their community.

Over the next week or so, candidates will be in a mad dash to meet as many of their constituents as they can. What they hear on your doorstep or at a hustings in your community may follow them into the House of Commons. To help you get started, we produced this brief one page guide outlining how you can campaign on behalf of FPH. It includes sample questions to ask, opportunities to take advantage of, and tips for building relationships with your candidates.

Make sure you also visit our General Election webpage to access allStart Well, Live Better front cover of our resources (including our Start Well, Live Better manifesto) to help you campaign and to see the election ‘asks’ from our allied organisations and partners.

Finally, we want to hear from you! Your feedback is invaluable to us. If you do speak to any of your candidates, we would love to hear how it went. Or, if you need help in reaching out to them, please feel free to email FPH’s policy team (policy@fph.org.uk) for some advice and guidance. We want to help as many members as possible build and maintain relationships with their candidates, both in the run up to election and, crucially, with the next government. Thank you for your continued support.