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By Dr Uy Hoang, Chair of the FPH Film Special Interest Group

Following the announcement of a General Election, FPH called for the next Government to think more about our long term health, embed health in all policies, and work with people and communities to focus on preventing ill health and easing pressure on our overburdened NHS.

At FPH’s Annual Conference in Telford (20-21 June), FPH’s Film Special Interest Group (SIG) will bring together public health specialists, academics, and film makers to discuss the role that film can play in helping policy makers locally and nationally perform the type of joined-up thinking that health in all policies demands. We’d love for you to join us in Telford as we screen critically acclaimed films, hear from expert panels of film makers and public health professionals, and open to the floor for wider discussion and debate.

Headlining the FPH Annual Conference will be a screening of I, Daniel Blake, the winner of the 2016 Palme d’Or Cannes award and the latest film from legendary director Ken Loach. The film highlights many issues that are in the fore of this election campaign, including how to best support people with complex health and social needs.

With Brexit and the impact of economic migration likely to dominate this election cycle, we will use film to shine a light on a less discussed aspect of the movement of people- human trafficking- to ensure that that story is not missing from the dominant narrative surrounding immigration. We will screen the award winning film Slaved, followed by a debate with representatives from the police force, public health, and NGOs working within the field. The film brings to life the personal stories behind the public health statistics, shows what our public health workforce is contributing now to tackle these issues, and demonstrates how relevant a public health perspective will be to the next Government as it grapples with these complex problems.

Those of you interested in prevention will find the screening of Up for Air particularly engaging. This award winning documentary follows Jerry Cahill, a 60-year old pole-vaulting coach battling cystic fibrosis. Due to his vigorous exercise regime, Jerry is now 20 years past his expected life expectancy and is one of the oldest living patients with the genetic disease. This film is a powerful and stark example of the benefits of exercise, especially for those living with a chronic disease.

The Global Violence Prevention SIG will highlight the work of public health practitioners, especially women on the front lines of care delivery, with a screening of the film Grace Under Fire. The film follows the story of Dr Grace Kodindo, a leading reproductive health advocate and champion of women’s rights, as she works to expose the horrific toll of the conflict in the Democratic Republic of Congo and rebuild health services for women and children.

As you can see we have a full and compelling programme. We hope you will join us for our ‘film festival’ and contribute to the debate.

For details of the conference and to register please visit http://www.fph.org.uk/fph_annual_conference_and_public_health_expo_2017

For FPH’s election briefing please click here

If you are interested in joining the FPH PH SIG or have any suggestions for films that we could screen, please contact Policy@fph.org.uk

By Melisa Campbell MFPH, Research Fellow in Public Health, (Out of Programme: SpR Public Health [St4]), Department of Public Health and Policy, University of Liverpool

Melisa Campbell

Telling the story of child inequalities in health and care using big data research has been my passion for the last six months of my Health Education England Academic Fellowship, a focus fuelled by my personal working experiences within public health departments and healthcare systems.

As many of us will be welcoming spring and making plans for the summer, I am at the ‘show how’ phase and planning for my pending PhD application, which builds firmly upon my out of programme academic experience at the Farr Institute and the Department of Public Health and Policy at the University of Liverpool.

During my fellowship so far, I have been fortunate enough to share my work at the recent Lancet Public Health Conference (2016) Swansea and the Society for Social Medicine (SSM) Conference 2016.  I am also currently drafting further papers with colleagues from University of Liverpool, University of Nottingham and University College London.

The first months of the fellowship were quickly consumed by intense technical training, making connections within and outside the university and refining my understanding of theories and methodologies necessary to deliver my proposal, particularly with relation to health inequalities and statistical methods.

On-going learning has appropriately defined my fellowship and considerably expanded my skills, knowledge and practice of research methods including statistical methods for regression analysis, dealing with missing data and longitudinal data. I’ve been learning to undertake these analyses in STATA, and also in R, which is an open source statistical platform that anyone can use for free, and so gaining transferable skills for public health service practice.

Much of my work has been exploring childhood social inequalities using the Millennium Cohort Study data – a nationally representative birth cohort of 19,000 children born at the turn of this century. Within this, I have maintained a special interest in childhood unintentional injuries, but my professional growth from this experience has facilitated a greater breadth of topics relating to child inequalities pertaining to paediatric hospital admissions, smoking initiation and school bullying, drawing on the expertise in the Farr Institute.

This has already been a rewarding experience and I look forward to making the most of my remaining time. My contact details, previous and when ready information on my current and future work can be found at: University of Liverpool: Melisa Campbell

By Margaret Whitehead

David Player led the Health Education Council in the 1980s. On April 2 he celebrated his 90th birthday in Edinburgh

I first met David Player in the mid-1970s, when I took up my first public health research job in the Scottish Health Education Unit (SHEU) in Edinburgh, where David was Director. At the time, David had this great idea: to pump-prime academic health promotion by funding academic lectureships in the various relevant disciplines in Scottish universities. As this was a novel strategy at the time, a range of committees had to be convinced, and David taught me how to put a compelling case with different messages for different interest groups. He triumphed in the end, and the fruits of his far-sighted vision can still be seen today, not least in the leaders of public health research that his initiative produced.

One of the first lessons that working under David’s directorship taught me was that everything about public health is political – even the seemingly most innocuous subjects could catch you out. One of my very first tasks was to produce a factual guide to family-planning services in Scotland, which I never dreamt anyone could object to. I was wrong. Somehow it came to the attention of the Scottish health minister with a strongly Catholic constituency in Glasgow, and, before I knew it, objections were being raised and outrage was being expressed. This was the sort of challenge that David cheerfully faced every day – be it about sugar, alcohol or tobacco – as he waged war with what he termed “the anti-health forces”.

It was David’s longstanding passion about unemployment and health and inequalities, however, that shone through for me. David moved from SHEU in the 1980s to take up the post of Director General of the then Health Education Council (HEC). By then I was a freelance researcher and in January 1986, David commissioned me to update the evidence that had accumulated since the publication of the Black Report in 1980 and assess the progress made on the report’s 37 recommendations. My report, entitled The Health Divide, was eventually published in March 1987 as an HEC occasional report, one week before the HEC was disbanded. David did two politically astute things when he commissioned the report: he set up an informal panel of distinguished scientific advisors, including three of the original members of the Black Report working group, and he signed over copyright of The Health Divide to me (as opposed to the commissioning body, HEC), thereby ensuring that the report would be published irrespective of what happened to the HEC.

As the launch date drew nearer, Peter Townsend, a scientific advisor for the report and one of the authors of the original Black Report, suggested that the HEC needed to call a press briefing, backed up by the scientific advisors because, in Peter’s memorable words:

“We can’t let Margaret face the flak alone.”

At the time I was young and so naïve that I hadn’t realised that there would be any flak!  How wrong I was again. After we had all travelled to London on the appointed day, the Chairman of the HEC decided to cancel the press briefing at the HEC offices an hour before it was due to begin. He was quoted in the Independent as saying that The Health Divide was “political dynamite in an election year” and so it was necessary to postpone the press briefing.  Members of the panel, who had already assembled, decided to proceed with the press briefing at the nearby offices of the Disability Alliance – David and his staff were instructed not to attend and so had to watch from the sidelines as the story unfolded. And what a story it turned out to be. As we made our way towards the Disability Alliance in Soho, journalists who were hurrying towards the HEC came across the procession going the other way and joined in behind – a Pied Piper effect. The press, TV and radio swung into action, spurred on by the hint that the report had been suppressed, possibly by the intervention of the department or even government ministers. The fact that this was remarkably similar to the treatment that the Black Report received seven years earlier was not lost on the media. The result was a public relations triumph for health inequalities advocacy (or a public relations disaster for the Chair of the HEC and government).

A health journalist, Peter Davies, recalled how a few days after the event, David Player told him gleefully: “It is going like hot cakes. They were queuing outside in New Oxford Street. We have a bestseller on our hands.” (1).

We had indeed – publishers started queuing up to publish The Health Divide, and it was eventually published in one volume with The Black Report by Penguin and became a non-fiction bestseller (2)

In the hectic aftermath of the press conference, the House of Lords requested copies for all the members as they prepared to debate the NHS, and a re-print had to be hastily prepared. It was, however, when a request for a copy of The Health Divide from Margaret Thatcher’s office landed on David’s desk that things became scary. David told a witness seminar at the London School of Hygiene and Tropical Medicine that, as he signed the complements slip to the PM, “It felt like I was signing my own death warrant.” (3).

The Times fanned that particular flame, by suggesting that the report was a “devastating final salvo from David Player to the government” on the eve of the disbandment of the HEC. That did David a great injustice – at the time he commissioned The Health Divide, over a year earlier, there was no inkling that the HEC would be disbanded, or that the Government would call a snap election, timed not long after the eventual publication.
It meant, however, that David did lose his job with the closure of the HEC and a very difficult time ensued for him. When I think of David during this episode and the battles he fought before and after it, I think of his courage in the true spirt of the great public health pioneers, mixed with his great Glaswegian sense of humour. An unstoppable combination!

1.    Davies P.  Review. BMJ 2003; 326: 169.
2.    Inequalities in Health: the Black Report edited by Peter Townsend and Nick Davidson and The Health Divide by Margaret Whitehead. 2nd Edition. Harmondsworth: Penguin. 1992.
3.    Berridge V, Blume S. (eds) Poor health: social inequality before and after the Black Report. Report of a Witness Seminar.   London: Frank Cass &Co Ltd. 2003.

By Woody Caan, Editor, Journal of Public Mental Health

The impact of parental drinking on the health and development of children (e.g. Caan W. Alcohol and the family. Contemporary Social Science 2013; 8: 8-17) has been recognised for decades but has never produced government policy that reduces harm. For example, in its final days, the National Institute for Social Work profiled a representative, national caseload of children and families. By far the most common characteristic of families assessed by social services (for any concern) was a parent dependent on alcohol. On behalf of the old UK Public Health Association alcohol group, I met with the British Association of Social Workers to discuss policies that would span public health and social work, but even when we identified quick wins (such as better care and assessment in emergency care for those young people with a history of abuse, who self harm when intoxicated) we failed to change policy.

It is not surprising that the 2003 government genetics & health strategy, Our Inheritance, Our Future, failed to address the common observation that many families with a pedigree of alcohol-use disorders repeat the same history across generations. There have never been official UK guidelines on effective child-health interventions after parental alcoholism is identified, although there are many recommendations from NGOs on both sides of the Atlantic.

The US company Kaiser Permanente first studied Adverse Childhood Experiences (ACEs) and their cumulative, long-term impact on adult health. From the beginning, having one or more adults with an alcohol use disorder within a child’s home environment was seen as a serious adversity. (Note: diverse studies have sometimes explored either parental addiction or shorter-term ‘alcohol abuse’, while the grown-up recollection of parenting in childhood tends to be fragmented and not like a clinical assessment.) In 2016, the Public Mental Health Network hosted by the Royal College of Psychiatrists decided to make ACEs our priority. In 2016, Public Health Wales produced a large-scale report on childhood adversity that includes parental drinking as a cause of both mental and physical harm.

What gives me hope for change in 2017? In February, three Members of Parliament (Jon Ashworth, Caroline Flint and Liam Byrne), supported by the Archbishop of Canterbury, all described their own experience of parental alcoholism and issued a manifesto for action. Subsequently, I sent the current Under Secretary of State for Public Health a letter in support of those MPs, with a little public health evidence. On 15 March that minister, Nicola Blackwood, replied to me that she was “committed to developing a strategy to help alleviate this serious issue”. The Public Health Minister also wants professionals like us to share our knowledge “as the new strategy is being developed”.

By Daniel Flecknoe, Co-Chair of the FPH Global Violence Prevention Special Interest Group

The preliminary report of the Lancet/American University of Beirut Commission Health workers and the weaponisation of health care in Syria [Fouad et al, 2017] was published on 14 March, calling attention to the principles of medical neutrality and unhindered patient access that have been so badly neglected in the ongoing Syrian conflict. Systematic targeting of health workers by ISIS, Syrian and Russian military forces is a war crime committed against civil society, and epitomises a disturbing trend of indifference and impunity to international humanitarian law by warring governments and armed groups over recent years. Established norms in the conduct of war, built up over the past century and a half since the founding of the International Committee of the Red Cross, may be irrevocably degrading, and the public health consequences for civilian populations exposed to such deliberate brutality will be correspondingly more severe.

The Faculty of Public Health’s (FPH’s) Global Violence Prevention Special Interest Group (SIG) is committed to engaging with this neglected and worsening cause of preventable morbidity and early mortality. Its members contribute to research into the health impacts of armed conflict (including the Lancet paper referenced), engage and collaborate with other conflict-prevention organisations and conduct advocacy for arms control, economic/democratic reforms, and respect for human rights and the rules of war. We encourage all public health professionals to give parity to armed conflict along with other major global causes of illness, injury and death, and to lobby (both as citizens and medical professionals) for foreign policies that will protect and preserve health.

The SIG will be represented at the FPH conference in June, and members will be happy to discuss our current workstreams with anyone who might be interested in getting involved.

References:
Fouad FM, Sparrow A, Tarakji A, Alameddine M, El-Jardali F, Coutts AP, El Arnaout N, Bou Karroum L, Jawad M, Roborgh S, Abbara A, Alhalabi F, AlMasri I,  Jabbour S. 2017. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria. The Lancet. Published online 14/07/17 http://dx.doi.org/10.1016/S0140-6736(17)30741-9

By Professor Aileen Clarke, President of the Society for Social Medicine

A highlight of this year’s UK Faculty of Public Health Conference in Telford is going to be the Society for Social Medicine’s (SSM’s) ‘Research in Action’ session.

The SSM will be hosting this research feast at the always fantastic and hugely enjoyable FPH conference. Last year this session had standing-room only and this year it will be bigger and better than ever – and hopefully will have more chairs!

In our ‘Research in Action’ session, we will be presenting the top-scoring abstracts from SSM’s own annual scientific conference with a variety of public health topics. Last year they ranged from obesity, to housing and health and active commuting. This year we’re including public health advocacy, youth mentoring and immunisation uptake.

You can also expect the presentations to cover a range of research methodologies from epidemiology, cost-effectiveness modelling, systematic reviews and mixed methods to qualitative research.

SSM’s purpose is “advancing knowledge for population health” and in this case we are hoping to advance knowledge by showcasing exemplar public health research. Our session at the FPH conference is an exciting opportunity to promote linkages and future collaborations between public health researchers and practitioners.

I hope I have been able to sell our session to you. Please do come along and get involved.

Please find more information about the FPH conference at Telford on 20-21 June here.

By Ben Barr, Senior Lecturer in Applied Public Health Research, University of Liverpool, and Lee Bentley, Research Associate, University of Liverpool

The Chancellor of the Exchequer is due to deliver this year’s Budget on Wednesday. It is imperative that he provides additional financial support for disabled people affected by the planned cuts to Employment Support Allowance (ESA) – or risk further widening the disability–poverty gap.

One in three working age disabled people are living in poverty. Their risk of poverty is one and a half times greater than for people without a disability. The government’s strategy, however, for improving the lives of disabled people, focuses almost exclusively on the disability-employment gap rather than this disability-poverty gap (1). It is true that the high risk of poverty amongst disabled people is largely because they are less likely to be in work and supporting people into employment is an important strategy for reducing poverty. Welfare benefits, however, also play a crucial role in preventing poverty by limiting the loss of income people experience when they can’t work due to disability.

People who have lost their jobs because of a disability are likely to be out of work for longer than people who become unemployed. For this reason, disability benefits have generally been set at a higher level than unemployment benefits. From April, this will no longer be the case. The government is reducing the level of ESA for disabled people who are assessed as being currently unable to work but potentially capable of work at some time in the future. The benefit will be reduced by 30% to £73 a week – the same level as unemployment benefits. But whilst 60% of new claimants of unemployment benefits will move off the benefit within six months, 60% of people on ESA will still be claiming this benefit two years later (2). This means that many people out of work because of a disability will have to survive for long periods of time without an adequate income.

Levels of poverty are already very high amongst people out of work with a disability and have been increasing since 2010, particularly amongst people who have a low level of education – the group most reliant on disability benefits (see Figure 1). Cutting these benefits will exacerbate this adverse trend.

Percentage of people with disability in poverty

FIGURE 1: % of people with a disability in poverty, aged 16-64, between 2007 and 2014, by employment status and educational level 

The government argues that reducing these benefit levels will incentivise disabled people to stay in or return to work (3), but there is little evidence to support this assumption (4), and some that suggests it may reduce their employment chances (2). Strategies to reduce the disability-employment gap over recent decades have increasingly focused on more stringent assessment criteria for disability benefits, reduced payment levels and requiring claimants to do more to prepare for work or risk losing their benefits (5, 6, 7). These strategies have had little impact on the employment of people with disabilities (8). It remains to be seen whether the government’s new strategy to halve the disability employment gap will be any more successful (1).

Even if the government’s strategy does improve the employment of disabled people, it is likely this will disproportionally benefit disabled people with greater skills and education (9, 10). The planned cuts in ESA will increase the risk of poverty for the most disadvantaged disabled people who remain out of work, and this may increase the disability-poverty gap.

Increasing poverty amongst people out of work with disabilities will adversely affect their health and increase health inequalities. We know that poverty damages peoples’ health, and adequate welfare benefits for people who can’t work can reduce these effects (11). We have seen that in recent years inequalities in health are increasing (12) in part due to disability benefit reforms (13). The severe cut planned by the government will further exacerbate these inequalities, potentially increasing levels of disability.

1    Great Britain, Department for Work and Pensions, Great Britain, Department of Health. Improving Lives: The Work, Health and Disability Green Paper. 2016 (accessed March 2, 2017).
2    Work and Pensions Committee. Disability employment gap. London: House of Commons, 2017 (accessed March 2, 2017).
3    Kenedy S, Murphy C, Keen K, Bate A. Abolition of the ESA Work- Related Activity Component. House Commons Libr Brief Pap 2017.
4    Barr B, Clayton S, Whitehead M, et al. To what extent have relaxed eligibility requirements and increased generosity of disability benefits acted as disincentives for employment? A systematic review of evidence from countries with well-developed welfare systems. J Epidemiol Community Health 2010; 64: 1106–14.
5    Watts B, Fitzpatrick S, Bramley G, Watkins D. WELFARE SANCTIONS AND CONDITIONALITY IN THE UK. York: Joseph Rowntree Foundation, 2015.
6    Banks J, Emmerson C, Tetlow GC. Effect of Pensions and Disability Benefits on Retirement in the UK. National Bureau of Economic Research, 2014 (accessed Sept 26, 2015).
7    Baumberg B, Warren J, Garthwaite K, Bambra C. Rethinking the Work Capability Assessment. London: Demos, 2015.
8    Mirza-Davies J, Brown J. Key statistics on people with disabilities in employment. House Commons Libr Brief Pap 2016; 7540.
9    Burstrom B, Nylen L, Clayton S, Whitehead M. How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework. Disabil Rehabil 2011; 33: 453–66.
10    Clayton S, Bambra C, Gosling R, Povall S, Misso K, Whitehead M. Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people. BMC Public Health 2011; 11: 170.
11    Cooper K, Stewart K. Does money in adulthood affect adult outcomes? York: Joseph Rowntree Foundation, 2015 (accessed July 30, 2015).
12    Barr B, Kinderman P, Whitehead M. Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013. Soc Sci Med 2015; 147: 324–31.
13    Barr B, Taylor-Robinson D, Stuckler D, Loopstra R, Reeves A, Whitehead M. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. J Epidemiol Community Health 2015; : jech-2015-206209.