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I retired from my main career within the public health system because I had stopped enjoying many elements of it; the benefits were not refuelling the tank that was being drained by the disbenefits I was experiencing.

Since retirement, I have taken two very part time roles. I was asked to stay on as a clinical advisor to the bloodspot screening programme for one day a week. This was complicated since the screening programmes also transitioned to NSHEI when PHE was abolished. It has taken me until now to be able to link in to some of the NHSEI Public Health arrangements and structures – over six months. I have also taken a role as Training Programme Director in the newly established Kent Surrey and Sussex School of Public Health, for half a day a week. This has been way smoother in comparison to the NHSEI role.

Having two part time roles makes it difficult to switch off from work sometimes, and I log in most days to check emails. Both roles are flexibly worked rather than having set times which I greatly prefer but which does allow the time spent on work topics to inexorably increase. I have started to book other things into my diary to keep this under control, and now spend more time catching up with friends, visiting art galleries, going to gigs, reading more and finally sorting the house and garden out. My longer term plans to travel more are starting to feel possible again as the covid situation eases, and meanwhile we have a summer of music festivals booked. My confident expectation that I would exercise more when I no longer had to rush to fit a swim in to an already long day hasn’t happened though. With all day to fritter away I some how haven’t got around to much exercise at all, and have started to book into more classes to make myself get more active.

My next decisions will need to be how long to continue in the part time roles I have. I feel I add less and less value to these roles as my other organisational knowledge becomes more and more out of date, and the effort of keeping up with requirements such as appraisal seems less justified. I suspect I will not be doing any formal work in a few years time, and am greatly looking forward to learning how to make cider from Dilys. My one attempt so far developed a very strange smell – will be trying again this year.

Jane Scarlett

Could you please tell us a bit about your professional background and how this has led to you working on this series and stories

There has always been a creative seed deep inside me and, over recent years, my professional and creative worlds have become excitingly inter-twined. Professionally, I specialised both in general practice and public health, but the latter has been my mainstay for the past two decades. I have worked as a local director of public health at Camden, in national roles as director of public health strategy and global public health director at HPA/PHE, and am currently based at NHS HQ as clinical director for national clinical policy. I am also senior public health adviser to the Football Association (FA), advise the UK film/TV industry on Covid, and have worked academically at the London School of Hygiene and Tropical Medicine for many years.

As much as I have tried to be imaginative in my professional work, the creative seed has been slowly germinating. Early on, this was reflected by studying philosophy after my medical degree, but through the past decade the impetus has been increasingly expressed in literary form – further inspired by my involvement on the board of the wonderful national charity, BookTrust. In 2013, I published my first children’s book, The Amazing Adventures of Perch the Cat, and my current book, The Five Clues, was published by Crown House last year (https://www.crownhouse.co.uk/publications/the-five-clues).

The Five Clues is a YA detective/adventure book centred on 13-year-old Edie Marble, who discovers that her mother’s death a year earlier may not have been an accident. There is a public health plot (conceived well before the Covid pandemic!) and an important sub-theme around supporting mental health in children and young adults. The book – which is the first in the 4-book ‘Don’t Doubt the Rainbow’ series – has, so far, been short-listed for the Dudley Children’s Book Award 2021, People’s Book Prize 2022, Hampshire Book Awards 2022, and CrimeFest Best Crime Fiction Novel for Children Award 2022.

How do you think children and young people’s mental health has been impacted by the pandemic? And what are your hopes for how your books might be able to offer support to this group?

Today’s mental health challenges for children and young adults are immense. This was the case pre-2019, but since the pandemic the situation has heightened with significant rises in the demand for services for depression, anxiety, phobias, eating disorders, OCD, addictions and the like. In April 2021 the Royal College of Psychiatrists (RCPsych) said “the country is in the grip of a mental health crisis with children worst affected”. On 21 March 2022, the British Medical Journal reported that the RCPsych has now urged the government to fund a recovery plan for specialist mental healthcare due to “unprecedented demand”.

Against this backdrop, I have had a long-standing personal and professional interest in children’s mental health. In recent years, I have become especially interested in a new-ish approach to psychological wellbeing based on an understanding of how the mind works – and thereby an understanding of how we experience life, moment by moment and day by day. Awareness of how we generate our experience of life enables the reduction of psychological distresses (e.g. stress, fear, pressure, discouragement) and the uncovering of our inner well-being. The approach is therefore not just about managing life’s challenges, but also about facilitating the capacity for individuals to thrive and flourish. I have published articles in the Journal of Public Mental Health about this approach as well as a summary on my own Medium site (https://akessel.medium.com/the-three-principles-understanding-of-how-the-mind-works-an-overview-55c03a255296), and I sit on the board of a mental health charity that provides ground-breaking programmes (informed by this approach) to schools in this country and internationally.

In The Five Clues the young protagonist, Edie Marble, learns from her mum about this understanding, which helps Edie in solving clues, bringing criminals to justice, and navigating grief and other emotional challenges. This sub-theme of supporting children’s psychological wellbeing and resilience is threaded through the whole ‘Don’t Doubt the Rainbow’ series. In terms of public health improvement, my intention is to generate mental health benefit in the young using the vehicle of fiction.

How do you think story-telling more generally could be used in public health to reach certain audiences, particularly children and young people?

Story-telling is an incredibly powerful way of sharing ideas, conveying messages and effecting change. Much of what we already do professionally in public health involves telling a story. A well-written board paper tells the story of a new strategy to tackle obesity locally or the story of a proposed organisational re-design. To be successful such papers need a compelling story arc, in the same way as an impactful academic article tells a good tale of why the research is needed, how the authors set about conducting the study, what were the outcomes, and what should be done as a consequence. An annual public health report is, at heart, a chronicle of the health of the population.

If convincing, the narrative of a good story is more likely to capture the audience’s attention, and thereby more likely to be effective. This is just as true for a spoken story as a written one. Telling a story well is therefore a powerful, and somewhat underused, instrument in the public health toolkit. We need to harness this skill in public health, perhaps through first supporting development of the art.

Young people love a good story, perhaps even more than adults, and I hope that my children’s books can provide a touchstone to igniting deeper use of story-telling in the practice of public health.

Finally – are you able to give us any hints about what we can expect from the future books in the series?

Set three months apart, each book in the ‘Don’t Doubt the Rainbow’ series has a new adventure story, with the psychological wellbeing theme continuing throughout. The second book, Outside Chance, will be published in July 2022 and involves eco-terrorism, climate change, stolen dogs and exam fraud – as well as an over-arching discussion of determinism and free will. Plus, of course, Edie containing her journey of self-discovery.

I now spend a lot of time in schools – speaking to children and doing book readings – and at events focused on the relationship between fiction/reading and children’s mental health. It’s wonderfully enjoyable and rewarding, but nothing gives me more pleasure than a single child telling me how much they enjoyed my book and what they got from it. A story is an extraordinary vehicle for joy, entertainment and learning, as well as a potentially vital means to enhancing wellbeing.

Anthony Kessel

In October 2017, I was honoured to present the Royal College of Physicians of London Milroy lecture.

In the lecture I described the potential benefits of four dividends for better health: 

The Peace Dividend, the idea of ‘swords to ploughshares’- diverting military technology for peaceful, socially-useful purposes; an idea which took off with the end of the Cold War.

The Health Dividend, first described in three local Sandwell studies of anti-health vested industries and which came to be applied to the corporate citizenship role of health services.

The Inclusion Dividend, whereby design for disability in industrial and technological processes can produce better solutions for independent living for people with disabilities, but also for everyone.

The Green Dividend– where, for the protection of the planet, and for our health, we must look to the most environmentally-friendly use of energy and natural resources.

After the Cold War, politicians talked about the ‘peace dividend’ – the benefit that would arise from diverting investment, material resources, human intellect, and endeavour in war, towards peaceful, socially beneficial use. From 1986-1996, I was involved in researching Coventry defence industries and advocated alternative applications of the technologies for socially and environmentally useful purposes.

 I applied the same principles in my work as Director of Public Health in Sandwell. There were industries with a vested interest in making people ill, which could diversify into less-unhealthy production and services, thereby delivering a health dividend. We researched local tobacco retail, the food industry and alcohol trade and proposed new models of production and services for food and alcohol.  

Recognising human ingenuity and a drive for socially useful production led me to argue for design for independent living and for technology, which limited the impact of disability and promoted inclusion.  Applying technology to the needs of people with specific handicaps can generate solutions, which are of benefit to the wider community. This we called ‘the inclusion dividend’.

In the era of global warming and climate chaos, a new green industrial revolution is needed, capable of delivering sufficient green energy to supply the world. It requires us to harness technological and socially useful production- for energy-saving devices, for renewable energy production, for energy storage, for energy generating buildings and for transport systems.  In so doing, we can create jobs, create healthier living standards, and protect the global environment- the green dividend.

My lecture considered the relevant issues of diversifying health-damaging industry and harm reduction in issues which affect us today: Non-lethal weapons? The safer cigarette? Healthier eating? The non-polluting car?

Effort to engage with ‘Big’ business to find healthier alternatives is difficult and is fraught with pitfalls and dangers. Unhealthy big business will continue to profit from the misery they inflict on millions, and will continue to need regulation, taxation, and controls. “BIG” businesses will throw a smoke screen on the extent of their concerns for health and their efforts to create healthier alternatives, and we will be deflected and distracted. But dialogue, and challenge, and real diversification of industry is needed more than ever.

You can download the slides from the lecture here.

Read the full lecture transcript here.

And watch a recording of the lecture here.

Professor John Middleton
Past-President of the Faculty of Public Health

Sometimes I think politicians must be smarter than they seem when baying during Prime Minister’s Questions.  I’ve spent the past couple years or so discussing pension reform with relevant actors within the social policy process (academics; civil servants; employers; politicians; professions; think tanks; trade unions) without realising that UK Members of Parliament had built an escape clause into the legislation.  As Therese Coffey (Secretary of State for Work & Pensions) explained to the House of Commons last 4th December: Section 27 of the 2014 Pension Act demands a second Government Review of the State Pension Age by May 2023, for which already she has commissioned independent reports from Martin Clarke (Government Actuary) and Lucy Neville-Rolfe (Peer of the Realm). 

If you look at the ONS Longitudinal Study, it is clear that at each decennial census since 1971 the proportion of women in their 50s who describe themselves in labour market terms (paid employment; unemployed; permanently sick; retired) has increased steadily, so it is reasonable that women and men should have the same State Pension Age, although why the gender difference should have been equalised up (first to age 65 years, now 66 years and soon 67 years, then 68 years) rather than down (to age 60 years), is less obvious.          

The official reason is the increase in life expectancy during recent decades.  One problem with this explanation is that the rate of increase in life expectancy now appears to have stalled and that, if and when it resumes, it is likely to lack its previous vigour.  The bigger problem is that being alive is not the same thing as being capable of holding down a job; hence the need to think in terms of healthy life expectancy.  Here the devil is in the detail and Lucy Neville-Rolfe has been tasked with adjudicating.  John Cridland’s previous review opted to measure the healthy part of healthy life expectancy in terms of self-assessed health, although many consider that the absence of physical or mental disability would have been more appropriate.    

I am one among the number who would prefer to see the State Pension Age linked to disability-free life expectancy, but my concerns are not limited to this technical issue.  I am also part of an informal group of public health specialists who wish to draw attention to the possible unintended consequences of raising the State Pension Age and contribute to discussion of how to mitigate these.        

Our concerns are that extending work-life may: (1) worsen the health of those with pre-existing illnesses; (2) overwhelm sparse occupational health and over-stretched general practitioner services; (3) hinder informal caring at a time when the need for it is projected to increase; (4) deter the volunteering which supports the NHS and the many charities upon which public health depends; (5) trigger overt disease in those with asymptomatic pathology or previous good health.  Our report, detailing each of these items, can be downloaded free here.       

We suggest that our concerns could be mitigated by [1] commissioning two pieces of research to establish (a) evidence-based triage criteria to guide occupational health & general practitioner services in deciding which older employees are most at risk; (b) whether extending working lives will increase the mortality risk of older employees in the most disadvantaged occupations. And [2] two changes to administrative regulations to accept (a) greater flexibility in the age range 60-68 years, to accommodate patterns of relapse and remission in chronic disease; (b) that paid employment is not the only type of socially necessary labour at these ages, with informal caring and volunteering as appropriate and legitimate alternatives.

Finally, there are issues of financial loss and workfare.  Many of those now working until age 66 years spent most of their life paying their National Insurance contributions when its regulations increased the size of their State Old Age Pension in line with any years worked beyond the state pension age; the increase in the state pension age removed this entitlement, at a cost per person of up to £300 per month for life which, for Pension Credit recipients, could be the difference between living with or without the older person’s Minimum Income for Healthy Living.  To add insult to injury, now these same individuals find themselves subject to conditionality (fitness for work testing) and sanctioning (benefit cuts), which those who saw the Dispatches report on the subject (Channel 4, 17th December 2021) will find it hard to believe that MPs intended when they voted through the 2014 Act.    

David Blane
Professor Emeritus of Imperial College London

CORRECTION WITH APOLOGIES

“all three of whom, it may be relevant to note, will be entitled to solid gold pensions when they retire (non-contributory, defined benefit, final salary).” – removed from final line of Paragraph One.

Civil service and parliamentary pensions are contributory (at 6% of salary) and paid on the basis of career average salary; inflation-indexed defined benefits remain.  

The Yorkshire and Humber speciality registrar committee spent time reflecting on 2021, with a focus on the challenges we have faced and the positive things which have supported wellbeing. The COVID-19 pandemic has seen working from home become the norm for many public health professionals, and this was prominent in our conversations.

Office for National Statistics (ONS) show that the proportion of working adults who did any work from home increased in 2020, and 85% of those currently homeworking wanted to use a “hybrid” approach of both home and office working in future1. If working from home is to become a norm of working life, we must work together to support wellbeing.

Challenges

The pandemic has had a profound effect on everybody. There are some aspects which we cannot control and must live with. This can leave us feeling quite bleak and such feelings are particularly prominent at times when restrictions change.

Many registrars have undertaken placements without meeting their colleagues in person. A lack of human interaction face to face left people feeling disconnected. There is more challenge in building relationships with colleagues and partners.

The line between work and life can become blurred. People might be working at their dining table or in their bedroom. As well as this physical blurring of work and home, there is a psychological blurring too. There are back to back meetings which might not leave much time for admin and replying to emails. It is “easier” to start early or stay late.  It is “easy” to pop back to your work area.

Culture and leadership really set the tone for wellbeing. In Yorkshire and Humber, registrars receive regular wellbeing check in calls from the Head of School and Training Programme Directors. I extend thanks on behalf of the registrar body to the School of Public Health Team for their support and for setting the tone for a positive culture. These tips are based on experiences in our region which have been helpful. 

Top tips to support wellbeing for organisations and leaders

  1. Create mini breaks by starting meetings at five past the hour
  2. Encourage protected time for lunch, including getting outside during day light hours in winter
  3. Encourage meeting free time each week (e.g. 1 meeting free day per week)
  4. Thanking people for good work they have done
  5. Flexibility in working hours
  6. Hold regular meetings that help teams to keep in touch (e.g. weekly registrar catch ups)
  7. Offer walking meetings using telephone rather than video conferencing where able
  8. Consider optional weekly wellness sessions (e.g. desk-based stretches, mindfulness)
  9. Care about people – share good news, respect their personal circumstances, support time off if people are unwell
  10. Lead by example – be open about vulnerability, take annual leave, block out lunch breaks, have meeting free days

Top tips to support wellbeing for individuals

  1. Being kind to yourself
  2. Shut the computer at breaks and the end of the day
  3. Set your out of office on none working days
  4. Taking you work emails off your phone
  5. Organise your time to include breaks and meeting free time
  6. Go out during the daylight
  7. Take time to exercise
  8. Remind yourself of things to look forward to, no matter how small!
  9. Work on your support network e.g. action learning set, peer coaching

Dr. Jaimee Wylam
Public Health Registrar

  1. Business and individual attitudes towards the future of homeworking, UK – Office for National Statistics (ons.gov.uk)

Mosquitoes winging their way north across Europe bringing dengue. Floods and drownings. Heat stress. Despair. We are all aware of the health impacts of climate change. But how do we get governments to act? Ballot box pressure (in democracies) does not guarantee results as shorter-term concerns distract from our overheating planet. No easy answers, but experience from the environmental movement provides clues and inspiration.

On 7 October the Faculty of Public Health co-hosted a webinar on Public Health, Climate Change and Strategic Litigation (recording now available online). It aimed to alert public health academics and practitioners to the opportunities for legal action to hold governments and private sector polluters to account for health-harming pollution and climate change.

Moderated by Dr Farhang Tahzib, the webinar attracted over 800 registrations from around the globe. Starting close to home, Rosamund Adoo-Kissi-Debrah recounted how air pollution in London led to the death of her daughter, Ella. Sir Stephen Holgate gave expert testimony at the coronial enquiry into Ella’s death. He noted how air pollution is now largely invisible and hence neglected – yet ‘breathing clean air is a right, just as we have the right to clean water.’ Dr Maria Neira, WHO’s climate change and health champion, presented the ‘health argument for climate action’ that WHO will take to CoP26.

But governments have long been aware of the short- and long-term health impacts of pollution. What else can be done? Strategic alliances between public health actors, environmental activists and legal academics and practitioners are using court action to highlight government inaction and industry abuses. Marlies Hesselman, lecturer at the University of Groningen, Netherlands, gave a ten-minute ‘strategic litigation 101’, noting four recent and current cases where governments have been called to answer before international courts and tribunals for health harms related to climate change. Irmina Kotiuk, senior lawyer with ClientEarth’s Clean Air Program, noted the huge role for public health specialists as experts in strategic litigation – building on the experience of tobacco and asbestos. She urged nurses and doctors to collect and record evidence in medical files which can later be used in expert testimony.

Richard Harvey, barrister and legal counsel for Greenpeace, drew parallels between tobacco companies’ now infamous denials of the link between smoking and ill-health, and today’s spin from fossil fuel companies. The Dutch District Court in The Hague was not fooled – in a landmark 2021 decision it ordered Shell to reduce CO2 emissions by 45% by 2030, globally. Dr Marina Romanello, Research Director for Lancet Countdown, reiterated the health impacts of climate change and the continuing financing of the destruction of our health through fossil fuel industry subsidies.

Yet the Lancet Countdown 2021 report on health and climate change: code red for a healthy future, makes no reference to the role of the law (other than to the International Health Regulations), let alone to the hundreds of current and recent legal cases on climate change alone, easily searchable through online databases. Restating the problem in ever greater detail is not a strategy for change. We need to combine the credibility of hard science with the legal skills of seasoned national and international litigators and the experience in social mobilization tested and proven by other social movements – all adapted to today’s online, COVID-19 constrained world. Dr Neira remarked that ‘People working in the environment say we need to hear more from the public health community – because you are still trusted – politicians will listen to you.’

Bridges between the public health, environmental and legal communities must be strengthened if we are to ‘keep 1.5 alive.’ The 7 October webinar was co-hosted by the Global Health Law Groningen Research Centre and the ‘law and public health’, ‘environment and health’ and ‘ethics and public health’ sections of the European Public Health Association. Section membership is free and not limited to public health practitioners or people resident in Europe.

David Patterson LLM. MSc.
PhD. Candidate
Global Health Law Groningen Research Centre
Netherlands

Today (Sunday) is a day of rest at COP 26.  That is, in the formal Presidential Programme, but there are still plenty of ‘side’ events happening.

I have had a few interesting days at COP 26 so far. It is VERY busy with many parallel sessions and activities going on, both inside the main blue zone and in the green zone and at satellite meetings. It is quite hard (maybe impossible!) to follow the president’s programme and the negotiations as the ‘agenda’ for each day only appears late the night before, so it is difficult to plan. Also many of the ‘negotiation sessions’ are not really negotiations, but are a series of announcements about various initiatives and commitments that countries (and / or organisations) have signed up to, but the real question is whether they will deliver on them, as there is often only a headline and no tangible substance about delivery given.

There has been a calculation made that if ALL the pledges made so far are enacted then the figure reached would be 1.9 degrees Celsius, which is better than the calculated 2.7 for which we were previously on track  BUT still does not reach 1.5 degrees, AND there are certainly doubts that all the promised actions will be fulfilled. Previous promises have not been fulfilled.

At the Paris COP there was agreement that $100bn would be transferred, by 2020, from global north to those countries who needed to address climate change most (i.e. LMICs in global south) but that promise has not been fulfilled, although there is now a commitment to do so by 2023. (We shall see!) 

I was going to outline some highlights for me from the past few days, but I was just distracted listening (on you tube) to the first session of the People’s Health Hearing. It was amazing. Stories and testimonies from people who have suffered directly the impact of climate change. A testimony from the Philippines about the massive floods a year ago (November 2020), stories of having to sit on their roof until the water went down, of raw sewage and water pouring into their houses and trying to clear it up, of rashes and scars from contact dermatitis, of the mental health impacts of having to move house 4 times in the last year and most particularly of the inequalities (as we in Public Health would call it)  – of the peoples who have contributed least to global emissions being the most affected. Calling for ‘climate Justice’.

 And another story of how it was the removal of massive areas of trees, by extraction industry (mining etc. for natural resources including gold and fossil fuel), that caused the area to flood, and how the indigenous people, losing their homes and communities, livelihoods and lives, are now being gagged by their (and global north) governments who are still supporting the industries.

And yet another concerning mining, in an indigenous region – West Papua (west part of Papua New Guinea) about the devastation and pollution ruining their water supply and crops and an anthropologist from the community who was murdered, (together with 130 others from the community) – and how the family had to flee to the Netherlands – and that the anthropologist was the storyteller’s father. No wonder he is now an indigenous activist. But how does this link to Climate change, well through the need to protect forests and the staggering statistic that indigenous people populate 5% of the world’s land but their forests are responsible for nearly 90% of biodiversity. They have maintained that for 1000’s of years, living in harmony with nature, unlike western societies. We must learn from them and protect indigenous people and their lands, if we want to avert the climate crisis.

Very powerful stories, I do not do them justice here. And what I learn from this is that we must use stories and storytelling and we, as PH professionals, should learn more about storytelling, find the people who are directly affected and listen and learn from their experiences and utilise their experiences to influence policy makers and the climate and health agenda

Professor Sue Atkinson CBE
Chair, FPH Climate and Health Committee

So here I am on the train to Glasgow, on my way to COP 26, which started earlier this week and ends on 12th November 2021.

I am excited to be one of the FPH group with ‘observer’ status, so able to attend the main conference where negotiations take place, though I suspect many actually take place in whatever is the 2021 equivalent of ‘smoke filled rooms’! Or in fact have already taken place prior to coming to Glasgow.

 By the way COP stands for Conference of the Parties of the UKFCCC, which is the international mechanism to address climate change across 197 countries.

The first two days of COP is when the world leaders attend and many of them have made declarations as to what action their countries will take to address climate change and cut emissions, in order to reach no more than 1.5 degrees, as agreed at the Paris COP in 2015. Unfortunately the plans (NDCs) currently in place will still not go far enough or fast enough, so hence the urgently at this COP to get countries to sign up to increased targets and faster action. The science has shown that action is NOW really urgent.

The following days of the Presidents Programme are devoted to specific topics, so yesterday was on finance and today is on energy. You will have seen in the news various reports from yesterday with announcements about the financial sector agreeing to take action on fossil fuel investment, though clarity is needed on exactly what it means in practice. There were also announcements about engagement of the private sector to help finance climate action I think to the tune of $ trillions,

For the first time there is a ‘health pavilion’ at this COP and very many of the international health community are attending (including ourselves from FPH) to make the case for health being part of the agenda and that there are already major impacts on health, both direct and indirect, due to climate change. But also to demonstrate that health can be part of the solution; both health systems – the greener NHS is a strong example – and we anticipate a number of other countries may announce similar initiatives during COP. But also climate action can also improve health- for example active travel, with increased cycling and walking, reduces emissions, reduces air pollution (improving health) and improves physical activity, which improves people’s health.

Similarly more plant based, sustainable food is better for people and better for the planet.

But we are also here to remind everyone that there is a climate justice / health equity issue, both across the UK and globally. The most vulnerable are likely to be hit hardest by climate change – poor housing is least resilient to higher temperatures or flooding and internationally global south has contributed least to the current emissions but are already feeling the impact of climate change with increased extreme weather and its sever impacts.

So what do I expect to do at COP?

  • Hopefully contribute to that health voice, both informally and collectively in speaking to country delegates. Or really just anyone who might listen
  • Certainly listen and learn both from other countries and from other sectors such as energy and transport. We, in public health, need to hear where they are coming from and what language they use and see how our agenda on health and inequalities etc. can fit in and contribute to what they want to achieve. That way we can work together for a win win.
  • Feel the buzz of collaborating with the international health community working together to address climate change and all its health ramifications

That will do for now.  

Sue Atkinson

4.11.21 at COP 26 in Glasgow

In public health we often work in partnership with statutory and non-statutory organisations developing relationships that are necessary to implement public health projects to benefit local communities.  How often have we teamed up with colleagues where the relationship is informal, not prescribed and not expected?

April 2020 the national spotlight was on acute physical health care and there was a frantic attempt to scale up provision of acute beds and ventilators. Those of us working in community Trusts saw our services take a back seat and many were stopped altogether; but there was unease over impending problems over the horizon. What would be the impact on community rehabilitation services? What would the mental health ramifications of the pandemic be?  Would our community palliative care services cope?  

It was reassuring to network with other public health colleagues who had similar concerns. Connected by the national network for public health professionals working in providers (facilitated by PHE) we joined forces and worked as one team on this topic of mutual concern. One of the challenges for public health specialists in provider trusts is that we often work single-handedly and don’t have colleagues in a team, as in local authorities for example. Becoming a virtual team (consultants, StRs) doubled the number of people working on the project and meant we could split up article reading and writing up. It also gave us more brains to think about the implications and critique what we were reading and thinking. We barely knew each other, but had our training in common and shared public health language meant that we were able to work effectively together – and enjoyably!

So even before the term Long Covid had been coined and mental health concerns had been profiled nationally, we had teamed up and started needs assessments and were doing papers for our local integrated care systems. We even managed to submit articles for publication. 

Furthermore, we have continued regular problem solving meetings and act as a virtual department separated by a dotted line of a few hundred miles. Freed up from formal, standard ways of working – under the radar – our organisations get a greater range of public health expertise than they pay for!

Jane Beenstock
Consultant in Public Health

Dr Zafar Iqbal
Associate Medical Director Public Health
Chair, FPH Pakistan SIG

Given the widespread recognition of COVID-19 as a public mental health emergency that has deepened existing mental health inequalities, the theme set by the World Federation for Mental Health for World Mental Health Day on Sunday 10th October – Mental Health in an Unequal World – was especially fitting.

It seemed to have come around even more quickly again this time, which probably says a lot about what the past year has been like. Those of us working in public health will be well versed in efforts to promote wellbeing in our own organisations and others, particularly at a time when workload and stress have been high and morale has been low.

What comes through less clearly is where the focus is not just on reducing stress in individuals, but on tackling wider underlying issues contributing to that stress – particularly where there are marked disparities.

I don’t just mean equal access to support, services and activities that help to improve wellbeing, although that is extremely important – both in our own workforces and the populations we serve. I’m talking about workplace policies, working practices and cultures that seek to actively counteract prejudice, discrimination and structural disadvantage, all of which are detrimental to mental health and wellbeing.

In other words: what are we doing to advance equality in our own workforce?

Last year the FPH highlighted the importance of embedding anti-racism into public health practice. This means challenging our own unconscious biases and refusing to be silent bystanders to racism in our own organisations. The same principles can be applied for other forms of discrimination, including but not limited to sexism, ableism and homophobia – however, this is as much about questioning the status quo in the ways we work as it is about challenging overtly discriminatory behaviour.

The public health workforce is diverse in itself (people, roles, organisations) and has wide-reaching links across partner organisations and communities. If we want to be effective advocates for mental health equality in the population, we need to start with equality overall and we need to start from within.

What stress means and what it looks like is different for everyone, but can be summarised as ‘a lack of fit between individuals and their world’ (Cassidy, 2001).[1] We’ve started to recognise the limitations of traditional workplace wellbeing approaches, which focus on supporting individuals to fit into existing structures rather than improving their ‘world’ to fit them – but we also need to be looking at who built that world in the first place. Many workplace policies and interventions for inclusion and wellbeing still operate within norms and cultures that have been established by white, middle class men without disabilities – even where workforces are considerably more diverse, and even where there is representation at senior levels.

For example, offering flexible working arrangements such as flexible start/finish times and remote working can improve work-life balance and wellbeing for people with children or care responsibilities (who are disproportionately women), or those with disabilities or long-term health conditions. Yet limiting the offer to these groups where there is no real business need to do so just reinforces the current culture as the norm and those who don’t fit in as ‘others’, instead of including everyone as equal partners in re-shaping that culture.

It also ignores the wellbeing benefits that these changes can have for everyone. A workplace that promotes equality and diversity is a workplace where everyone can flourish and feel that their contribution is valued. More flexible working as standard can help to improve work-life balance for all. Making workplaces more autism friendly can make those workplaces happier, calmer and more productive spaces for everyone. When we default to the status quo and consult rather than co-produce, we all miss out.

The brilliant Dr Nisreen Alwan explains this far better than I ever could in the context of language and anti-racism:

“Diversity” and “inclusion” imply charity from a position of power and superiority.

They give the impression that the group who is opening the door to diversify and include others still holds the key. The point of antiracism is that there should not be a key in the first place. The door should be widely open to all. Clubs with locked doors should not exist in an equitable society. Once that is achieved, the natural result of equity is diversity. It is the end not the means.”

So what does this mean for promoting mental health equality?

We cannot improve mental health and wellbeing in the public health workforce without actively tackling inequities in our workplaces – and we cannot address those inequities without confronting the structures underpinning them. Whether it’s improving opportunities and experiences of people with mental health problems, or reducing disparities in mental health and wellbeing, we have to actively change working practices that allow systemic discrimination to persist.

It isn’t enough to work to improve mental health in an unequal world; we also have to work to make the world more equitable to improve mental health.

Lina Martino

Chair, FPH Public Mental Health SIG


[1] Cassidy T (2001). Stress, Cognition and Health. Psychology Press: Hove & NY.