By Neil Squires, the elected International Registrar on FPH’s Board and member of FPH’s Brexit Advisory Board

Neil Squires web cropI am very pleased to have been re-elected for a second term as International Registrar. The past 3 years have helped to demonstrate the real potential of FPH members to contribute to public health development in other countries and opportunities for members to engage globally are now beginning to increase. Over the last couple of years we have delivered training in Odisha, India, which has provided public health leadership skill training to 300 senior personal in the Government of Odisha. That work sparked requests for similar support in other States and an invitation for FPH and PHE to support the development of India’s MPH curriculum – an important in-road in to developing the next generation of public health leaders in India.

Similarly, the Pakistan Special Interest Group (SIG) has been increasingly active, working alongside PHE, developing a mentorship programme for health leaders in Pakistan. Stronger links have been made with both the National Institute of Health and with Academic Schools of Public Health, laying the foundation for future capacity building work. This programmes of work were commissioned using Overseas Development Aid (ODA) funding, and respond to needs identified by host countries. In addition, the Africa SIG has made strong connections with the Public Health Foundation of Africa, meeting public health leaders from across Africa in Nigeria, and has developed a network of health professionals who will be the cornerstone of future efforts to build on African Public Health Assets to strengthen Regional capability.

In addition to work with resource poor countries, there are an increasing number of requests to FPH from wealthier countries wishing to build stronger public health systems and adopt competency based training. A recent funded mission to Kuwait has created opportunities for potential future collaboration, where we hope to draw on a number of FPH members who have expressed interest in supporting training and public health capacity development. These funded opportunities both allow FPH to support our partners to develop their public health capacity and also generated the necessary income to enable FPH members to work internationally, helping to cross-subsidise work in the poorest countries.

At a time when it seems even more important that the UK remains actively committed and engaged internationally, the work of the Global Health Committee provides a real opportunity to productively engage in support of our colleagues in other countries as we collectively strive to achieve the Sustainable Development Goals (SDGs). In June FPH will organise a global session for the Association of Schools of Public Health in the European Region (ASPHER), where we hope to promote a coming together of a number of international networks committed to strengthening public health training and capacity globally, linking this to support of stronger national public health agency development. There is a significant opportunity and appetite for the international public health community to come together to tackle common concerns linked to poverty reduction, inequality, to global threats such as climate change, and to tackle global challenges such as violence.

Collaboration with other Royal Colleges remains an important objective, and strengthening relationships across the UK health system in support of global public health a priority. We are actively seeking committed members to join one of a number of causes that have global dimension, where there is a real opportunity to shape the future work and growing global profile of the Faculty of Public Health. These are opportunities we encourage all interested members to engage in, with a growing international membership to serve and an expansion in our practitioner members, who can help us champion multi-disciplinary public health globally.

To find out more about FPH Special Interest Groups specialising in global public health, click here.

By Stevie Benton, Communications Manager at ASH (Action on Smoking and Health)

As smoking prevalence continues to fall, NHS and public health organisations are taking things to the next level with the NHS Smokefree Pledge. 

Co-ordinated by the Smokefree Action Coalition, the NHS Smokefree Pledge is a commitment to help smokers in their care to quit for good and to create smoke-free environments that support them to do so. By signing the Pledge, organisations agree that they will take a number of actions to reduce smoking prevalence and help smokers quit. The commitments in the pledge include:

  • Treat tobacco dependency among patients and staff who smoke, as set out in the Tobacco Control Plan for England
  • Ensure that smokers within the NHS have access to the medication they need to quit in line with NICE guidance in secondary care
  • Create environments that support quitting through implementing smoke-free policies as recommended by NICE

Smoking remains the single greatest cause of premature death and disease in our communities. Around 79,000 people die because of smoking in England every year and for every death, another 20 smokers suffer from smoking-related diseases. Smoking imposes a huge burden on the NHS. Stopping smoking is the single most effective action a smoker can take to improve their health.

Signing the pledge is simple and a visible commitment to a smoke-free NHS. This No Smoking Day, if you’re a director of public health, why not take that crucial first step and encourage your Trust to sign up?

John Middleton 2 webBy Professor John Middleton

Last month I let you know about the progress we’ve made in our Public Health Funding campaign. A new FPH project group – made up of staff and registrars – will be focussing its efforts on making the case for greater investment in public health services in local government and moving the dial towards prevention in the health and care system.

I’m blogging today to let you know about the Government’s recent response to the House of Lords Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care and what it means for our new campaign.

In their response, the Government dismissed recommendations to reverse past cuts and cancel future ones to the public health grant and to extend the ring-fence for the next decade.

The Government’s argument rested on four central planks.

Firstly, the Government argued that ‘public health is about far more than the services funded through the grant’. With the transfer of public health to local government, prevention interventions are now delivered by many other local services, such as housing, which are not necessarily funded by the grant. These types of joined-up services are exactly what public health reform has sought to achieve.

Secondly, the Government argued that public health teams are now ‘demonstrating real innovation’ to achieve more with less. Now that local authorities have the autonomy to redesign services in a holistic and place-based way, councils are achieving better value for money while still producing good outcomes. These innovations are very welcome.

Thirdly, the Government argued that despite a challenging period for public finances overall, local authorities will still receive more than £16 billion for public health over the 2015 spending review period. This is not an insubstantial amount.

Lastly, the Government argued that any conversation about public health funding must include the role of the NHS. Local authority public health spend is bolstered by ‘well over £1 billion a year’ that the NHS spends on key public health functions, alongside the commitments to prevention outlined in the Five Year Forward View. Prevention is a core priority for the whole health system.

So what does the Government’s response mean for our campaign?

Firstly, we think the public health community needs to be able to respond to the Government’s key arguments if we are to make an effective case for greater investment in public health. We’re pleased that the focus of our campaign is seeking to address these points.

We are calling for increases to public health spending, but we’re not simply asking for greater investment in current services for ‘business as usual.’ We agree with the Government’s point that public health teams achieve great results when they are able to innovate. While recent reforms have provided local authorities with the autonomy and the responsibility to innovate, they have so far not provided proper funding in order to enable this to happen in a systematic or equitable way.

That’s why we’re calling for investment in an ‘Innovation and Transformation Fund’ to enable local authority teams to transform services to match the needs of their fast changing local populations. This investment is needed now in the short-term to allow public health teams to respond to the challenges of the future. We believe that investment in public health innovation needs to be placed centre stage during the next spending review period if public health reforms are to be viable for the long-term.

We know that the £16 billion allocated to local authorities for public health over the 2015 spending review period is no small figure when placed within the context of overall central Government funding for councils. We would contend, however, that when compared to the over half a trillion in funding allocated for NHS treatment and care over the same period, £16 billion for public health is a modest investment.

This is why our campaign will also be driving forward a programme of work around prevention activity within the NHS. The Government is right to point out that local authorities are not alone in providing prevention interventions. Around 40% of all accounted-for public health spending originates from the NHS, on Section 7A services like immunisations as well as other initiatives like the national diabetes prevention programme. The NHS itself, with its long reach into every community, is also a wider determinant of health.

But we believe that to deliver the ‘radical upgrade’ the NHS needs to make better use of its existing preventative spend and also explore further opportunities for targeted increases in investment. In order to achieve this, we first need to know what the health system actually spends on prevention. While most estimates of public health spend place it at between 4-5% of total government spending on health, according to PHE’s Chief Economist, ‘we do not actually know what the whole health and social care system currently spends on prevention’.

That’s why our campaign is calling on the Government to conduct a review into NHS spending on public health and prevention. We need to know where we are now before we’re able to move forward and ensure that the NHS and local authorities are truly providing the kind of joined-up care envisioned in Sustainability and Transformation Partnerships.

Finally, we believe we’ll have the best chance of securing increases in public health investment if we’re able to tell our story in a compelling way to policy-makers and the public. We’re proud of the work our members do every day in their communities to protect and improve the health of the public. We have a good record, as demonstrated by major successes in our screening, immunisation, and smoking cessation programmes.

And that’s why we’re supporting PHE’s work on their new public health dashboard. This dashboard will enable a lay audience to understand and see the incredible range of services that public health teams provide and allow us access to up-to-date evidence that we can use to support our calls for greater investment in services.

In my last blog I asked for your help in marshalling our arguments, developing our policy thinking, and spreading the word to your networks. I’d like to say a big thank you to members and partners across the public health community who have already been in touch to say they would like to be involved in the campaign.

The strategic case for investment in prevention and investing in better outcomes has lessons which can apply in all four nations of the UK and indeed anywhere in the world. We will build on our four nations work as this campaign takes shape.

If you’d like to contribute to our campaign and help shape our thinking then please contact policy@fph.org.uk.

By Wendy Nicholson, National Lead Nurse – Children, young people & Families & Deputy Head of World Health Organisation Collaborating Centre for Public Health Nursing and photo_wn_5Midwifery.

Clearly, nursing is a diverse and far-ranging profession. The traditional stereotype of nursing and nurses is changing and the drive to provide care closer to home and really get serious about prevention has quite rightly put public health nursing in the spotlight.

When I pulled on my crisp new student nurse uniform in the early 1980s I could never have imagined I would find myself working in public health, as the focus and direction of travel for most nurses was gaining experience in hospitals before venturing into the ‘community!’ Like my peers and other nursing colleagues, I recognised that many of those hospital admissions were avoidable and many of the A&E visits could have been prevented.

Shifting the balance to upstream prevention and public health was certainly not a new phenomenon. Probably the most well-known nurse, Florence Nightingale, was a pioneer for prevention and indeed the use of evidence to underpin practice.

So much of Florence Nightingale’s legacy reinstates today with public health nurses and we know that there are many public health challenges, particularly for children and young people. We know giving children the best start in life and building resilience across the life course can improve outcomes – and this is where my passion lies.

For myself, moving to public health and focusing on prevention was a huge shift, I had my PICU mapped out. The catalyst for change was a small child who sadly will never know the difference she made to my nursing career. She arrived in A&E after being hit by a car. Her injuries were severe and she died soon after arrival. Like so many unintentional injuries her death was preventable and this made me re-think my career choices.

Public health nursing and the prevention agenda is vast. I have been fortunate to lead the development of new projects such as Sure Start and Teenage Pregnancy Prevention. Both have been challenging, but working with communities to support behaviour change and cultural norms was indeed rewarding!

Today, I find myself working for Public Health England as the National Lead Nurse for Children, Young People and Families and a Deputy Head of World Health Organisation Collaborating Centre for Public Health Nursing and Midwifery, working within the Nursing, Midwifery and Early Years directorate. This is an incredible role, and provides an opportunity to advocate for public health nurses who make a huge difference to individuals, community and population health.

Being a WHO Collaborating Centre for Public Health Nursing and Midwifery is an amazing opportunity to contribute to the global Sustainable Development Goals and to influence globally – ensuring prevention is a clear focus with public health nursing driving improvements.

It is quite apt that today I am with 400 nurse leaders at the Chief Nursing Officer summit in Liverpool – this city which is steeped in the history of public health. On International Women’s Day, we should take the time to reflect on great leaders such as Florence Nightingale. She was so much more than ‘the lady with the lamp’ – clearly a visionary for public health, nurses and prevention.

Let us never consider ourselves finished nurses….we must be learning all of our lives.
Florence Nightingale

Read more about All Our Health here

By Sue Lloyd, Fellow and Board member of Faculty of Public Health

During the past year the Faculty of Public Health (FPH) has been celebrating the contribution of women to medicine and health alongside the Royal College of Physicians. As a woman working in this field it’s been a joy to hear the stories of women’s lives and their work to improve the lives of others, despite the challenges, or maybe because of the challenges, that they faced.

It’s not an accident that woman have been active throughout human history in improving the lot of us all; it’s part of our DNA. Women have always been active as carers whether in an official capacity or not, this being subject to the whims of the cultural orthodoxy of the time. We’re fortunate to have seen great contributions from the likes of Kitty Wilkinson, the Liverpool ‘Saint of the Slums’ who in the 1832 Cholera epidemic offered her boiler to slum families so that they could wash clothes (this killed the bacteria); Josephine Butler who campaigned to end child prostitution; and Anne Bieznak, who opened the first Catholic contraceptive clinic, after she had personal experience of eleven pregnancies by the age of 34 years. These are just a few examples, of many.

Public health historian Virginia Berridge of the London School Hygiene and Tropical Medicine, said: “Women have played a significant role in public health in the past – just think of the work of the Ladies Sanitary Associations in the nineteenth century which were one of the first ways in which women were visible in public life. We must use knowledge of that past history in planning for the future of public health.”

Today, we are joyfully celebrating International Women’s Day. FPH is proud that from its establishment in 1972 women and men have always been equally active partners.
Many of the institutional challenges that FPH’s founders overcame have been removed. Rosemary Rue (President 1986-1989) was expelled from her medical degree when she married and was later sacked from her first job when it was discovered that she had a husband and child. Rosemary pushed against the cultural norms of her time as a woman to improve housing, water supplies and immunisation in Oxfordshire, where she was Chief Medical Officer.

It’s fortunate that these barriers are now somewhat diminished, but as public health professionals we are always vigilant that these barriers don’t transform into something else, something with a different name. We see echos of this in the #MeToo campaign.

As we move forward into a new era where women and men are contributing equally to health and social care we want to celebrate what has gone before and to hope for a truly integrated future.

We look forward to seeing health in all policies and the radical prevention approach integrated into new ways of working.

Dr Catherine Calderwood, Chief Medical Officer, Scotland, celebrates this future with the following words: “Despite the social and cultural obstacles facing women, evidence from across the centuries clearly shows them at the forefront of delivering practical solutions to past public health issues. Although attitudes to women providing healthcare have changed, I am sure that we will continue to make the same positive contribution to drive forward improvements in public health in the future.”

By Jennifer Mindell, FPH Fellow and Chair of the Health Improvement Committee

Public Health England (PHE) and Department of Health and Social Care yesterday unveiled plans to limit excessive calorie consumption as part of the Government’s strategy to cut childhood and adult obesity. The plans target both consumers and industry, challenging the latter to reduce calories in products consumed by families by 20% by 2024. If the 20% target is met within five years more than 35,000 premature deaths could be avoided. Yesterday also saw the launch of the latest One You campaign, which will encourage adults to use the 400-600-600 calorie guidance for breakfast, lunch and dinner.

This is a very welcome step forward. We know that there are many drivers of obesity, including our environment, our genes, our behaviour and our surrounding culture. This very complexity means that if we are to tackle and prevent obesity, we must mobilise all sectors of society to take action and bring workable solutions to the table, and we are hopeful that PHE’s package of targeted reforms and initiatives will do just that.

We particularly welcome the Government’s focus on solutions that will impact families rather than just individuals. More than a quarter of children aged two to 15 in England are currently overweight or obese and younger children are becoming obese at earlier ages and staying obese for longer. This burden falls disproportionately on children and adults from low-income backgrounds. There are few effective interventions in place at the moment to help children identified as overweight or obese, making the prevention of obesity in children all the more urgent.

At the Faculty of Public Health (FPH) we believe that actions to protect children from obesity must be prioritised. This is why the FPH Health Improvement Committee has been developing policy to protect children from exposure to the advertising of foods high in fat, sugar, and salt (HFSS). We know that marketing greatly influences the food and drink children consume. The promotion of unhealthy food and drink is a significant risk for childhood obesity and the development of diet-related diseases. This is widely recognised by the World Health Organization (WHO) and many other countries. Industry spends 500 times as much on promoting HFSS products as the WHO spends on promoting healthy diets.

We recognise that regulations on HFSS food and drinks in the UK are among the toughest in the world. We are proud that the UK was the first country in the world to introduce scheduling restrictions on food advertisements, when in 2007, the Government banned HFSS product advertisements during or adjacent to ‘children’s TV’ programming or those that are likely to be ‘of particular appeal’ to children aged 16 and under.

However, we think that now is the time for additional progress to reflect modern family life. Children do not just watch children’s TV programmes and their viewing time actually peaks from 6-9pm, during what is called ‘family viewing time’. ‘Children’s TV’ programming generally is not broadcast during family viewing time, meaning that current regulations banning HFSS products make no impact then.

We started developing our thinking on this issue at the FPH conference in June of last year, where delegates discussed and debated how we could implement policy to limit children’s exposure to junk food marketing and encourage healthier behaviours. Around 15 different policy solutions were debated, covering a wide range of interventions. We’ve since refined our thinking; we believe that to protect children and support parents, the Government should take forward the following three interventions as priorities:

1. Strengthen existing broadcast regulations to restrict children’s exposure to junk food marketing by introducing a pre-9pm watershed on all HFSS food and drink advertising
2. Take action to ensure online restrictions apply to all content watched by children
3. Extend regulations to cover sponsorship of sports and family attractions and marketing communications in schools.

We believe that voluntary calorie reduction initiatives and behaviour change campaigns – like the ones launched by PHE and DHSC yesterday — will have the best chance of success if they are complemented by other regulatory measures like the ones we have proposed above.

We continue to be heartened by the progress that the Childhood Obesity Action Plan has made and are hopeful that PHE’s calorie and sugar reduction initiatives will prove to be world-leaders in tackling obesity and its health-related consequences. We believe that action against junk food marketing to children will support those aims and be critical to their success. We look forward to continuing to engage FPH’s membership and other partners in the development of this policy.

By Alexandra Swaka, WHO Collaborating Centre, Imperial College London

In support of Eating Disorders Awareness Week, an international event that raises awareness on the challenges and stigma associated with various types of eating disorders, I invited clinical nutritionists, Rhiannon Lambert and Sophie Bertrand, to deliver a seminar to resident GPs and fellow academics of the Imperial College Faculty of Medicine to enhance current knowledge on eating disorders in the context of public health.

As the GP is most often the first point of call for the patient, with very little time to address the holistic needs of patients, Rhiannon and Sophie established some of the complex nutritional and psychological factors that are involved in catalysing both the onset and the continuance of disordered eating. The conditions, which include anorexia (the extreme limitation of calorie intake), bulimia (compensating binge eating through subsequent purging), emotional overeating, and orthorexia (a clinical obsession with eating only ‘pure’ food) are fuelled by severely unhealthy relationships with food and are usually exacerbated with prolonged suffering. With social media having more impact on everyone’s daily lives, sufferers of eating disorders are a particularly vulnerable group, facing greater susceptibility to impossible and unrealistic body ‘standards’ which they are bombarded with through mediums such as Instagram. In a study which Sophie was involved in conducting, she found that 21% of young people are referring to social media influencers for nutrition advice, and 44% of young people believe that eliminating an entire food group equals ‘health’. This may include complete elimination of fats, carbohydrates, or animal products. The two pointed out the dangers of turning to social media images for dietary advice.

It is now more than ever crucial for GPs to listen for clues that their patients might be internally suffering from an eating disorder, as body mass index may not always be an indicative factor of the psychological trauma associated with such conditions. While consultation time is limited, it is important to open up the conversation and have a list of resources, helplines, and referrals of nutritionists or charity organisations specialised in the field as an effective option to offer patients while (and if) they are on a waiting list for further clinical help. Like any illness, early intervention is key for successful long-term outcomes, and they recommend that patients are referred to qualified clinical nutritionists with professional experience in working with this vulnerable and impressionable population.

Rhiannon’s book, Re-nourish: A Simple Way to Eat Well, offers readers expert guidance to “eat like a Nutritionist” as well as evidence-based understanding of how nutrition affects the body, and sounds like a great starting point for everyone interesting in learning more about how to love food and feel great.

Links of interest: