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As part of FPH’s Public Health Funding campaign, we are undertaking a project examining the role that NHS organisations play in prevention.

We have received an award from the Health Foundation to carry forward a varied work programme over the course of 9 months, involving our members from across the UK and other key partner organisations. The project aims to:

  • Build a better understanding of how the NHS currently delivers prevention
  • Understand what ‘good’ prevention in the NHS looks like
  • Explore the barriers and enablers for NHS organisations seeking to take a more preventive approach
  • Determine initial priorities for increased investment or focus – including interventions, approaches, and workforce needs

As part of our work so far, we have commissioned an evidence review exploring prevention in the NHS, which looks at 3 main topics:

  1. What are the main types of prevention work researched in various NHS settings?
  2. What are the benefits of prevention programmes in the NHS?
  3. What helps and hinders prevention in the NHS?

The review is a unique and fantastic overview of prevention approaches in different NHS settings. It looks at impact, what works and what doesn’t, and what might improve current approaches if done well. The review highlights the importance of a systems approach, and engaging with both staff and the public. For a summary of some of the main takeaways please have a read of this blog or have a read of the review itself.

We also held a stakeholder workshop in October gathering expert opinions on prevention in the NHS, which we used to inform part of FPH’s submission to the NHS long term plan consultation. Attendees at the workshop included representatives from NHS England, Public Health England, Cancer Research UK, and the Royal College of Physicians.

A key takeaway from the day was that this is a complex topic, but colleagues across the health field are committed to supporting the NHS to do more, better, and system-wide prevention. We will soon be publishing our first in a series of discussion papers, summarising our learning so far and discussing some of the tensions we still need to reconcile. We’ll also be posing some key questions around the evidence base and priority areas for action that we will need our members to help us answer. We then plan on hosting two more workshops in the Spring to continue building our evidence-base and drawing together expert advice and consensus.

This is a really exciting piece of work and has been expertly supported by the wider FPH team and our Public Health Funding Advisory Board, who graciously give up their time to contribute. Please stay tuned to the FPH blog and follow FPH on Twitter to hear more about the progress of the campaign. If you wish to comment, contribute, or donate to the campaign please contact policy@fph.org.uk or visit the public health funding page of the FPH website by clicking here.

Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group

We’re calling for the UK Government to invest in a Prevention Transformation Fund to support the upgrading of prevention and early intervention activity in local authorities in England in next year’s Comprehensive Spending Review. (This is the Treasury-led process to allocate resources across all government departments.)

The recognition that local authorities have a much greater influence on the wider determinants of health was the reason for the transfer of public health from the NHS to local authorities in 2013, and we were pleased to see local authorities again acknowledged as “leaders in local health improvement” in the Department of Health & Social Care’s (DHSC)’s recently published vision for prevention.

The vision recognises that the enormous potential of councils to improve the health and wellbeing of their residents rests largely on their ability to “tailor public health services to local need, to support economic growth, and to influence the wider determinants of health through policies on housing, leisure and other services”.

However, in recent years, local authorities’ ability to do just this has been severely curtailed by extensive cuts to the public health grant and wider council budgets. Most authorities have just about coped with budget cuts while maintaining a high level of standards, but our members working in local public health teams have told us they have reached the absolute limit of the savings they can make without adversely impacting the wellbeing of their residents.

Local authorities have enormous potential to improve the health and wellbeing of their residents, but to achieve it, they need both the funding and the freedom to do exactly what is asked of them: tailoring services, developing new and innovative ways of working and of engaging with their communities in order to best meet local needs.

We believe a dedicated Prevention Transformation Fund, separate from and in addition to the ring-fenced grant, would give local authorities back the ability and freedom to do just this. Our recently published discussion paper, developed following extensive consultation with our members and other stakeholders, outlines why we believe a Prevention Transformation Fund is the right approach, as well as initial ideas about how large the fund should be, what it should pay for and where the money for it could come from.

The ultimate aim of this work is to change national policy to benefit the health of the public and, in doing so, we want it to reflect your voices. We’re very keen to continue to get feedback on the paper from our members and other stakeholders, including answers to the following questions:

  1. What should the high-level objectives of the fund be?
  2. What conditions should be attached to the fund?
  3. What should we expect to get from this investment and in what timeframe?
  4. What are the accountability arrangements?
  5. What would the likely consequences be if we didn’t invest in prevention transformation?

We will be publishing a revised version of the discussion paper next month, including answers to the questions posed above, so please do have a read and send your comments to policy@fph.org.uk.

This is your campaign and your chance to influence national policy, so please get involved and help us make local government public health the national priority it deserves to be.

Written by Andrew Turner, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group.

John Middleton 2 webIt’s the season of goodwill and I wanted to write a special extended version of my regular monthly column as a Christmas gift to you all. This month is packed with significant celebrations. Today (10 December) is the final Day of the Hanukkah Celebrations and it is also the 70th Anniversary of the Universal Declaration of Human Rights.

For all of us December is a time to reflect and enjoy precious moments with our family and friends. May we each, according to our beliefs, enjoy, mark, reflect, share and give in our December festivals. I wish you all a very Happy Christmas, Hanukkah, Bodhi day, Pancha Ganapati, Omisoka, Kwanzaa, Yalda, Zaratosht No Diso, Yule, Winter Solstice, and more.

Please do come back restored, refreshed and revitalised for the uncertain times we face. There has never been a more necessary time to protect and improve the health of the public and there has never been a more important time for the work of our public health community. Happy New Year!

Prevention is better than cure

On 5 November, Matt Hancock, Secretary of State for Health and Social Care, published his Prevention Vision. I welcomed this vision which paves the way for a Prevention Green Paper. You can read my full statement here. 

It is the first time that anyone has seriously talked about cross-governmental health in all policies since the 1999 ‘Our Healthier Nation’ white paper. We will be working closely with the Government on the publication of the Green Paper with the aim of making the case for prevention to help tackle inequalities, a commitment to health in all policies and to protect the well-being of future generations.

The right to health is a growing and significant idea which needs to feature in all our lobbies for health in every nation. Scotland is leading the way on rights to health, and the FPH in Scotland conference in November was a triumph showcasing clear thinking on the place of rights, law, and values in our work to improve the public’s health. I congratulate the FPH in Scotland convenor, Julie Cavanagh, the FPH in Scotland Committee, our colleagues at the NHS in Scotland and everyone involved in putting the event together. You can read more about the conference below and anyone interested in viewing my presentation can click here.  

Invest in public health and prevention

There is a swelling tide of bold public statements about the need to invest in prevention and public health. Amongst them, The Academy of Medical Royal Colleges in its response to the NHS 10 year plan, the President of the Royal College of Physicians of London, and the Association of Directors of Public Health. The Health Foundation argues the Government should invest £1.3 billion in 2019-20, reversing cuts since 2015 and investing according to need, with the most deprived areas benefiting early, but they also call for £1.9 billion in new investment by 2024.

The Kings Fund has added to this sea-change of thinking, in their call for investment in prevention and addressing the wider determinants of health. The King’s Fund name checks our emerging policy call for a ‘Prevention Transformation Fund’ to inject new funding into local government prevention services of between £1-2 billion per annum. We will be arguing strongly for this in the comprehensive spending review lobby and in our contributions to the public health green paper. On such a full sea are we now afloat. And we must take the current when it serves, or lose our ventures.

Poverty, destitution and health inequalities

The UN rapporteur Philip Alston’s hard-hitting report on poverty was published earlier this month. Despite receiving some negative critiques, we should all be deeply shocked – he was holding up a mirror for us and we should not blame the mirror for what we see. The inequalities in health I have fought against most of my professional career have taken a new low, a new level of injustice. For example, Universal Credit was meant to simplify the benefits system but in some cases has seen people wait for up to six weeks to receive their payments, meaning they’ve had to rely on foodbanks to eat. The Joseph Rowntree Foundation Report on destitution earlier this year showed us how national and local government are now the biggest creditors on the poor – not loan sharks and the gambling industry.

Fracking, sustainable development, climate breakdown and FPH disinvestment 

Our Sustainable Development Special Interest Group responded to two government consultations on fracking last month which you can read here and here. Our view on fossil fuels is ‘leave it in the ground.’ 

Professor Patrick Saunders and I visited the fracking pad at Little Plumpton in Lancashire to talk to locals and witness first-hand the disruption, stress and uncertainty they are experiencing. If you believe we don’t need shale gas because we have to prevent climate breakdown, it also follows that no community should be subjected to this. And as Greenpeace’s UK director said earlier in the month:

“After all the many millions invested, the changes in the law, the removal of local democracy and property rights and weeks of earth tremors, the industry has produced a deep hole in a muddy field with a small amount of very expensive gas at the bottom. Over the same period, onshore wind became the cheapest source of power in the UK.”

Also on the climate breakdown front, I bought a new electric car this month. And no I don’t see them as an answer to our air pollution problems. In my paper to the RCP History of medicine conference I described the Spice Wars of the 1600s, involving private armies and private corporations from the superpowers, England and Holland, plundering local wealth, destroying local culture, enslaving local people, mutilating and torturing as they went, in order to supply the treasures and everyday comforts of the wealthy back home, who were oblivious to what lives were destroyed to get them what they wanted. The modern day parallel with cocaine wars is obvious, but the parallel with more commonplace consumer trade today is only just coming into focus. Conflict minerals required for all our latest devices, and now with the growth of electric cars, it seems we will create newer bigger and better conflicts in the grab for lithium and cobalt.

News in brief

  • Along with Presidents of the other medical royal colleges, I signed a letter to NHS England’s Chief Exec Simon Stevens calling for tobacco control measures to be part of the NHS’s Long-Term Plan
  • I presented at the East of England’s Public Health Conference this month – you can take a look at my presentation here
  • Chris Packham, our Chair of the Health Services Committee has published a thoughtful piece on population health on the RCP London website – it is very much in keeping with our aspirations for greater involvement and commitment to public health skills and thinking in acute healthcare
  • Look out for BMJ opinion pieces on ‘The Nanny State’ and NHS charging migrants for healthcare

FPH in Scotland Conference, Nanny State report, Universal Declaration of Human Rights, migrant health

Scotland is leading the way on rights to health and their conference in November was a triumph of clear thinking on the place of rights, law and values in our work to improve the public’s health. I congratulate FPH in Scotland’s convenor Julie Cavanagh, the rest of the Committee of the FPH in Scotland, and everyone involved in putting the event together.

The conference also saw the launch of our Nanny State report by John Coggon, Professor of Law at Bristol University. The public health community needs to grow its understanding of law and how to use it and apply it across the full range of our work. High level intervention, through regulation and taxation are far more effective than exalting individuals to change and victim blaming. Our ‘Do No Harm’ campaign briefing shows how we should be pushing these legal protections in future trade deals.

At the Scottish conference many of the speakers, including myself, highlighted the significance of the Universal Declaration of Human Rights. This month also marks the 80th Anniversary of the arrival of the first Jewish refugee children to escape Nazi oppression on the Kindertransport. It is timely to reflect on our country’s honourable pedigree as a haven for people displaced by war and intolerance and to reassert our respect for human life and rights. With other Royal Colleges we will be calling on the Department of Health and Social Care to review the provisions for migrant charging, which we see as hostile, unhelpful and uneconomic. We have already published our own statement. Thank you to Robert Verrechia, Liam Crosby and Farhang Tahzib for their work on this.

Song of the month

Not particularly festive, but certainly party-time, good time blues. At the East of England conference I asked what was the best music to come out of the East of England? No-one said Benjamin Britten, someone said Pink Floyd, and someone was too shy to say ‘Ed Sheeran’. I played ‘The Shoals of Herring’, Ewan MacColl’s great song inspired by the Yarmouth herring fishers. But the answer to the question was ‘Doctor Feelgood’, the Canvey Island delta bluesmen. This is our version of one of their songs, ‘Down at the doctors’. 

Written by FPH President Professor John Middleton. You can follow John on Twitter @doctorblooz.

Yemen image 1One Saturday afternoon 2 years ago, not long after I had joined the Public Health training scheme, a WhatsApp message came through from one of my childhood friends. The remarkable thing about this was that my childhood friends are all from Yemen, and therefore all in the middle of ‘the War’, and so did not often have WiFi. The message meant that someone had managed to get hold of some increasingly unaffordable diesel, to power up a WiFi mast.

I rang her; she said there was no point video-calling as they had no electricity and all 8 of them were huddled around one solar-powered desk lamp in the basement, which also charged their phone. I felt a little unsure of what to say, so I switched my video on and walked them around my roomy house and we laughed at how many electrical appliances I had and how useless I would be should I also find myself in the middle of ‘the War’. I think they were just relieved to hear someone else’s voice, to have a sense that there was a part of the world where things were calm enough for things like toasters to exist, but after I had rung off my mind was buzzing and I felt a strange ache. What could I do? I felt far away and helpless.

Yemen image 2But it made me think that is these very things that compelled me to pursue public health in the first place. I want to use whatever drop of energy I have in things that challenge my mind, but also give me heart ache; that bizarre human feeling of being both strong and weak all at once.

I felt it again today, while I sat on a train going to work reading a new report by Martha Mundy for the World Peace Federation; “Strategies of the Coalition in the Yemen War”. It is a fine piece of public health work. It collates and displays a range of data and information to generate patterns, from which to draw evidence-based conclusions, which are to motivate change that would save many many lives.

In general the war in Yemen, despite being in its fourth year, gets little press. However, as the civilian death toll in Yemen rises, there has been increasing international scrutiny of the Coalition, which consists of Saudi, backed by its allies the UK, France and the US. Are so many non-military hits justifiable?

It seems not.

This new report profiles large amounts of data on Coalition attacks in Yemen between March 2015 to March 2018. It describes the geography and changes in tactics of attacks over time, along with mapping out the proportion of attacks on civilians in the different governorate regions, shown in Figure 1 below.

Yemen image 3

Proportion of civilian, military and unknown targets in governorates of Yemen. YDP data March 2015 – March 2018.

“From August 2015 there appears a shift from military and governmental to civilian and economic targets, including water and transport infrastructure, food production and distribution, roads and transport, schools, cultural monuments, clinics and hospitals, houses, fields and flocks.”

In particular, the report maps the targeting of agricultural land and fisheries, and explains the consequences for a country on the brink of famine, that relies on small scale farming and fishing for survival.

The report describes some of the recent attacks with high civilian death counts, such as a school bus target from August this year, and then states:

These atrocities receive attention from the UN Humanitarian Affairs Coordinator and the international press, but shielded by allies, the Coalition remains exempt from any independent investigation to determine legal responsibility and from significant international mobilization to stop the war in Yemen.

Yemen 4.jpg

Figure 2. All Agricultural targets

The conclusion that the report comes to is a clear one, as colluding in war crimes is not an allegation to make lightly:

If the Coalition war in Yemen is not to mark the erasure of legal referent in war, other forces and institutions will need to call into question the blanket ‘legitimacy’ accorded the Coalition to date by the world’s highest legal body, the UN Security Council. If UN Security Council resolution 2417 (24 May 2018), condemning starvation of civilians in wartime, is to be meaningful, then it is necessary for the UNSC and its member states to halt such crimes in Yemen, to investigate them, and to call to account those responsible for perpetrating them.

I wish I could tell my friends, that people who are out there, with toasters, feel that humanitarian laws should apply to Yemen.

You don’t need to be an expert on Yemen, just have a mind, and a heart. It’s in these challenging times that we are invited to exercise what is important.

If you are interested in knowing or doing more, please get in touch with the Yemen Special Interest Group via this link. Depending on what you are like, you can also write to your MP, share the report, or even write a song.

Written by Rachel Handley, member of FPH’s Yemen Special Interest Group

Duncan SelbieThe Secretary of State for Health and Social Care, Matt Hancock, has launched his prevention vision; confirming it as one of his key priorities alongside technology and workforce. PHE’s Chief Executive Duncan Selbie discusses why this is a transformative moment for public health.

Investing in public health is the smartest thing we can do – good health underpins a strong economy.

For years we have known that prevention is better than cure and that we should be moving away from a system that prioritises treatment, to one that can also predict and prevent poor health.

Up until now efforts to invest in prevention within our healthcare, workplaces and communities have fallen short. The NHS Five Year Forward View had genuine ambition to reverse this, but it failed to deliver with short term priorities taking precedence.

The Secretary of State, through publishing his prevention vision has shown he is determined to move more resources into prevention. And he has signalled the NHS Long Term Plan as one way to fund this.

We welcome this, as a promise of prioritising prevention is meaningless without investment.

Good health is of course about more than only healthcare. Wider determinants, including income, remain the most important thing.

But we all have a part to play and there are actions the NHS can take, as part of its Long Term Plan, which will help everyone to live for longer in better health.

Using bedside moments to promote wellbeing and avoid future illness is one step the NHS could take. For example, a smoker who comes into hospital for any reason should be helped to quit smoking. And then when they are ready to leave hospital, this support should continue in the community and at home.

The opportunity that we have now as a public health family is to embrace the energy and commitment of the Secretary of State, and to see more investment going into improving the public’s health.

A promise of radical action with no commitment, where nothing gets done is not an option. Realistic and tangible movement where we can actually achieve something is what we want to see.

This shift in focus is an exciting milestone and should signal a synchronised effort to place prevention at the heart of national and local government, and the NHS.

Written by Duncan Selbie, CEO, Public Health England (PHE). You can follow PHE on Twitter @PHE_UK.


If you’re an FPH member and want to play a bigger role in our Public Health Funding Campaign, please consider joining our membership ‘sounding board’. To find out more, email us via policy@fph.org.uk.

Darkness.

A sinister droning, plaintive chords and the distant tramp of marching feet.

Blood red letters emerge from the void, forming words, and then fading back into the night.

WAR ALWAYS TAKES A HEAVY TOLL…
EVEN AFTER THE FIGHTING ENDS, CONFLICTS CONTINUE TO KILL.

This is the riveting opening scene of “War & the National Immune System”, a short animated film written and produced by the Global Violence Prevention SIG in collaboration with Médecins Sans Frontières/Doctors Without Borders. You can watch it here. The film’s online release this week is the culmination of a long process to which many different people have made extremely valuable contributions. Therefore in the fine tradition of the Oscars acceptance speech, let me tell you the story of how this project came about.

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As a special interest group (SIG), we have found it quite helpful to have an overarching theme or a primary project for each year (would you like to know about next year’s theme?). I like to think that this helps to guide and focus our activities. Sometime in mid-2017, we decided that our theme for 2018 would be the association between armed conflict and infectious disease, using the dual centenary of World War One’s conclusion and the Spanish Flu pandemic as a “hook”. It was an obvious opportunity to take an anniversary that we knew would be getting a lot of media attention (as it should), and to present it with a slight twist – a different perspective which would hopefully be memorable enough to help us draw attention to the wider public health impacts of armed conflict.

I had been mainly thinking in terms of some journal articles and a bit of public speaking, but when I mentioned our proposed annual theme to John Middleton he responded “Why don’t you make a film about it?”. It wasn’t an idea that I had ever considered, perhaps because of my total ignorance of film making. But what is a public health training programme for, if not for expanding your experience of different methods of communicating with the public?

Members of the SIG formed a working group and started putting together a script. The many benefits of collaboration quickly became apparent. We had a vision and the evidence base to create the film’s narrative, but no experience of script-writing to guide us. Fortunately we had colleagues from the Film SIG to advise and steer us towards the sort of concise story-telling that was required. We had vague ideas about what producing such a film might cost, but no contacts to give us actual quotes.

Luckily the Film SIG was again able to help, putting us in touch with independent film makers who gave us some estimates. We had the potential to raise some funds, but probably not enough to cover the scope of our ambitions. Fortuitously my contacts at Médecins Sans Frontières (MSF) were interested in our ideas, so much so that they were happy to collaborate with us and to bear half of the total cost. They also brought fresh eyes to our script, new perspectives and some invaluable experience in using film as a tool of public communication.

A huge amount of work by many people went into the writing process. How to adequately describe the calamity of the Spanish Flu pandemic, coming at the end of the worst war the world had ever seen, in less than 30 seconds? How best to balance the messaging priorities of MSF with those of the FPH? It took months. Having decided that animation was the best medium to communicate all of the information that we wanted to get across, we pitched the finished script to a range of studios, and chose one called Beakus on the basis of the storyboards they created in response to our brief.

While the animators got to work, sending us progressively more and more detailed storyboards and tantalizing clips of what the finished film might look like, we turned our attention to where on earth we would find our half of the money. By a happy coincidence, a generous financial bequest had recently been given to the Faculty for the explicit purpose of supporting public health film collaborations, and we were able to get approval to use some of it for this project.

In a brilliant sequel to this good news, the excellent MSF team managed to secure the services of Academy Award winning British actor Jim Broadbent, who kindly donated his time and his mellifluous tones to the voiceover. We could never have achieved these things alone.

The finished product, of which we are all incredibly proud, is now being spread (can I say “virally”?) from various online platforms, as well as the Faculty website. For example, it is currently being hosted on the Telegraph Global Health Security page along with an excellent article jointly written by SIG co-chair Dr Sylvia Garry, and also on the Socially Minded Documentaries channel on Vimeo. We will be promoting this novel perspective on the centenary, and its implications for conflict prevention in the present, as we approach Remembrance Day.

Anyone interested in using film to better communicate public health ideas should definitely consider joining the Film SIG. Anyone interested in exploring (through a variety of mediums) the public health impacts of conflict and war should unquestionably think about joining the Global Violence Prevention SIG. If you have a passion, find a SIG. If there isn’t one yet, then start one – this is a member-driven organisation. And if you’re part of a SIG contemplating an ambitious project, consider who you might be able to partner with. Collaboration is an enriching and empowering experience.

Anyway, I can hear the orchestra starting to play me off. Let me just quickly thank the Academy, my agent, all of my hypothetical future children, my make-up artist, my lifestyle consultant… [music]

Written by Dan Flecknoe, FPH member and Chair of FPH’s Global Violence Prevention SIG.

This week, at the Faculty of Public Health in Scotland’s Annual Conference, there will be welcome debates and discussion on the related topics of the right to health and on ethics in, of, and for the public’s health. A crucial component of this will be a session on the nanny state debate, a matter on which the Faculty of Public Health (FPH) is about to publish a report.

Public health activities are sometimes characterised as standing in conflict with individual rights. The reasons for this are straightforward: we often find tensions between what might serve an individual’s interests and what might promote the public or general good. In this sense, rights are of fundamental importance: it is rights that protect a person’s dignity; that allow our lives to be our own. In philosophical jargon, our rights place side-constraints on what the government might do.

Regardless of how much general good might follow from interferences with our rights, they protect us from torture and ill treatment, and from arbitrary and unjustified interferences with our liberty. Rights underpin a system of justice that accords with the rule of law. Rights protect our privacy and our personal and family lives. They safeguard our freedoms to associate with others, to practise a religion (or not), and to express our views freely. Rights protect minority interests against ‘the tyranny of the majority’. A society that doesn’t recognise and protect rights places us within, or at risk of falling into, political angst.

However, rights are not just about protections of ‘negative freedoms’; guards against wrongful government interference. To be realised, the empowering ethos of rights requires that government take measures that help promote a healthy society. This includes things like ensuring the right to a sound education, good housing, and of course conditions in which we can enjoy good health. Rights also require that government’s guard against and keep a check on other powerful actors—for example large corporations—whose influence may be enormous, and who present considerable threats if left with unchecked power.

As such, rights—including the right to health—are essential to good and ethical public health. Yet there are real difficulties, at times, in communicating this. One of the barriers to meaningful understanding within public debates on health policy is the nanny state, which is frequently presented as a ‘knock down’ argument. Where a proposed public health intervention is ridiculed for being ‘nanny statist’, the implication is that it necessarily and illegitimately interferes with our rights: that it is meddling rather than empowering. The impact of nanny state rhetoric is enormous. And, unsurprisingly, nanny state accusations are often simplistic. Indeed, they are often arbitrary or incoherent.

We must recognise that, at its best, the nanny state refers to valid concerns. None of us wants to live in a ‘health theocracy’. Just as too much emphasis can be given to simplistic accounts of individual autonomy, so too can the value of health be overstated. We want the right balance between autonomy and health, and require to think about other things that matter too. A good society recognises and promotes a range of important values, including health, happiness, liberty, autonomy, connectedness, and community. Our enjoyment of these is related directly to good government. Often a nanny state accusation is not even formally a claim about the rights of individuals. It may be a smokescreen to cover hidden interests, or just an easily used political slur that tarnishes a policy that in reality cannot—on any count—be said to be ‘nannying’.

I authored the report at FPH’s invitation, as a member of the special interest group on ethics, in consultation with experts in public health ethics, training, practice, and leadership. It provides examples and scrutinises how nanny state claims work in practice. It aims to explain the principled positions that support nanny state accusations, and expose the ways in which claims of nanny statism may be used without principled coherence. The report also provides practical guidance on means of responding to nanny state claims within public and political debates. It is hoped that we can advance health—and other important social agendas—without reducing ourselves to unhelpful slurs and slogans that perpetuate harms and injustices. Our focus should rather be on achieving a more fair and equitable society.

Written by John Coggon Honorary Member of the Faculty of Public Health, and Professor of Law, Centre for Health, Law, and Society, University of Bristol Law School. John launched a report entitled ‘The Nanny State Debate: A Place Where Words Don’t Do Justice’, which was launched at FPH in Scotland’s Annual Conference in Peebles on 2 November 2018.