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Archive for July, 2013

By:

  • Kate Harvey, Public Health Specialty Registrar, University College London
  • Conall Watson, Specialty Registrar in Public Health & MRC PhD Researcher, LSHTM
  • Nigel Field, NIHR Academic Clinical Lecturer in Public Health & Infectious Disease Epidemiology, UCL

An unknown pathogen was ravaging Scotland’s capital in April 2013, turning unlucky infected souls into bloodthirsty, ambling beasts. The city was under military lock-down and scientists were working around the clock to identify the pathogen and develop means of control. Each night, 250 uninfected citizens reached the safe zone at a former veterinary college, taking democratic responsibility for the public health and military response.

Biohazard: man in biohazard suuit

So read the script for Deadinburgh; an immersive theatre event that brought scientists and actors together and gave the public a window into scientific and public health decision-making during an emergency response. This high degree of citizen power and insight into the often unseen world of outbreak management is hard to achieve in real emergency situations. The paradox of success in averting outbreaks is that the world never hears about the ones that didn’t happen and effectively communicated ‘sound bite’ messages do not illustrate the complexity of evidence and decision-making. Behind public health guidelines and advice lies scientific evidence and ethical awareness of the ways that decisions affect peoples’ lives and health.

If knowledge and understanding can affect risk perception and health behaviour, there may be something to be gained from raising awareness of how and why public health decisions are made. The process gave us, as public health professionals, valuable insights into the motivations and priorities of the populations we serve and the challenges that arise when decision makers are presented with conflicting scientific opinion. It was surprisingly difficult to get the audience to agree with us about the best course of action.

The critical reception and audience feedback from Deadinburgh showed that people are interested in public health and, given the chance to see it up close, seemed to engage with us, whether discussing the zombies’ predilection for brains or the transmission dynamics of a plague of undead.

We tried to simulate situations that were emotional, full of uncertainty and characterised by conflicting or incomplete information – and we got some great questions from audience members appreciative of the challenges of evidence-based decision-making. The show was amongst the most entertaining few days any of us have spent working in public health; the audience and critics seemed to love it too.

Whether immersive theatre and simulated situations can get people to engage with public health on a larger scale and help build trust and empathy with the way that science is used to inform public sector decision-making remains to be seen. What we do know is that people like science; people like zombies; and the two combined can help us to reflect on our own practice as public health professionals.

Deadinburgh was an Enlightnment Café by LAStheatre in association with the Gate Worldwide and made possible by funding from Arts and Business Scotland. Additional supporters included BBSRC, the Royal Society of Edinburgh and Entourage Live. Scientific collaborators included Centre for Eating Disorders Scotland, Heriot Watt University, London School of Hygiene and Tropical Medicine, Manchester Metropolitan University, Roslin Institute, University of Edinburgh, and University College London and covered: cell biology and virology; computer modelling and epidemiology; eating disorders; public health; neuroscience; stem cells and 3D printing.

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By Alan Maryon-Davis, honorary professor of public health at Kings College London and past president of the Faculty of Public Health

WE love our NHS, despite its failings. We trust it, we depend on it and we cherish its fundamental principles of fairness and universality – free to all at the point of use.

Born out of Beveridge, midwifed by Bevan, the safe arrival of the infant NHS in the aftermath of war was nothing less than a revolution – the sort of massive change that could never happen today. It was huge – so big it dwarfed outer space.

Now, as we all know, the NHS is under threat – weighed down by the ageing population and high-tech hypertrophy, harried by small-state politicians, encircled by drooling marketeers  and asset-strippers.

The NHS is accused of being too monolithic, lumbering and unsustainable. The Government’s response has been to claw back millions of pounds and fire an explosive harpoon into its belly. The 2012 Act has torn into the flesh of the NHS, damaged many of its vital organs and put it on the critical list.

But it’s not dead yet. They have underestimated the power of the people. The NHS is healthcare of the people, by the people, for the people, all for one and one for all. This is why so many of us feel so passionate about it – and why we delighted in seeing it celebrated in the Olympics opening ceremony.

I believe the NHS at 65 is still, fundamentally, in good shape – in spite of all the ‘efficiency savings’, all the sniping and Cassandras, all the barbs, rug-pulling and clattering of bedpans in the corridors of Whitehall. The NHS can be nursed back to full health and vigour. Of course this requires political will – but political will is driven by the power of the people. And people power can be shaped and energised by the advocacy of those of us who feel strongly about defending the NHS and its fundamental principles.

We must seize this 65th birthday celebration to let everyone know that we will fight to make sure the NHS – the real NHS, not just the logo – is here to stay.

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I was born before the NHS.  My Dad was a window cleaner and Mum a shop worker.  He saved the equivalent of three week’s wages to have a ‘midwife’ come and help his young wife through 12 hours of labour.  No gas, no air and no prospect of going to hospital.  Her first born had died, she nearly bled to death.  A woman at risk but determined to start a family.

When the 1948 NHS Act came along it lifted, from the shoulders of working people, the anxiety of sickness, injury and accident.  It was an heroic piece of politics, built on belief and vision.

Today, that young wife is a frail widow being cared for, in her own home, by a hospital in-reach team.  Her husband died years ago but his life was extended by an aortic valve replacement.  It was innovative, new and must have cost thousands.

I started life without the NHS and I expect to end without it.  Today’s politicians are driven by balance sheets, not beliefs.  There are no visions or convictions, just focus-groups and practicalities.  The eagerness to get the NHS off the nation’s books will become more urgent.  The damage to the economy has hobbled the NHS and the grim economic prospects with cripple it.  The NHS is running up the down escalator of time, costs, and demand.

Can we learn or legislate to make fat people thin?  Can we find a way to help old people remember who they are?  Can we turn the feral into families?  Probably yes; but we don’t have the time or the money or the know-how.

Yes, the NHS has to be efficient and safe and clean but it has to be central to a political desire to promote, encourage and endorse social medicine and its values.  I judge it is not.  If we want an NHS we have to pay for it.  No politicians have the courage to ask for the money.

We can fiddle with technology, fidget with data and lean care-pathways but the truth is; the NHS is about smart people with a strong sense of vocation.  There is no shortage of them but the places that can employ them will become scarce.

In ten years we will be well on our way to 20 giant hospitals, vertically integrated with privately run health and care shops in the high street.  Basic services will be available, top-ups common and a major source of NHS income.

Nurses will provide their own uniforms, patients will buy their pills on-line and in-patients pay for their meals.  As maternity is a condition and not an illness, mums will pay for their deliveries – just like it was when I was born.

My message comes from the past, delivered in the present but meant for the future.  ‘We tried, we did our best but they wouldn’t listen.  Not enough of us saw it coming and too few saw it going.  I’m sorry’.

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