Archive for October, 2016


By Dr Amrita Jesurasa

Ever since our most ancient ancestors left Africa to populate the rest of the world the appearance of their descendants has changed.

Height, facial features, hair type, body size and shape, and invisible genes that can protect from or predispose to disease have developed and differentiated racial groups. But the most profound (and superficial) change has to be in the colour of our skin as people migrated and settled around the world.

Skin colour forms a strong part of our physical and social identity, at times unifying people but more distressingly, causing division. The legacy of this evolutionary change has left its scars on human history in the last few hundred years and continues to cause tension in the present. Ethnic inequalities in health are well recognised and yet we perhaps fail to recognise the true message from history: why did skin colour change?

Current theory suggests that this phenomenon arose as a result of our need for vitamin D. As our early ancestors migrated to northern latitudes, they experienced the severe consequences of vitamin D deficiency. These included bone deformities that affected their ability to walk, breathe and – crucially – to give birth (the latter the result of changes to the female pelvis).

In Europe, natural selection began to favour lighter skin that allowed ultraviolet radiation to be more readily absorbed, vitamin D to be synthesised and ultimately our species to survive in Europe and other northern climes.

Fast-forward to the 21st century and rapid technological advances have transformed the way we live. Some of these developments, including air travel, have facilitated evolutionary shortcuts, enabling the humans of today to live in environments that are totally different to that of even the previous generation. But other advances have affected the behaviour of us all by encouraging a more indoor lifestyle than that of our ancestors, creating fear of the adverse effects of the sun and altering our dietary habits.

This perfect storm has allowed vitamin D deficiency to become a population-wide issue, but one which has the greatest impact on those with darker skin. The irony is that this disproportionate effect within the population marginalises the issue of vitamin D deficiency, creating an ethnicity-related health inequality.

To raise the profile of vitamin D deficiency, universal issues need to be addressed and universal solutions provided. While improving access to vitamin D supplements must be part of this strategy, there are worrying common pitfalls associated with an exclusively medical approach.

Instead, a simple message may resonate more with both the public and policy-makers. This could mean promoting a basic principle that “like plants, we need food, water and sunshine to thrive”. With a more holistic approach we can relate prevention of vitamin D deficiency to other important and well-recognised public health concerns, thereby raising the priority of this historically important issue.

  • Dr Jesurasa is a Specialty Registrar in Public Health Medicine/ Honorary Clinical Lecturer in Public Health, University of Sheffield

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By Philip Daniels, Health Education England Global Health Fellow

Over the next year I will be working within the Public Health England Global Health Team. Based in London and Freetown, I’ll be supporting the development of the Sierra Leone National Public Health Agency, working with colleagues from Sierra Leone, USA and China.

Being awarded a Health Education England Global Health Fellowship is an enormous privilege. It gives me the chance to work with colleagues from a diverse range of backgrounds, disciplines and nationalities. I’ll be blogging regularly to help me record what I see and learn.

It is an incredibly exciting time to be involved in Global Public Health. Issues such as pandemic disease, outbreaks such as Ebola and Zika, as well as the growing threat of antimicrobial resistance (AMR) and climate change are increasingly informing the UK’s approach to Public Health.

The UK is a signatory of both the International Health Regulations (2005) and the Sustainable Development Goals (2015) – the latter of which include an explicit commitment to ensure healthy lives and promote wellbeing for all at all ages.

The UK Aid strategy (2015) restructured Overseas Development Aid (ODA), on which the UK spends 0.7% of its GDP, to ensure that it is spent on tackling the great global challenges. As part of this, the UK government has established:

  • The Ross Fund, a £1 billion initiative to tackle the most dangerous infectious diseases such as Ebola, malaria, neglected tropical diseases and drug resistant infections
  • A £500 million ODA crisis reserve to enable effective cross-government responses to crises as they happen
  • A Global Challenges research fund of £1.5 billion over the next five years to ensure UK science takes a leading role in addressing the problems faced by developing countries – such as building resilience during emergencies and tackling AMR.

In addition, the government has committed to increasing UK climate finance for developing countries by at least 50%, to reduce emissions, increase access to energy, build resilience of the poorest and most vulnerable people, and to reduce deforestation.

All of this reflects an awareness that what happens internationally and globally affects health security in the UK. It’s also apparent that the expertise based in the UK has much to offer the rest of the world, as illustrated by PHE’s successful efforts to give public health and science a bigger role within the Sendai Framework for Disaster Risk reduction (2015-2030).

Reflecting this, Public Health England and the Faculty of Public Health have published Global Health Strategy. It highlights not only the complexity of the problems faced, but also the enormous contribution that will be made in the coming years by UK Public Health. It is within this context that I begin my Global Health Fellowship.

It is set to be a challenging and rewarding year; I look forward to sharing it with you.


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Tomorrow (11 October) marks a day of mourning and sadness to many Muslims across the world. It is Ashoura – a day which not only has sad connotations for many Muslims but also sees increasing numbers of people making potentially dangerous cuts to their body.

Ashoura means the tenth day of the Islamic month of Muharam. It commemorates the brutal death of Imam Hussain (Muslim prophet’s grandson) in a fierce battle over 1000 years ago. Imam Hussain, his family and his followers were murdered.

This event is observed mainly within the Shiite Muslim community in different ways. The range of responses varies from donating to those in need to, at the extreme end of the scale,  Shiite Muslims showing their repentance through self-inflicting injuries using knives, spiked or bladed chains and other sharp tools.

This practice is well known as Zanjeer Zani. It is most common in Pakistan, Iran, Iraq, Bahrain, Oman, and to a lesser extent, in Afghanistan, Egypt, Lebanon and Syria. However, there have been reports of this practice emerging in Europe and the UK.

While many Islamic scholars are publicly opposing  Zangeer Zani it is impossible to control or ban this deeply rooted cultural practice. Hence a harm reduction approach is best to minimise the risks associated with this ritual.

The main public health risk is Blood Borne Viruses (BBV) and other bacterial skin infections.

Unfortunately, the risks are not well documented and there is nothing published in the literature. The ministries of health of those countries where this practice is common and the WHO-EMRO region have no protocols or guidelines in place in response to this annual practice.

Although I fully acknowledge the challenges in the EMRO region, I would like to call upon clinicians and public health professionals in the UK to raise awareness, encourage testing for BBV and promote contact tracing and Hepatitis B vaccination as interim measures to reduce the risks associated with this ceremony.

Dr Bayad Nozad, FFPH with special interest in Blood Borne Viruses


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Last week marked the end of the fifth global World Alzheimer’s Month. It gave us all a chance to reflect on the importance of this international campaign to raise awareness and challenge the stigma that surrounds dementia.

The theme for World Alzheimer’s Month 2016 was Remember Me. Alzheimer’s Disease International asked people to get involved by sharing their favourite memories, or memories of a loved one, on social media with the hashtags #RememberMe and #WAM2016.

Alzheimer associations in more than 60 countries took part in this year’s campaign, raising awareness, and advancing action to make dementia more understood.
FPH members, as part of the leading professional body for public health specialist in the UK, provide sterling service at local and national levels, promoting effective preventative measures to reduce the risk of people developing dementia, and advocating for a more dementia friendly society.

Below is just one example of that work.

Claire Beynon, Registrar and Chair of Specialty Registrars Committee – Dementia Health

Needs Assessment for Cardiff and Vale
Dementia in Cardiff and Vale
Currently in Cardiff and Vale there are estimated to be approximately 5,500 people with dementia, about half of whom have a diagnosis.  Due to a growing and ageing population by 2025 this is expected to rise to nearly 7,000 people living with dementia.  Timely diagnosis can slow the progression of dementia and help individuals identify sources of support.
How has Cardiff and Vale promoted World Alzheimer’s month?
Cardiff and Vale have been running a campaign on social media and have produced three patient stories that have proved popular, see the website for the stories. http://www.cardiffandvaleuhb.wales.nhs.uk/caring-for-someone-with-dementia
So how does my work fit into this?
By undertaking a health needs assessment I hope to raise the profile of unmet health needs in the local area.
One in five cases of dementia may be preventable with exercise, diet, diabetes prevention, and early treatment of depression so we need to consider how we can move more focus towards prevention.  The Welsh Government recently produced a guide on how to reduce your risk in six steps.


Why undertake a Health Needs Assessment for Dementia now?
The Cardiff and Vale 3 Year Dementia Plan is due to end in 2016/17, and there is a need to refresh the information on which it is based and make new recommendations based on the altered circumstances.  The purpose of this Dementia Health Needs Assessment Plan is to outline the process that will be undertaken to assess the health needs of people with dementia and their carers in Cardiff and Vale.
In my role as a Specialty Registrar time I will co-ordinate the Dementia Health Needs Assessment. The needs assessment will be undertaken during the period July to December 2016.  A final report will be prepared in December 2016.

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