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Archive for April, 2017

By Melisa Campbell MFPH, Research Fellow in Public Health, (Out of Programme: SpR Public Health [St4]), Department of Public Health and Policy, University of Liverpool

Melisa Campbell

Telling the story of child inequalities in health and care using big data research has been my passion for the last six months of my Health Education England Academic Fellowship, a focus fuelled by my personal working experiences within public health departments and healthcare systems.

As many of us will be welcoming spring and making plans for the summer, I am at the ‘show how’ phase and planning for my pending PhD application, which builds firmly upon my out of programme academic experience at the Farr Institute and the Department of Public Health and Policy at the University of Liverpool.

During my fellowship so far, I have been fortunate enough to share my work at the recent Lancet Public Health Conference (2016) Swansea and the Society for Social Medicine (SSM) Conference 2016.  I am also currently drafting further papers with colleagues from University of Liverpool, University of Nottingham and University College London.

The first months of the fellowship were quickly consumed by intense technical training, making connections within and outside the university and refining my understanding of theories and methodologies necessary to deliver my proposal, particularly with relation to health inequalities and statistical methods.

On-going learning has appropriately defined my fellowship and considerably expanded my skills, knowledge and practice of research methods including statistical methods for regression analysis, dealing with missing data and longitudinal data. I’ve been learning to undertake these analyses in STATA, and also in R, which is an open source statistical platform that anyone can use for free, and so gaining transferable skills for public health service practice.

Much of my work has been exploring childhood social inequalities using the Millennium Cohort Study data – a nationally representative birth cohort of 19,000 children born at the turn of this century. Within this, I have maintained a special interest in childhood unintentional injuries, but my professional growth from this experience has facilitated a greater breadth of topics relating to child inequalities pertaining to paediatric hospital admissions, smoking initiation and school bullying, drawing on the expertise in the Farr Institute.

This has already been a rewarding experience and I look forward to making the most of my remaining time. My contact details, previous and when ready information on my current and future work can be found at: University of Liverpool: Melisa Campbell

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By Margaret Whitehead

David Player led the Health Education Council in the 1980s. On April 2 he celebrated his 90th birthday in Edinburgh

I first met David Player in the mid-1970s, when I took up my first public health research job in the Scottish Health Education Unit (SHEU) in Edinburgh, where David was Director. At the time, David had this great idea: to pump-prime academic health promotion by funding academic lectureships in the various relevant disciplines in Scottish universities. As this was a novel strategy at the time, a range of committees had to be convinced, and David taught me how to put a compelling case with different messages for different interest groups. He triumphed in the end, and the fruits of his far-sighted vision can still be seen today, not least in the leaders of public health research that his initiative produced.

One of the first lessons that working under David’s directorship taught me was that everything about public health is political – even the seemingly most innocuous subjects could catch you out. One of my very first tasks was to produce a factual guide to family-planning services in Scotland, which I never dreamt anyone could object to. I was wrong. Somehow it came to the attention of the Scottish health minister with a strongly Catholic constituency in Glasgow, and, before I knew it, objections were being raised and outrage was being expressed. This was the sort of challenge that David cheerfully faced every day – be it about sugar, alcohol or tobacco – as he waged war with what he termed “the anti-health forces”.

It was David’s longstanding passion about unemployment and health and inequalities, however, that shone through for me. David moved from SHEU in the 1980s to take up the post of Director General of the then Health Education Council (HEC). By then I was a freelance researcher and in January 1986, David commissioned me to update the evidence that had accumulated since the publication of the Black Report in 1980 and assess the progress made on the report’s 37 recommendations. My report, entitled The Health Divide, was eventually published in March 1987 as an HEC occasional report, one week before the HEC was disbanded. David did two politically astute things when he commissioned the report: he set up an informal panel of distinguished scientific advisors, including three of the original members of the Black Report working group, and he signed over copyright of The Health Divide to me (as opposed to the commissioning body, HEC), thereby ensuring that the report would be published irrespective of what happened to the HEC.

As the launch date drew nearer, Peter Townsend, a scientific advisor for the report and one of the authors of the original Black Report, suggested that the HEC needed to call a press briefing, backed up by the scientific advisors because, in Peter’s memorable words:

“We can’t let Margaret face the flak alone.”

At the time I was young and so naïve that I hadn’t realised that there would be any flak!  How wrong I was again. After we had all travelled to London on the appointed day, the Chairman of the HEC decided to cancel the press briefing at the HEC offices an hour before it was due to begin. He was quoted in the Independent as saying that The Health Divide was “political dynamite in an election year” and so it was necessary to postpone the press briefing.  Members of the panel, who had already assembled, decided to proceed with the press briefing at the nearby offices of the Disability Alliance – David and his staff were instructed not to attend and so had to watch from the sidelines as the story unfolded. And what a story it turned out to be. As we made our way towards the Disability Alliance in Soho, journalists who were hurrying towards the HEC came across the procession going the other way and joined in behind – a Pied Piper effect. The press, TV and radio swung into action, spurred on by the hint that the report had been suppressed, possibly by the intervention of the department or even government ministers. The fact that this was remarkably similar to the treatment that the Black Report received seven years earlier was not lost on the media. The result was a public relations triumph for health inequalities advocacy (or a public relations disaster for the Chair of the HEC and government).

A health journalist, Peter Davies, recalled how a few days after the event, David Player told him gleefully: “It is going like hot cakes. They were queuing outside in New Oxford Street. We have a bestseller on our hands.” (1).

We had indeed – publishers started queuing up to publish The Health Divide, and it was eventually published in one volume with The Black Report by Penguin and became a non-fiction bestseller (2)

In the hectic aftermath of the press conference, the House of Lords requested copies for all the members as they prepared to debate the NHS, and a re-print had to be hastily prepared. It was, however, when a request for a copy of The Health Divide from Margaret Thatcher’s office landed on David’s desk that things became scary. David told a witness seminar at the London School of Hygiene and Tropical Medicine that, as he signed the complements slip to the PM, “It felt like I was signing my own death warrant.” (3).

The Times fanned that particular flame, by suggesting that the report was a “devastating final salvo from David Player to the government” on the eve of the disbandment of the HEC. That did David a great injustice – at the time he commissioned The Health Divide, over a year earlier, there was no inkling that the HEC would be disbanded, or that the Government would call a snap election, timed not long after the eventual publication.
It meant, however, that David did lose his job with the closure of the HEC and a very difficult time ensued for him. When I think of David during this episode and the battles he fought before and after it, I think of his courage in the true spirt of the great public health pioneers, mixed with his great Glaswegian sense of humour. An unstoppable combination!

1.    Davies P.  Review. BMJ 2003; 326: 169.
2.    Inequalities in Health: the Black Report edited by Peter Townsend and Nick Davidson and The Health Divide by Margaret Whitehead. 2nd Edition. Harmondsworth: Penguin. 1992.
3.    Berridge V, Blume S. (eds) Poor health: social inequality before and after the Black Report. Report of a Witness Seminar.   London: Frank Cass &Co Ltd. 2003.

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By Woody Caan, Editor, Journal of Public Mental Health

The impact of parental drinking on the health and development of children (e.g. Caan W. Alcohol and the family. Contemporary Social Science 2013; 8: 8-17) has been recognised for decades but has never produced government policy that reduces harm. For example, in its final days, the National Institute for Social Work profiled a representative, national caseload of children and families. By far the most common characteristic of families assessed by social services (for any concern) was a parent dependent on alcohol. On behalf of the old UK Public Health Association alcohol group, I met with the British Association of Social Workers to discuss policies that would span public health and social work, but even when we identified quick wins (such as better care and assessment in emergency care for those young people with a history of abuse, who self harm when intoxicated) we failed to change policy.

It is not surprising that the 2003 government genetics & health strategy, Our Inheritance, Our Future, failed to address the common observation that many families with a pedigree of alcohol-use disorders repeat the same history across generations. There have never been official UK guidelines on effective child-health interventions after parental alcoholism is identified, although there are many recommendations from NGOs on both sides of the Atlantic.

The US company Kaiser Permanente first studied Adverse Childhood Experiences (ACEs) and their cumulative, long-term impact on adult health. From the beginning, having one or more adults with an alcohol use disorder within a child’s home environment was seen as a serious adversity. (Note: diverse studies have sometimes explored either parental addiction or shorter-term ‘alcohol abuse’, while the grown-up recollection of parenting in childhood tends to be fragmented and not like a clinical assessment.) In 2016, the Public Mental Health Network hosted by the Royal College of Psychiatrists decided to make ACEs our priority. In 2016, Public Health Wales produced a large-scale report on childhood adversity that includes parental drinking as a cause of both mental and physical harm.

What gives me hope for change in 2017? In February, three Members of Parliament (Jon Ashworth, Caroline Flint and Liam Byrne), supported by the Archbishop of Canterbury, all described their own experience of parental alcoholism and issued a manifesto for action. Subsequently, I sent the current Under Secretary of State for Public Health a letter in support of those MPs, with a little public health evidence. On 15 March that minister, Nicola Blackwood, replied to me that she was “committed to developing a strategy to help alleviate this serious issue”. The Public Health Minister also wants professionals like us to share our knowledge “as the new strategy is being developed”.

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