Archive for October, 2017

By Dr Samia Latif, member of the Global Violence Prevention special interest group at the Faculty of Public Health

Pakistan, Afghanistan, Syria and Nigeria have something common between them other than being third world nations. They are the only remaining countries where polio, amongst other infectious but preventable diseases, still ravages and raids childhood and the dreams of an entire generation.

Vaccinations have been one of the single most effective public health interventions known to mankind but in order for a good immunisation programme to take root there needs to be a safe and stable environment to deliver the vaccinations alongside a good understanding of the political context in which these immunisation programmes operate. These countries have been in a state of conflict recently and as such, Polio triumphs along with other childhood infectious diseases.

Wars, insurgencies and conflict drive resources away from the basics such as health, education and societal structures. Ways of life are disrupted which is further compounded by forced migration, displaced populations and a breakdown of trust. It comes as no surprise then that polio’s final strongholds are some of the most complicated places in the world to deliver vaccination campaigns.

There is evidence that hostility to immunisation programmes may not necessarily be the result of insurgents’ theology, rather it arises from suspicion and mistrust. For example, in Nigeria, the last African country harbouring endemic polio, many believed that the vaccine contained anti-fertility drugs and cancer-causing viruses. Similar misconceptions were rife in Pakistan where the Taliban insurgents propagated rumours that led to the targeting and killing of healthcare workers delivering the vaccinations; such can be the indirect and uncalculated costs and victims of conflict! It did not help of course that America had used the immunisation programme as a cover up for its spying operations.

Trust is key to the acceptance and success of any public health intervention but more so for an immunisation programme that involves inoculating apparently healthy individuals with weakened strains of microbes or antibodies to the same.

Access to healthcare is a major determinant of health; war and conflict destroy the routes and health and social care structures to access so it is no wonder then that war and infectious diseases are such good comrades. Add to the picture of already exhausted and fragmented health and social care the genetic evolution of bacteria and viruses causing infectious diseases and you have a recipe for disaster that cooks for many years even after the conflict or war has ended. Lack of access to immunisation programmes, antimicrobial resistance and changing strains of microbes may have very long lasting effects that are witnessed by subsequent generations as herd immunity falls below optimal levels. Bosnia and Herzegovina being a case study in time where the recent measles outbreak was a consequence of the conflict 20 years ago.

In today’s global context, when borders are increasingly porous and diseases neither respect nor recognise these borders, the challenge posed by global conflict threatens the very premises on which our society’s foundations of health and social care have been laid. A clear example is the resurgence of polio in Iraq 14 years after being disease free due to spread from neighboring Syria.

A problem thousands of miles away does not mean it won’t come knocking on our doors soon. There needs to be a united call to arms by world leaders and all levels of society to advocate for peace, building trust and working with and through communities; something public health does best!

Read Full Post »

By John Middleton, FPH President

better mental health infographic

Mental health in the workplace is the theme for this year’s World Mental Health Day today. The workplace is a key setting for health as good work is a key determinant of health.

Job control, fair treatment, job security and reward for our efforts are what characterise good work. Those who lack autonomy to do their job, have insecure terms and conditions, are treated unfairly or receive no praise or recognition from their managers will feel their health suffer. This in turn will impact on productivity, staff retention and sickness absence.

Sadly, we too often see workplace mental health action focussed on individual behaviours rather than organisational actions that tackle these determinants of health at work. Workplace wellbeing has become extremely popular but yoga at lunchtimes may do little, if anything, to tackle the causes of stress.

The National Institute for Health and Care Excellence (NICE) guidance for workplace health recognises the organisational commitment needed, the role of good line management and the value of staff participation in decision-making. It also recommends the Health & Safety Executive’s excellent management standards for workplace stress. The public health workplace is not exempt. There are many stressors out of our control but there is also much that we can do. As well as implementing the NICE guidance or management standards we can also look out for one another. Relationships are key for good health and equally so at work.

Being aware of our own mental health and wellbeing is the start of taking any action. This helps us improve our communication with others and create meaningful solutions with others. The revised Faculty of Public Health (FPH) curricula 2015 included a new learning outcome that we could all do more to demonstrate and apply: an understanding of how mental health and wellbeing can be managed and promoted in staff and yourself in a range of situations.

Mental health remains a priority for FPH and for me personally. Last month I pledged FPH’s support by signing the Prevention Concordat for Better Mental Health that we have contributed to through our Public Mental Health Special Interest Group. We will continue to take action, to support our members in their practice and to advocate nationally for the public’s mental health.

As a standard-setter and educator, we will include positive mental health in our education and training programmes, and we will work to become a Mindful Employer.

Read Full Post »

By Dr Tina Maddison, CCDC PHE West Midlands Team

Human trafficking is the acquisition of people by improper means such as force, fraud or deception, with the aim of exploiting them (1). Sexual exploitation is by far the most commonly identified form of human trafficking (2), with women and girls disproportionately affected (3). This is a problem that is not diminishing.

Indian brothel

Inside an Indian brothel

My husband and I are currently volunteering in South East Asia for an NGO that rescues and rehabilitates children from human trafficking and sexual exploitation. My husband has recently returned from India where he witnessed first-hand the prolific nature of this trade. Many of the women and children are subjected to sexual exploitation either by the families into which they are sold or in the public brothels that line the backstreets of countless cities.


In New Delhi, home to a myriad of brothels and massage parlours, children as young as 12 are sold to men up to 40 times a day. This abuse is beyond comprehension. The damage to the individual, both physically and emotionally, is catastrophic. Babies born to these girls are also used for the gratification of perverted minds.

Abha was just 12 when she was trafficked into a brothel in Delhi (4). “I was kept day and night in that place. They made me go with men all day and all through the night. If I resisted the owners would cut my arms, burn my face with cigarettes and scald my body. They would open up my wounds the next day to remind me not to disobey. They would inject me with drugs and force me to drink alcohol to make sure I did what I was told.
Whilst I was there I caught TB from the other girls. Seven men escorted me to hospital; they did not let me out of their sight. I was a prisoner, and I lost all hope of ever escaping. Eventually I tried to kill myself by cutting my wrists. They stitched me up so I could carry on making money for them.”

Across South East Asia, in the poorest of towns and villages, families are forced to make agonising decisions just to survive. Fathers will sell their oldest daughters to feed their younger siblings. The fundamental human rights of a child have no meaning in a world of extreme poverty.

Cultural issues in some countries contribute to the problem. Women and girls are viewed, by many, to be of little significance or worth. This diminished social standing is exploited by organised criminal gangs who view young girls as objects to be bought, auctioned and sold. To them women have a high value but for all the wrong reasons.
The crisis in India, where woman and girls routinely face sexual exploitation, harassment and lack of human worth has, in recent years, been amplified by the availability of pornography on the internet. One exasperated Indian social worker put it like this: “Pornography has intensified the lack of respect for women here. The problem has become much worse in a short space of time.”

Where does our public health duty lie in response to the appalling reality faced daily by girls such as Abha? Poverty, disregard of a woman’s worth and the prevalence of pornography are all underlying factors in this human tragedy. Should our response be to attempt to deal with these fundamental problems?

If these root causes are just too enormous a challenge, then should our public health response be to deal with the aftercare of individuals directly affected? Children rescued from the brothels have been broken mentally, physically and spiritually. Many suffer with rejection, they cannot reconcile the fact that their own families could have sold them. For others, the shame they burden for the abuse they have suffered is a barrier to ever being reunited with loved ones. They become outcasts.

Those still trapped within this insidious industry suffer with even greater self-degrading effects. A sense of hopelessness inevitably leads to depression. Many try to take their own lives as their only means of escape. Others develop a dependency upon the drugs and alcohol they are plied with in an attempt to block out the fear and pain they have been sentenced to.

Our public health response could be to identify and develop services to deal with these devastating emotional effects on young lives. Or as public health practitioners we could respond to their physical needs; screening and treating TB, HIV and other STIs, improving their poor nutrition and working to ameliorate their squalid living environments.

However, within India and neighbouring countries, for many there is still an unwillingness to admit that such problems exist. On the flight into Delhi one Indian passenger was adamant there were no issues with prostitution in India. “You will not be able to show me even one woman or child in prostitution. There is no problem here, this does not happen!”

Perhaps, therefore, our public health duty first and foremost should be to continue to raise awareness about this atrocity so that no one can honestly deny that the problem exists. Unless the issue and scale of human trafficking is recognised and acknowledged by all countries, and political pressure applied at the highest levels to invoke change, then those on the ground who fight daily against such evils will continue to fight alone.

“The only thing necessary for the triumph of evil is for good men to do nothing” – Edmund Burke


1. UNODC. UNODC on human trafficking and migrant smuggling. Available at URL: http://www.unodc.org/unodc/human-trafficking/ (Accessed 8 May 2017)

2. UNODC. Global Report on Trafficking in Persons. Executive Summary. February 2009.

3. International Labour Organization. Summary of the ILO 2012 Global Estimate of Forced Labour. June 2012

4. Abha – not her real name. Notes from a personal conversation with a girl rescued from a brothel in Delhi, May 2017.

Read Full Post »