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Archive for January, 2018

By Jamie Waterall, National Lead for Cardiovascular Disease Prevention and Associate Deputy Chief Nurse at Public Health England, and Honorary Associate Professor at the University of Nottingham

Over recent weeks, we’ve seen constant media reporting about the increased pressures our health and care system is experiencing.

There’s no disputing that the NHS is facing ever greater demands, often linked to our aging population and many more people living with long-term conditions such as heart disease, diabetes, dementia and certain cancers.

But it’s worrying that most of the news reports only focus on the need for more acute hospital beds and ambulances, rather than discussing the need for a radical upgrade in prevention to reduce demand on these services.

As public health professionals we know that there are no easy solutions to the pressure on our health and care system. These are complex problems, requiring a whole-systems response.

However, we also know that many of the health issues keeping our hospitals so busy are preventable. Having worked in acute medicine and cardiology for a number of years I witnessed the scores of patients I treated who were admitted to hospital with conditions that could have been delayed or avoided altogether.

And when working in the acute trust environment, I would have agreed that more beds and acute services was the answer to our problems. It was not until I was working in primary care as a nurse consultant that I became more aware of the need for an increased focus on prevention.

So I frequently ask myself; how can we better harness the skills of our trusted front-line professionals, ensuring we all get behind this radical upgrade.

Our research informs us that there’s real appetite to build more prevention into our daily practice, however it also shows us that there can be barriers and challenges.

Time and resource is of course an issue, but we’ve heard that some professionals can be apprehensive about talking to members of the public about their weight, for instance, or whether they smoke or keep active. We also know that there can be uncertainty about the availability of local lifestyle services to refer patients to.

With all this in mind, Public Health England has developed All Our Health, a framework which supports all health and care professions to get more involved in the upgrade in prevention. It provides tools and advice to support ‘health promoting practice’ with quick links to evidence and impact measures and top tips on what works.

Based on user research we’re making improvements to All Our Health as well as forging new links with universities and Health Education England, so we can build more prevention into the way we train our future professionals to practise in this different world with new expectations and opportunities.

We also hope All Our Health will help health and care professionals to engage with the local public health system, including getting involved in the development of prevention initiatives.

Surveys of the public constantly show that our frontline health staff are amongst the most trusted professionals in our communities. Just imagine the impact if our estimated two million health and care staff built more prevention into their practice. We could truly achieve the radical upgrade we so urgently need to see.

For further information and to read more about All Our Health, click here.

 

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By John Coggon Hon MFPH, Professor of Law, Centre for Health, Law, and Society, University of Bristol Law School

Public health is proudly an evidence-based field. But evidence without values cannot tell us what we should do.

We need public health ethics if we are to understand and explain, by reference to the classic definition of public health advanced by Winslow, what we, as a society, ought to do to assure the conditions in which people can enjoy good health and equitable prospects for health. Using the ‘organised efforts of society’ to protect and promote health and wellbeing is an ethical goal – indeed, as many of us would argue, it is an ethical imperative. And to be achieved, it requires law and policy. To evaluate when threats to health warrant a public health response, scientific analyses must be complemented by matters such as the balancing of values, an assessment of the relative merits of different possible interventions, an appreciation of the likely risks and impacts of intervening, and a sensitivity to political and cultural contexts and realities.

At a workshop convened in London, at the Royal College of Physicians on 18 January 2018, public health practitioners, trainees, leaders, researchers and policy-makers joined with scholars in public health ethics to discuss how public health ethics and law (PHEL) might be established as a professional competency, and how we might ensure that it is robust and rigorous through education and training. This is part of a project I am involved in with AM Viens at the University of Southampton, and Farhang Tahzib, Chair of the Faculty of Public Health (FPH)’s ethics committee and a champion for bringing academic public health ethics into practice.

We argue that the public health workforce needs a clearly defined PHEL competency, secured within public health education and ongoing professional training. This builds on further work that we have done regarding PHEL expertise to support the Public Health Skills and Knowledge Framework. As contributions throughout the day affirmed, such a competency requires to be explained in a way that is academically robust: is it based on sound and coherent principles? It must be practically realisable: is it clear how to apply the PHEL competency in the vast, complex, and challenging range of practical situations covered by public health? And it must be treated properly as an essential part of public health capacity: how, for example, can we ensure it is taken seriously as part of continuing professional development requirements? The feedback and engaged discussion from all participants were complemented and further stimulated by contributions from Bruce Jennings – described by Farhang as one of the fathers of public health ethics – as well as an expert panel on which Bruce was joined by Angus Dawson, Vikki Entwistle, Kevin Fenton and Fiona Sim.

Just as areas such as statistical analysis and detection of disease require skills and expertise, so do legal and ethical understanding and practice. As FPH President John Middleton suggested at the start of the day, we need to consider how questions of justice impact public health practice, and how our overall political agendas should be shaped if we are to achieve a sustainably fairer society. For good practice, and good frameworks for practice, PHEL experts need to work with the public health community to ensure that ethical challenges, big and small, can be addressed with proper knowledge, understanding, and skills in ethical, legal, and political reasoning.

We look forward to publishing a full report on our findings, detailing how the PHEL competency should be defined, and a range of model materials for PHEL education and training through FPH’s website, as well as wider academic papers. It is an exciting time to be engaging with FPH and other partners to advance these agendas, strengthening capacity for ethics and law in public health.

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By Darryl Quantz, North West School of Public Health

It has now been over a year since the Paris agreement which aimed to strengthen the global response to the threat of climate change. Although this agreement was a positive step and has now been ratified by 173 countries (including the United Kingdom), public health must continue to take an increasing leadership role around environmental sustainability. This was the clear message at an event hosted by the All-Party Parliamentary Health Group and the All-Party Parliamentary Group on Climate Change.

The event brought together representatives from across sectors, including members of the Faculty of Public Health (FPH), to discuss the release of the Lancet Countdown report. The report tracks progress on health and climate change and highlights concern over the delayed response to climate change over the past 25 years. The panel discussed a wide range of public health opportunities for public health action including women’s rights around family planning, healthier agricultural policies and implementation of the UN’s Sustainable Development Goals.

FPH has shown its commitment through the development of the Sustainable Development Special Interest Group and by continuing to embed climate change/sustainability into the training of public health consultants. As individuals, you can consider your own personal opportunities to reduce your impact such as changing to a renewable energy provider, selecting a greener diet or choosing ethical/financial institutions for your banking. Professionally, it is important for us to consider the opportunities for environmental sustainability (and the positive health benefits!) throughout our practice. The FPH Sustainable Development Special Interest Group exists as a forum to promote and coordinate actions to support sustainable development. If you are interested in joining us, please contact the chair at jeremywight73@gmail.com

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