Better Health For All

Whatever you may think of Tony Blair you can’t fault his choice of Tessa Jowell as the Country’s first Minister for Public Health. For those of us who came into public health in the 1970’s after 18 years of unremitting attack on the welfare state, which had given many of us opportunities which had been unknown to our parents, the Labour election victory of 1997 was a heady time. For one thing we were allowed to talk about inequalities in health for what they were: a matter of serious social injustice. The mealy mouthed ‘variations’, as if an act of God, was set aside and we had a government that seemed to be serious about fairness; and Europe was no longer something to be ignored or vilified but to be embraced. The appointment of somebody who actually ‘got’ public health as the nation’s first public health minister was a revelation.

As North West Regional Director of Public Health and a member of a great team under the leadership of the new Chief Medical Officer, Sir Liam Donaldson, we found that Tessa was more than a breath of fresh air – she breathed the same air as ourselves. This was the air that went as deep as her understanding of the insights that she had imbibed from the writings and teaching of the London School of Economic’s Richard Titmuss, one of the founding fathers of the welfare state. ‘Services only for the poor are poor services’, was one such nugget and mantra to be proclaimed early, loud and often. So too was the notion that ‘there are things that government must do, things that organisations and employers must do, and things that we, as individuals, families, neighbourhoods and associations must do’. So much for the poisonous allegation of the nanny state.

With Sure Start, Healthy Living Centres, her embrace of a long needed strategy for teenage pregnancy, and everything she turned her hand to, Tessa demonstrated that she knew how to turn high flown rhetoric into practical action that made a difference at street and neighbourhood level . Here she demonstrated so clearly how her background as a social worker in mental health, as well as a politician, could be at the heart of public health. The Regional Directors in particular were so fortunate in being on the inside track in shaping and drafting the government’s Public Health White Paper together with Tessa and Liam. For everybody it was a labour of love, made special by the passion and personal imprint from the top. Close to my heart was the inclusion of a regional network of Public Health Observatories, based on the one we had established in Liverpool in the early 1990’s to ensure a steady flow of local and practical intelligence supporting the uniqueness of each public health community.

When she was ready to go on the road to share her ideas and plans it coincided with the forthcoming Faculty of Public Health Conference in Liverpool. This presented us with the unique opportunity of bringing together the first public health minister’s first public speech, at a Faculty event where she would deliver a Duncan lecture in honour of the country’s first Medical Officer of Health. As the local lad on the ground I had the unique opportunity of working closely with her on the speech and it was while she was in Liverpool that I really began to appreciate what a special person she was. One of my sons who had just passed his driving test offered to drive her around between engagements. In a state of some anxiety at the responsibility he stalled the car more than once but was to experience that spontaneous warmth, understanding and support for which Tessa was so well known.

When disillusion with politics and trust in politicians appears to be at an all-time low, the outpouring of love and respect for Tessa Jowell from across the political spectrum and beyond is all the more remarkable. One of her major concerns over the period that I knew her was what she regarded as the ‘time poverty’ that now so affects family life. In some ways this is ironic considering her own special relationship with what her private office officials referred to as ‘Tessa Time’. My own experience of this was when she called me in to discuss the final details of the highly sensitive teenage pregnancy initiative which she was due to present to the Prime Minister the following morning. At the end of the working day and with my half hour slot in the diary whittled down to 5 minutes and a slurp of tea we barely had time to rehearse the ubiquitous 3 main points. The result of her forensic grasp and advocacy can be judged by the fact that teenage pregnancy rates today are less than half what they were at that time.

As with so many other people, I have such fond memories of Tessa, of her generosity of spirit and willingness to share her time and of her ability to see the best in almost everybody. Family life, her own and others, was at the heart of her reason for being. After she moved from public health we kept in touch and had intermittent dealings and contact, not least with regard to the emergency planning arrangements for the Commonwealth Games in Manchester which went on to become the template for the London Olympics. With the change of government in 2010 came changes and new challenges. She carried her peerage lightly and was thrilled to be invited to teach on the Harvard leadership programme and to be made a professor at the London School of Economics. As president of the Faculty it was a particular pleasure to be able to award her honorary fellowship at our annual conference in Manchester in 2014.

The last time I saw Tessa was in 2017, shortly before she was diagnosed with her brain tumour. She invited me to tea in the House of Lords for a catch up. It took a good 10 minutes to navigate the tea room as so many parliamentarians of all parties wanted to speak to her, but as usual when we were settled I had her full attention. Together we regretted the fate of the Public Health Observatories and the direction of travel of Public Health in England before returning to her enduring passion for children, for the opportunities that should be available to all of them and in particular for her focus on the first 1000 days of every child’s life. For many Tessa Jowell is synonymous with having brought the 2012 Olympic Games to London. I would suggest that her focus on guaranteeing a Sure Start to the nations’ children will be her real legacy.

Written by Dr John Ashton C.B.E. Former President of the Faculty of Public Health (FPH) from 2013-2016.

[Photo of Tessa Jowell has been taken from her Twitter profile]

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Claire Beynon, Specialty Registrar, has co-authored a chapter of the Chief Medical Officer’s annual report 2016/17 on gambling.

Gambling is an emerging public health issue. It has the potential to cause harm to both individuals and to wider society.

Claire developed the chapter during her nine month placement at the Welsh Government. She worked under the supervision of Dr Frank Atherton, Chief Medical Officer.

Support from a wide range of academics working on gambling from across the UK and Canada was provided, and Claire spent much time talking to the relevant partner organisations including the Gambling Commission, GambleAware, the Responsible Gambling Strategy Board, local Assembly Members, Ministers as well as local charities and third sector organisations that provide services for people with a gambling addiction.

The work is now moving forward. She has drafted a position statement on gambling for the Faculty of Public Health, which will be considered later this year. Claire said:

“It was a great opportunity to see how Welsh Government works, and how policies can have an impact on Public Health issues. I would highly recommend this placement to other registrars on the training scheme in Wales.”

Claire also worked on several other high profile projects. This included working with Dr Ruth Hussey, former Chief Medical Officer, on the Parliamentary Review of Health and Social Care. 

The Parliamentary Review of Health and Social Care in Wales is the first ever cross party independent review undertaken in Wales.  It had a wide ranging remit including:

• Define the issues facing health and social care
• Identify where change is needed and the case for change
• Set out a vision for the future, to include health and social care moving forward together
• Look at developing primary care services out of hospitals
• Give advice on how to deliver change, building on the positive aspects of the current system

The review covered six main areas including:

1. An analysis of the way things are now, including learning from previous studies
2. Define what the future of health and social care could look like. Different delivery models, organisational issues and the citizen’s perspective
3. Metrics, systems, governance and pace of change
4. Workforce including culture, morale, education & training, rurality and Welsh language
5. Quality and safety including research & development, and innovation
6. Productivity including data and insight, digital, & finance

Claire supported Professor Dame Carol Black and Professor Anne Marie Rafferty on the workforce element of the report, assessing current status of morale, culture, training and specifically looking at rurality issues and the Welsh language.

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By Hamira Sultan, Consultant in Public Health and Member of FPH’s Pakistan SIG

On March 20th, FPH’s Pakistan Special Interest Group (SIG) sent two open letters to the PM of Pakistan, and the Chief Justice of the Pakistani Supreme Court pledging our support to help improve tobacco control in the region.

The chair of our SIG, Prof Zafar Iqbal, initially peer reviewed a paper looking at a cross sectional study of smoking prevalence in urban and rural areas of Pakistan. Through this, he connected with the author (Haleema Masud) and identified an opportunity to undertake some advocacy work around tobacco control.

Zafar contacted me in August 2017 to invite me to help support this advocacy work. I was 6 months into my maternity leave and ready to use my brain! Zafar is a great networker and put me in touch with a range of people with an interest in smoking-related health in Pakistan. I spoke with them all about their views on how best we advocate for tobacco control and started to draft a letter to the Pakistani PM in November 2017.

We were keen to get support from colleagues in Pakistan as well as the UK to help enforce our messages. The secretary for the Pakistan SIG, Mohammed Jawad, introduced me to Professor Javaid Khan from the Aga Khan University who has led a range of advocacy work regarding tobacco control. He was key to our decision to write to the Chief Justice of the Supreme Court for Pakistan in asking for his support in implementing various tobacco control legislation that Pakistan has passed. Our letters have also been signed by our President of FPH, and academics in Pakistan and the UK.

We thought it was important to take this on given the level of harm that tobacco causes in Pakistan, being responsible for over 110,000 deaths per year . Our letters highlight this and acknowledge that Pakistan has made progress in passing legislation around smoke free places and size of pictorial graphics on cigarette packs. However, more needs to be done to ensure these laws are fully implemented, and importantly that taxation of cigarettes is a priority. Our letters come at a time when tobacco taxation is being cut by the Pakistani government. Our letters have made the Pakistani press which we hope will keep the issue of tobacco control in the country a priority.

Changing public opinion and national policy can take a long time. The FPH Pakistan SIG is considering the next steps of the campaign.

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