Archive for September, 2018

The public health community is accused of many things but insurrection is rarely one of them. In fact, insurrection sounds more like something out of Tudor England and the 1536 Pilgrimage of Grace. However, if the public health function were to adopt a rights-based approach to the delivery of health improvement then insurrection may indeed be just around the corner.

But what is a rights-based approach? Human rights are set out in the 1948 Universal Declaration of Human Rights and provide the world’s governments with a code of conduct. This declaration, most notably, covers civil and political rights – for example, the freedom of speech – but there is also a third element of social rights. The latter includes the right to education, an adequate standard of living, basic housing, food AND the highest attainable standard of health. All these rights are of equal standing. They are indivisible from each other, inter-dependent and inter-related. Upset one (eg remove housing) and others (eg health) is upset. Human rights are also backed by legal obligation and can therefore be both challenged and defended in a court of law.

Such rights can be delivered through a set of PANEL principles of Participation, Accountability, Non-discriminatory, Empowering, and Legally-supported. Rights-based services are always Available, Accessible, Acceptable and of high Quality (AAAQ). Social rights also carry the obligation to be realised progressively over time, although resources can be taken into account. It means that where evidence backs intervention and there is low or even no cost to the State, then the Government has a duty to implement the measures. That means a year on year, decade on decade, improvement. Think what that would do to help the population achieve the highest attainable level of health.

The idea of the right to health generating insurrection is not as far-fetched as it sounds. The demand for human rights to be observed and protected is often led by those who are deprived of such rights. Consider the resistance to apartheid as just one example of a movement to overturn injustice on a national scale. Although public health organisations are not human rights organisations per se, it is no stretch of the imagination to see that good public health is good human rights.

Public health organisations and professionals are in an excellent position to encourage the public both to want and to expect better levels of health. Reframing public health messages in terms of the right to health could create the potential for greater public demand and consequently increased political support. A rights-based public health policy might, for example, promote value-added nutrition labels on food and alcohol as information labels to satisfy consumers’ rights to know about the food and alcohol they purchase rather than as a mechanism for tackling obesity which raises objections as a barrier to trade.

The right to health should become a standard tool for the public health profession in its quest for a more equitable and healthier society. Used to its fullest extent it might even lead to the next “Pilgrimage of Grace” by a populace demanding the Government changes a course of action.

Written by Heather Lodge, UK Public Health Network Co-ordinator. The question of how the public health community can make use of the right to health will be on the table for discussion at Public Health England’s conference in September 2018. The session will be chaired by Paul Lincoln with John Coggon of Bristol University and Cath Denholm of NHS Health Scotland providing expert analysis and commentary.

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Jane Leaman provides her views on the importance of the recently published NICE public health guideline on preventing suicide in community and custodial settings

Jane NICEMore than 6,000 people take their own life each year in the UK. The risk of suicide is particularly higher in UK prison populations compared to the general population. In order to tackle and significantly reduce death by suicide, there needs to be a clearer approach to prevention; the recently published NICE public health guidelines aims to do this.

The guideline looks at ways to reduce deaths by suicide and help people bereaved or affected by suicides, including families and emergency responders, who may as a result be at risk of harming themselves. The recommendations also suggest ways to identify and help people at risk, particularly in places where suicide is more likely, such as high-buildings or medical, veterinary or agricultural settings where human or animal drugs may be readily available. Tackling access to high risk places where suicide can occur means we can explore prevention which is very important to consider.

The best way to put these measures in place is to have a multi-agency approach that looks at what plans and training local services need to put in place. A 2015 report published by the All-Party Parliamentary Group on Suicide and Self-Harm Prevention identified 3 main elements essential to the successful local implementation of the national suicide prevention strategy:

  1. Carrying out ‘suicide audits’ to collect data on suicides
  2. Developing suicide prevention action plans
  3. Establishing a multi-agency suicide prevention group

The guideline encourages local authorities to work with local organisations to set up and lead a local multi-agency partnership on suicide prevention. It also advises that there should be consideration of continuous and timely collection of data from police, coroners and other sources. This data will then inform services of suspected suicides and potential emerging suicide clusters and could also be used to identify people who need support after such events.

The guideline also includes evidence-based recommendations on suicide and self-harm in custodial settings. Government records of deaths in prison custody, specifically self-inflicted deaths, have risen steadily over time. The guideline recommends that custodial and detention settings should collect data on sentence type, offence, length and transition periods when gathering data in their institutions to identify trends.

The NICE team also made sure that the core members of the committee who developed the guideline were those who have specific lived experience of this topic or who work within the field such as within a custodial setting. Having such a broad range of views and expertise further strengthens the final recommendations.

A clear message from the guideline is that action needs to be taken at local level to really understand risk factors, demographic profile, and settings and places that could be contributing to suicide levels. Crucially, it makes services and organisations aware that suicide is preventable. By working together and identifying where and by what means suicide occurs, we can look at ways to prevent and support those who are at risk of suicide. As a result we might begin to see a decrease in the current figures for self-inflicted death, particularly in high risk environments such as custodial settings.

Written by Jane Leaman, core member of the public health advisory guideline committee for the National Institute for Health and Care Excellence (NICE) and a Public Health Consultant. NICE is developing a quality standard that supports this guideline and will be published later on this month.

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Dear FPH members and the wider public health community,

Organ Donation Week, taking place this week, is our opportunity every year to seek to encourage consideration and discussion of organ donation across the UK. As a consequence I am immensely grateful to be given this opportunity to reach out across your organisation and share a plea for help.

Every day in the UK 3 of our fellow citizens die because the organ for transplant they so desperately needed did not arrive in time. Look around your workplace and imagine that rate of attrition, 3 people every day passing away when there is no need, all that life and hope ended. That stark image is what drives us to encourage everyone to think about their own personal organ donation decision and just as importantly to have a conversation about that decision with their loved ones. We know over 80% of the UK population believe in Organ Donation and that where someone is on the Organ Donor Register and their loved ones know they want to be an organ donor that 92% of families support their donation decision. Where a family does not know the wishes of their loved one the number who agree to donation drops down to just under 50%.

So, my plea this Organ Donation Week is that if you want to be an organ donor you share that message, and if you believe in organ donation that you take the opportunity this special week offers to have a conversation about organ donation. Only by spreading the word can we offer hope to those waiting for an organ hoping for ‘the call’ before time runs out. Words Save Lives, that is our motto this Organ Donation Week and with your help we can make that a reality.

Anthony Clarkson image

Thank you and best wishes

Anthony J. Clarkson

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