Better Health For All

October 2018 and I flew 10,000 miles to Sydney to start my final year of training in a different system. It requires a very different ‘winter’ wardrobe!

I’m spending eight months hosted by South Eastern Sydney Local Health District and based at the oldest working hospital in Australia. Having been here almost two months I’m getting used to a host of new acronyms and a healthcare system which includes a combination of Public Health responsibilities at commonwealth, state and district level and a bigger role for fee paying services than in the UK.

What was clear from my first day here however was not the differences but the similarities. Discussions around an ageing population and a desire to integrate care and risk-stratify the population made me feel very much at home straight away. A stereotypical image of Australia is that it is universally active and ‘healthy’ but rises in obesity, diabetes and mental health are huge challenges here, just as in the UK. In addition the impact of climate change is becoming, albeit slowly, a big issue in a country that has already seen the impacts of increasingly adverse weather events, especially droughts, heatwaves and bushfires.

The health and wellbeing of the Indigenous population, aboriginal and Torres Strait islanders, is something that shouldn’t and cannot be ignored. Prior to colonisation the Indigenous population had a 60,000 year history here but have only been counted as part of the population (via the census) for the last 50 years.

Aboriginal people can expect to live at least 10 years fewer than everyone else in Australia. Virtually all health indicators show vast inequalities between the Indigenous and non-Indigenous populations. Despite making up only 3 per cent of the general population they constitute 28 per cent of the prison population. Rates of smoking are more than two and a half times that of the rest of the population. Indigenous children are more than 10 times as likely to be removed from their families and placed into state care as non-Indigenous children. The list goes on and on.

The term ’aboriginal people’ suggests a single homogenous group. In fact, the map below illustrates how Indigenous communities see the boundaries within their land rather than the states and territories which have emerged in the last couple of hundred years. Hundreds of separate regions with separate languages, customs and traditions.

During my placement in Sydney I’ll be based within the Eora nation and on the lands of the Gadigal people.

I’m placed with SESLHD (South East Sydney Local Health District). SESLHD is an organisation responsible for the health of almost a million people. It covers urban areas in some of Australia’s most prestigious neighbourhoods as well as areas of high deprivation and has the world’s second oldest national park within its boundaries. SESLHD covers nine hospitals with commissioning and management responsibilities for a range of community services and everything from pre-birth to palliative care. I guess Clinical Commissioning Groups are the closest ‘fit’ with local health districts.

I’ll be leading on a couple of work areas. Firstly, the development of an Environmental Sustainability Plan for SESLHD. Secondly, I’ll be investigating patient pathways looking for opportunities to reduce variation and integrate services across a number of areas, including paediatrics and Child and Adolescent Mental Health Services.

I’ve also been fortunate to be awarded a scholarship with the Deeble Institute, a research unit within the Australian Healthcare and Hospitals Association (AHHA), and I’ll be working with them to produce an evidence review around the role of accreditation in healthcare. This has already involved spending time in the national Capital, Canberra. I was part of a delegation from the AHHA who met with the Minister and Shadow Minister for Health in Parliament.

Finally a word on the Public Health training here. I’m discovering there are both similarities and differences with training in the UK. The Australasian Faculty of Public Health Medicine is responsible for a three-year public health training scheme for medics. Some of the states also run additional Public Health Officer training programmes for medical and non-medical staff – the largest of which is here in New South Wales. As part of my placement I’m spending time with trainees from both schemes and attending some of their training – and they’re social events of course!

So in summary, so far it is a great placement with great people and lots to learn. It doesn’t feel like Christmas as I write this in my shorts looking at the beach but the conversations about the Coca Cola truck confirm that it’s that time of the year and that some things in Public Health are universal!

I’ll be writing more about my time in Australia towards the end of my placement. I’m keen to reflect on what lessons I can bring back to the UK and consider what new opportunities there could be for registrars across the commonwealth in a post-Brexit world. In the meantime, I’ll be making an effort to tweet more about my time in Sydney so please feel free to follow me on Twitter and ask any questions @RyanSwiers.

Written by Ryan Swiers, Specialty Registrar in Public Health

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Today we’ve published FPH’s first major contribution to the national discussion about the role of the NHS in prevention.

Our discussion paper – the first of three we’ll be publishing – reflects many months of thinking and engagement with key NHS and public health stakeholders and the conclusions of an evidence review of prevention initiatives in the NHS.

It is also the first major ‘output’ from our Role of the NHS in Prevention project, which has been funded via an award from the Health Foundation.

We explore three main themes in the discussion paper:

1. What does the evidence tell us about what works?

We’ve discovered that there is lots of good evidence about what helps or hinders prevention in the NHS. But there are still far too many evidence gaps and there’s a very long way to go to make the evidence we do have as useful as possible for NHS leaders, local commissioners and providers. In the meantime they are all having to make ‘best guess’ decisions about which NHS prevention initiatives are likely to provide the most ‘bang for buck’ in their local area.

2. What are the different roles the NHS plays in support of the prevention agenda?

We heard that although NHS organisations are doing a lot of prevention, there is a sense that the NHS responsibility for and capacity to do prevention is poorly defined and poorly understood. This confusion can sometimes impact on service delivery. Based on our evidence-gathering about what prevention in the NHS currently looks like, we’ve come up with five descriptors that we think do a good job of summarising distinct NHS prevention activity:

i. Leader – e.g. commissioning services, providing governance and management, setting the national agenda, role-modelling.

ii. Partner – e.g. providing services, hosting services, working in collaboration to deliver services with local authority, statutory, or other voluntary sector entities.

iii. Employer – e.g. initiatives aimed at improving NHS staff health and wellbeing; NHS as a community employer and ‘anchor institution.’

iv. Advocate – e.g. lobbying governments on public health agenda, lobbying for prevention within individual institutions.

v. Researcher – e.g. funder and driver of new research.

It’s important to stress that we know these categories often overlap and are imperfect descriptors of a diverse range of activity. We’ll be looking to refine these as the project continues.

3. Where should the NHS focus its prevention efforts, now and in the future? In October FPH held our first NHS prevention stakeholder workshop. Over 40 healthcare leaders from across the UK came together to share their knowledge and ideas. Our discussion document sets out a shortlist of 11 prevention interventions that they said should be the focus of the NHS’s prevention efforts. But the majority of experts agreed that a collection of individual interventions alone will not deliver the kind of change we need to support the long-term sustainability of the NHS. A systems approach was identified as a crucial way of achieving change at a population level. We think the NHS should focus some of its effort towards this longer-term goal without losing sight of the fact that delivering more cost-effective prevention interventions could still be very impactful now if implemented in a place-based way and integrated into regular services.

As we set out the themes we will be exploring in more detail in future discussion papers, what’s already clear is that ill-health prevention is a significantly under-exploited way for the NHS to keep people healthy and better manage demand on services. The forthcoming NHS England long-term plan and the UK Government’s prevention green paper offer ‘once-in-a-generation’ opportunities to further promote prevention and make the step-changes we need to integrate prevention into the day-job of every healthcare professional. We hope these opportunities will be grabbed with both hands.

The whole point of a discussion document is to encourage more people to build on the ideas we’ve set out, to challenge them (please be nice!), and to inspire new thinking. We would be very interested to hear your comments and answers to the various questions we pose. You can do this in three ways:

• By tweeting us @FPH
• By emailing us via policy@fph.org.uk
• If you’re an FPH member, by joining our Public Health Funding Campaign ‘sounding board’ and getting involved in the further development of our thinking. Email policy@fph.org.uk to find out more

The final thing to say is a huge thank you to everyone who has contributed to the Public Health Funding project so far. We are extremely grateful for all your help and please do continue to get involved. Click here to read the discussion paper. 

Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group, and Lisa Plotkin, Senior Policy Officer and FPH’s Public Health Funding Project Group Lead.

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I first read George Orwell’s 1984 when I was fifteen and it terrified me. Never had I experienced such an acute realisation of the importance of human freedoms and civil rights. This never left me during my first career working for ‘the state’ as a psychiatric nurse within the National Health Service, and it has become ever more salient during my current career working for ‘the state’ in public health.

Public health is first and foremost a belief that a better world is available to us through planning, organising, collaboration and action. A world with less disease, fewer premature deaths, and greater equity in the achievement of human flourishing and wellbeing.

It goes without saying that all potential actions can provoke debate and the voicing of concerns. Such concerns can be sincere or cynical, and it is helpful to be able to differentiate them in order to inform one’s best response.

This is where FPH’s Special Interest Group (SIG) on public health ethics comes into its own. Having secured the invaluable involvement of professional philosophers, ethicists and legal scholars, the SIG works to strengthen our understanding of relevant issues in political philosophy, ethics and law, and how to deploy these in our everyday practice. Leading the case for change requires engagement with such issues, as much as it requires engagement with the empirical epidemiological and healthcare evidence base.

Of particular relevance here is the recent report on the Nanny State Debate authored by Professor John Coggon Hon MFPH, Professor of Law at the University of Bristol. This resource, in which Professor Coggon generously makes the breadth and depth of his scholarship accessible to the public health workforce, provides the key facts one needs to know to be able to classify voiced concerns of ‘nanny statism’ and respond appropriately.

People can have heartfelt concerns about human autonomy and proposed restrictions on freedom of choice. I relate to this in light of my early experience of reading Orwell. Professor Coggon’s report reassures me that it is entirely appropriate to recognise and acknowledges these concerns. Dialogue is worthwhile, making use of empirical evidence to set out the issues and the benefits of action, while other relevant values can be introduced for consideration alongside freedom, such as fairness, equality, and solidarity. In this way, progress can be made.

Alternatively, vested interests whether financial or power-based or both, can cynically seek to prevent action to protect or improve population health. I suspect we will each have had our own experience of this in one form or another. Professor Coggon clarifies how claims of ‘nanny statism’ can be deployed to shut down debate and block action. Direct attempts to engage and persuade, through evidence and appeals to justice, are unlikely to be effective. As public health professionals we need to know how to craft public responses to constructively maintain debate and momentum for action.

In summary, I found The Nanny State Debate to be concise but hugely thought-provoking, and a valuable addition to my public health ‘toolkit’.

At a time of ecological crisis, growing inequalities, and stalling life expectancy we need evidence-based and values-based planning, organising, collaboration and action more than ever before. As a practitioner on the public health front line may I commend Professor Coggon’s report to you, and urge you to read it and put it in to action.

Written by Christopher Littlejohn FFPH, Deputy Director of Public Health, NHS Grampian. 

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Since its foundation, the Faculty of Public Health (FPH) and the organisations from which it was built have advanced public health standards, which is done on the basis of continuously evolving knowledge of what constitutes best practice and policy. In turn, this knowledge is based on the best quantitative and qualitative evidence available. The nature of this evidence has also evolved. Controlled, and, where feasible, randomised trials are now the source of a great deal of the best evidence about what works, what doesn’t and what represents good value for money. The health of the public now relies on such evidence.

Perhaps the main role of FPH and of its parent Royal Colleges with regard to evidence is to make sure it is infused into the professional lives of their members and fellows and is applied – through the curriculum, through career advancing membership and fellowship examinations and assessments, through courses, training standards and wider CPD, through journals and policy statements, and through their networks of advisors. This function is often called evidence mobilisation.

Importantly, FPH also provides powerful incentives to excel – prestigious and eponymous prizes for example. These are often awarded for excellence in evaluation and development and then, through personal example, for pioneering and promoting better practice and policy based on this.

FPH and RCP (The Royal Colleges of Physicians) also provide welcoming professional homes – attractive environments in which practitioners and policy makers engage with the latest evidence and guidance and decide how it might inform and change their practice.

But this Royal College model of continuous improvement was not adopted by some other professions until very recently. It seems astonishing that until 2014 there was no such institution for the police, and until 2016, no professional body for teachers in primary and secondary education.

Since evidence has come a long way in the last few decades across all of these policy areas, it seemed to me that a declaration on evidence, signed by the relevant professional bodies, would strengthen a culture of evidence-informed policy and practice in these institutions and in the professional lives of their members and fellows.

As an honorary fellow of FPH and a member of FPH’s Academic & Research Committee, I drafted this declaration and then took it through the boards of the Academy of Medical Royal Colleges, the Chartered College of Teaching and the College of Policing. It was signed by leaders of all the Royal Colleges and police and teaching institutions at the Royal Society on 7 November 2017. This event was facilitated by the Alliance for Useful Evidence and chaired by the former Cabinet Secretary, Lord O’Donnell. The Faculty president, Professor John Middleton, signed for FPH.

The signing ceremony at the Royal Society*

This declaration signals FPH expectations of all its members and fellows with regard to evidence and also signals its commitment to support high quality evaluation.

At the signing event at the Royal Society I introduced the declaration and commented that:

This is a unique meeting of leaders of professional bodies in healthcare, teaching and policing. Teachers, police officers, doctors and dentists make up a sizable proportion of the UK workforce. The influence of the institutions represented here extends to more than one million professionals across the UK and more widely. This event is testament to the great importance of evidence for our professions and for the public we all serve.

*The people featured in the photo are:

Front row, left to right, Chief Constable Ian Hopkins, director, College of Policing; Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges; Dame Alison Peacock, chief executive, Chartered College of Teaching. Back row, left to right, Lord O’Donnell, former Cabinet Secretary; Professor Jonathan Shepherd, declaration author; Jonathan Breckon, director, Alliance for Useful Evidence.

Written by Jonathan Shepherd, professor of oral and maxillofacial surgery at Cardiff University. Jonathan is a fellow of the Royal College of Surgeons of England and the Academy of Medical Sciences, and is an honorary fellow of the Royal College of Psychiatrists and the Royal College of Emergency Medicine. He is a member of the Home Office Science Advisory Council and the What Works Council at the UK Cabinet Office.

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The Public Health Dashboard is an online, easy to use tool providing information at your fingertips on a number of indicators related to local activity to improve the public’s health and wellbeing. You can learn more about the tool, the data it presents, and how to use it here.

Tools like this one are aimed at local decision-makers, such as senior council officers, to help inform their investment decisions. This will be especially useful when, at some future date, the public health grant fence is removed. At the moment, the tool includes the following local authority service areas:

• Best start in life
• Child obesity
• Drug treatment
• Alcohol treatment
• NHS Health Checks
• Sexual and reproductive health
• Tobacco control
• Air quality (interim indicator)

Based on feedback, PHE (Public Health England) and the Faculty of Public Health (FPH) have embarked on a partnership to consider the inclusion of wider determinants of health indicators in the tool and ensure that the voice of the public health workforce is reflected in the final outcome. Our members believe that if this tool is really going to help them make the case in their local authority for more investment for the interventions or services that keep us healthy and well, then indicators that speak to places, sustainability, good jobs, and community cohesion need to be included alongside the mandated services.

However, there are potentially hundreds of ‘wider determinants of health’ (WDOH) indicators that could be included in the tool. To come up with a manageable list of indicators to consider in more detail, we surveyed FPH members about influence and impact. Here is a summary of what they told us:

The Top 5 indicators that councils can influence

• Active transport
• Number of premises licensed to sell alcohol per square kilometre
• Density of fast food outlets within 400 metres of schools
• Density of fast food outlets
• Access to parks and recreation spaces

The Top 5 indicators that impact health and wellbeing of local residents

• Overcrowded households
• Social isolation in adult social care users
• Fuel poverty
• Statutory homelessness
• Active transport

The survey findings provided us with a wealth of information about influence, impact, and future priorities for our members in terms of the work that they are currently doing locally and also what they think will become more important over the next 2-3 years.

We then used our survey findings to inform two workshops held in London and Birmingham in early November. The workshops were attended by FPH members working in local authorities. Over the course of two afternoons, we had lively and interesting debates about the indicators and how a simple tool like the dashboard could best represent a complex area, such as the wider determinants.

The PHE team is still considering the next steps in terms of how – or indeed if – to incorporate the WDOH indicators into the tool. We hope to use the findings from this work to do a larger project, examining how our members and others working public health can better influence spending in their local authority to tackle the wider determinants of health.

If you would like to get involved in our work or learn more about this project, please email policy@fph.org.uk or click here.

Written by Lisa Plotkin, Senior Policy Officer, FPH

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A thread that runs through the entire Public Health Funding Campaign is the need to demonstrate the value of public health and the vital work public health professionals do. As Steve Brine, Minister for Public Health and Primary Care, said earlier this year:

The competition for resources isn’t getting less fierce. We all need to get better and smarter at making the case for our share of resources.

As well as gathering and generating the evidence we need to make the case for investing in public health across our three policy ‘asks’, we wanted to find a way to visually bring it to life as well.

As you’ll know from this blog, it’s challenging to find photos that communicate what public health is and the diverse nature of the work our members do, so we decided to change that.

We launched a photo competition to challenge our members and wider public health community to take a photo that illustrates what ‘public health looks like’ through their eyes. The aim was to celebrate the breadth, diversity and importance of public health in the UK and around the world, and we were blown away by the entries.

From the moment we launched the competition in mid-July, we were overwhelmed by the positive responses we received, so it’s important to take this opportunity to thank absolutely everyone who helped us make it such a success. When we closed the competition in October we’d received over 200 entries, including some spectacular images covering a whole range of public health activity from community outreach programmes combating loneliness to immunisation clinics in the Middle East. A large chunk of the entries we received were from non-members, indicating how many people are engaged in FPH and the valuable work our members and other public health professionals do.

The story is not over yet though. Our judging panel, made up of both public health and photography experts, met on 13 November to narrow the impressive array of entries down to a final shortlist. Before beginning the judging, the panel agreed that they wanted each of the selected photos to tell a public health story in its own right and be visually arresting as well as technically proficient. They also wanted the final shortlist as a collection to showcase a broad and diverse range of public health activity. In the end the standard was so high that, instead of 20 photos, this shortlist ended up including almost 30.

Vote for your favourites!

It’s now down to you, our members, to decide on the ten photos that will be displayed at FPH’s first ever photography exhibition. The winning photos will also have a permanent home on our website, and will be used as a travelling exhibition, displayed at key events throughout the year.

Please get involved by taking a look at the shortlisted photos, then voting for your five favourites via this link.

We are so excited to hear your views on the final photos, which we can all use to celebrate public health as we see it and strengthen the case for increased funding of our vital public health services. We hope they make you proud to work in public health because they make all of us at FPH proud to represent you.

To cast your vote, click here!

Written by Rachel Thomson, Specialty Registrar and member of FPH’s Public Health Funding project group. You can follow her on Twitter @rachel_thomson. If, like Rachel, you’re a Specialty Registrar and want to get policy & comms experience by joining our Registrar Project Scheme, email policy@fph.org.uk to find out how you can apply.

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As part of FPH’s Public Health Funding campaign, we are undertaking a project examining the role that NHS organisations play in prevention.

We have received an award from the Health Foundation to carry forward a varied work programme over the course of 9 months, involving our members from across the UK and other key partner organisations. The project aims to:

• Build a better understanding of how the NHS currently delivers prevention
• Understand what ‘good’ prevention in the NHS looks like
• Explore the barriers and enablers for NHS organisations seeking to take a more preventive approach
• Determine initial priorities for increased investment or focus – including interventions, approaches, and workforce needs

As part of our work so far, we have commissioned an evidence review exploring prevention in the NHS, which looks at 3 main topics:

1. What are the main types of prevention work researched in various NHS settings?
2. What are the benefits of prevention programmes in the NHS?
3. What helps and hinders prevention in the NHS?

The review is a unique and fantastic overview of prevention approaches in different NHS settings. It looks at impact, what works and what doesn’t, and what might improve current approaches if done well. The review highlights the importance of a systems approach, and engaging with both staff and the public. For a summary of some of the main takeaways please have a read of this blog or have a read of the review itself.

We also held a stakeholder workshop in October gathering expert opinions on prevention in the NHS, which we used to inform part of FPH’s submission to the NHS long term plan consultation. Attendees at the workshop included representatives from NHS England, Public Health England, Cancer Research UK, and the Royal College of Physicians.

A key takeaway from the day was that this is a complex topic, but colleagues across the health field are committed to supporting the NHS to do more, better, and system-wide prevention. We will soon be publishing our first in a series of discussion papers, summarising our learning so far and discussing some of the tensions we still need to reconcile. We’ll also be posing some key questions around the evidence base and priority areas for action that we will need our members to help us answer. We then plan on hosting two more workshops in the Spring to continue building our evidence-base and drawing together expert advice and consensus.

This is a really exciting piece of work and has been expertly supported by the wider FPH team and our Public Health Funding Advisory Board, who graciously give up their time to contribute. Please stay tuned to the FPH blog and follow FPH on Twitter to hear more about the progress of the campaign. If you wish to comment, contribute, or donate to the campaign please contact policy@fph.org.uk or visit the public health funding page of the FPH website by clicking here.

Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group

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We’re calling for the UK Government to invest in a Prevention Transformation Fund to support the upgrading of prevention and early intervention activity in local authorities in England in next year’s Comprehensive Spending Review. (This is the Treasury-led process to allocate resources across all government departments.)

The recognition that local authorities have a much greater influence on the wider determinants of health was the reason for the transfer of public health from the NHS to local authorities in 2013, and we were pleased to see local authorities again acknowledged as “leaders in local health improvement” in the Department of Health & Social Care’s (DHSC)’s recently published vision for prevention.

The vision recognises that the enormous potential of councils to improve the health and wellbeing of their residents rests largely on their ability to “tailor public health services to local need, to support economic growth, and to influence the wider determinants of health through policies on housing, leisure and other services”.

However, in recent years, local authorities’ ability to do just this has been severely curtailed by extensive cuts to the public health grant and wider council budgets. Most authorities have just about coped with budget cuts while maintaining a high level of standards, but our members working in local public health teams have told us they have reached the absolute limit of the savings they can make without adversely impacting the wellbeing of their residents.

Local authorities have enormous potential to improve the health and wellbeing of their residents, but to achieve it, they need both the funding and the freedom to do exactly what is asked of them: tailoring services, developing new and innovative ways of working and of engaging with their communities in order to best meet local needs.

We believe a dedicated Prevention Transformation Fund, separate from and in addition to the ring-fenced grant, would give local authorities back the ability and freedom to do just this. Our recently published discussion paper, developed following extensive consultation with our members and other stakeholders, outlines why we believe a Prevention Transformation Fund is the right approach, as well as initial ideas about how large the fund should be, what it should pay for and where the money for it could come from.

The ultimate aim of this work is to change national policy to benefit the health of the public and, in doing so, we want it to reflect your voices. We’re very keen to continue to get feedback on the paper from our members and other stakeholders, including answers to the following questions:

1. What should the high-level objectives of the fund be?
2. What conditions should be attached to the fund?
3. What should we expect to get from this investment and in what timeframe?
4. What are the accountability arrangements?
5. What would the likely consequences be if we didn’t invest in prevention transformation?

We will be publishing a revised version of the discussion paper next month, including answers to the questions posed above, so please do have a read and send your comments to policy@fph.org.uk.

This is your campaign and your chance to influence national policy, so please get involved and help us make local government public health the national priority it deserves to be.

Written by Andrew Turner, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group.

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It’s the season of goodwill and I wanted to write a special extended version of my regular monthly column as a Christmas gift to you all. This month is packed with significant celebrations. Today (10 December) is the final Day of the Hanukkah Celebrations and it is also the 70th Anniversary of the Universal Declaration of Human Rights.

For all of us December is a time to reflect and enjoy precious moments with our family and friends. May we each, according to our beliefs, enjoy, mark, reflect, share and give in our December festivals. I wish you all a very Happy Christmas, Hanukkah, Bodhi day, Pancha Ganapati, Omisoka, Kwanzaa, Yalda, Zaratosht No Diso, Yule, Winter Solstice, and more.

Please do come back restored, refreshed and revitalised for the uncertain times we face. There has never been a more necessary time to protect and improve the health of the public and there has never been a more important time for the work of our public health community. Happy New Year!

Prevention is better than cure

On 5 November, Matt Hancock, Secretary of State for Health and Social Care, published his Prevention Vision. I welcomed this vision which paves the way for a Prevention Green Paper. You can read my full statement here. 

It is the first time that anyone has seriously talked about cross-governmental health in all policies since the 1999 ‘Our Healthier Nation’ white paper. We will be working closely with the Government on the publication of the Green Paper with the aim of making the case for prevention to help tackle inequalities, a commitment to health in all policies and to protect the well-being of future generations.

The right to health is a growing and significant idea which needs to feature in all our lobbies for health in every nation. Scotland is leading the way on rights to health, and the FPH in Scotland conference in November was a triumph showcasing clear thinking on the place of rights, law, and values in our work to improve the public’s health. I congratulate the FPH in Scotland convenor, Julie Cavanagh, the FPH in Scotland Committee, our colleagues at the NHS in Scotland and everyone involved in putting the event together. You can read more about the conference below and anyone interested in viewing my presentation can click here.  

Invest in public health and prevention

There is a swelling tide of bold public statements about the need to invest in prevention and public health. Amongst them, The Academy of Medical Royal Colleges in its response to the NHS 10 year plan, the President of the Royal College of Physicians of London, and the Association of Directors of Public Health. The Health Foundation argues the Government should invest £1.3 billion in 2019-20, reversing cuts since 2015 and investing according to need, with the most deprived areas benefiting early, but they also call for £1.9 billion in new investment by 2024.

The Kings Fund has added to this sea-change of thinking, in their call for investment in prevention and addressing the wider determinants of health. The King’s Fund name checks our emerging policy call for a ‘Prevention Transformation Fund’ to inject new funding into local government prevention services of between £1-2 billion per annum. We will be arguing strongly for this in the comprehensive spending review lobby and in our contributions to the public health green paper. On such a full sea are we now afloat. And we must take the current when it serves, or lose our ventures.

Poverty, destitution and health inequalities

The UN rapporteur Philip Alston’s hard-hitting report on poverty was published earlier this month. Despite receiving some negative critiques, we should all be deeply shocked – he was holding up a mirror for us and we should not blame the mirror for what we see. The inequalities in health I have fought against most of my professional career have taken a new low, a new level of injustice. For example, Universal Credit was meant to simplify the benefits system but in some cases has seen people wait for up to six weeks to receive their payments, meaning they’ve had to rely on foodbanks to eat. The Joseph Rowntree Foundation Report on destitution earlier this year showed us how national and local government are now the biggest creditors on the poor – not loan sharks and the gambling industry.

Fracking, sustainable development, climate breakdown and FPH disinvestment 

Our Sustainable Development Special Interest Group responded to two government consultations on fracking last month which you can read here and here. Our view on fossil fuels is ‘leave it in the ground.’ 

Professor Patrick Saunders and I visited the fracking pad at Little Plumpton in Lancashire to talk to locals and witness first-hand the disruption, stress and uncertainty they are experiencing. If you believe we don’t need shale gas because we have to prevent climate breakdown, it also follows that no community should be subjected to this. And as Greenpeace’s UK director said earlier in the month:

“After all the many millions invested, the changes in the law, the removal of local democracy and property rights and weeks of earth tremors, the industry has produced a deep hole in a muddy field with a small amount of very expensive gas at the bottom. Over the same period, onshore wind became the cheapest source of power in the UK.”

Also on the climate breakdown front, I bought a new electric car this month. And no I don’t see them as an answer to our air pollution problems. In my paper to the RCP History of medicine conference I described the Spice Wars of the 1600s, involving private armies and private corporations from the superpowers, England and Holland, plundering local wealth, destroying local culture, enslaving local people, mutilating and torturing as they went, in order to supply the treasures and everyday comforts of the wealthy back home, who were oblivious to what lives were destroyed to get them what they wanted. The modern day parallel with cocaine wars is obvious, but the parallel with more commonplace consumer trade today is only just coming into focus. Conflict minerals required for all our latest devices, and now with the growth of electric cars, it seems we will create newer bigger and better conflicts in the grab for lithium and cobalt.

News in brief

• Along with Presidents of the other medical royal colleges, I signed a letter to NHS England’s Chief Exec Simon Stevens calling for tobacco control measures to be part of the NHS’s Long-Term Plan
• I presented at the East of England’s Public Health Conference this month – you can take a look at my presentation here
• Chris Packham, our Chair of the Health Services Committee has published a thoughtful piece on population health on the RCP London website – it is very much in keeping with our aspirations for greater involvement and commitment to public health skills and thinking in acute healthcare
• Look out for BMJ opinion pieces on ‘The Nanny State’ and NHS charging migrants for healthcare

FPH in Scotland Conference, Nanny State report, Universal Declaration of Human Rights, migrant health

Scotland is leading the way on rights to health and their conference in November was a triumph of clear thinking on the place of rights, law and values in our work to improve the public’s health. I congratulate FPH in Scotland’s convenor Julie Cavanagh, the rest of the Committee of the FPH in Scotland, and everyone involved in putting the event together.

The conference also saw the launch of our Nanny State report by John Coggon, Professor of Law at Bristol University. The public health community needs to grow its understanding of law and how to use it and apply it across the full range of our work. High level intervention, through regulation and taxation are far more effective than exalting individuals to change and victim blaming. Our ‘Do No Harm’ campaign briefing shows how we should be pushing these legal protections in future trade deals.

At the Scottish conference many of the speakers, including myself, highlighted the significance of the Universal Declaration of Human Rights. This month also marks the 80th Anniversary of the arrival of the first Jewish refugee children to escape Nazi oppression on the Kindertransport. It is timely to reflect on our country’s honourable pedigree as a haven for people displaced by war and intolerance and to reassert our respect for human life and rights. With other Royal Colleges we will be calling on the Department of Health and Social Care to review the provisions for migrant charging, which we see as hostile, unhelpful and uneconomic. We have already published our own statement. Thank you to Robert Verrechia, Liam Crosby and Farhang Tahzib for their work on this.

Song of the month

Not particularly festive, but certainly party-time, good time blues. At the East of England conference I asked what was the best music to come out of the East of England? No-one said Benjamin Britten, someone said Pink Floyd, and someone was too shy to say ‘Ed Sheeran’. I played ‘The Shoals of Herring’, Ewan MacColl’s great song inspired by the Yarmouth herring fishers. But the answer to the question was ‘Doctor Feelgood’, the Canvey Island delta bluesmen. This is our version of one of their songs, ‘Down at the doctors’. 

Written by FPH President Professor John Middleton. You can follow John on Twitter @doctorblooz.

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