Better Health For All

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.