Archive for January, 2019

Jonathan Shepherd

All the medical Royal Colleges and the independent, standard setting institutions which are the homes of engineering, architecture and other major professions, award prestigious, often eponymous, honorary appointments. By this means, national institutions celebrate and incentivise the public good which their professions deliver. In this tradition, the Faculty of Public Health (FPH) has developed its new Bazalgette Professorship scheme.

Nowhere, perhaps, is such an incentive needed more, especially for academics and their teams. The disconnect between academic public health and public health practice is clear; this has happened gradually but its effects are profound. Among the most important of these are that public health research is less focused than previously on solving the problems encountered in public health practice and that, as a result, trainees in public health are rarely attracted by the research products of, and potential career advancing opportunities in, academic departments.

A cause of this problem is the geographical distance between places where public health trainees and academics work, exacerbated by the absorption of public health into local authorities. This is in sharp contrast to academics and trainees in other branches of healthcare. In primary care, emergency medicine, dentistry and orthopaedics, for example, trainees are co-located with academic departments based in the practices and hospitals where academics practice their art and craft. This co-location and integration of training, research and practice, led by academics whose research is prompted and sustained by the everyday challenges of practice, is a model from which public health has largely withdrawn.

The march of evidence informed practice was largely prompted, and certainly accelerated, by practitioners deeply worried about the effectiveness of treatments available for their own patients; practitioners who have learnt trials skills, and then championed evidence informed change for the better. Separate practice from research though, as has happened in public health, and this motivation dissipates, and the precious evidence ecosystem in medicine, in which evidence generation, synthesis and mobilization are joined, fractures. Crucially, John Snow identified a source of cholera in Victorian London and took the handle off the Broad Street pump.

This disconnect is having negative effects in other ways too. For example, public health academics, because they have become separated from public health practice, are less able to demonstrate the significant contributions to the delivery and development of services which are necessary to compete successfully for clinical excellence awards.

As another example, although alcohol misuse is a major public health problem, medical presence on the Home Office health and enforcement alcohol forum (formerly the alcohol strategy group) comprises three liver doctors, a psychiatrist and a maxillofacial surgeon – practitioner academics all – but no public health academic. This may reflect Home Office blinkers but might it also reflect concentration of alcohol research relevant to practice and policy, and also real concern about the life destroying impact of alcohol misuse, not in public health but in these other disciplines? Surprisingly to clinical academics in other specialties, there has been little academic public health interest in putting NIHR funded findings about alcohol licensing into local action.

From this perspective, solutions suggest themselves. Strategically, public health academic departments need a physical presence in local authorities; professors of public health need to be co-located with public health practitioners and policy makers so that problems can be solved, hypotheses formulated and tested, and evidence applied together. Crucially, this would also benefit trainees, their supervisors and their research teams and make their endeavours more relevant, impactful and valued by local authority chief executives. But achieving this co-location, and evidence co-production and implementation is a major challenge. Other solutions are also needed. This is why the concept of an FPH professorship scheme came about.

The new Bazalgette professorships commemorate and seek to maintain the tradition of Sir Joseph Bazalgette, chief engineer to London’s metropolitan board of works in the mid-19th century who, through implementing his design for an efficient sewage system, did much to eradicate cholera across the city. Importantly, throughout this work, Bazalgette continued to train young civil engineers and provide independent advice to other British towns and cities – as well as places as far apart as Budapest and Port Louis, Mauritius. Recipients of this FPH honour will be scholars who, especially as team leaders, have translated their research to the benefit of UK population health.

FPH will appoint no more than one Bazalgette professor in any calendar year during which the holder will hold the honorary title of professor. Appointees will be fellows of FPH in good standing who have made a major contribution or contributions to public health by translating their own research. Since research translation involves collaboration, appointees will have built and sustained translation teams. These teams might include, but would not be limited to, NHS, civil service or local authority colleagues.

Two comments galvanised my thinking on this: the assumption expressed at FPH by a distinguished professor of public health that academics and practitioners are entirely separate groups, and the spontaneous reaction of a senior public health academic in my own medical school to the question why academics don’t consider themselves practitioners, “Well, we’ve tackled cholera haven’t we?”

Written by Jonathan Shepherd, professor of oral and maxillofacial surgery at Cardiff University. Jonathan generated the idea of the Bazalgette Professorship and secured funding from the Alliance for Useful Evidence to fund it, for which FPH is most grateful. Jonathan is a fellow of the Royal College of Surgeons of England and the Academy of Medical Sciences, and an honorary fellow of FPH and the Royal College of Psychiatrists. He is a member of FPH’s Academic and Research Committee.

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The purpose of the Public Health Dashboard (PHD), developed by Public Health England, is to support local decision-making by bringing existing comparative data into one place and making it accessible and meaningful to a wide audience. Its development is part of a wider Government drive to support transparency and local accountability for delivery across all public services and not just public health.

The PHD contains data on public health service areas that local authorities lead. These include mandated functions. The majority of data included in the PHD is already in the public domain, but by summarising the data the dashboard will help stakeholders understand how local authorities compare to one another. The PHD provides a summary of data in seven service areas: best start in life, child obesity, drug treatment, alcohol treatment, NHS health checks, sexual health services, and tobacco control. Alongside these is a single headline indicator on air quality. The dashboard is aimed at local decision-makers, such as senior council officers, to help inform their investment decisions and better support them to prioritise resources when it comes to improving the public’s health.

Tools like the PHD will be especially needed once the public health grant ring–fence is removed, to help non-public health professionals make good public health investment decisions. It is also intended that members of the public, the voluntary sector and service providers will use the dashboard to learn more about service provision in their area and how it compares to other areas.

The dashboard was released in ‘shadow’ form in October 2017, prior to a more formal release in July 2018. During the shadow period PHE invited feedback on the tool. Users suggested that data on the wider determinants of health would be a useful addition to the tool. At this time the Faculty also contacted PHE to discuss how we could work together to help develop the tool further. PHE and the Faculty agreed that the wider determinants was an important area that we could collaborate on.

It was agreed that we would seek views on the addition of the wider determinants through a survey, which the Faculty publicised to their members. We also jointly hosted two workshops to discuss the results in more detail. Working with the Faculty allowed us to do something far more user-centred i.e. ensure that we were able to speak directly to potential users of the tool and those who are responsible for local decision making.
Being able to tap into the expertise of the Faculty in running these types of events has been extremely beneficial. By being able to send out the questionnaire to all of their members, a far larger and more diverse audience was potentially able to participate.

Instead of those we traditionally seek views from (for example public health analysts) we were able to access people working in all areas of public health. Additionally, the Faculty’s endorsement of the Dashboard as a tool that could be used to facilitate discussion on investment in public health services with local decision makers is also extremely beneficial, as is the interest that they have helped to generate in the tool.

Over the course of two afternoon workshops in London and Birmingham, vibrant discussions were had with an extremely engaged audience. Participants were able to express their views and discuss the pros and cons of adding wider determinants into the Public Health Dashboard, the specific indicators themselves, and feedback on the tool itself.

The work is complex, but the workshops proved fruitful in providing some guidance as to what users find useful and would like to see. Work will now be undertaken to consolidate the outcomes of these discussions, with a view to creating a number of options for further discussion. Collaboration will continue with the faculty to share these options and seek further feedback and implementation into the tool in due course.

Written by Nicholas Coyle, Principal Public Health Analyst, Public Health England

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Calling all public mental health practitioners!

Are you practising public mental health? Are you developing and delivering evidence based policies and programmes aimed at advancing the public’s mental health and wellbeing?

If yes, then submit your work for the Sarah Stewart Brown Award for Public Mental Health and be in with a chance of winning the £500 cash prize that’s on offer. The award is an opportunity to highlight what you are doing and the impact you are making in enhancing mental health and wellbeing at a population level. It’s also an opportunity to highlight innovation and to share good practice with public health colleagues and with the wider public.

What is public mental health?

Public mental health has been described as the art and science of improving mental health and wellbeing and preventing mental illness through the organised efforts and informed choices of society, organisations, public and private, communities and individuals.

Good mental health and wellbeing are profoundly important to our quality of life and our capacity to cope with life’s ups and downs. They also help protect us against physical illness, social inequalities and unhealthy lifestyles. There are now a large number of evidence-based approaches to promoting mental wellbeing and preventing mental illness, and these are growing daily. They range from programmes to mitigate the impact of Adverse Childhoood Experiences (ACEs) through to tackling social isolation in the elderly.

Who is Sarah Stewart Brown?

For the last 20 years, Professor Sarah Stewart Brown has devoted herself to developing and promoting public mental health at the Faculty of Public Health (FPH) and in other settings. She chaired FPH’s Public Mental Health Committee from inception in 2007 to 2015 and before that worked with various FPH committees including the Mental Health Working Group.

Since 2003 she has been Professor of Public Health at Warwick University where she leads research and development in the fields of mental health and wellbeing and teaches on public mental health to medical and public health students.

As an advocate for public mental health, Sarah has sponsored the award with the aim of encouraging and promoting leadership and innovation in public mental health in the UK.

Now is the time to bring your work into the spotlight.

Who can apply?

If you’re a member of FPH, you work in the UK and you’ve played a significant, but not necessarily lead role in the development or implementation of an innovative approach to promoting mental health and wellbeing, you are eligible to apply.

Criteria for award

Submissions must provide evidence of:

  • Development or implementation of an innovative approach to mental health and wellbeing improvement at population level
  • Use of appropriate research evidence to inform practice
  • A sound plan for monitoring and evaluating the innovation
  • Engagement by appropriate stakeholders including service providers, partners and/or community
  • Potential for sustainability


  • Projects or programmes addressing secondary or tertiary approaches to prevention are not eligible for this award

The Award recipient will have:

  • Enabled public health mental health work to flourish and grow – either directly or by enabling others to act
  • Demonstrated innovation in the field of public mental health – doing things differently – thinking differently and / or enabling others to do so
  • Shown how their contribution has made a difference to individuals, to communities, to staff or to public policy

What can you win?

A cash prize of £500 which must be spent in a way that either promotes the work that’s already been delivered, or helps to progress the work in some way. For instance, it could fund the design of a discussion paper and associated comms or it could go towards an event.

How do you enter?

To nominate yourself for this award, please submit a proposal (500 words max.) that briefly outlines the work you’ve led, or enabled others to lead, and your plans as to how the award money will be spent. Email your submission to policy@fph.org.uk by 1 March 2019 or for more information, click here.

Written by Dr Mike McHugh, Public Health Consultant at Leicestershire County Council and member of the FPH Public Mental Health Special Interest Group (SIG). Follow Mike on Twitter @hguhcmekim.


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The fourth international LEPH (Law Enforcement & Public Health) conference was held in October 2018, with an overarching theme of disparities in health and criminal justice. We were delighted to be invited to speak about our work developing a national consensus agreement between policing and health (and not just because the conference was in Toronto!), and humbled by the amount of national and international interest it generated.

Attention to the links between public health and policing is growing at the moment, especially the concept of a “public health approach to…”. The conference showcased both the breadth and depth of work going on in this field internationally. In particular, it demonstrated that “a public health approach” is being applied effectively in law enforcement far beyond violent crime. This blog gives an overview of the different strands of the conference and picks out some highlights for us.

An opening presentation from Dr Eileen de Villa, Toronto’s Medical Officer of Health, set the scene, outlining the health needs of her communities, the inequalities and challenges and her hopes for their future. The crisis of opioid overdose is not at the same scale for us in the UK (and we hope never will be) – but the rest of her words felt very familiar, a reminder of shared values and challenges and the necessity of taking a shared approach to evidence, research and practice in order to meet common goals.

Wellbeing of law enforcement staff was a key theme at the conference, with powerful personal stories and evidence about the impact of trauma on emergency service workers. Work to develop a national emergency services wellbeing service, starting with the National Police Wellbeing Service in England and Wales was highlighted, along with Oscar Kilo (a joint Public Health England and police evidence-based wellbeing initiative). There was a real recognition that this is world-leading, and should be common practice across the international community. Not only is this essential to support and protect the protectors; but it also links to our own understanding of trauma and adversity as a cause of poor health and wellbeing.

The emerging discipline of epidemiological criminology, or ‘epicrim’, was explored. At its most basic this is the study of crime as a form of disease, but also more broadly involves merging the techniques and theories of epidemiology and criminology. Examples of studies were from the US and South Africa focussed mainly on gun crime. Many more examples of innovative inter-disciplinary policing and health research were presented throughout the conference. In particular, we were really excited by the work colleagues in Scotland are doing to develop the law enforcement and public health evidence base, with workstreams around vulnerability, better partnership working, information and data sharing, peer support and organisational wellbeing; and mental health crisis.

Violent crime is of increasing concern in London and other cities in the UK – and there were several sessions discussing public health approaches to violence. The Cure Violence approach began in the USA, and is part of a movement to recast violence as a health issue. Other examples included a data sharing, surveillance and analysis system in Wales enabling targeted early intervention. Traumatic brain injury was highlighted as a vastly under-recognised issue.

Mental health was another theme, with presentations focussing on evidence-based partnership approaches. The question of unintended consequences and fragile intersections between policing and mental health services was also raised many times: for example concerns that efforts to upskill police staff to better support people in mental health distress can lead to a scaling back of mental health services – and/or that scaling back of mental health services leaves police supporting individuals who need crisis treatment. This was a reminder that problems we are struggling with here in the UK are also being experienced internationally.

Colleagues from Public Health Wales presented on their Early Action Together programme which marries an academic and a practical intervention-focussed approach to Adverse Childhood Experiences (ACEs) and trauma informed services. ACEs were discussed in many of the presentations throughout the conference, and there was a strong commitment to early intervention and prevention.

There were many other strands of law enforcement and public health being explored – prison health featured strongly, with presentations ranging from the impact of austerity in English prisons to needle exchange programmes. Other sessions explored the role of public health and law enforcement collaborations to address alcohol; drugs; race; particular needs of indigenous and other marginalised communities; and the role of technology.

The oration was given by Professor Sir Michael Marmot and was a definite highlight of the conference. He spoke with clarity and energy about inequalities in a way that brought together the potentially quite disparate audience of academics and practitioners, from across law enforcement and public health. The intersection of evidence base and passion for social justice is always music to the ears of public health people – but to witness it also being shared equally by a conference hall of law enforcement professionals was a special moment.

Our focus as we presented the work that we’ve done to develop, agree and implement the policing and health consensus is also very upstream, and it was a privilege to be able to share that with colleagues from around the world. One of our main strengths so far in England has been our partnership approach, and we hope that as we collaborate with our colleagues internationally with their strong academic, evaluation and intervention skills we can together grow and embed a holistic approach to public health and policing that will demonstrably improve outcomes for the most vulnerable in society that we are all here to serve. We look forward to sharing our progress at LEPH 2019 in Edinburgh.

Written by Helen Christmas, Specialty Registrar in Public Health at PHE, and Supt Justin Srivastava, Lancashire Constabulary. You can follow Helen on Twitter @helen_christmas and you can follow Justin @SuptSrivastava. If you’re interested in policing and public health, you can also follow @police_health.

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