Better Health For All

We, as a nation, will strive together to build a Culture of Health enabling in all our diverse society to lead healthier lives, now and for generations to come.

You could be forgiven for thinking this bold vision came direct from the mouth of a secretary of state for health, a prime minister, or better still the queens Christmas speech. In fact, it comes from a US thinktank the Robert Wood Johnson Foundation . But it got us thinking at FPH about whether we could build as a compelling a vision to advocate with policy makers, and if so, how we could work with our wider civic society to make this happen.

A big question!

We started by exploring the following (slightly smaller) questions: What do we mean by a culture of health in the UK? Is it helpful terminology? What assumptions are we making? How close are we to a culture of health and how is it different to the status quo?  And finally – what is the role for the Faculty of Public Health?

What do we mean by a culture of health in the UK?

In the UK, recent reflections on a Fifth Wave of Public Health perhaps come the closest to describing a culture of health.  It is emerging as we develop new approaches to complex public health challenges e.g. obesity, social inequalities, loss of wellbeing; all in the context of stresses on population, environment, climate and the economy.

It requires commitments from a range of social actors and structures: government, law, education, business, communities, arts…    However, we know that each of these have the potential to both promote and inhibit a culture of health.

Is it helpful terminology?

We are a long way off from being able to articulate a vision for a UK culture of health with the same clarity and conviction as the RWJF; but the sentiments are present in policy emphasis on systems approaches, integration and reach into the community and voluntary sector.  Additionally, the Welsh Government’s focus on ‘wellness’, NHS Scotland’s focus on fairness and social change and discussion of a ‘social movement’ for health in the recent Prevention paper in England all contribute to a vision of health as a key value in society.  The challenge is 2-fold – how these polices are enacted and interpreted within health and local government structures, and then, how these values are nurtured and developed in wider civic society.

Reflexivity is fundamental as a starting point – being aware of our own paradigms and how they differ from others.  The recent Health Foundation and Frameworks Institute Seeing Upstream report highlighted for me the real differences in expert and public understandings of health and the implications for practice.  At the first meeting I chaired as a public health practitioner, after previously attending in a voluntary sector provider capacity, a colleague told me that I ‘already spoke all the NHS language’.  9 years later, there is no doubt I am completely immersed in public health thinking, writing and speaking.

A culture of health in action

The changing place of smoking in our society provides a good case study and some experience to draw on:

This thought-provoking paper explores the changing culture towards smoking over the last 60 years concluding that change was facilitated by a number of factors interacting over time: the publication of evidence showing the link between smoking and non-communicable disease, a growing non-smokers advocacy lobby, ever-tightening legislation and policy, and the changing image of a smoker from someone who deliberately undertook a harmful activity to someone who is addicted to a harmful substance and needs support (individually and within their environment) to break the addiction.

The caveat, which is recognisable to us, is that cultural perceptions of smoking did not change uniformly across the population, there remains socio-economic and ethnicity related inequalities in smoking.  The authors propose that culture is a product of interactions at a ‘micro-social level’ – in this case smoking is ‘a social behaviour that responds to the convenience or inconvenience of smoking, and this is influenced by legislation, social attitudes and social prevalence in one’s own reference groups’.

Alcohol consumption is another example of an interplay between evidence, values, public opinion and policy, following a similar story arc to tobacco.

What is the role for FPH?

Recent consultation to inform the new FPH Strategy described the role for public health professionals to lead across systems, reframe public health issues to be of relevance to the public and value to policy makers, and to work at community and macro-policy level in the ‘Art’ and ‘Science’ of public health.  This makes us key facilitators in developing and promoting a culture of health.

So, we might be a way off realising a vision like the RWJF quote above, but we know that in public health we work in long story arcs.  For now, the achievable part of this vision is to collectively work through our networks, with awareness of how and when to best influence at micro and macro- level and that is a good start.

Join us in developing these ideas further, through the SIGs and committees at FPH and at the forthcoming workshop on Means, ends, and ethics in the ‘culture of health’ agenda as part of the pre-conference programme at the PHE Conference 2019.

Siobhan Horsley, Specialty Registrar in Public Health on behalf of the FPH Health Improvement Committee. You can follow Siobhan on Twitter @siobhanmari

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My name is Claire Beynon and I am a Specialty Registrar in Public Health in Wales. I am passionate about reducing childhood obesity in the UK and wanted to explore how the wider determinants of health impact childhood obesity in children after accounting for deprivation.

One of my placements gave me the opportunity to work with the Nuffield Trust and University College London (UCL) as well as my home institution of Public Health Wales. I used the Childhood Measurement Programme data for Wales collected over the last five years and matched this to the wider determinants of health by local authority area.

Following a presentation of the results to the Welsh Government and Welsh Local Government Association I produced a simple one page summary of the research to share with local authority staff.

The idea of this simple summary was to turn research language into plan English and to communicate the findings of the research clearly.  This work was also timed to influence the Wales Obesity Strategy (Healthy Weight: Healthy Wales).  For more information on the study please contact Claire.beynon@wales.nhs.uk

Work undertaken by Public Health Wales, University College London and the Nuffield Trust.

Written by Claire Beynon, Specialty Registrar in Public Health, Public Health Wales

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“I would like you to close your eyes. Imagine that you have lived on the Moon for 15 years, and now you are returning to Earth. You land in Yemen. It is a very peaceful country. Begin to imagine a peaceful Yemen.”

I was sitting in a grand but tired Council room in Birmingham’s Town Hall. I was aware of a slight nervousness, my own, mingled perhaps with that of the others who were present; Yemeni diaspora from across the West Midlands, humanitarian aid groups, Members of Parliament and people like me who are connected to Yemen in some way. I grew up in a city called Taiz which has been hit pretty hard by the “Invisible War”.

The idea for the event came just four months before. I had been invited to an All Party Parliamentary Group for Yemen event and I met Taher Qassim for the first time, the founder of Friends of Yemen. As we enthused about Yemen, we shared our pain, even despair, at the apparent impossibility of Yemenis from different sides of conflict being able to work together.

While we shared, something new was sparked; hope. Now hope is an intoxicating thing where there has been none; we were both undeniably excited. We speculated. As the world awakened to the tragedies in Yemen, perhaps Yemenis, not only in Yemen but also right here in the UK, would be feeling as we did. We would host an event, we would have it in Birmingham, and it would be about peace. It might not work, but hope had thrown us into an open space of risk and believing in others, shouting a peace cry convinced that others would join.  Taher then started to contact different organisations and individuals to make the workshop happen.

And now here we were. It was a Saturday afternoon, yet 50 people had gathered from far and wide to be part of a new conversation and movement. Perhaps I was nervous because it was new, but I sensed the undercurrents of suspicion. Some more overt; a whispered “which side do you support, you must know there is only one side that should win?” I pointed silently at my little wooden badge that said “I’m with Yemen”. Would it be possible to put these differences aside?

We were being led by peace-advocacy worker Kate Nevens from Saferworld; it was her fun but authoritative voice that rang out now. I did as she said, and closed my eyes.

I was landing in Yemen after 15 years on the Moon. Despite the benefits of imaginary travel through time and space, to begin with I only imagined complete desolation. The silent cry of mothers. The abandoned shells of homes, hospitals, markets. Tiny bodies struck with cholera, life literally running out into the ground. I was so used to these thoughts that they filled my mind.

But Kate went on: “Think about what it would look like on the streets in a peaceful Yemen, what would the children be doing? What would you see?”

Slowly, I imagined the view from my bedroom window where I grew up, the light wind in the fruit tree where the little yellow weaver bird was making her nest.

The hundreds of tiny lines of smoke rising from the mountain slopes as villages baked their bread. The peaceful streets were far from quiet, clattering with the sounds of laughter, bustling with greetings and street venders, goat herders and honking horns. Along the little rough stone alleys between the houses washing lines full of colour billowed out. The school playgrounds were full. Even as dusk fell, no one feared to go outside. Children wandered through the balmy evening eating toasted watermelon seeds as the old men watched on street corners and drank their tea.

I realised that tears were pouring down my face. I had not thought of Yemen in this way for so long. In all my grief about the War, I had stopped remembering her beauty. But the spell was breaking. I listened in absolute wonder as others across the room called out what it was that they had seen; everyone was describing the same thing. In almost no time, we had covered a board with our vision, scribbled on paper shapes of hearts and doves.

The scene was set: we were gathered together for peace. The rest of the afternoon sped by. We watched a short film about the infrastructural impacts of war, providing context for why action for peace is so crucial. Guest MPs held a panel and spoke of their love of Yemen, support for the diaspora and commitment to speak up for peace. Their presence and contributions felt deeply honouring, giving power and purpose to our fledgling peace movement.

Bursting with ideas, snatches of conversations and new-found friendships (and also very good sandwiches), we split into four workshops to design small projects that we as the diaspora could initiate to support peace in Yemen.

Group themes included children and young people, women, mental health, and local humanitarian organisations. Such was the enthusiasm after our learning, an extra group was formed on sustainable peace. Everyone seemed to get louder and louder as we considered current challenges, shared connections and drew our ‘headlines’ as if they were newspaper stories.

At the end we gathered back as a whole room, and discussed our next steps. We wanted to do this again. We wanted more MPs to be involved. We wanted other regions to join the movement and form a national platform for the Yemeni diaspora and friends to act together for peace.

We also took some pictures, swapped numbers, and laughed a lot. Trying to get out of the room in time for closing was joyful chaos, like a peaceful Yemeni street.

If you have been wondering, as I was, whether it is possible after so much violence and conflict to find a way to come together, I think we would like to say: there is hope for peace in Yemen. We are ready for a new movement, and it has already started. I hope you can be part of it.

To be part of this new ‘Together for Peace in Yemen’ movement contact Taher Qassim via email: taherqassim@gmail.com. You can get involved in many ways that include; helping your region join the movement, asking your MP to join ‘Friends of Yemen’, being part of one of our project subgroups, or requesting a free “I’m with Yemen” badge.

Written by Dr Rachel Handley, Vice-Chair of the Faculty of Public Health’s (FPH) Yemen Special Interest Group (SIG). To join or to find out more about the SIG, click here.

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Air pollution impacts us all – from our first breath to our last.

What is Clean Air Day?

Clean Air Day is a campaign coordinated by Global Action Plan, a charity who aims to help the UK discover what is good for us, and what is good for the planet. The purpose of Clean Air Day is to raise awareness about the issue of air pollution, and to learn how we can each make small changes to drastically improve the quality of the air that we breathe.

Why?

As you might already know, we have reached a crisis point with current pollution levels in the UK, which have now surpassed legal EU limits (1). Only a few weeks ago residents in West London had been warned to avoid jogging due to the dangerous levels of pollution at that time (2). Exposure to air pollution has many potentially negative consequences for our health, which can result in an increased risk of lung cancer, high blood pressure and cardiovascular disease. Furthermore, air pollution could trigger asthma in children, or make symptoms worse for sufferers. Shockingly, is thought that up to 36,000 deaths per year in the UK can be accounted for by air pollution.

Whilst the hard facts and stats may seem overwhelming, they are necessary to illustrate just how damaging the effects of pollution can be. However, you’ll be glad to know – it is not all doom and gloom! By making small but necessary changes to some of our daily activities, together, we can significantly reduce air pollution.

How?

It can be challenging to get involved with an “invisible issue” such as air pollution. A lot of the time, we can’t physically see air pollution, so it can be difficult to understand just how bad the problem is. Furthermore, air pollution levels vary from area to area, and will even fluctuate throughout the day. (You can check the pollution levels in your area at https://uk-air.defra.gov.uk).

I like to imagine that there are two “spheres” of pollution – one within our homes, and the other within our neighbourhood. There are small changes you can make to positively impact both of these spheres.

At home

There are several steps to limit the negative effects of pollution at home. They may sound simple – and that’s because they are!

1. When cooking, open the window and/or turn on the extractor fan if you have one.
2. Vacuum regularly to reduce the amount of dust.
3. Limit the use of a fire/wood-burning stove.
4. Burn dry, well-seasoned wood or smokeless fuels if you have an open fire or barbecue.
5. If redecorating, choose paints with a low volatile organic compound (VOC) composition.

In your neighbourhood

It is well known that reducing both the amount you travel by plane or car can result in a significant reduction in the wider levels of air pollution. However, depending on where you live, it may be unrealistic to not use or own a car. If this is the case, have you considered:

1. Switching to walking, cycling or public transport? Walking and cycling are not only good for the planet, but they are also great for your health! Make an experience of the walk or cycle, particularly when the weather’s nice. Or, use Google Maps to see if there is a feasible public transport route to your destination.
2. Carpooling and car sharing? There are lots of ride share and short-term car rental apps/services popping up – check out https://www.sustrans.org.uk/what-you-can-do/use-your-car-less/car-clubs-and-car-sharing for more info.
3. Driving an electric vehicle?
4. Switching off the engine when stationary?
5. Ensuring your car is regularly serviced, particularly keeping the tyres inflated to increase efficiency?

Make a pledge

Finally, as part of the Clean Air Day campaign on the 20^th June, we are encouraging you and your family to make a small pledge of one (or more!) activity that you can alter in order to reduce pollution levels. This might be in your sphere at home, or in your neighbourhood, or even one for each sphere!

It is important to remember that small changes to the choices we make every day can make a big difference when widely adopted. So, what will you change this Clean Air Day?

Find out more at the Clean Air Hub, which contains lots of easily accessible information, material to raise awareness in your area, and other ways that you can get involved www.cleanairhub.org.

Written by Steph Pitt, a final year student at the University of Bath studying for a BSc Honours degree in Natural Science with a year in Industry.

References

• https://www.theguardian.com/environment/2018/may/17/uk-taken-to-europes-highest-court-over-air-pollution
• https://www.mylondon.news/news/west-london-news/air-pollution-bad-parts-west-16373897

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Today we’ve published the results of an opinion poll of over 300 NHS leaders about prevention. We commissioned this research as part of FPH’s larger project examining the role of the NHS in ill-health prevention.

With this poll we wanted to explore with an NHS audience several of the key issues that have emerged from our project’s extended consultation so far with predominantly a specialist public health audience. We were interested to see if the opinions, perceptions, and priorities of these two (sometimes overlapping, but often distinct) groups diverged or were in general alignment.

We explored the following six main issues:

1. Do NHS leaders consider prevention to be part of their job, e.g. is it a core, large, or small part of their departmental work?
2. Prevention priorities now and for the future – which approaches to prevention delivery (e.g. addressing common risk factors or targeting specific populations) is their local NHS currently prioritising and which approaches do they think their local NHS should be prioritising?
3. The effectiveness of NHS prevention activity – how effective or ineffective do they think their local NHS is at delivering its current prevention priorities?
4. Prevention budgets – on average, what percentage of their budget do they currently spend on prevention and what percentage do they think they should be spending? Do they think the NHS should reallocate its budget away from treatment and towards prevention?
5. The top barriers to NHS prevention activity – what is getting in the way of their department doing more or more effective prevention?
6. NHS advocacy for prevention – which taxes and regulatory measures do NHS leaders think would most benefit the health of their local population?

You can learn all of the answers to these questions and with some very brief analysis in our short summary paper here.

We think these results provide a useful (and much needed) benchmark for the current state of what the NHS does, spends, values, prioritises, and would like to do more of (or better of) when it comes to prevention. We also think they can help our members and others working on the frontline of healthcare delivery ‘do’ more prevention. Additionally, we also think they can inform the ongoing debate around the implementation of the prevention aspirations laid out in the NHS Long Term Plan.

But we’d really like to know what you think.

Please do take 10 minutes and have a read-through and then let us know what you make of our findings by emailing policy@fph.org.uk or tweeting us @FPH using #NHSprevention

Thank you so much in advance for taking the time to read and share.

Lisa Plotkin
FPH Senior Policy Officer

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On 13 February 2019 I visited Balukhali refugee camp (Camp 18 in the Kutupalong refugee camp) near Ukhia, a sub-district of Cox’s Bazar in South East Bangladesh. I travelled with my colleagues Dr Sam Watson and Ryan Rego as the guests of Drs Sirajul Islam and Mohammed Yunus from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Our purpose was to set up a study to test the utility of stool pathogen screening, rather than diarrhoea rates, as an outcome of choice in the study of Water, Sanitation and Hygiene (WASH) interventions. 

I had watched and read news reports about the plight of displaced Rohingya people, and as I travelled towards the camp I imagined that I would encounter a scene of squalor and desolation, reminiscent of the most extreme among informal urban settlements. 

What I found was completely different to my mental image. We drove into the camp along a pristine brick road. Dwellings were mostly made of bamboo, and were nicely laid out as in a French campsite. There were regular bore-hole outlets providing safe water at source, numerous advanced pit latrines, and no unpleasant smells. Many of the adult inhabitants were hard at work making a concrete drainage system in preparation for the coming monsoon. Children were in school. They looked healthy and were well-groomed. There were football pitches and plants growing in the many parts of the camp. 

Four things seem to have come together: 

1. The government in Bangladesh, after some hesitation, decided to accommodate the refugees – a country of 170 million can absorb another 1 million, said the Prime Minister. 
2. UN agencies, such as the High Commission on Refugees, were available to supply logistics and know-how. 
3. Money was provided on the back of the many NGOs that gravitated to the area. At the peak, over 150 NGOs had a presence in the camp. 
4. The effort was co-ordinated by the Office of Co-Ordination of Humanitarian Affairs. There was no ‘free-for-all’. 

Too good to be true? Yes, I am afraid so. If you look at “Open Street Map” (OSM) you will see that we visited a well laid out, orderly part of Ukhia. There is another section where the dwellings are much more closely packed among narrow lanes laid out in a disorderly way – much like a slum. Apparently, this was where the Rohingya settled following the initial, unanticipated influx that we all watched on our television screens. What lessons can I draw, tentatively, from my visit? 

First, what I observed is a good news story on balance – a tiny proportion of the worlds resources were harnessed and focussed on a real and present need, and the majority of the camps in Ukhia appeared to be in good order.  

Second, it is amazing what moderate resources can achieve, given an organising hand. I think there may be an important lesson in the contrast between the orderly, planned part of the Ukhia, and the disorderly sector where I understand WASH is less developed and intrinsic violence is prevalent. I hypothesise that planning for an influx of people lends itself to a favourable environment, whereas, once an urban area has developed in a disorderly way, it is much harder to remedy. 

Third, service provision in slums could learn a lot from refugee camps. Bamboo could be provided free of charge by NGOs to provide better insulated, more attractive accommodation. I fancy this would be a big improvement over corrugated iron shanties that are hot by day and freezing by night. Advanced pit latrines I observed in the camp would be a big advantage over the facilities usually provided in slums and their marginal cost is modest. Above all, a centrally co-ordinated approach is essential. I think cities that harbour slums should appoint officials with responsibility for informal settlements and a responsibility to co-ordinate investments and community engagement. 

Fourth, the problem for the Rohingya people is averted not solved – a long-term, sustainable solution is required and a return to Myanmar does not seem to be that solution. 

Written by Richard Lilford, Professor of Public Health at the University of Warwick. You can follow Richard on Twitter @rjlilford. 

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President’s end of term report – Part one: Professional public health development

As my term of office comes to an end, I have been reflecting on our major achievements over the last three years. You can read some of these in our latest annual report, which does, I think convey the spirit of work over a much longer period. I hope it presents a view of a Faculty in a respected position, ready to build further to create an organisation of which our members can be confident and proud. So, I won’t reflect on all of the business I have been involved in, but rather give my personal top ten things I’ve most appreciated. All of them reflect extraordinary team effort on the part of our members, our officers, our Board and our partners, and I am extremely grateful to all of you.

1. FPH as a trusted source of public health advice

The Faculty is now respected and restored in the public health lobby and in advice to government in the four nations. We are seen as the trusted, authoritative voice for public health by ministers, chief medical officers, public health agencies, civil servants and partners. We are in the tent. We are in the room, speaking truth to power. When we disagree, we are not disagreeable. Good public health practice has been very helpful to me in shaping the behaviours we need to demonstrate. Patience, courtesy, authority. We should hold to our professional independence, but we must ensure it is not personal prejudice, party politics or preaching we are beholden to. And we must speak well of our colleagues, having our disagreements in private and a united front in public. Our policies are written to a tone of voice policy, our behaviours are conditioned by codes of conduct for staff, members and Board trustees.

Our members should be confident that our voice and our concerns are being heard in the places that matter.

2. Contributions to national policy making

Over the last three years we have made substantial contributions to national policy making – more behind the scenes and under the radar than shouted from the rooftops. Among these, our responses to the NHS long term plan; the Call to Action Scotland; the Brexit ‘Do no harm’ campaign and work on healthy trade; our strategic case for funding for prevention and public health including the role of NHS in prevention. Our special interest groups and committees have contributed to 29 position statements and consultation responses. I am grateful to Sue Lloyd for her fantastic work this year as Board lead for policy.

3. Training offer

I am always impressed by the quality of our new registrar intakes each year. I am also heartened that they are all finding consultant jobs on leaving the scheme. We have undoubtedly improved the training offer through the curriculum review 2015 and will do so again through the review starting this year. I am grateful to Brendan Mason, Samia Latif, Suzanna Mathew and the staff team for their considerable work in raising our standards through the curriculum, the education committee and related bodies. It is our lifeblood. I am particularly delighted by the scheme we have for Specialty Registrars to undertake national project work with us. So far 18 registrars have been involved in project work on funding for public health, Brexit, FPH strategy, ethics and values work and other special interest groups.

4. FPH governance and strategy

Our business in support of workforce, training, standards, membership and governance has been substantial and puts us in a good place as we seek to build a new strategy to 2025. Outstanding elements of this work have been the Workforce strategy; our work with PHE on quality standards for public health teams; our Board membership development group led by Sue Atkinson; our new website; our revitalised attention to Equality and Diversity, thanks to Harry Rutter and Megan Harris; and our new governance committee. Our members supported 171 advisory appointments committees in 2018, a record in my memory. Employers value our advice on the role of public health and making these vital appointments. Our Registrar, Maggie Rae has been the key driver of this work and I am most grateful to her for all she has done in this most unsung, essential but unexciting area of our business. Our finances, thanks to Ellis Friedman and the staff team are better placed than in previous years, with a balanced budget planned for 2019. I am also grateful to Ted Schrecker and Eugene Milne for the awesome job they have done in making the journal the successful, authoritative, international journal it is today.

5. Wales: a beacon for the public’s health, and future generations

I was heartened by my first official visit to Wales in January 2017. I was inspired by the potential of the Wellbeing of Future Generations Act and the central role for Public Health Wales in taking forward the health in all policies approach and the sustainable development agenda. In two further visits I have watched the confidence grow in Welsh colleagues taking up this baton, and believe it is where we all need to be. I am also profoundly grateful to Angela Jones for revitalising the work of the Faculty in Wales.

6. Health come all ye! Scotland

The Committee of the Faculty of Public Health in Scotland, led by Julie Cavanagh, have also grown their influence and made themselves the go to voice for public health in Scotland. I’ve spoken at two Scottish conferences, met with two health ministers, given my support to the development of the Call to Action, and the work of the CFPHS on Scottish Public health reforms. The UK Public Health Network was impressed with Scottish leadership on health as a human right, the theme of the 2018 conference and the launch pad for FPH’s Nanny State report.

7. Public Health walk, Belfast

David Stewart’s Walk in Belfast recounting the stories of the public health of the city he served as DPH was fascinating and inspiring. After our productive meetings with colleagues in Belfast in November 2016, the government collapsed and colleagues in the north still find themselves in difficulty getting policy agreed and services developed. I have been made very welcome in visits to Irish colleagues in Belfast and Dublin and we will build on these relationships for the future.

8. British public health in demand abroad.

Colleagues in other countries value and seek to emulate the British system of public health. Thanks to the dedicated work of our international registrar, Neil Squires, FPH continues to be involved in work with a wide range of international partners in the lexicon of public health acronyms. Among them, the International Association of National Public Health Institutes (IANPHI), the Association of Schools and Programmes of Public Health (US), the Association of Schools of Public Health Africa (ASPHA) and the Association of Schools of Public Health in the European Region (ASPHER). The European work is glued together by the World Health Organisation European office’s Coalition of Partners and through them we held productive meetings at Imperial College and the London School of Hygiene and Tropical Medicine last year. Our country-based special interest groups for Africa, India, Pakistan, Yemen and Sudan have been active. The India SIG have scored a significant result in getting a public health curriculum approved nationally, based on pioneering work by Sushma Aquila in the FPH Odisha community health workers training pilot.

9. Great public health hiding its light under a bushel

I have been privileged to observe just a few of our brilliant colleagues work first hand and heard about very much more in conferences over the last three years. I have been involved in business meetings and conferences in all regions of England, in Scotland, Wales and Northern Ireland and also in the European Public Health conferences and the World Federation of Public Health Associations in Melbourne, 2017.

Great public health goes unsung in the Inter-island public health forum, which I’ve seen in Jersey 2017 and Gibraltar 2018; thanks Susan Turnbull and Vijay Kumar; David Ross and colleagues gave a great series of presentations on the work of the Defence Forces public health service in February 2018 in Lichfield. I’ve visited DSPH in Newcastle, Herefordshire, Knowsley, Sefton, Wakefield, Wolverhampton as well as attending ADPH regional committees across four nations. I was humbled and inspired by the work of the University College London Pathway Homeless health care team ward round, which has led to some collaboration with Alex Bax of the Faculty of Homeless health and inclusion.

10. Stand together, or fall, apart.

Partnership is a vital element of what we do.

FPH has been active as a key partner in forums, such as the United Kingdom Public Health Network. We are respected members of the Academy of the Medical Royal colleges. We have developed partnership agreements with the paediatricians, emergency medicine and dentistry. The Public Mental Health conference with the psychiatrists was outstanding. We have also restored our partnership with the British Medical Association and other health unions representing public health colleagues, through the Public Health Medical Consultative committee. We have been active in enhancing academic public health and its partnership with service public health, through our academic and research committee through the Academy of Medical Sciences, ‘2040’ report, the National endowment for Science Technology and the Arts (NESTA) for the Alliance for Useful Evidence and our Bazalgette lecture 2019.

The future

After a lifetime in service public health making partnerships work, I believe we need to see more progress on partnership at the national level. I am surprised at how little government departments and other national leaders think partnership. In an increasingly complex and inter-related world, it is essential that partnerships work at all levels, across all disciplines, and interests private public, user and community. Our FPH strategy 2025 seeks greater and more effective partnership working. It is crucial that we work together or divided, we fall. I urge everyone in the public health community to come together to explore better ways of working together.

Many thanks for all your support and interest in the work of the Faculty during my time in office. Please continue to give your support to my successor, Maggie Rae.

Yours in health,

John Middleton

Written by Professor John Middleton, outgoing FPH President

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Networking and working in partnership is second nature to me; however, the Synergy Award I received in 2018 helped me realise that these things take insight, creativity, knowledge, effort and time to be successful and have an impact. It was a huge surprise and accolade to be recognised for my partnership work aimed at addressing a range of deep-seated health inequalities challenges. Like many of you I have long recognised that multi-agency relationships and inter-professional approaches are required and that increasingly we need different skills and viewpoints to address significant public health issues.

It was motivating to be noticed for my innovation and integration of public health approaches across different areas of multiple vulnerability. It was most excellent to be commended for my collaboration with the voluntary, sector where, in partnership, I have highlighted health inequalities and social issues for the most vulnerable and It is more than rewarding to be valued and recognised for my contribution in developing these trusted relationships.

The FPH Special Interest Groups have provided further impetus and demonstrate commitment to working collaboratively in a range of exciting and challenging areas impacting upon the public’s health.  The SIGs have been an important vehicle to enable me to develop further shared commitments for children and young people; housing and arts and health – particularly the use of film as a powerful and impactful medium to raise awareness and promote public health approaches.

I wish the next winner of the Synergy Award success and use the opportunity to build on what you have achieved and to continue to extend the reach and impact of the FPH in addressing public health priorities.

Written by Karen Saunders, Public Health Specialist, Public Health England (West Midlands) .

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What do you do on a Saturday morning?  Ah, Saturday morning. The weekend has just begun. 48 hours of freedom. Maybe you’re working this weekend, maybe you’ve got plans with friends, or maybe you’re tackling the chaos that is the Tupperware drawer. We might spend the first portion of the weekend with some housework, homework or, maybe if you’re a student, a hangover. However, there are roughly a quarter of a million people across the world who participate in a Saturday morning parkrun. And believe me, it feels amazing.  

What is parkrun? 

parkrun is a weekly, free timed 5km held in parks worldwide and completely led by volunteers. Simply put, you pitch up to your local park at 9.00am, and at the sound of “go!” you walk, jog or run to the finish line. Operating in 20 countries, there are over 3.5 million parkrunners who have collectively run 221 million km (a gentle jog to and from the moon 285 times). 

Paul Sinton-Hewitt, who was awarded an MBE for his positive contribution to society, set up the world’s first parkrun in London back in 2004. (You can read the story behind parkrun written by Paul himself via this link.) From there, an increasing number of people joined. parkrun’s positive impact on public health is undeniable – we all know the mental and physical benefits of exercise – and so it follows that parkrun’s mission statement is “creating a happier, healthier planet.”  

Essentially, parkrun is a dream public health campaign, but what has facilitated its growth? Why does parkrun work so well? And what can we learn from its success?  

The Three Cs 

I like to summarise the fundamental aspects of parkrun’s success in three simple words, all starting with C. And no, sadly, the first word is not ‘Cake’ (heavily associated with the post-parkrun coffee and cake situation I seem to end up in each week).  

First, consistency. Consistency is key. Consistency helps people find a routine that works for them, and when something becomes normalised within a routine, it is never nearly as arduous as first perceived. For some, the idea of waking up before 9am on a Saturday and running 5km is an unbelievable idea, ludicrous in fact; but do it one week and you’ve pushed yourself out of your comfort zone. Return the following week, and the next, and next after that, you soon find yourself enjoying the regularity. It becomes habitual. And for any social change we may want to make – changing habit is certainly a good place to start.

Consistency is also seen at an individual level as people aim to improve their times each week. Having the times documented pushes people to try harder. It gives us something to work towards. A target to smash. A small win that just makes your day. parkrun is rewarding.

Secondly, we have community. One of the best things about parkrun is its inclusivity – regardless of your age, fitness or previous running experience, everyone is welcome to join in and become a parkrunner. With a truly welcoming atmosphere and complete absence of judgement, combined with the genuine desire to celebrate each other’s achievements, parkrun successfully creates a feeling of unity between runners. This enables people to feel positive, building confidence and encouraging them to return. Parkrun provides a sense of belonging.

Finally, collaboration. There is an idea of collective interest which runs deep within the roots of parkrun. Inclusive of both the volunteers (without whom parkrun would simply fail to exist) and the runners, everyone invests their time in making it work. parkrun defies popular theories of social change, such as top down and nudge, as it began with one initiator event which “snowballed” into something much bigger. This snowball effect would be lost without collaboration between individuals with a collective interest to improve our society. parkrun encourages people to work together.

Generating positive social change is a process, not a project. It can start with one idea that becomes habit. One idea that helps to grow, develop and empower people. One idea that acts as a catalyst for people working together. As the saying goes, ‘a journey of one thousand miles begins with a single step.’ While the effects of this saying may be lost from slight overuse (and the fact that it is completely cliché), its words stand nothing less than true. When looking at public health initiatives, we must try to think almost in reverse – what can we do to make this change normal and routine for people? How can we engage groups and build that sense of teamwork? What will allow this initiative to erupt and become the social change which we so wish to see? 

Written by Steph Pitt, a final year student at the University of Bath studying for a BSc Honours degree in Natural Science with a year in Industry.

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