Better Health For All

Do you want to complete some of your CPD and learn about Health and Climate Change and Sustainable Development (SD) at the same time? Well now you can.

The FPH Sustainable Development Special Interest Group (SD SIG) has put together a series of fact sheets. Each resource is a two-page introductory summary of a major topic in sustainable development, with references and signposts to more detailed information. The resources explain the relationships between the work of public health practitioners, the causes and effects of climate change, and health. You can read these fact sheets, learn more about sustainable development and log this activity in your CPD diary.

The topics cover areas of knowledge such as ‘Principles of Sustainable development’, ‘Health benefits of action on climate change’ and ‘Sustainable food systems’ which includes issues such as the contribution of agriculture to greenhouse gas emmissions (GHGE). There are also some ‘action’ resources e.g. ‘Adaptation to climate change’ which gives examples of health impacts and the adaptation required and how the built environment can be more climate resilient.

At the end of each resource there are specific CPD questions as well as the general CPD diary questions and there are model answers so that you can learn as you go and get credits in your CPD diary.

These resources are useful to everyone; whether you are a specialist trainee addressing competency 5.7 or you are a specialist or educational supervisor who wants to learn more about climate change and health or you are supervising your trainee. A survey of both SpRs and educational supervisors showed there was some good work in this area but that SD needed to be more embedded into routine placements and projects and that SpRs should be empowered to be leaders in SD.(1)

We’ve made this link between the resources on the FPH website and CPD as in the last membership survey it was identified that members wished for more CPD support from FPH. CPD is something we all do every day; we learn as we go and don’t always need to go to a specific training course. Over time the aim is for other SIGs to similarly make the explicit link between their intelligence and resources and your CPD.

Why is health and Climate change important?

• Lancet commission identified in 2009, that ‘Climate Change could be the biggest global threat of the 21st Century’.(2)
• Climate change science is real, but it is often difficult to get our heads round. The impacts of climate change can seem like a long way off, and we know that politicians and all of us find it hard to recognise this and take action on threats that are in the more distant future.
• The co-benefits of addressing health and climate change together are clear, for example increasing active travel is good for your health and good for the planet.
• Health brings home the real story of the impact of climate change; imperative, immediate and life changing. People’s health is being damaged today by climate change through effects ranging from deadly heatwaves in Europe, (I write this on what is being anticipated as the hottest July day in UK ever!) to rising dengue fever in the tropics, major floods and devastating fires.
• “We cannot delay action on climate change. We cannot sleepwalk through this health emergency any longer.” (3)
• For trainees and educational supervisors don’t forget the FPH Curriculum competency 5.7 – “Demonstrate leadership in environmental sustainability with a focus on the links to health and climate change”

So click this link, read these resources and chalk up some CPD credits as well as getting yourself up to speed on SD, health and climate change.

References

1. UK Public Health Registrar Sustainable Development Network. Embedding Sustainable Development in UK Public Health Training: Update Report. November 2018. Available at: https://www.fph.org.uk/media/2268/sdn-report-final-2017-2018-nov1-1.pdf
2. Lancet Commission. 2009. “Managing the health effects of climate change”. Lancet and UCL Institute for Global Health Commission. April 2009.
3. Lancet Commission.2018. “Health and Climate Change: shaping the health of nations for centuries to come” Lancet. December. 2018

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No 1. The European National Anthem

There was always going to be music in my presidency. We were still in the EU before the 2016 EU referendum when I played the European National Anthem, ‘Ode to Joy’ at John Ashton’s leaving party.  There’s a taste of it from my leaving party, three years later, still just in Europe here:

No 2. I almost lost my mind

At the Brighton Conference 2016 where I became President, David Stuckler in his keynote presentation gave me the licence I needed to play, when he said he had the ‘Brexit blues’ , when opinion polls showed Brexiteers in the lead.  Seeing Muddy Waters and Bruce Springsteen on the walls of the conference syndicate rooms, I needed no more excuse to play the Brighton Dome and played a blues with my closing speech.  So, I played my ‘go to’ blues number., the one I learned from Shakey Walter Horton, one of the giants of Chicago blues harmonica,  he called it ‘Easy’, and Dr Harp’s Medicine Band version of it is here . He borrowed it from Ivory Joe Hunter, a blues crooner and piano player; he called the song ‘I almost lost my mind’. His words were sadly prophetic for the Brexit experience.

“Well, I can tell you, people, the news was not so good 
She said, “Your baby has quit you, this time she’s gone for good”

No 3. Freedom come all ye! 

Scottish colleagues had already booked me for their Autumn conference, but now they expected me to also play the mouthie.  I said I would if they could find me someone to sing the great Scottish anthem, ‘Freedom come all ye!’ in Scots.  And they did: the wonderful Josie Murray stepped up to the mark. ‘Freedom come all ye’.  It is wonderful song, written by Hamish Henderson at the time of the Polaris CND protests at Faslane in 1960. The ‘Come all ye’ is a rallying cry used in political protest, forever, I called my talk to the Scottish conference ‘Health Come All ye.’ , and recounted my time in Dundee, by the silvery Tay. I spoke also to great Scottish public health work, the campaign for rights to health and the Scottish beacon and conscience for health. Henderson saw his anthem as a world anthem, overcoming Imperialism, where ‘no more would our bonnie callants march to war’, instilling fear as the bagpipes played ‘Scotland the brave’.  The tune was ‘The bloody fields of Flanders’, Henderson had heard on the beach of Anzio in the allied invasion of Italy in 1944.  The poetry of this song is important, elegant and worth the effort.

No 4.  Please see my grave is kept clean

One of my saddest, but ultimately uplifting duties was to commemorate the life of Alwyn Smith, one of our best regarded presidents, which we held at the Christie Hospital in his beloved Manchester.  But he was, at least, a proper Yam Yam, like June Crown, they were  born in the Black Country; I was only adopted ‘Honorary Black Country’. In amongst the remembrances, I performed Blind Lemon Jefferson’s  ‘Please See my Grave is Kept Clean’  more symbolic than literal, the words are a celebration of living, and a plea to remember the achievements of those gone before. I also gave the Faculty Grace that Alwyn composed, passed on to me by John Ashton.  I hope my successors will keep up alive this lovely, simple statement which I say at family meals and now, in European public health gatherings.…

No 5. Watermelon man

Another great hero of my public health history was Peter Draper.  Peter Draper invented ‘upstream factors’ the things we carelessly talk about not realising this is internal jargon that few outside public health will get without an explanation.  He also compiled the definitive text ‘Health through public policy’ to which we all owe an enormous debt for our pious thoughts on health in all policies. His forensic analysis of how media predicts and hijacks our efforts to communicate health messages, was visionary. It pre-dated anything anyone is trying now with social media and we need to develop this kind of surveillance of media – fortunately Martin McKee and colleagues are on the case.

Peter was a great humanist and a great jazz lover, so when we came to celebrate his life, it was fitting that we went to Conway Hall, home of British humanists, and also a venue in which Humphrey Lyttleton had recorded one of his great jazz live albums. Herbie Hancock’s jazz classic is a blues tune I love to play wherever I get the chance. So where better than Conway Hall?  I also got to play it at the 2016 Gastein conference with the house band. Thanks guys!

No 6. Juke

Little Walter was the Hendrix of the Chicago blues harmonica. I would take his songs to a desert island hoping I might practice and learn how he did it. I played my version of ‘Juke’ at the brilliant Oxford Registrars public health conference in September 2017. Thank you, Emily Dobell and colleagues.

It was a joy to perform overlooked by Sir Richard Doll, and in the company of the brilliant and chilling presentation of Nigel Hewitt, conscience of the care of homeless people in the UK.

No 7.  The songs of Ewan McColl

I talked about ‘Dirty Old town’ in my presentation to the Salford University conference on social prescribing in November 2017. I also talked about ‘Kind of Loving’ and Kitchen Sink drama, somehow I didn’t get my organ out though!   But Ewan McColl has been with me since I first learned a few words of the Manchester Rambler in about 1971. McColl was the British equivalent of Woody Guthrie, an extraordinary chronicler of UK working lives and communities, and able to put himself into their heads to sing songs of their experience. We should try to do the same- bringing stories into the tapestry of statistics and policies. So I’ve sung ‘Manchester Rambler’ at the 2017 conference in Telford,  and on my leaving do  It is a song which celebrates the triumph of working class people for the right to roam- started with the Trespass trail in 1934, the ‘Battle of Kinder Scout’; and finally won in 1998 with the Ramblers Association victory in England (Scotland knew the right to roam was there’s!).

I also got to play ‘The Shoals of  Herring’ at the East of England  Conference in October 2018. It is a truly beautiful song, celebrating herring fishers and fishing fleets from Yarmouth to Peterhead: a life, and an industry long gone. Although post Brexit, we will all have to revert to eating the most healthy oily fish, the Herring!

No 8.  Irish tunes

The Irish have the best tunes.   It’s a fact.  Tunes I’ve been able to play on my travels have been  Dingle Regatta,  Raglan Road,  the Fields of Athenry, Star of the County  Down, and Tell Me  Ma., though I’ve not recorded that one!   The Green Fields of France, is probably the greatest ever song about war, written by a Scot, Eric Bogle, who became an Australian, about a could be, Scottish, could be Irish, Soldier in WW1, Willie McBride. The Fureys made the greatest version I’ve heard and I commend it to you, but our version, featured in the  November 2018  FPH bulletin, is here.

No 9. Notable public health tunesmiths and the song of the month

In our number are many outstanding songsters and musicians.  Apologies, Alison MacFarlane, but I only learned just after I had passed on the President robes that you have a public health music review- something like ‘the cholera blues’ I believe?  I’d like to sit in on that one!  I tried to get more public health participants into my song of the month feature in the bulletin. So far only had the great Gabriel Scally’s ‘Public Health Call’ and Carole Wood’s  ‘Five in a bar’ acapella piece, ‘Let every spirit fly’.

To mark Fats Domino’s demise in November 2017, I put up the previously unreleased  version of ‘Walking to New  Orleans’ by  Dr Harp’s Medicine  Band.  I also put up the brilliant piece of stand up by John Denver- not a song in sight- and I know, hijacked by the US temperance movement. But this version of Joseph Mallins’ poem- ‘The Ambulance down in the Valley’ is a parable of the plight, and the need for public health.

We had ‘Down to the Doctors’ at the Christmas  bulletin – to remind me of the greatest band to come out of the East of England!

No 10.  Hearts and Minds

I first met Lady Nade, performing for my daughter’s café’s 1^st year anniversary party in   September 2016 in Bristol.  I was on stage playing ‘Back to Black’ with her in minutes and we have been working on an album ever since.  Nade is a talented singer songwriter who has just completed her second album launch and tour. We have been cooking the album ‘Hearts and Minds’  over three years. I commend it to you.  We are selling the CD for young people’s mental health and older people’s dementia charities. You can find us on Apple Music, Spotify, Amazon, CDBaby.com, or you can buy a CD form me.  Bill Wither’s great soul anthem, ‘Lean on me’ is also a long-standing favourite of mine. It is a great statement for community development and public mental health. I first heard it played for a health audience by Jackie Lynton at Sandwell’s first public mental health event in 1997!  We featured it on the World Mental Health Day issue of the FPH bulletin in October 2018. Enjoy!

Written by Professor John Middleton,
Immediate Past President, United Kingdom Faculty of Public Health,
President, Association of Schools of Public Health in the European Region (ASPHER)
Honorary Professor, University of Wolverhampton,
Visiting Professor, University of Chester.

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Life expectancy has gone down in my term of office. I am the first President of the UK Faculty of Public Health who has had to admit that, in 47 years.

Why beat about the bush? Austerity kills. We can now be clear that the – “un-‘natural experiment’”–austerity, has indeed made poor people poorer, made inequalities in health wider, and killed people.  Economic depression is a phenomenon, ‘austerity’ is a political policy. Austerity policies have killed large numbers of people in Britain who would otherwise still be with us.

Austerity kills. There has been a flood of reports in the last six months alone, and their links are buried in this blog – please do them the courtesy of clicking on them and bringing them back to life -they deserve and need it! On overall life expectancy, the Society of Actuaries reported in March that life expectancy had gone down on average by 6 months, Close on its heals, the Office of National Statistics reported widening inequalities in mortality for women, with women from poor areas dying years before women in rich areas.

To quote ONS: ‘The gap in life expectancy between the richest and poorest areas of England and Wales has widened during the past decade. Women living in the most deprived parts of England lived an additional half a year less than women in the most affluent parts of the country in 2015 to 2017 compared with 2012 to 2014. The corresponding figure for men was four months. Men in the most deprived areas could expect to die 9.4 years earlier than counterparts in the richest places, while for women the figure was 7.4 years. “We’ve found a large fall in life expectancy at birth among women living in the most deprived areas in England,” said Ben Humberstone, deputy director for health analysis and life events at the ONS. “This has led to a significant widening in the inequality in life expectancy at birth in England. Wales mirrored this pattern, although significant changes were not detected,” he said.’

A review of recent trends in mortality in England, acknowledged that life expectancy has levelled off, and indeed decreased for women. They point to a range of factors which are contributing to this- not a single issue, but effects of drug-related deaths, infant deaths, deaths from flu? dementia, lower respiratory disease, a rise in strokes, and cardiovascular disease no longer going down as fast as it should be. However, between 2010-12 and 2014-16, life expectancy in the more deprived areas in England increased more slowly than in the least deprived areas. In addition, female life expectancy in the most deprived decile areas has decreased since 2010-12 and inequality in life expectancy has increased. Inequality in male life expectancy has fluctuated over time but increased since 2011-13.

This analysis indicates that whatever is causing the reduction in the rate of improvement, it is affecting the most deprived areas more than the least deprived areas, and that widening health inequalities has exacerbated the slowdown in improvement. There is also some recognition that social care cuts might be a factor.

In a damning editorial in the BMJ David Taylor-Robinson and colleagues described our child health unravelling.  The rise in infant deaths and the widening of inequalities between rich and poor is alarming and should be a wakeup call that not all is well in the public health world. Infant mortality is this most fundamental of public health measures and a marker for a new public health emergency. More babies dying should not happen in a rich country, but it is. Our infant death rate is now higher than Cuba’s. It cannot be attributed to worsening behaviours, or poorer treatment; the causes are upstream in the advance of child poverty and destitution and the worsening conditions and services in our poorer neighbourhoods.

Nearly 200,000 more children live in poverty now than in 2010 & more than half are aged under 5. At a population level, fewer children are likely to get the best start in life & more are at risk of poor lifelong outcomes. Other manifestations of our neglect of young people’s health can be found in the Nuffield Trust report on international comparisons of adolescent health, and a warning from Britain’s head teachers, describing schools as the unofficial emergency service for the victims of Britain’s poverty, This is a crisis & must be urgently addressed.

Between 2004–05 and 2017–18, the share of those in headline poverty that are in working households grew by 10 percentage points (from 48% to 58%), and for severe poverty it grew by 26 percentage points. In May, ONS data showed ‘an astonishing difference in the risk of avoidable death between the rich and poor.’

We are letting down the next generation. Leaving them potential victims of destitution, knife crime, modern slavery and homelessness. We owe our children more.

The politics of austerity is the politics of cruelty. On an average day in the UK, 3700 people are forced to visit a food bank, 5400 suffer domestic violence, 4750 sleep rough on the streets…There are daily stories of children being hungry in school and in school holidays. Food bank usage continues to rise.

Food charity cannot be the answer. We continue to ignore the root causes of poverty and suffering in favour of short-term charitable relief? Baby equipment banks are now springing up, catching up with food banks. Long recognised problems of fuel poverty are now joined by stories of period poverty. Universal credit changes will hit the poorest hardest. In my BMJ Editorial with Alex Bax, President of the Faculty of Homelessness and Inclusion, we described the escalating problem of homelessness and the health care crisis it is creating.

The word destitution has been brought back into use- conveying a sense of extreme and absolute poverty. 1.5 million people, including 365,000 children, were destitute in the UK at some point during 2017. They could not afford to buy the bare essentials that we all need to eat, stay warm and dry, and keep clean. There is no longer a welfare safety net- national and local government, and utilities, are the biggest creditors on the least able to pay. And people are being sent to prison for civil debt. 

UN Rapporteur, Professor Phillip Alston returned to the UK in May and compared British government policies to the era of the Victorian workhouse. 14m people live in poverty despite the UK being 5th richest economy in world; 40% of children in poverty within 2 years; millions in work dependent on charities, people joining gangs to avoid destitution and a shocking rise in food banks. And, in a reprise of 17th Century philosopher Thomas Hobbes famous quote, the UK’s poorest facing “nasty, brutish, solitary, and short” lives.

What to do about it?

There is an owners club in reports on the ‘wider determinants of health’ and rightly, a clamour for health in all policies approach from our governments.

Poverty is bad for the nation’s health and also for its economic efficiency. Ten years after the Marmot report, it is completely clear that we have gone in exactly the opposite direction, in policies and in investments, that would have continued to reduce inequalities in health. Worse still, the national policies have gone completely in the opposite direction, wilfully creating more inequality. Following Acheson report recommendations in1998, health inequalities narrowed in the years to 2010, with real political will and local implementation of national policies. It is notable how much progress was made narrowing the gap between rich and poor areas on childhood mortality during the 2000s. The policies implemented were reinforced by Marmot in 2010. Early years support was a key and central recommendation of Acheson and Marmot. I attributed improvements in past pieces for FPH, to the ’Surestart Generation’ (a better name than ‘Millennials’?) There was a raft of evidence-based policies implemented from 1997: Surestart, Surestart-Plus services for teenage mothers, Surestart maternity grant, but also the minimum wage, working families tax credit, new deal for employment, Decent Homes Standard and a reduction in child poverty of half a million. And when we talk ‘millennials’- they are no longer smoking, drinking, having babies as teenagers- might that not also be a ’Surestart effect’? Ben Barr, Clare Bambra and colleagues  have now provided some evidence to back up this view, and so has the Institute of Fiscal Studies, in its evaluation of Surestart programmes.

Marmot also highlighted a need for tax policies reducing inequalities in income. The poor pay more proportionately, in tax than do the rich. Reform of tax systems and the overall national and local provisions for taxation need urgent review.  As major corporates and the super-rich avoid tax, the case for property, land and location taxes  become more compelling. Danny Dorling’s book ‘All that is solid’ describes the nightmare of UK housing policy and some of the remedies; buried in them, fair and proportionate property tax for high value properties.

England spends less on social care per person than Scotland and Wales, and the gap has widened since 2010/11. Today, England spends £310 compared to £445 in Scotland (43% more) and £414 in Wales (33% more). For many eminent public health authorities this is a driver of inequalities in health and the observed reductions in life expectancy.

Cuts in local government budgets have fallen disproportionately on the poorest local authority areas. I share the view that we must redress the cut in social care- I would go as far as to say we should fully fund social care from taxation. We must also rebuild public health investment in local authorities in England and in all health systems. And there must be place in our comparatively wealthy country, for greater investment in an NSH – a National Service for Health.

Throughout my presidency I championed the Welsh Wellbeing of Future Generations Act. This visionary piece of legislation seeks to take political thinking beyond its usual ‘my term of office’ and ‘my back yard’ and offers Public Health Wales the chance to scrutinise all policies for their health and health inequalities impact. All health systems in every political administration need this provision.

Climate change is a health issue, and an inequalities issue, a cause and consequence of violence and conflict, and interconnected with environmental degradation, loss of biodiversity, creation of trafficking, refugees and slavery. I am pleased that FPH divested from fossil fuels investments last year. But our efforts have been given greater urgency. There has never been a greater need for public health expertise. We need to be resolved and stand together in the fight against darkness and destruction.

Written by Professor John Middleton,
Immediate Past President, United Kingdom Faculty of Public Health,
President, Association of Schools of Public Health in the European Region (ASPHER)
Honorary Professor, University of Wolverhampton,
Visiting Professor, University of Chester.

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In 2017 I was in ST5 and getting ready for my first consultant interviews. This blog follows on from my earlier blog sharing my top tips gathered for Consultant job applications during the final stages of Public Health Specialty training.

After a great application, you will get your invitation to attend interview. Generally, those I was invited to attend contained details about the interview panel and format, e.g.  situational judgement/ psychometric test, role play with actors (memories of Part B!) or a presentation.

Research the interview panel through online searches, particularly if you are applying outside of your training zone and you don’t know them. Knowing that a Councillor on the panel has an interest in smoke free playgrounds and e-cigarettes is softer intelligence that can give you an edge over other candidates.

Real-life Consultant experiences

The biggest preparation that you can do for a job interview is consultant level on-the-job learning, shadowing and experiences in the year beforehand. You will collect examples and stories which you can use to answer interview questions. Use these real-life experiences to show that you are ready and capable to be a Consultant and hit the ground running.

Interview Questions

Use the library of interview questions you gathered earlier in the year from recently qualified Consultants. Think about themes from Job Descriptions and Person Specifications e.g. Leadership/ Change Management/ Commissioning/ Media/ Collaboration/ Continuing Professional Development or Learning Needs. Develop two to three examples using a simple answer framework (Situation Action Outcome Reflect).

Don’t forget the Part A and Part B frameworks from years gone by – you might get asked a technical question or a ‘how would you?’ question.

Look at some useful online resources too: –

https://www.healthcareers.nhs.uk/i-am/working-health/information-doctors/medical-specialty-training/consultant-interview

http://careers.bmj.com/careers/advice/Great_answers_to_tricky_consultant_interview_questions

Have a sensible question to ask of the panel at the end, but never ask a question that you could have found out in the recruitment pack or clarified beforehand (e.g. terms and conditions). You want to leave the panel with a positive impression as you exit the room.

Interview Presentation

Be prepared to deliver a presentation on the day – this might be sent out to you in advance or might be on the day. Either way, make sure you know and can talk about the organisation’s values, local & regional challenges and aspirations.

Consider the wider stakeholder context through websites, public health indicators and reports, plus any recent local press or social media. In one interview, knowing that there had been a recent avian flu outbreak meant that I had read up on outbreak responses and considered wider migrant worker health needs in my response.

Don’t be scared to ditch PowerPoint, unless you are specifically asked to provide one. I know some interviewees that have arrived with flash cards and props, making their point very effectively and memorably.

Clearly describe what you know about the role and organisation, what experience you have and what you can do for them.

Practice makes perfect!

Invest your time in interview preparation and presentation practice with buddies and Consultants to get feedback and ‘test’ examples. Set yourself interview questions when driving or making a cup of tea and talk out loud; it will help you refine your answers, being clear and succinct.  I tried recording myself; awkward I know, but this helps refine the waffling.

Unique Selling Point

You have worked hard training to become a Public Health Consultant, so what makes you special and stand out? What are you going to say about you? What is your ‘unique selling point’? Ask your colleagues and peers for informal feedback to boast your confidence and give ‘live’ examples for interview regarding personal qualities, leadership style and what makes you a good Consultant.

On the day

Arrive in good time, breathe, do your best and good luck!

Written by Hayley Mercer, Screening & Immunisation Lead – Public Health Consultant, Public Health England, North West

You can follow Hayley on Twitter

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I joined the Faculty of Public Health a year ago. I work across health and transport sectors but hadn’t ever joined a professional body before. Going to the Faculty of Public Health conference in Peebles in 2016 and 2018 broadened my interest in Public Health.

I joined FPH and attended an Introduction to Pubic Health event in London and then a training day in Manchester, led by Professor Gurch Randhawa from University of Bedfordshire on evaluation of joint interventions.

I was really enthused by the course run by FPH and liked the idea of inviting Professor Randhawa to Aberdeen and it was a very enjoyable experience working with FPH to arrange delivery of the course.

We had 25 attendees on the day and the event was held in the Beach Ballroom, a real Ballroom by the beach if you ever visit Aberdeen. The event took place on May 16 and the feedback has been extremely positive. Many of the attendees felt it should be re-run for the benefit of my Health & Transport Action Plan Steering Group members.

My advice to anyone thinking about joining the Faculty is to do so, it will certainly introduce you to new colleagues. Personally, I’ve found it helpful to belong to something collective as my role can be isolating at times.

I’ll end with thanking Nikol and Gurch for helping arrange the event and support my work around adding strategic value to partnership working across health and transport issues. I also thank CIVITAS PORTIS and Nestrans for funding the event, making it free for attendees.

Written by Andrew Stewart, Aberdeenshire Council (post jointly funded by NHS Grampian and Nestrans)

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The publication of the Scottish Public Health Priorities² in 2018 provides an opportunity to consider the future direction of public health as part of Public Health Reform¹. How can oral and dental health contribute to the wider public health landscape? This is something that I along with the Consultants in Dental Public Health and Chief Administrative Dental Officers Group in Scotland have considered. In this blog post I want to share some of our key findings and messages.

The risk factors for oral diseases are the same as for other non-communicable diseases

If I mentioned poor diet, excess sugar intake, alcohol and tobacco use as risk factors for non-communicable diseases, what conditions immediately spring to mind? Type 2 Diabetes? Coronary Heart Disease? Cancer? Well in the mind of a dental professional those same risk factors might lead them to consider dental caries, periodontal disease and oral cancer. There is a high degree of overlap in the risk factors for oral disease and other non-communicable and chronic conditions which affect our population. Therefore we can use a common risk factor approach³ to ensure we have consistent messages and exert the greatest influence in our prevention activities.

Dentists are well placed to routinely see a “well” population

In a recent survey⁴, 73% of adults reported they had attended their dentist in the last year. Many of these patients will be attending for routine check-up appointments with no specific problems or symptoms. Therefore, the dentist might be the only healthcare professional a “well” patient sees for a while, why you ask is this important? Well, this provides a unique prevention opportunity, with dental professionals able to identify risk factors, such as smoking, alcohol intake or diet at an early opportunity and provide evidence based behaviour change advice and support such as referral to stop smoking services. As outlined in the Scottish Government’s Oral Health Improvement Plan⁵ there might also be the opportunity to explore the possibility of dental teams providing general health checks to aid the early detection of non-communicable diseases such as diabetes.

We have shown that investment in prevention pays

Childsmile the National Oral Health Improvement Programme for children in Scotland was first established in 2006. Every child in Scotland has the opportunity to benefit from Childsmile, from the toothbrushing packs and free flow drinking cups handed out by Health Visitors to all children and the universal supervised toothbrushing programme being offered in nursery schools. There is also targeted provision of fluoride varnish in priority nurseries and schools, and the extension of toothbrushing into some primary schools. Research⁶ has been able to demonstrate cost savings associated with spending on prevention activities. Within three years the nursery tooth brushing programme was shown to have recouped its annual expenditure through savings on actual and anticipated dental treatments. Indeed the programme was recently recognised by the EU Commission as an example of public health best practice⁷.

We still have a long way to go

Over the past 10 years, oral and dental health professionals, along with our varied range of collaborators have made huge improvements in the oral health of the Scottish population. We have high seen significant increases in the percentage of the population registered with a dental practice⁸ and have decreased the percentage of the Primary 1 child population suffering from dental disease by around 25%⁹.

However, we still have much left to do. By the start of primary school nearly a third (29%) of children will have dental decay at a level where treatment is required. We still see a huge inequity in the oral health of our population, with those living in areas of deprivation experiencing significantly poorer oral health as well as marginalised groups such as those experiencing homelessness.

Action can, and must be taken to harness existing momentum and build new and innovative actions to address the inequalities we see. Using a common risk factor approach, and recognising the clear cross cutting issues which affect dentistry, oral health and general health will be key. Action on oral health will result in improved health and wellbeing for our population. Indeed, we cannot strive to have good health for our population without improving oral health.

1. https://publichealthreform.scot/
2. https://www.gov.scot/publications/scotlands-public-health-priorities/
3. https://www.ncbi.nlm.nih.gov/pubmed/11106011
4. https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2018/09/scottish-health-survey-2017-volume-1-main-report/documents/scottish-health-survey-2017-main-report/scottish-health-survey-2017-main-report/govscot%3Adocument/00540654.pdf
5. https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2018/01/oral-health-improvement-plan/documents/00530479-pdf/00530479-pdf/govscot%3Adocument/00530479.pdf
6. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136211
7. https://twitter.com/CDO_Scotland/status/1141375479309639680?s=19
8. https://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2019-01-22/2019-01-22-Dental-Report.pdf
9. https://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2018-10-23/2018-10-23-NDIP-Report.pdf

Written by Jacky Burns, Specialty Registrar in Dental Public Health NHS Fife. You can follow Jacky on Twitter.

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The Centre for Health and Development at the Staffordshire University and the Faculty of Public Health (FPH) held a hugely successful conference at the University on 26th June. Given the current political uncertainties and the mounting evidence of the public health impacts of austerity on life expectancy and infant mortality in particular, it was perhaps unsurprising that an event on ‘Economic, Environmental and Health Inequalities in a time of Austerity’ attracted over 100 registrations from a diverse range of public health professionals, including consultants, practitioners, academics, researchers, nurses, students and community workers.

These delegates were drawn from key public health and partner bodies including Public Health England, the National Instiute for Health and Care Excellence, Clinical Research Network, NHS, Universities, local authorities, the Illegal Money Lending Team, the Modern Slavery Network and the voluntary sector. This ensured lively, productive and, on occasions, inspirational discussion.

The speakers also reflected the diverse and inter-connected factors that impact on public health as well as representing the key bodies and levers for mitigating them. Keynote presentations from Professors Mark Gamsu, John Middleton and Chris Gidlow together with Dr Jacqui Ashdown set the scene for each session with evidence and experience-packed critiques of poverty, welfare, environment, food, economic development, debt, and housing.

The three workshop sessions were themed around living, moving and economic inequalities and provided delegates with expert detail on issues ranging from homelessness to county lines, mental health to obesity, loan sharking to the bedroom tax and all points between. Speakers drew on each other’s experiences and a particular highlight was a speaker going ‘off-piste’ to share his lived experience. Two of the speakers were recent MPH graduates and presented work from their dissertations with great assurance and to enthusiastic response. All three Q/A sessions were lively affairs and contributed to the learning gained. There is a rumour that one of our FPH Professors was completing his online CPD in real time! Presentations were complemented by displays from NIHR, a Big Local community project, North Staffs Financial Inclusion Group, PHE and the cream of the recent FPH #PublicHealthLooksLike photograph exhibition.

In short a powerful and productive public health day; much learned and much more to do.

Watch this space for news of next year’s event!

You can download the slides from the Conference here.

Professor Christopher Gidlow, Staffordshire University

Dr. Patrick Saunders, Visiting Professor of Public Health University of Staffordshire

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It wasn’t that long ago in 2017 that I was approaching ST5 and worried about getting my first consultant post. Here are my top tips gathered for Consultant job applications during the final stages of Public Health Specialty training.

Think forward

• In the last 12 months before the end of training, ask for lists of interview questions from recently qualified Consultants. Use these to undertake a personal SWOT (strengths, weaknesses, opportunities, threats) analysis, then develop an action plan linked to your personal development plan and work programme. One of my gaps was working with elected officials, therefore it was better to know this early and proactively seek out opportunities sooner rather than later.
• Consider what training and courses there are available as you might need to book on early due to demand. I was lucky to attend a deanery funded course ‘preparing for interview’ with Anna Jackson but the FPH also run a similar course. This really helped with identifying what is my ‘unique selling point’ and frameworks for answering interview questions e.g. (Situation Action Outcome Reflect)
• Look at what courses are available through the Deanery too. My Deanery provided a Consultant Careers Awareness Workshop, Leadership, Resilience and Educational Supervisor Accreditation. I was also able to access political awareness training through the local authority where I was based.
• The most impact in my preparation in readiness for Consultant interviews and work life was through coaching and mentorship from new Consultants and a Director of Public Health (DPH). I choose a DPH coach who was quite different in ‘type’ to me.
• Know about what is important to you in a future Consultant job – a career anchors assessment can help with this. At the time I was applying, I knew I needed a post that offered job satisfaction, stability, supported work-life balance (preferably no on-call) and with a main work base relatively close for school drop off and pick up.
• Sign up to job alerts (NHS Jobs/FPH Jobs/BMJ Jobs/Jobs Indeed/ Public Health Jobs – Twitter), as knowing what types of jobs that have come up recently gives you a sense of what’s out there. Looking at job descriptions and person specifications also help you identify your gaps so you can work on these before you start applying for jobs.
• Review and update your CV – it will then be fit for job enquiries. I found this HEENW Checklist useful and asked my Educational Supervisor to review my final draft. Identify your referees and make sure they are happy to be named on your CV or future job applications.

Job Enquiries

When you make that initial enquiry, you don’t know who might pick up the phone. On one of my first enquiries, I thought I would be booking a time slot for a future call but ended up directly speaking to the DPH for 30 minutes.

Think about what are you going to say about yourself and what questions you are going to ask. First impressions count, so even though it’s an enquiry, treat it like an ‘informal’ job interview.

It may sound obvious but before you even pick up the phone to enquire about a job make sure you have checked the following: –

• Job Description and Person Specification
• Organisational website and twitter
• Organisation/DPH/Consultant Team through online searches
• Local Public Health Outcomes Framework and public health annual report

Use your networks to find out more information about the team and location – Public Health is a small world!

Applications

In advance of ‘the job’ being advertised, start preparing your application: –

• Ask your Consultant colleagues if they would be happy to share any previous applications they have made with you.
• Prepare a generic application that can be flexed and adapted for different posts, organisations and job specifications.
• Seek feedback from your coach, consultant and DPH. They all have experience and insight to offer.
• Double check your referees are still happy and available to give you a reference and let them know that you have started applying for jobs. Reference requests can get lost in busy inboxes or junk mail folders.
• Always make sure that any application matches the Job Description and Person Specification, plus use information gathered during your enquiry phone call and pre-visit. Make it easy for the recruiting team to ‘mark’ your application with clear layout and headings.
• Don’t underestimate the time it takes to complete applications – formats vary considerably depending on the organisation and country.
• It sounds obvious, but if known from the advert, protect the date of the interview in your diary. It’s hard to get an alternative date for an interview, so if you know there is a clash with another important event, let the recruiting team know in advance. If they really like your application, they may try and set another panel date.

Summary

Take control of the consultant job application process through your individual strategic plan.

The biggest preparation that you can do for a job applications and interviews is on-the-job learning, shadowing and experiences in the year before hand. In future weeks I will be sharing a blog on interview preparation.

Be confident as you have passed FPH exams and gained a wealth of experience through training – now is the time to get your first Consultant post! Good Luck!

Written by Hayley Mercer, Screening & Immunisation Lead – Public Health Consultant, Public Health England, North West

You can follow Hayley on Twitter

You may also find this bog from Kathryn Ingold on transitioning from Registrar to Consultant.

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Community cardiopulmonary resuscitation (CPR) teaches people living in the local community the basic skills of delivering chest compressions and artificial breaths until lifesaving defibrillation can take place for people that have suffered a cardiac arrest (their heart has stopped beating). Many causes of cardiac arrest are reversible with the right treatment, but without CPR and early defibrillation people do not survive long enough to receive these treatments. On average only 10% of people who suffer a cardiac arrest outside a hospital setting will survive. This figure more than doubles when the victim receives community CPR(1).

History of CPR

We haven’t always had this valuable skill at our disposal. People have been trying to resuscitate victims of cardiac arrest since the 1500s, with varying levels of success. By the 1800s the accepted method of treating cardiac arrest became surgically opening the chest and massaging the heart by hand(2). The first publicised mention of CPR as we know it today appeared in Journal of American Medical Association in 1961, entitled ‘Closed Chest Cardiac Massage’. The revolutionary new technique was an alternative to the currently accepted technique of open heart massage(3).

Community CPR in the East Riding of Yorkshire

The East Riding of Yorkshire is a predominantly rural locality. Precious minutes can be lost before victims of cardiac arrest receive CPR, making community CPR even more important. The local council is offering free 1 hour drop-in sessions on CPR and defibrillation to their employees and the public, giving people the opportunity to feel more confident about what to do if someone close to them suffers a cardiac arrest be it family, a friend or someone on the street. The events are advertised using the council intranet and Facebook page and have been received very well. 100% of the feedback collected has been positive and all attendees reported improved confidence performing CPR and using a defibrillator. The council also took part in the British Heart Foundation’s ‘Restart a Heart’ day, raising awareness and training around 50 employees in CPR. There is a common misconception that you have to have a qualification to perform CPR on somebody. The truth is that is you have the knowledge, you can use it to try and save someone’s life.

Automated external defibrillators (AEDs) talk you through how to deliver an electric current to restore a person’s own heartbeat. There are over 100 publicly available AEDs in the East Riding of Yorkshire and Hull, a number the council and partners have worked hard to increase(4). When you call 999 the operator will direct you to the nearest AED if needed, and give you the code to open the safety box. AEDs are much less useful when CPR does not take place – something the council has recognised in its efforts.

The Yorkshire Ambulance Service are also working to address this issue with a successful community responder scheme. Community responders are normal people who are trained to provide initial lifesaving treatment and help to bridge the gap until paramedics arrive.

Community responders carry portable AEDs and are often able to reach the people who need them much faster.

Does it work?

The resus council recognises a Chain of Survival for Cardiac Arrest, which includes: early recognition of cardiac arrest and calling for help, early CPR to buy time and early defibrillation to restart the heart. When each link in this chain is strong, chances of survival can rise to over 50%(5), but if one part of the chain is delayed this percentage drops dramatically.

FAQs

‘Is it difficult to do?’

Research has shown that life-saving skills such as CPR can be taught successfully to children as young as 10 years old, whereas younger children aged 4 and above have been shown to be capable of calling for help and operating an AED correctly(1). In fact the Department of Education has plans to add CPR and first aid to the curriculum by 2020(6).

‘What if I hurt them, can I get sued?’

When a person has a cardiac arrest they are effectively dead. You cannot make the situation worse, but you may save their life. Sometimes you can crack a rib when giving CPR, but broken bones will heal and are a small price to pay for your life. No one in the UK has ever had legal action brought against them for trying to help someone by giving them CPR(5).

‘How can I get involved?’

The worldwide annual Restart a Heart Day courtesy of the British Heart Foundation takes place on the 16th of October. Why not raise awareness and join the millions of people all over the world learning CPR to keep each other safe. You can also look out for local BHF Heartstart schemes which run free 2 hour courses across the country. The easiest way to learn about CPR is via the British Heart Foundation website where you can browse their free information and videos.

References

1. Plant. N, Taylor. K. (2013). How best to teach CPR to schoolchildren: A systematic review. Resuscitation. 84, 415-421
2. CPR & First Aid Emergency Cardiovascular Care . (2019). History of CPR. Available: https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/HistoryofCPR/UCM_475751_History-of-CPR.jsp#10. Last accessed 25/4/19.
3. CLOSED CHEST CARDIAC MASSAGE-P. Safar. Anesth. Analg. -Vol. 40:609 (Nov.-Dec.) 1961.
4. OpenStreetMap. (2010-2019). Defibrillators in HU postcode area.Available: https://osm.mathmos.net/defib/progress/HU/#11/53.7516/-0.5493. Last accessed 9/7/1
5. Resuscitation Council (UK). (2019). Frequently asked questions: CPR.Available: https://www.resus.org.uk/faqs/faqs-cpr/. Last accessed 10/5/19.
6. Resuscitation Council (UK). (2019). CPR Education Campaign: CPR to be added to the school curriculum. Available: https://www.resus.org.uk/campaigns/cpr-education-campaign/. Last accessed 9/7/19.

Written by Isabella Price, FY2 Doctor in Public Health, East Riding of Yorkshire Council 

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June was a busy month for the Policy team at FPH. We released our project’s second discussion paper, furthering our investigation into how NHS organisations are responding to or shaping the broader prevention agenda. Thank you to all FPH members and other partners who contributed!

We also released the results of our opinion polling of 310 NHS leaders about prevention – which we think provide a fascinating starting off point for understanding the journey that NHS organisations are on towards (hopefully) a more prevention-led service.

We also travelled to Edinburgh to meet with our Committee of the Faculty of Public Health in Scotland (CFPHS) members and others working in NHS Scotland organisations, NHS Health Scotland, and NHS National Services Scotland to discuss our findings from a Scottish perspective. We received a very warm welcome from the CFPHS Chair Julie Cavanagh and all of the attendees, ensuring the workshop was not only incredibly informative but also very enjoyable.

We covered a huge amount in a relatively short period of time, but here are our initial 5 takeaways from the event:

• The planned public health reforms are a huge opportunity to make a significant step-change towards a culture of health – Scotland’s public health reforms are striving to address three key issues: Scotland’s poor relative health, significant and persistent health inequalities, and the unsustainable pressure on health and social care services. The ambitious reform programme has already seen the development of public health priorities for Scotland and the development of a new public health body, Public Health Scotland (PHS), is currently underway. There is a commitment that PHS will be an NHS organisation, at least initially and the current NHS public health workforce will continue to be employed by the NHS, but with increased reach/relationships with local authorities and other community partners. CFPHS is broadly supportive of this approach, but recognises the need to maximise NHS contribution to public health while broadening the reach of the public health function. This is the space of the debate at the moment.
  

• Our opinion polling findings of NHS leaders about prevention only partially reflect the Scottish experience and mind-set – only 6% of NHS leaders who we polled were living and working in Scotland. We were curious to see if our overall results around prevention priorities, barriers to prevention delivery, prevention budgets, and the most pressing issues facing the health and wellbeing of local communities reflected the situation in Scotland. Workshop attendees told us the following main points:

1. NHS leaders overall who we polled were most likely to say that the NHS should be prioritising the following five approaches to prevention delivery: the systems approach, embedding prevention into routine practice, embedding prevention into clinical and/or patient pathways, reducing health inequalities, and addressing common risk factors. Attendees at our workshop similarly emphasised the need to prioritise the first four of those, but then prioritised ensuring the NHS is a good employer, e.g. by improving NHS staff health and wellbeing over addressing common risk factors.
2. We also asked NHS leaders to tell us (based on a long-list of potential tax and regulatory measures spanning alcohol, drugs, obesity and food, and tobacco) the policy or regulatory changes that they thought would most benefit the health of their local communities. NHS leaders overall were most likely to choose measures that impacted on the local food environment, with four out of their top five shirt-listed measures relating to that. Participants at our Edinburgh workshop, however, also chose some of the same measures relating to the local food environment, but they also short-listed a measure relating to drug and alcohol treatment. This, they told us, reflected the fact that in Scotland drugs, alcohol, and suicide are the three largest contributors to years of life lost to premature mortality.
3. They were most surprised (in a good way) that around half of all NHS leaders polled say that prevention is a core or large part of the work in their department. They were heartened by that result, but some wondered whether understandings of what ‘prevention’ approaches or activity actually constitutes is so variable as to render this finding misleading.

• FPH may need to revisit our definition and understanding of healthcare public health – Interestingly for FPH colleagues working across health services and in education and training, we heard the strong message that the FPH definition of health care public health (as one of the three domains of public health) was not necessarily applicable to the Scottish health system. Unlike in England, in Scotland there is no existing national framework for the delivery or governance of HCPH and the domain is experienced and described differently. Due to the structure of the public health and health system in Scotland, the majority of those working in specialist public health capability and capacity for HCPH are located within territorial NHS Board Public Health Directorates and are often working across all of the domains at once. This workforce is unlikely to find the FPH definition of HCPH useful for their work. They told us that we need to establish better the scope and vision for HCPH in Scotland and strengthen the HCPH role beyond clinical healthcare services. The Improving Services Commission in Scotland is exploring whether or not to describe the function as ‘Population Integrated Care’ instead.

• Colleagues in Scotland agree that better governance of prevention is absolutely critical to supporting a prevention led NHS – In our first workshop back in October 2018, stakeholders identified better governance of prevention as a key area that needed to be prioritised if the NHS was to sustainably pivot towards prevention. Scottish colleagues were very interested to learn from the Deputy Director of Healthcare Public Health at PHE East Midlands, Ben Anderson, about his team’s work addressing the prevention challenge and the governance gaps that they’re striving to fill at trust and CCG levels. Colleagues in Scotland spoke of similar challenges around ensuring strategic leadership for healthcare public health across the system (including the NHS, LA, HSCP, education, public sector, voluntary sector, SG policy makers), the need for better coordination and optimisation of data and intelligence, issues incentivising outcomes, and the need for better performance management of essential prevention activity.
  

• FPH needs to do more support learning across the nations and help our workforce tell a better story – Despite some clear differences and unique challenges, many of the barriers standing in the way of prevention within the NHS are shared, for example: a lack of funding, a lack of understanding of what prevention and more broadly health care public health actually constitutes and their impact, and a lack of data, and service fragmentation. But different places are overcoming these barriers successfully or identifying some of the missing pieces to help other places overcome them. Attendees at our Scotland workshop want to learn more from what colleagues elsewhere are doing. They would like FPH to host more events like our workshop, to bring colleagues working across the UK on similar issues together to learn from one another. There was also a really strong message for FPH ‘to support us to think differently as a workforce’ and ‘develop a more compelling narrative for what the public health workforce does.’ This will help them communicate the value of the public health approach more effectively.

These are just a few of our initial thoughts. But we’d love to know what you think of our papers, findings, and initial conclusions.

Please let us know by emailing policy@fph.org.uk Thank you so much and we look forward to hearing from you soon

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

and

Lisa Plotkin, FPH Senior Policy Officer

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