Archive for March, 2020

An enduring memory from my time as a Public Health Registrar was the Director of my local Health Protection Agency telling me (during a particularly interesting and high profile outbreak) that Public Health was the arena where “medicine meets politics.” At the time, I thought that he was mainly referring to the fact that he was getting phone calls every 5 minutes from local politicians wanting assurances that this outbreak was under control, and that the very successful and globally renowned local business would not be shut down permanently. But in hindsight, as my career has taken me increasingly in to the political arena, I have begun to appreciate just how much of my work as a public health professional overlaps with the world of politics.

My involvement in all things Political began fortuitously as my love of working in a Local Authority declined. I have never been very good at keeping opinions to myself, and the move from an NHS training programme (where I was generally allowed to argue my case, and decisions were more often than not made on available evidence) into a Consultant post in a Local Authority (where the arguments I made were filtered through Political persuasion) was always going to be tricky. I worked with a great Public Health team in the County Council, many of whom had weathered the Political arena for some years already and were far wiser than me when it came to working with our allocated Cabinet Member. Our Cabinet Member was also well seasoned and knew what she wanted and how she wanted it – I frequently disagreed, both from a Political (ideological) standpoint and from the available evidence base. When the 2015 election saw another defeat for my Political Party of choice, I threw in the officer towel (continuing to be very grateful to all colleagues who stayed the course!) and decided to play to my opinionated strengths. I became active in my local Labour party, and in 2017 was elected as the first Labour Councillor on Worthing Borough Council for 41 years.

In Politics, one of the first things I learned is that our evidence base in Public Health will only get you so far. The arguments that you make to achieve your goals are as much about the relevance to your audience and the zeitgeist of the day, as they are about what the data tell us. I am eternally grateful for my instructions in the art of reading statistics (lies, damned lies etc.), but I have had to learn that my local constituents need to know what that statistic will mean for their family, not a thousand families. Our understanding of the wider determinants of health (I am constantly recommending anything written by Sir Michael Marmot to any colleague who will listen) is one of the areas that I treasure most from my training and work in both the NHS and Local Authorities, but there is nothing quite like sitting with a local family who are about to go in to emergency accommodation because they cannot find any affordable housing in the area, to nail the lesson that a home is at the heart of a human’s wellbeing.

In our area, as with most of the UK, we have seen an increasing use of foodbanks as austerity and the introduction of Universal Credit have cut people’s ability to provide for themselves and their families. A National Government has enforced austerity for 10 years now, leaving Local Government finances at an all-time low. In spite of the frequent soundbites from Government benches that the deep cuts to the public purse were absolutely necessary, there are numerous economists who have argued that this drastic response to the financial crisis was unnecessary and has penalized the poorest in our society for the problems of our deregulated financial system.

Local Authorities like mine, now find themselves in a bind. The pairing down of the State might fit with the councils ideology, but the reality on the ground is that we are hugely under-resourced and failing to provide adequate social care, education, public health, housing, waste management, or transport infrastructure. As a Public Health Consultant, seeing on a daily basis in my local area what this Political ideology has taken from our population’s health and wellbeing, I find that the translation of our statistics, reports and research is more pressing and relevant than ever. Public Health needs a strong voice in the Political arena, and it is my privilege to be one of those voices.

Written by Rebecca Cooper, Public Health Consultant

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On the 7th November 2019, the Children (Equal Protection from Assault) (Scotland) Act 2019 received Royal Assent. This Act abolishes the defense of reasonable chastisement, thereby prohibiting the physical punishment of children, and so brings Scotland in line with its obligations under the UN Convention of the Rights of the Child to protect children from all forms of violence.

On the day of this legal change, I traveled from Scotland to England, and crossing the border I was very aware that while children in Scotland would benefiting this Act, children in England would not. English children will continue to be denied full legal protection from violence.

Changing the law is a tool to improve public health – this is my experience of the process that led to this change in legislation.

Finding allies

A group of children’s charities – NSPCC Scotland, Barnardos Scotland, Children’s 1st, and the Children and Young People’s Commissioner for Scotland came together in a coalition and together they commissioned a systematic review, published in 2015, on the effects of physical punishment of children (https://learning.nspcc.org.uk/media/1117/equally-protected.pdf)

The systematic review showed that the evidence could not be any clearer – physical punishment has the potential to damage children. The number one recommendation of the report was that all physical punishment of children should be prohibited.

In 2016, shortly after the Scottish Parliament election, the coalition of children’s groups approached John Finnie, a Member of the Scottish Parliament (MSP), to consider taking forward a Members Bill to give children equal protection from assault – by prohibiting physical punishment of children. They chose to approach John Finnie because he had previously showed support for this issue before the end of the previous Parliament session by trying to get an amendment into a different Bill.

Using public health evidence & responding to consultation

In 2017, John Finnie’s proposal for a Bill to give children equal protection from assault went out for consultation. At that time the Scottish Government did not support legal change to give children equal protection from assault. However, the consultation had over 650 responses – 75% of these were supportive and many submissions cited the 2015 systematic review on the effects of physical punishment of children, and other public health evidence. After this consultation the Scottish Government changed their position and decided to support the Bill. I heard it said that it was the public health argument – rather than the children’s rights perspective – that influenced the Scottish Government to change their position.

Further engagement in the political process & working with the media

In September 2018, the Bill was introduced into Scottish Parliament and in the year that followed there was much public health advocacy in support of the Bill as it made its journey through the Parliament. This advocacy fit with the Faculty of Public Health (FPH) in Scotland’s Healthy Lives, Fairer Futures Call to Action (https://www.fph.org.uk/about-fph/board-and-committees/a-call-to-action/) priority on preventing adverse childhood experiences, which enabled the FPH to support the Bill. Advocacy on behalf of the FPH included submitting written evidence in support of the Bill, sending a briefing paper to all MSPs ahead of a key debate, as well as sending an open letter to the leaders of all the Scottish political parties before the final debate on the Bill. I found writing a first-person article in one of the Scottish national newspapers (https://www.thenational.scot/news/17502438.tamasin-knight-a-law-that-justifies-assaulting-children-harms-health/) helpful in increasing awareness that protecting children from physical punishment is a matter of public health concern.

On the morning of the final debate, several FPH members attended a gathering outside Parliament to demonstrate our support for the Bill, and this gathering was featured in the national print and broadcast media. The passing of the Bill was reported positively in the press, with calls for the rest of the UK to follow Scotland’s lead and introduce similar legislation (https://www.theguardian.com/commentisfree/2019/oct/03/the-guardian-view-on-scotlands-smacking-ban-follow-the-leader)

Wales has since passed legislation to protect children from physical punishment (https://endcorporalpunishment.org/wales-prohibits-all-corporal-punishment/). While the children of Scotland and Wales will have their rights under Article 19 of the UN Convention on the Rights of the Child upheld, children in England and Northern Ireland will not. The difference living a few miles apart can make.

Written by Dr. Tamasin Knight
Consultant in Public Health Medicine
NHS Tayside

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I and my wife have been adopting strict social distancing practices for a week. We are both in the group that has been told that it needs to be shielded for at least 12 weeks.

I have been following the evidence about Covid19 very closely and because of my assessment of the literature, I and my wife started strict social distancing shortly before it became national policy.

Part of my response to a feeling of some helplessness as a pensioner confined to home has been to ensure that I have contributed on-line to the professional debate about how to combat the pandemic. My portfolio career in retirement has included roles with the Faculty – I am the Treasurer – and with the BMA on many committees and this has facilitated this aforementioned activity. Indeed I agreed today to join another BMA committee on Covid19. Gradually my diary which had been a sea of cancelled meetings is being replaced by on-line (unpaid) work!

I am deeply appreciative of the work done by PHE and other public health staff in planning for the epidemic and attempting to control it. The pressure on the public health and national health service will be immense over the coming weeks and months but I am confident they will rise to the challenge.

The goodwill shown by my local community in suburban London has been heartwarming. It looks like we may have secured a mechanism to reliably receive a home delivery of food. My wife and I were quite emotional about the support that has been arranged by the United Synagogue and offered to all sheltered members in its community.

Social isolation is a real issue. I have made a point of trying to contact all people we know who are also in the moderate to high risk groups requiring sheltering. I am preparing for seeing many repeats on TV.!

My wife is a pianist and musician and thought she may not be able to continue working. However virtually all the people she teaches have already agreed to have their lessons by Skype or Facebook! Maybe her choirs might also be able to reform!?

My sons and their partners live some distance away but are in regular contact. My 5 year old granddaughter whose school closes tomorrow, has begun regularly calling us from Leeds after she returns from school. Seeing her happy face is always a comfort.
Ellis Friedman
March 19 2020

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So I have made it through DAY 1 of social isolation…

This followed heavy pressure from our (grown up) children that we should not come back to London to fulfil various commitments or attend meetings that we had in London this week – so here we are in Lyme Regis.

All this because of COVID-19, now designated a pandemic by WHO.

As a retired public health doctor I am proud of the fantastic work public health professionals are doing to try to get on top of things and to protect the public. Similarly as a Non-Executive Director of an NHS Foundation Trust, I am proud of what the NHS is doing to prepare for this epidemic; one of the benefits of the ‘command and control’ system that we have in the NHS – even though in normal times we mutter about lack of autonomy.

We are fortunate that for the past 20 years we have divided our time between London and Lyme Regis in Dorset and we have homes in each, so we have decamped for now to the ‘country’.

Day 1 was ok, for one thing we had some sunshine, so we did some gardening; planted some seeds, tidied up the vegetable beds and sat in the sun. Later on we went for a walk by the sea, getting chillier but still nice and we got some exercise and improved our mental health – alas the ice cream shop was not open or we could have indulged!

And now the news tonight – 16th March 2020 – and government reiterating that we/ I am in the ‘vulnerable group’ and that more draconian measures are needed and we must self-isolate and reduce social contacts; everyone to avoid pubs, restaurants, theatres and non-essential travel, work from home if they can, more flights cancelled. Goodness knows what will happen to the economy.

And all us oldies (over 70) and ‘vulnerable’ may need to go into self-isolation and be ‘shielded’ from social contacts for 3 months!

Jigsaw opened, and one of our children signed us up for Netflix!

We will just have to take it a day at a time…

Sue Atkinson

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