Better Health For All

Climate change has been identified as the greatest threat, and opportunity, for global public health in the 21^st century.  It is therefore incumbent on public health consultants, registrars and practitioners to be aware of the action we need to take to reduce this threat and mitigate the consequences.  

The opportunity: According to The Intergovernmental Panel on Climate Change, a warming greater than 1.5°C is “not geophysically unavoidable: whether it will occur depends on future rates of emission reductions.” https://www.ipcc.ch/sr15/  

The challenge: About 80% of known fossil fuel reserves would need to stay in the ground to limit the concentration of CO2 in the atmosphere to 450 parts per million.  This level would in turn give a 50% chance of limiting global warming to a maximum 2°C global average temperature rise.    

The consequences: Poverty and disadvantage are expected to increase as global warming increases; limiting global warming to 1.5°C, compared with 2°C, could “reduce the number of people both exposed to climate-related risks and susceptible to poverty by up to several hundred million by 2050 (medium confidence).” https://www.ipcc.ch/sr15/chapter/spm/  

What help is available?  

1. The sustainable development and climate change resources produced by the Faculty of Public Health Sustainable Development Special Interest Group support specialty registrars and their educational supervisors in meeting Faculty of Public Health learning outcomes and offer information for public health consultants and practitioners.  They are available here  on the FPH website. 

2. The Faculty of Public Health have established a Climate & Health Committee.  This is a really important step, and I would like to thank Sue Atkinson – the chair, and our President Maggie Rae for setting it up.  It illustrates the seriousness with which FPH are now taking this agenda.  The Committee aims and objectives are to: 

• lead FPH’s sustainability and climate change policies. 
• embed sustainability and climate change in all FPH policy developments. 
• increase the Faculty’s profile in sustainability and climate change work. 

• advise on the Faculty’s ethical investment policy and the transition to carbon neutrality by 2030. 
• promote best practice in sustainability and climate change work across the Faculty. 

3 I recently attended an on-line meeting of the All-Party Parliamentary Group (APPG) on the UN Global Goals for Sustainable Development: – a cross-party group of UK parliamentarians who champion the United Nations Sustainable Development Goals and monitor their implementation.  The meeting was about their assessment of the UK’s progress on delivering the Sustainable Development Goals (SDGs), their investigation and evaluation of the impact of Covid-19 on the SDGs, and a summary of the steps the UK Government should take to ensure the SDGs are at the heart of efforts to build back better.  The report is available here: – Build Back Better.  This is an important report, particularly as it is likely to inform the Government in the lead up to COP26 in Glasgow in November 2021.  You will see that the recommendations are high level.  The questions for us in Public Health are as follows: 

• Does the report cover all the key Public Health and Climate Change issues? 
• Is the level of ambition sufficient to enable the UK to reduce the severity of climate change? 

• What will the role of Public Health be going forward? 

Please feel free to e mail me with your comments at hzross2@myphone.coop.  They will help us to crystallise our thinking about how we Build Back Better (post Covid) for the Faculty of Public Health.   

4 Other resources:  

• Mapping “the co-benefits of climate change action to issues of public concern in the UK”  
  
• https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30167-4/fulltext?dgcid=raven_jbs_etoc_email

• LAYING THE FOUNDATIONS FOR A NET ZERO SOCIETY: Principles and Infrastructure for a Climate Resilient and Economically Sustainable Recovery – Professor Karen Turner Director et al, Centre for Energy Policy, University of Strathclyde July 2020 

• UKHACC – 6 principles for a healthy recovery 

• “Actions that health organisations might take to counter the climate emergency.” http://www.ukhealthalliance.org/wp-content/uploads/2020/04/Actions-for-Health-Organisations.pdf 

The next meeting of the FPH SD SIG will be held on Thursday 15th October from 2pm to 4pm by Zoom. If you have any items that you would like the SIG Committee to discuss, then please do not hesitate to e mail me. 

Helen Ross  

Faculty of Public Health 

Chair: Sustainable Development Special Interest Group 

 e mail – hzross2@myphone.coop 

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8 October is Clean Air Day. Due to COVID-19 it looks a little different this year, but the need to keep air pollution high on the public health agenda has never been greater. Evidence is emerging around the links between air pollution and COVID-19 outcomes. And during the lockdown we experienced cleaner air and saw massive shifts to low pollution behaviours. Let’s keep up the momentum as we all have a part to play in keeping our air clean.

Public health professionals can play a particularly important role in providing information and advice to people about how to protect their health from air pollution, and we have basic resources for health professionals available to help you in these conversations. The Clean Air Hub https://www.cleanairhub.org.uk/ also provides straightforward public information on air pollution.

Clean Air Day Live on 8 October at 14:30 will be running a session on ‘How Can the Health Sector Tackle Air Pollution?’ to explore the role of the health sector in both cutting air pollution through its own operations, and the role of health professionals in providing air pollution guidance to patients.

We have an unprecedented opportunity to build back cleaner air as part of our ‘new normal’ as we recover from this COVID-19 crisis, so do join in with Clean Air Day and find out more about the part you can play to help maintain cleaner air and protect people’s health, as the need to do so is greater than ever.

There is a detrimental link between the health outcomes of COVID-19 and air pollution. Emerging evidence suggests that air pollution may play a role in making us more vulnerable to catching COVID-19. It also makes those with health conditions that are caused or worsened by air pollution – such as asthma, heart disease and COPD – more vulnerable to complications, even death, if they contract COVID-19. And high air pollution is causing irreversible damage to some children’s health, reducing their lung function and creating a generation who may be more susceptible to future pandemics.

People have also realised that clean air is possible and want it to stay. During the COVID-19 lockdown, levels of NO2 air pollution dropped by 20-30% across the UK, and by up to half in parts of London, primarily from a reduction in private car use. People noticed and appreciated the cleaner air and safer streets. The vast majority of people (72%) believe that clean air is even more important now because coronavirus can affect people’s lungs, and want government and businesses to tackle air pollution more urgently than before the outbreak of the virus.

And behaviour has shifted offering a profound moment of change. During lockdown millions of people changed their routines in a way that reduced air pollution, by working from home and walking and cycling more, and many are willing to continue to do so: 87% want to keep working from home to some extent, half want to walk more and a third would like to cycle more. It is easier to maintain a habit than foster a new one, so we can build on this unique moment to create lasting positive change.

Clean air was one of the few silver linings of the COVID-19 lockdown suffering. Through our collective behaviours we saw and experienced extraordinary improvements in outdoor air quality. On Clean Air Day – and every day – let’s keep doing these behaviours to keep our air clean. Find out how you can advise your patients and the public to protect their health from air pollution and together let’s make 8 October the cleanest Clean Air Day yet.

Larissa Lockwood
Director of Clean Air
Global Action Plan

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We held the inaugural meeting of the new FPH Climate and Health Committee on 10th September 2020. Of course like everything else these days it was held remotely by zoom. Slightly strange doing ‘introductions’ around the ‘screen’ rather than round the room, but we have all now got quite used to this way of working. The President came to welcome all the new members and offer her support, which was great – thank you Maggie.

The Board had agreed this new committee at the February board meeting in the recognition that climate change and health is both the biggest threat but also the biggest opportunity of the century. That was before Covid-19 arrived and sent us all (across the globe) into turmoil and for much of the time into lockdown. I write this as we head into the ‘second wave’ and we may all be in lockdown again by the time this is published, but I will try not to get diverted onto Covid!

Importantly Covid has impacted on public health professionals and hence our decision to delay the first meeting of the Climate and Health Committee (C&HC) until now.

I think it was the right decision. We have learned a lot through Covid impacts. It has demonstrated how rapidly change can happen if it needs to and people see the imperative – that in itself is a useful lesson for the necessary change for a sustainable planet. It has also heightened peoples’ awareness of inequalities and BAME issues, of the importance of nature and the environment and physical activity for peoples’ mental as well as physical health. All good PH issues. We agreed to build in more about the environment and biodiversity into the committee’s Terms of Reference

So the first meeting of C&HC was a lively affair with good discussions and challenge about a number of topics. Of course it is early days and much of the meeting was ground setting – such as briefly outlining what the FPH has already done on climate change (CC) and sustainability. There was a recognition that the FPH needs to be more proactive on CC and sustainable development (SD).

The work of the committee will build on the good work already being undertaken by the SD SIG and by other SIGs, such as transport and food. We will aim to utilise the mass of expertise on CC and SD held by our members by working closely with SIGs and other FPH committees and would welcome any offers of support and help.

The Sustainable Development Goals (SDGs) were floated as a potential ‘framework’ for a Climate and Health strategy and action plan, and whilst we recognise there is some criticism of some of the SDGs, overall we thought they were worth exploring further. We need to look also at the key roles of the FPH – as an organisation – in standards and training –and as an advocate for the public’s health, and consider what actions the FPH should take and what needs to be prioritised.

One of the big issues for us is knowing what would be most helpful for the FPH to do to support members – both trainees and existing consultants and DPHs – in respect of taking action and moving the climate and health agenda forward. And we are only too aware of how busy most members are dealing with aspects of Covid. So any suggestions gratefully received. I guess if you are busy with Covid etc you may not even have time to read and respond to this blog! But if you are reading this and do have thoughts on what FPH should do on the CC agenda then please email Sue Atkinson as Chair.

An update from the SD SIG on its work on the opportunities in recovery from Covid-19 showed that a statement on this will be coming shortly. Also ‘watch this space’ on Net Zero NHS (greening the NHS) as Nick Watts, the newly appointed NHS Chief Sustainability Officer (and a member of the FPH and the C&HC) updated us on their work. We also received an update on the PHE changes into the NIHP (National Institute of Health Protection) and how these may impact PHE’s work on CC and SD and related topics such as air quality. The FPH will need to keep a close eye on these changes.

As a committee, our first action was to recommend that FPH support an open letter calling on the United Nations Human Rights Council to recognise the universal human right to a safe, clean, healthy and sustainable environment. FPH signed the letter, and we would encourage FPH members to support the call.

We still need, on the committee, reps from practitioner and from associate members and from ADPH. So if anyone wants to volunteer or has any suggestions or wants to be involved please get in touch.

So much food for thought and much work still to be done. A huge thank you to the members of the committee for great and helpful discussion. Thank you also to Helen Johnston who is the SpR supporting the C&HC through the FPH project scheme, and we will hope to continue this attachment into the future, and of course, thank you to Julian Ryder, from the FPH who is supporting the C&HC. I look forward to working with you all as we progress this important work for the FPH.

… watch this space.

Sue Atkinson
Chair, FPH Climate and Health Committee

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So as I and many others predicted some weeks ago, new cases are rising rapidly in the UK and these cases are predominantly amongst the young and the disadvantaged.

The impact on hospitalisation rates and deaths has so far been modest, which is to be expected because of the epidemiology of the disease in the under 40s, but we only have a small window of opportunity before infection rates start significantly rising in persons at much greater risk of experiencing significant morbidity and mortality.

The ‘rule of six’ is a good start but much more needs to be done if we are to achieve the prime aim of preventing significant further morbidity and mortality in the population and the secondary aim of allowing the economy to function at a reasonable level.

This is obviously not easy but i repeat again that the epidemiology of this disease is very helpful in achieving these aims and we need to follow the epidemiology.

Why is the epidemiology so helpful? Because the most at risk group, say people aged over 60 years who represent over 95% of deaths in the UK are usually retired!

So the policy that needs to be followed is simple to describe

1. Protect the most at risk, especially the elderly and those with underlying conditions, by positively discriminating in their favour by making the safe choice the easier choice for them.
2. Encourage other people to work in a Covid secure setting. For many this can mean continuing to work from home. So what needs to change?
3. Visiting to care homes and hospices should be stopped. It is reckless not to learn the lessons of the first wave. We must minimise the risk of introducing the virus into high risk settings by regularly testing staff, preventing visits and adherence to strict control of infection procedures.
4. Pubs should be closed at 10 pm. Allowing pubs to stay open for long hours encourages drunkenness and disinhibition and therefore non-adherence to viral control of transmission measures.
5. Change the regulations so that the elderly and others at high risk can maintain a 2 metre rule. So for example in a restaurant, some tables would be obliged to allow 2 metre distancing whilst others could continue to follow the one metre plus guidance. This is an example of positive discrimination.
6. A public health messaging campaign to encourage those at high risk not to engage in risky behaviour and to encourage the general public to take particular care when they are meeting persons at high risk.
7. An effective test and trace system.
   5.1 This requires a significant increase in public health staff and others in the test and trace system – as the number of new cases rise the amount of contact tracing work increases.
   5.2 An increase in testing capacity with prioritisation of the testing to those with classic Covid19 symptoms. The test needs to be accessible and provide fast, reliable results.
   5.3 End the reliance on phone contact by ensuring non-responders are visited.
   5.4 Have a more agile local system, with more control over resources and decision making.
   5.5 Integration of the app into the system.
8. Maintain messages on the fundamental need for hand washing, social distancing and mask washing to prevent transmission.
9. As lab capacity increases, a prioritised use of this capacity to detect asymptomatic infectious persons.
10. An effective quarantine system at ports of entry.

It would have been useful to have introduced measures to try to eliminate the virus a policy which has worked so effectively in countries like New Zealand but that opportunity has probably been lost.

We can expect that improvements in hospital management will mean that the mortality rate in hospital will be lower than in the first wave.

Public health messaging will need to be both sensitive and authoritative. We will be disrupting people’s normal lifestyles in important ways.

Ellis Friedman
13/09/20

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Dr Helen Walters, an NIHR Public Health Consultant Advisor, introduces four newly launched public health research teams, contracted under the PHIRST scheme, to enable local authorities to rapidly evaluate interventions aiming to improve health and tackle health inequalities in their areas. 

When I was a Director of Public Health in London I knew that my team were delivering innovative schemes that affected large numbers of people. Our hope was that the schemes would improve health and reduce the health inequalities experienced by some highly deprived populations. But we didn’t really know whether they were achieving this. 

Did the Healthy Schools programme working across more than 1,500 schools in the capital improve the health of thousands of children? Did the Healthy Workplace award scheme improve sick leave levels for London’s employers? Would getting the Healthy Streets approach into the heart of the Mayor’s Transport Strategy make any difference to physical activity levels in the city?  

We were basing these schemes on the little evidence that was available, but we could not find a way to get them evaluated to build that evidence-base any further. Public health practice in local government is mainly distant from academic public health research. Local government does not have a culture of undertaking research. It moves fast, and does not have routes into research funding. Golden opportunities to learn and evaluate were being lost. 

The PHIRST Scheme 

The NIHR’s Public Health Research programme (PHR) is experimenting with a new scheme to try and solve this conundrum – the PHIRST scheme. PHIRST stands for Public Health Intervention Responsive Studies Teams. The idea is that the PHR contracts with four academic teams who are ready and waiting, fully-funded, to evaluate schemes that are happening in local government across the UK. 

The timing could probably not have been worse but somehow, despite pestilence and lockdown, we have managed to appoint four teams, and to match them up with four local authorities that are keen to have their schemes evaluated. Issues include:  

• free school breakfast clubs in Hammersmith and Fulham 
• citizen-informed design of employment support in Fife 

• remote provision of drugs and alcohol services in Leeds 
• reducing exposure to adverts for foods that are high in fat, salt and sugar (HFSS) on the transport system in Yorkshire 

The PHIRST teams are led by prominent public health researchers: Ashley Adamson (Newcastle University), Susie Sykes (London South Bank University), Rona Campbell (University of Bristol), and Katherine Brown and Wendy Willis (University of Hertfordshire). They will work closely with each local authority to co-create the evaluation with the heavy lifting being undertaken by the PHIRST teams and fully funded by the NIHR, starting in September. 

Timely and accessible research for local authorities  

And in a few months the PHR programme will go out to Directors of Public Health and ask for more schemes to evaluate, so we can keep the PHIRST teams busy. If it works the plan is to make this a rolling programme. 

Local authorities have huge opportunities to influence health and health inequalities but without an evidence-base they cannot maximise these opportunities. The hope is that this scheme will provide timely and easily accessible evaluations for those who are still hard-pushed Directors of Public Health so that, in the future, there will be an evidence-base. 

______________ 

For more information please email the PHR programme on phr@nihr.ac.uk 

More information on the PHR Programme is also available on the NIHR website. 

This blog was first published on the NIHR website.

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