Better Health For All

As I reach the halfway point of my Presidency, I find myself reflecting on both the significant strides we’ve made as a Faculty and the complex challenges that lie ahead in 2024. We face a landscape shaped by domestic and international elections, a persistent cost-of-living crisis, international conflict, and the ongoing threat of communicable diseases like MMR. Our public health teams, already stretched thin, face difficult conversations about prioritisation and the reality of ‘doing less with less’ as demand continues to outstrip our limited resource.

Yet, amid these complexities, the Faculty’s commitment to our members and the vital role of public health remains unwavering. Guided by our Organisational Strategy and Board-Led Focus Areas, we are actively building a stronger, more supportive future for both the profession and the populations our members serve.

For members, your voice matters. This is why our recently launched membership survey is an invaluable opportunity to shape how we support you in the year ahead. Building on the foundations of our 2023 Workforce Wellbeing initiative, we are currently working to establish a network of Regional Wellbeing Champions to co-ordinate work between the Faculty and our members at regional level. Working alongside partners like NHS WTE, we will also deliver our new Workforce Strategy, promoting clarity, equity, and a positive experience throughout your public health journey. We will also continue championing a Fair Training Culture within the profession.

Politically, 2024 presents a crucial window for engagement. With a UK election on the horizon, the Faculty will be a vocal advocate for evidence-based policies that prioritise health and reduce inequalities. This quarter, we will release a major new policy document outlining our recommendations on a broad spectrum of critical public health issues. These recommendations will guide our advocacy in the coming year as we deliver for our members, our profession, and the health of populations across the UK.

Poverty and the cost-of-living crisis remain key areas of focus. Our recent cross-sector report on childhood nutrition, launched in Parliament, stands as a testament to our commitment. Additionally, our work on climate change continues, guided by our Climate and Health Strategy 2021-25. And following the publication of our landmark Anti-Racism Framework, we continue to lead on anti-racism initiatives within our profession and beyond.

We must also recognise the essential role of purposeful, strategic collaboration. Alongside our partner Royal Medical Colleges and other stakeholders, we will work to ensure the NHS prioritises prevention and population health activities. Our Health Services and Health Improvement Committees are currently collaborating on a new report to be published in 2024, further cementing this vital partnership.

Looking to the future, we must prepare for the challenges ahead by harnessing the latest science and technology. Our Distinguished Lecture series continues in 2024, inviting leading public health thinkers to explore these complexities. Our ‘What is Public Health’ campaign will continue to raise awareness about the important and inspiring work that public health professionals do and the impact we have every day. Furthermore, new Special Interest Groups like our Digital and AI SIG demonstrate our commitment to embracing new technologies to advance our work.

Finally, I want to express my sincerest gratitude to all our members who have contributed to our successes in 2023. With such dedication and collaboration, I am confident that 2024 will be a significant year for public health. There has never been a better time to join the Faculty and be part of our journey towards a healthier, fairer future for all.

Together, we can navigate these complex times and deliver positive change. Let’s make 2024 a year where public health takes centre stage, shaping a stronger future for the UK and its communities.

Professor Kevin Fenton CBE FFPH
FPH President

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January 22^nd – 28^th 2024 is Cervical Cancer Prevention Week. It is an opportunity to raise awareness of cervical cancer and recognise the symptoms to help women understand how to reduce their risk and prevent illness.

Approximately 14 high-risk types of human papilloma virus account for most cases of cervical cancer. Through regular cervical screening and HPV vaccination, it is a largely preventable disease, and in 2018, the World Health Organization (WHO) called for worldwide action to eliminate cervical cancer (defined as an incidence rate maintained below 4 per 100,000).[1] However, despite it being largely preventable, approximately 3,200 women in the UK, mostly aged 30-34 years old, are diagnosed annually, with more than 800 losing their lives. This equates to nine diagnoses and two deaths a day.[2] Furthermore, data shows that there are ethnic inequalities in the uptake of cervical screening. A YouGov survey (date not provided) commissioned by Jo’s Cervical Cancer Trust found that women from Black, Asian and minority ethnic backgrounds were more likely than White women to report never having attended a screening (12% vs 8%).[3]

The same survey identified barriers to accessing screening for this group of women. These included a lack of awareness about the purpose of the screening test:[3]

• Fewer Asian women aged 20-65 (70%) knew that screening is a test to check cells from the cervix to find pre-cancerous abnormalities than White women of the same age (91%).
• Just over half (53%) of Black, Asian and minority ethnic women aged 55-65 think screening is a necessary health test compared with 67% of White women in the same age group.
• Twice as many Black, Asian and minority ethnic women as White women said better knowledge about the test and its importance would encourage them to attend a screening appointment (30% against 14%).

Women from an ethnic minority background (28%) were also less likely to be comfortable talking to a male GP about cervical screening.[3]

This was reinforced by the findings from another study which found that some women, mostly of Asian ethnicity, would not attend if the option for a female was not there.[4]

Other barriers to cervical screening that have been identified as potentially being more common among women from ethnic minority backgrounds include:[4]

• Considering themselves low risk due to not having a partner or being married.
• Lack of familiarity with the terminology used to describe the test, even among English-speakers.
• Shame and stigma of cancer in some ethnic minority communities.
• Embarrassment among women from older generations.

Addressing ethnic inequalities in screening uptake is an important part of achieving the WHO’s goal of elimination. Targeted education to improve understanding and awareness of cervical cancer and cervical screening among women from ethnic minority backgrounds is likely to play a crucial part in this⁴. Delivery of such education in community settings may be of benefit, particularly for older women, and it should include translating screening invitation leaflets/letters into different languages. Furthermore, it should address the shame, stigma and embarrassment that is experienced by some women from ethic minority backgrounds.[4],[5]

The Faculty of Public Health’s Sexual and Reproductive Health Special Interest Group will continue to seek out opportunities to raise awareness of sexual and reproductive health inequalities, including ethnic inequalities, in line with the Faculty’s anti-racism framework and action plan.

[1] https://www.who.int/initiatives/cervical-cancer-elimination-initiative

[2] https://www.jostrust.org.uk/sites/default/files/jos_cervical_cancer_trust_elimination_report_2023-2_june_1.pdf

[3] https://www.jostrust.org.uk/sites/default/files/bme_survey_website_final.pdf

[4] Barriers to cervical cancer screening among ethnic minority women: a qualitative study | BMJ Sexual & Reproductive Health

[5] https://www.gov.uk/government/publications/health-matters-making-cervical-screening-more-accessible/health-matters-making-cervical-screening-more-accessible–2

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“Try being nice first, but accept you may need to escalate.”

“Our best guess is that the average person needs to see and hear about climate at least 80 times a month — potentially even more — to become an active supporter of significant climate action.”

“People believe they will be protected from harm – they think if things were really that bad [with climate emergency], they wouldn’t be allowed to continue.”

These three pearls of wisdom were shared in FPH’s recent series of webinars on advocacy for climate and health, organised by us as members of the Sustainable Development Special Interest Group. In case you missed them, this blog summarises our work in this area, to help all public health professionals reflect on and sharpen their own advocacy skills, and apply them to the ‘biggest threat to global public health in the 21st century’: climate change.

What we did

In 2021, the Faculty of Public Health (FPH) published its first Climate and Health Strategy (2021-25). Advocacy was one of the core priorities and we, along with several others, signed up from the special interest group to work it. We quickly identified the need for actions across five main areas, which included: 

1. Some scoping, reviewing and learning from others and the past
2. Develop focused proactive advocacy on a very small number of issues
3. Develop mechanisms for reactive advocacy
4. Skills programme and networks and other support for members and SIGs doing advocacy
5. Developing our Theory of Change for advocacy

This blog focuses in particular on areas (1) and (4) in order to support FPH members to develop the skills for advocating on climate change, environment, and health, specifically for those most affected by climate change and environmental breakdown. To deliver this, we first conducted an ally mapping exercise, followed by a ‘quick and dirty’ literature review. This was to inform the FPH’s five advocacy work areas within the climate and health strategy, and lay a foundation for future work on building advocacy skills specifically. We wanted our work to be useful and built on over time, so we produced a full reading list, a slide set summary which we shared at a webinar, and resources for colleagues building proactive advocacy campaigns around climate and health (like the current campaign to prevent fossil fuel expansion).

To start a skill–building programme, we conducted a survey of members of the FPH to understand what colleagues felt were key skills gaps in this area. Confidence and skills around communications came out as a major gap, so we set about putting on webinars that shared knowledge and enabled peer learning. These webinars also included feedback and evaluation which added to our understanding about advocacy skills needs. Once finished, we brought learning from all steps together to form a set of recommendations for advocacy skills training.

What we found

In addition to communications, other skills gaps among FPH members in the climate advocacy space included negotiating for resources, how to make use of a vast evidence base, building useful networks, and achieving and maintaining change. The literature review also suggested that social change / social movement theory, critical analysis and systems thinking were topics about which public health professionals would benefit from learning.

The existing literature demonstrated that advocacy can be effective at achieving population and planetary health improvements, and also identified some key ingredients for successful advocacy in this area. Whether it’s collaborating with diverse stakeholders, using strategic framing, or using theory to inform campaigning, we know there are ways we can increase our chances of success in advocacy, and we know these approaches and tactics can be learned and practised.

There were also more detailed lessons extracted from webinars on what has worked in the past for FPH presidents, internal and external communications for climate and health, which you can explore here under the Advocacy CPD and learning resources section: https://www.fph.org.uk/policy-advocacy/special-interest-groups/sustainable-development-special-interest-group/resources-on-climate-change-and-health/

Across everything we did, we identified three key messages: 

1. Advocacy is an important public health skill
2. We don’t get sufficient opportunities to learn and practise advocacy skills
3. We’ve explored advocacy (and specifically skills for advocacy) through a climate and health lens but our findings are more widely applicable

What next for the FPH as an organisation?

Across the board, it’s important that the FPH looks for more opportunities to incorporate advocacy into curriculum and continuing professional development. Over the last year or so, we have scratched the surface of what an advocacy training programme could do with our climate and health webinars. It is therefore essential that a longer term programme of advocacy training and learning is put in place for all public health professionals, who can then apply these skills to a variety of different contexts (including climate change and health). This could take many possible forms, but we know from our work so far that it needs to (1) help people learn about key topic areas (which are current gaps), such as systems thinking, gaining political commitment, policy support and social acceptance for climate action, and (2) apply their learning through practice. This is not only in line with the ASPHER competencies that the FPH has already endorsed, but it also overlaps with the skills and actions required to counter the commercial determinants of health, and pushes professionals towards bolder approaches such as the planetary health education framework.

What can public health professionals do now?

If you weren’t able to join the webinar sessions, you can catch up now on YouTube with the external communications session here, and the internal communications and persuasion session here. Visual summaries from the sessions can also be found on the FPH resource pages here. The summary of the scoping work (including findings from the literature review and the reading list) can be found here.

Practice is another key aspect of strengthening advocacy skills, so if you would like to join small, informal groups of FPH members who are working to improve their communications and advocacy skills in relation to climate change and health specifically, please email anna.brook1@nhs.net.

Advocacy is an essential skill for all public health professionals, so we hope you will join us as we work to strengthen training around this topic.

Anna Brook and Emily Loud, members of the FPH Sustainable Development SIG

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