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By Professor Aileen Clarke, President of the Society for Social Medicine

A highlight of this year’s UK Faculty of Public Health Conference in Telford is going to be the Society for Social Medicine’s (SSM’s) ‘Research in Action’ session.

The SSM will be hosting this research feast at the always fantastic and hugely enjoyable FPH conference. Last year this session had standing-room only and this year it will be bigger and better than ever – and hopefully will have more chairs!

In our ‘Research in Action’ session, we will be presenting the top-scoring abstracts from SSM’s own annual scientific conference with a variety of public health topics. Last year they ranged from obesity, to housing and health and active commuting. This year we’re including public health advocacy, youth mentoring and immunisation uptake.

You can also expect the presentations to cover a range of research methodologies from epidemiology, cost-effectiveness modelling, systematic reviews and mixed methods to qualitative research.

SSM’s purpose is “advancing knowledge for population health” and in this case we are hoping to advance knowledge by showcasing exemplar public health research. Our session at the FPH conference is an exciting opportunity to promote linkages and future collaborations between public health researchers and practitioners.

I hope I have been able to sell our session to you. Please do come along and get involved.

Please find more information about the FPH conference at Telford on 20-21 June here.

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By Ben Barr, Senior Lecturer in Applied Public Health Research, University of Liverpool, and Lee Bentley, Research Associate, University of Liverpool

The Chancellor of the Exchequer is due to deliver this year’s Budget on Wednesday. It is imperative that he provides additional financial support for disabled people affected by the planned cuts to Employment Support Allowance (ESA) – or risk further widening the disability–poverty gap.

One in three working age disabled people are living in poverty. Their risk of poverty is one and a half times greater than for people without a disability. The government’s strategy, however, for improving the lives of disabled people, focuses almost exclusively on the disability-employment gap rather than this disability-poverty gap (1). It is true that the high risk of poverty amongst disabled people is largely because they are less likely to be in work and supporting people into employment is an important strategy for reducing poverty. Welfare benefits, however, also play a crucial role in preventing poverty by limiting the loss of income people experience when they can’t work due to disability.

People who have lost their jobs because of a disability are likely to be out of work for longer than people who become unemployed. For this reason, disability benefits have generally been set at a higher level than unemployment benefits. From April, this will no longer be the case. The government is reducing the level of ESA for disabled people who are assessed as being currently unable to work but potentially capable of work at some time in the future. The benefit will be reduced by 30% to £73 a week – the same level as unemployment benefits. But whilst 60% of new claimants of unemployment benefits will move off the benefit within six months, 60% of people on ESA will still be claiming this benefit two years later (2). This means that many people out of work because of a disability will have to survive for long periods of time without an adequate income.

Levels of poverty are already very high amongst people out of work with a disability and have been increasing since 2010, particularly amongst people who have a low level of education – the group most reliant on disability benefits (see Figure 1). Cutting these benefits will exacerbate this adverse trend.

Percentage of people with disability in poverty

FIGURE 1: % of people with a disability in poverty, aged 16-64, between 2007 and 2014, by employment status and educational level 

The government argues that reducing these benefit levels will incentivise disabled people to stay in or return to work (3), but there is little evidence to support this assumption (4), and some that suggests it may reduce their employment chances (2). Strategies to reduce the disability-employment gap over recent decades have increasingly focused on more stringent assessment criteria for disability benefits, reduced payment levels and requiring claimants to do more to prepare for work or risk losing their benefits (5, 6, 7). These strategies have had little impact on the employment of people with disabilities (8). It remains to be seen whether the government’s new strategy to halve the disability employment gap will be any more successful (1).

Even if the government’s strategy does improve the employment of disabled people, it is likely this will disproportionally benefit disabled people with greater skills and education (9, 10). The planned cuts in ESA will increase the risk of poverty for the most disadvantaged disabled people who remain out of work, and this may increase the disability-poverty gap.

Increasing poverty amongst people out of work with disabilities will adversely affect their health and increase health inequalities. We know that poverty damages peoples’ health, and adequate welfare benefits for people who can’t work can reduce these effects (11). We have seen that in recent years inequalities in health are increasing (12) in part due to disability benefit reforms (13). The severe cut planned by the government will further exacerbate these inequalities, potentially increasing levels of disability.

1    Great Britain, Department for Work and Pensions, Great Britain, Department of Health. Improving Lives: The Work, Health and Disability Green Paper. 2016 (accessed March 2, 2017).
2    Work and Pensions Committee. Disability employment gap. London: House of Commons, 2017 (accessed March 2, 2017).
3    Kenedy S, Murphy C, Keen K, Bate A. Abolition of the ESA Work- Related Activity Component. House Commons Libr Brief Pap 2017.
4    Barr B, Clayton S, Whitehead M, et al. To what extent have relaxed eligibility requirements and increased generosity of disability benefits acted as disincentives for employment? A systematic review of evidence from countries with well-developed welfare systems. J Epidemiol Community Health 2010; 64: 1106–14.
5    Watts B, Fitzpatrick S, Bramley G, Watkins D. WELFARE SANCTIONS AND CONDITIONALITY IN THE UK. York: Joseph Rowntree Foundation, 2015.
6    Banks J, Emmerson C, Tetlow GC. Effect of Pensions and Disability Benefits on Retirement in the UK. National Bureau of Economic Research, 2014 (accessed Sept 26, 2015).
7    Baumberg B, Warren J, Garthwaite K, Bambra C. Rethinking the Work Capability Assessment. London: Demos, 2015.
8    Mirza-Davies J, Brown J. Key statistics on people with disabilities in employment. House Commons Libr Brief Pap 2016; 7540.
9    Burstrom B, Nylen L, Clayton S, Whitehead M. How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework. Disabil Rehabil 2011; 33: 453–66.
10    Clayton S, Bambra C, Gosling R, Povall S, Misso K, Whitehead M. Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people. BMC Public Health 2011; 11: 170.
11    Cooper K, Stewart K. Does money in adulthood affect adult outcomes? York: Joseph Rowntree Foundation, 2015 (accessed July 30, 2015).
12    Barr B, Kinderman P, Whitehead M. Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013. Soc Sci Med 2015; 147: 324–31.
13    Barr B, Taylor-Robinson D, Stuckler D, Loopstra R, Reeves A, Whitehead M. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. J Epidemiol Community Health 2015; : jech-2015-206209.

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By Professor Azeem Majeed, Head of the Department of Primary Care and Public Health, Imperial College London

The departure of the UK from the European Union (EU) will have wide-ranging consequences for public health. The UK first became a member of the EU in 1973 and as a member of the EU for over 40 years, the UK has played a full part in European-wide public health initiatives. These have covered many areas, including food regulations, road safety, air pollution, tobacco control and chemical hazards.

Cross-national approaches to public health are essential when dealing with issues that do not stop at a country’s borders (eg. air pollution) and when dealing with large, multi-national corporations over which any single country will have only limited influence. Although EU public health initiatives have had important positive effects on health in the UK, there will be strong resistance from pro-Brexit politicians in participating in future programmes, as they generally view them as unnecessary interference in the UK’s internal affairs. The UK will also find that it is no longer able to lead such programmes or have much influence over their content, which will inevitably damage the leading role that the UK has played in public health globally.

The NHS will also find itself facing major challenges because of Brexit. With over one million employees and an annual spend of over £100 billion, the NHS is England’s largest employer. For many decades, the NHS has faced shortages in its clinical workforce and has relied heavily on overseas trained doctors, nurses and other health professionals to fill these gaps. This reliance on overseas-trained staff will not end in the foreseeable future. For example, although the Secretary of State for Health, Jeremy Hunt, has announced that the government will support the creation of an additional 1,500 medical student places in England’s medical schools, it will be more than 10 years before the first of these extra medical students complete their medical courses and their subsequent post-graduate medical training.

The recruitment of overseas-trained health professionals has been facilitated by EU-legislation on the mutual recognition of the training of health professionals. This means that health professionals trained in one EU country can work in another EU country without undergoing a period of additional training. For example a cardiologist or general practitioner trained in Germany would be eligible to take up a post in the NHS. Moving forward, it’s unclear that this cross-EU recognition of clinical training will continue. As inward migration to the UK looks to be the most politically contentious area in our post-Brexit future, we will need to take urgent action to ensure that the NHS has sufficient professional staff to provide health and social care for our increasingly ageing population.

The UK’s government will also have to address the issue of access to healthcare, both for EU nationals living in the UK and UK nationals living overseas in countries such as Spain. Currently, all these individuals are entitled to either free or low-cost healthcare. It’s unclear what will happen in the future, and this is particularly important for the UK nationals living overseas, many of whom are elderly and who will have a high level of need for healthcare. As the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.

In conclusion, Brexit will have important impacts on public health and health services, with scope for wide-ranging adverse consequences for health in the UK. It’s therefore essential that public health professionals engage with government to ameliorate these risks and also gain public support in areas such as the benefits of participation in EU-wide public health programmes and the continued recruitment of health professionals from the EU.

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By Sarah Payne

I have the privilege to be a Health Education England (HEE) academic fellow this year, taking up my fellowship just as summer was throwing us an extra few weeks of warm weather to take forward into the Autumn. My first weeks were a blur of getting my feet under the table in my new home, the Nuffield Department of Primary Care Health Sciences at Oxford University, meeting new colleagues and setting out my plan for the year ahead. I was then straight off to a week-long intensive course to learn the art of changing people’s behaviours – courtesy of Susan Michie and colleagues at the University College London Centre for Behaviour Change. And what a week it was! Not only was it a great course but it was a great way to kick off my fellowship year, providing lots of inspiration and a ‘to-do list’ as long as my arm to get stuck into when I returned to the office.

Developing a suitable research project and securing research funding for it was one of the aims of my HEE academic fellowship, so I was thrilled when I found out I had been successful in securing an award, from the British Heart Foundation, to fund my proposed research project – investigating ways to help people with high blood pressure reduce their salt intake. Cue a short but wild celebration – short because the funding was contingent on having ethics approval for all elements of the research in place before the award would be given. So, duly inspired from my behaviour change course and brimming with enthusiasm to delve into the literature to understand more about the target behaviour I hoped to change and effective behaviour-change techniques to do so, and to spend some quality time developing a behaviourally informed intervention… I was faced with ETHICS FORMS! Hmmm….not so inspiring, though of course a critical part of the process.

Thankfully, the HEE fellowship provides a perfect bridge to support the development phase of my work, allowing me to prepare detailed research protocols and all the associated documents that support an ethics application for my proposed research and to begin some of the training in research skills needed to carry out the research. As well as fulfilling the immediate requirement to secure my longer term PhD funding, the process of preparing ethics applications has forced me to consider the finer details of my research and really think through how I will deliver it. I’ve had great support from my supervisors and my department – including the opportunity to gather valuable statistics feedback from the regular department Stats Coven!

So, a slightly different focus for my first six months than I had planned, but it has so far been a fulfilling and interesting time, as well as suitably productive. I’ve attended a couple of other short courses, both of which have helped to keep my ‘inspiration and enthusiasm’ barometer high. I’ve attended various department seminars and workshops and had an opportunity to meet and network with other PhD students. Naturally, I’ve also learnt the ins and outs of the various ethics processes and undertaken some training in research integrity and good clinical practice!

So onward and upwards. I have submitted my ethics applications and I’m in the midst of the lengthy process of amendments and waiting… and waiting… Perhaps I will use some of this time to explore that behaviour change literature-base I’ve been waiting to get to. Maybe there are even the beginnings of a systematic review in sight…

Sarah Payne is a Health Education England Academic Fellow

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