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Archive for the ‘Academic’ Category

By Hannah Dorling, Helen Walters and Tara Lamont

How can alcohol licensing decisions impact upon alcohol-related crime and health issues? Does turning street lights out at midnight cause more accidents? How does a new bus service impact upon physical activity levels?

Front-line public health professionals need relevant evidence in formats that reach them and are digestible by them and those they work with. At this year’s FPH conference we are running a session on just this issue. The National Institute for Health Research (NIHR) spends £10m a year on its Public Health Research (PHR) programme and we are one of the main funders of public health research in the UK. We support research which may not be funded by others – from studies of impact of alcohol licensing to evaluation of urban motorways. NIHR also runs the Dissemination Centre whose specific role is to get research findings to the front line.

We want to fund research that evaluates public health interventions that happen outside the NHS – that will provide new knowledge on the benefits, costs, acceptability and wider impacts of interventions that impact on the health of the public and inequalities in health. We want this research to be multi-disciplinary and broad, covering a wide range of public health interventions. Funding comes from the Department of Health in all four UK countries. A key aim of the programme is to deliver information to allow practitioners and policy makers to improve services, rather than simply improving scientific knowledge. A challenge for the programme is finding the questions that most urgently need answering.

We also need to help decision-makers get hold of the evidence they need. Every day, about 75 new clinical trials and 11 new systematic reviews are published, many of which will be relevant to public health. The NIHR Dissemination Centre filters new knowledge and produces a wide range of publications. We want to know more about what kinds of evidence and formats work best for front line staff.

This is where we need you. This interactive conference session is aimed at front-line public health professionals (though academics are welcome!) who want to talk about how you use research in your daily work. Where do you find your research? What do you do with it? What would you like more of? Do you have challenges linking to the academic world? What questions would you like answered to help you in your work? Come along to our session and tell us what you think. We are keen to hear and to use your wisdom as we reflect on 10 years of public health research funding and make plans for the next 10 years.

In the meantime if you have an idea for research that needs doing please do contact us on phr@nihr.ac.uk or use the programme’s online mechanism for submitting suggestions.

Join the session at the FPH conference on Tuesday 20 June in Telford:
11:30 – 12:30: Public health need – filling the evidence gaps in local government
Location: Wenlock Suite 1&2
Presenters: Helen Walters, Consultant in Public Health Medicine / Consultant Advisor, NIHR NETSCC, University of Southampton
Tara Lamont, Deputy Director of the NIHR Dissemination Centre
Closing comments: John Middleton, President of the Faculty of Public Health

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By Melisa Campbell MFPH, Research Fellow in Public Health, (Out of Programme: SpR Public Health [St4]), Department of Public Health and Policy, University of Liverpool

Melisa Campbell

Telling the story of child inequalities in health and care using big data research has been my passion for the last six months of my Health Education England Academic Fellowship, a focus fuelled by my personal working experiences within public health departments and healthcare systems.

As many of us will be welcoming spring and making plans for the summer, I am at the ‘show how’ phase and planning for my pending PhD application, which builds firmly upon my out of programme academic experience at the Farr Institute and the Department of Public Health and Policy at the University of Liverpool.

During my fellowship so far, I have been fortunate enough to share my work at the recent Lancet Public Health Conference (2016) Swansea and the Society for Social Medicine (SSM) Conference 2016.  I am also currently drafting further papers with colleagues from University of Liverpool, University of Nottingham and University College London.

The first months of the fellowship were quickly consumed by intense technical training, making connections within and outside the university and refining my understanding of theories and methodologies necessary to deliver my proposal, particularly with relation to health inequalities and statistical methods.

On-going learning has appropriately defined my fellowship and considerably expanded my skills, knowledge and practice of research methods including statistical methods for regression analysis, dealing with missing data and longitudinal data. I’ve been learning to undertake these analyses in STATA, and also in R, which is an open source statistical platform that anyone can use for free, and so gaining transferable skills for public health service practice.

Much of my work has been exploring childhood social inequalities using the Millennium Cohort Study data – a nationally representative birth cohort of 19,000 children born at the turn of this century. Within this, I have maintained a special interest in childhood unintentional injuries, but my professional growth from this experience has facilitated a greater breadth of topics relating to child inequalities pertaining to paediatric hospital admissions, smoking initiation and school bullying, drawing on the expertise in the Farr Institute.

This has already been a rewarding experience and I look forward to making the most of my remaining time. My contact details, previous and when ready information on my current and future work can be found at: University of Liverpool: Melisa Campbell

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By Margaret Whitehead

David Player led the Health Education Council in the 1980s. On April 2 he celebrated his 90th birthday in Edinburgh

I first met David Player in the mid-1970s, when I took up my first public health research job in the Scottish Health Education Unit (SHEU) in Edinburgh, where David was Director. At the time, David had this great idea: to pump-prime academic health promotion by funding academic lectureships in the various relevant disciplines in Scottish universities. As this was a novel strategy at the time, a range of committees had to be convinced, and David taught me how to put a compelling case with different messages for different interest groups. He triumphed in the end, and the fruits of his far-sighted vision can still be seen today, not least in the leaders of public health research that his initiative produced.

One of the first lessons that working under David’s directorship taught me was that everything about public health is political – even the seemingly most innocuous subjects could catch you out. One of my very first tasks was to produce a factual guide to family-planning services in Scotland, which I never dreamt anyone could object to. I was wrong. Somehow it came to the attention of the Scottish health minister with a strongly Catholic constituency in Glasgow, and, before I knew it, objections were being raised and outrage was being expressed. This was the sort of challenge that David cheerfully faced every day – be it about sugar, alcohol or tobacco – as he waged war with what he termed “the anti-health forces”.

It was David’s longstanding passion about unemployment and health and inequalities, however, that shone through for me. David moved from SHEU in the 1980s to take up the post of Director General of the then Health Education Council (HEC). By then I was a freelance researcher and in January 1986, David commissioned me to update the evidence that had accumulated since the publication of the Black Report in 1980 and assess the progress made on the report’s 37 recommendations. My report, entitled The Health Divide, was eventually published in March 1987 as an HEC occasional report, one week before the HEC was disbanded. David did two politically astute things when he commissioned the report: he set up an informal panel of distinguished scientific advisors, including three of the original members of the Black Report working group, and he signed over copyright of The Health Divide to me (as opposed to the commissioning body, HEC), thereby ensuring that the report would be published irrespective of what happened to the HEC.

As the launch date drew nearer, Peter Townsend, a scientific advisor for the report and one of the authors of the original Black Report, suggested that the HEC needed to call a press briefing, backed up by the scientific advisors because, in Peter’s memorable words:

“We can’t let Margaret face the flak alone.”

At the time I was young and so naïve that I hadn’t realised that there would be any flak!  How wrong I was again. After we had all travelled to London on the appointed day, the Chairman of the HEC decided to cancel the press briefing at the HEC offices an hour before it was due to begin. He was quoted in the Independent as saying that The Health Divide was “political dynamite in an election year” and so it was necessary to postpone the press briefing.  Members of the panel, who had already assembled, decided to proceed with the press briefing at the nearby offices of the Disability Alliance – David and his staff were instructed not to attend and so had to watch from the sidelines as the story unfolded. And what a story it turned out to be. As we made our way towards the Disability Alliance in Soho, journalists who were hurrying towards the HEC came across the procession going the other way and joined in behind – a Pied Piper effect. The press, TV and radio swung into action, spurred on by the hint that the report had been suppressed, possibly by the intervention of the department or even government ministers. The fact that this was remarkably similar to the treatment that the Black Report received seven years earlier was not lost on the media. The result was a public relations triumph for health inequalities advocacy (or a public relations disaster for the Chair of the HEC and government).

A health journalist, Peter Davies, recalled how a few days after the event, David Player told him gleefully: “It is going like hot cakes. They were queuing outside in New Oxford Street. We have a bestseller on our hands.” (1).

We had indeed – publishers started queuing up to publish The Health Divide, and it was eventually published in one volume with The Black Report by Penguin and became a non-fiction bestseller (2)

In the hectic aftermath of the press conference, the House of Lords requested copies for all the members as they prepared to debate the NHS, and a re-print had to be hastily prepared. It was, however, when a request for a copy of The Health Divide from Margaret Thatcher’s office landed on David’s desk that things became scary. David told a witness seminar at the London School of Hygiene and Tropical Medicine that, as he signed the complements slip to the PM, “It felt like I was signing my own death warrant.” (3).

The Times fanned that particular flame, by suggesting that the report was a “devastating final salvo from David Player to the government” on the eve of the disbandment of the HEC. That did David a great injustice – at the time he commissioned The Health Divide, over a year earlier, there was no inkling that the HEC would be disbanded, or that the Government would call a snap election, timed not long after the eventual publication.
It meant, however, that David did lose his job with the closure of the HEC and a very difficult time ensued for him. When I think of David during this episode and the battles he fought before and after it, I think of his courage in the true spirt of the great public health pioneers, mixed with his great Glaswegian sense of humour. An unstoppable combination!

1.    Davies P.  Review. BMJ 2003; 326: 169.
2.    Inequalities in Health: the Black Report edited by Peter Townsend and Nick Davidson and The Health Divide by Margaret Whitehead. 2nd Edition. Harmondsworth: Penguin. 1992.
3.    Berridge V, Blume S. (eds) Poor health: social inequality before and after the Black Report. Report of a Witness Seminar.   London: Frank Cass &Co Ltd. 2003.

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By Daniel Flecknoe, Co-Chair of the FPH Global Violence Prevention Special Interest Group

The preliminary report of the Lancet/American University of Beirut Commission Health workers and the weaponisation of health care in Syria [Fouad et al, 2017] was published on 14 March, calling attention to the principles of medical neutrality and unhindered patient access that have been so badly neglected in the ongoing Syrian conflict. Systematic targeting of health workers by ISIS, Syrian and Russian military forces is a war crime committed against civil society, and epitomises a disturbing trend of indifference and impunity to international humanitarian law by warring governments and armed groups over recent years. Established norms in the conduct of war, built up over the past century and a half since the founding of the International Committee of the Red Cross, may be irrevocably degrading, and the public health consequences for civilian populations exposed to such deliberate brutality will be correspondingly more severe.

The Faculty of Public Health’s (FPH’s) Global Violence Prevention Special Interest Group (SIG) is committed to engaging with this neglected and worsening cause of preventable morbidity and early mortality. Its members contribute to research into the health impacts of armed conflict (including the Lancet paper referenced), engage and collaborate with other conflict-prevention organisations and conduct advocacy for arms control, economic/democratic reforms, and respect for human rights and the rules of war. We encourage all public health professionals to give parity to armed conflict along with other major global causes of illness, injury and death, and to lobby (both as citizens and medical professionals) for foreign policies that will protect and preserve health.

The SIG will be represented at the FPH conference in June, and members will be happy to discuss our current workstreams with anyone who might be interested in getting involved.

References:
Fouad FM, Sparrow A, Tarakji A, Alameddine M, El-Jardali F, Coutts AP, El Arnaout N, Bou Karroum L, Jawad M, Roborgh S, Abbara A, Alhalabi F, AlMasri I,  Jabbour S. 2017. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria. The Lancet. Published online 14/07/17 http://dx.doi.org/10.1016/S0140-6736(17)30741-9

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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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