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Archive for the ‘Healthcare’ Category

By Dr Justin Varney, National Lead for Adult Health and Wellbeing, Public Health England

Public Health England estimates that between 2-5% of the population identify as lesbian, gay, bisexual or other – comparable to many ethnic minority and faith populations. Despite legislative reform many LGBT people continue to experience discrimination, marginalisation and harassment.

  • 38 per cent of trans people have experienced physical intimidation and threats and 81 per cent have experienced silent harassment (e.g. being stared at/whispered about)
  • One in five (19 per cent) lesbian, gay and bi employees have experienced verbal bullying from colleagues, customers or service users because of their sexual orientation in the last five years
  • Almost 1 in 4 trans people are made to use an inappropriate toilet in the workplace, or none at all, in the early stages of transition. At work over 10% of trans people experienced being verbally abused and 6% were physically assaulted.

The impact of this discrimination on mental health is easy to understand, however the stark data on suicide and self-harm demonstrates the depth of the impact that this discrimination can have:

  • 52% of young LGBT people reported self-harm either recently or in the past compared to 25% of heterosexual non-trans young people and 44% of young LGBT people have considered suicide compared to 26% of heterosexual non-trans young people
  • Prescription for Change (2008) found that in the last year, 5% of lesbians and bisexual women say they have attempted to take their own life. This increases to 7% of bisexual women, 7% of black and minority ethnic women and 10% of lesbians and bisexual women with a disability
  • The Gay Men’s Health Survey (2013) found that in the last year, 3% of gay men have attempted to take their own life. This increases to 5% of black and minority ethnic men, 5% of bisexual men and 7% of gay and bisexual men with a disability. In the same period, 0.4% of all men attempted to take their own life
  • The Trans Mental Health Study (2012) found that 11% of trans people had thought about ending their lives at some point in the last year and 33% had attempted to take their life more than once in their lifetime, 3% attempting suicide more than 10 times.

The impacts aren’t limited to mental health, and the level of inequalities in lifestyle behaviours such as smoking and substance misuse will almost certainly play out in a great burden of chronic disease and premature mortality over the life course.

The evidence base of inequalities affecting LGBT populations continues to grow as we get better at incorporating sexual orientation and gender identity into the demographics of research and population surveys. Positively, as the NHS rolls out the sexual orientation monitoring information standard this year, this understanding will no doubt continue to grow.

As public health professionals we have a responsibility to advocate for the populations in our care, and this should include advocating for LGBT populations. Lesbian, gay, bisexual and trans communities are diverse, vibrant and varied and have many assets, although the LGBT community sector has faced fiscal challenges due to the economy there remain many small local LGBT organisations that are keen to work with public health teams to address these inequalities.  This is population who clearly need our professional expertise, advocacy and support to co-produce solutions for change and one where we could have a real impact.

So during this lesbian, gay, bisexual and trans Pride season please take up the opportunity to engage, empower and partner with your local LGBT community.

FPH is committed to improving the health and well-being of the LGBT population. If you would like to join us in our work please consider joining our Equality & Diversity Special Interest Group or our LGBT Health Special Interest Group. To express an interest in joining please email policy@fph.org.uk and we can help you get started!

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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 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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