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Archive for the ‘Media and public health’ Category

By Dr Nadeem Hasan

The importance of effective advocacy to achieving public health goals cannot be overstated.
Every day policies and regulations that affect health outcomes for better or worse are put on the agenda and kept off the agenda; discussed and debated; approved and rejected.

Many, if not most of these relate primarily to non-health sectors, such as food and beverages, energy and infrastructure, and alcohol and tobacco. But their impact on health outcomes is very real: all the stop-smoking programmes in the world can’t match the impact of the ban on advertising and smoking in public places on smoking prevalence; and there’s no amount of spending on childhood obesity programmes that can make up for the regulatory vacuum in this area.

Looking more broadly, policy decisions that affect income inequality, carbon emissions, and military action all have serious consequences for health across the world.

If we’re serious about prevention, we need to be serious about advocacy.
Where profits can be affected (almost everywhere), industry lobbyists seek to influence the regulatory environment in their favour. And they are very good at it. In principle, this is quite right – those affected by policy and regulatory shifts should indeed be able to make representations and provide additional evidence to support the decision-making process – and this includes relevant industry actors.
Representing the interests of everybody else is where advocacy organisations come in – acting as sort of ‘civil society lobbyists’ to balance out the discussion – advocating on behalf of the health, wellbeing, and broader concerns of the general population. Notably, this isn’t always an ‘us vs. them’ relationship: health insurance companies are routinely allies on advocating for lower drug prices; and renewable energy companies are more than happy to work with advocacy organisations on climate change regulation.

Put this way, it might sound like a fair playing field, with decision-makers receiving submissions from a range of groups and making balanced decisions to maximise the benefits to all parties. The reality of course is quite different, and much, much messier.
In 2014, there were an estimated 30,000 industry lobbyists in Brussels alone, falling just short of the 31,000 employees for the whole European Commission.

Civil society pockets are not deep enough to come close to matching this (or the salaries of lobbyists), and civil society advocacy and pressure groups are few and far between. Transparency falls short of the ideal, and the revolving door between policy-making and industry remains alive and well. Most recently the former President of the European Commission José Manuel Barroso was appointed Chairman of Goldman Sachs International, a move that has been widely criticised.
Advocacy organisations, then, have a difficult task – but one where even small successes can have far-reaching benefits for public health.
The European Public Health Alliance (EPHA), based in Brussels, is one such advocacy organisation. They bring together a range of health-related NGOs to advocate for better public health in Europe, working across five campaign areas: antimicrobial resistance; food, drink and agriculture; healthy economic policy; universal access and affordable medicines; and trade for health (and specifically the EU-US free trade agreement – TTIP – and the EU-Canada free trade agreement – CETA). Earlier this year, they hosted myself and another registrar in a pilot placement to understand health advocacy at the European level and to develop skills in this area.
So how to sum up the placement?
Invaluable. EPHA track the policy process for each one of their campaign areas and engage at every possible point. They attend every meeting at the European Parliament and the European Commission on these areas and make oral contributions at every opportunity; they submit comprehensive written responses to every relevant consultation; they engage on a daily basis with journalists to publicise their positions and build public support; they engage like-minded actors in the public, private, and not-for-profit sectors on a case-by-case basis to coordinate action; and they do all of this with just a handful of relatively young staff and interns.

They were very welcoming in bringing us into the whole process, allowing me to engage in every one of these steps – from writing position papers and consultation responses to making oral contributions at the European Commission and Parliament on their behalf.
Notably, EPHA also position themselves as an advocacy agency that actors from across the spectrum can engage with – in contrast to, for example, much more vocal organisations such as Greenpeace.

By way of example, the area that I was working on was TTIP. Whilst there are a raft of advocacy organisations across Europe (and the USA) that reject TTIP outright, EPHA’s

approach is to work through the whole agreement and advocate for the protection of public health on a section-by-section basis without rejecting the whole deal. With the European Commission politically committed to getting a deal, this makes EPHA one of the few organisations they can meaningfully engage with on this issue (though recent developments have called into question the likelihood of getting a deal in the near future).

This isn’t to say that their approach is ‘superior’ – every actor plays a particular role, with the more intransigent organisations key in shifting public opinion and providing the space for actors such as EPHA to engage in more balanced discussions. This means that they are invited to closed-door sessions with only a handful of actors, and have much more influence on the process than they otherwise would.
One of the challenges from a ‘public health professional’ perspective was that effective advocacy sometimes involves taking – shall we say – a less balanced view than we would normally as technical experts. From an ethical perspective, this raises a number of questions around whether the ends justify the means. I witnessed first-hand industry lobbyists making quite outrageous claims, including a rather undignified moment where I coughed up half my glass of water in a large auditorium at the European Commission when it was submitted that ‘alcohol is in no way an unhealthy commodity’ .

In a world where climate change denial is alive and well despite the most overwhelming evidence to the contrary, the ‘best’ approach to making our points is perhaps not so easy to discern.
And what of the relevance to the UK, particularly as we now start closing our doors to the EU in a bid to be a more open, global-facing country?
Whether or not the UK is a member, the EU remains a powerful actor that can influence policies related to public health both for its own citizens (which will still number ~450m after the UK leaves), and globally. As a close neighbour, EU regulations will have a strong bearing on public health in the UK too, and so engaging in advocacy at this level will continue to be an effective approach to improving UK public health.

This is true for everything from environmental regulations and air pollution, to pharmaceutical regulations and drug pricing and safety.
Within the UK, whilst it’s true that our policy-making process is not as amenable to advocacy as at the EU level (or remotely as civilised), effective advocacy still has huge potential to improve public health. We have not done well recently, with a watered-down childhood obesity strategy, no resistance to an unfunded ‘7-day’ NHS (that differs from the 7-day NHS that has existed since 1948 in some undefined way), and year-on-year increases in the use of food banks without any policy response (to name just three areas).

At the local level, there are a cornucopia of opportunities for advocacy to improve health, from influencing urban planning (fast food outlets close to schools, street design, cycling lanes) to advocacy around shifting public perceptions e.g. from opposing to welcoming refugees into local communities.
In this context, strengthening the advocacy skills of the UK public health workforce through engaging with and learning from experienced actors such as EPHA should be pursued with vigour – we can ill afford the alternative.

Dr Nadeem Hasan is a Specialty Registrar in Public Health

 

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by Professor John Ashton, County Medical Officer and Director of Public Health for Cumbria

In one of his brilliant short films in the 1960’s, Ingmar Bergman depicts an extravagantly dressed clown, rolling into a small Swedish town, amusing all the children with circus tricks as he passes through. He then goes on to call at a house where he carries out a murder, changes into everyday clothes and strolls out of town unnoticed.

Over the past few weeks, as the scale of Jimmy Savile’s alleged abuse continues to grow, I can’t help but be reminded of Bergman’s character’s wicked genius.

The enormity of Savile’s alleged crimes spanning four decades would seem to be equalled only by the failure of safeguarding and governance at a range of institutions.The apparent breakdown in those systems now extends well beyond the BBC to include local authority adult and children’s social services, the NHS and the media and press who we look to to expose crime and matters of public interest.

But the real lessons of the Savile affair go much wider. They extend to weaknesses in our democratic institutions and processes where powerful men sitting on the top of bureaucratic hierarchies are all too often themselves the product of closed institutions of one kind or another. They lack a 360 degree moral and social compass. This is compounded by systems that we have developed based on over-dependence on professionals and technico-managerial, box-ticking exercises. These systems are not fit for purpose and fail those very people – the young, the frail, the vulnerable – who they are supposed to guard and protect.

If there is to be any kind of a positive side to this major tragedy of epic proportions it is that it has revealed the bankruptcy of our attitude and arrangements to safeguarding the most vulnerable among us to whom we all have a duty of care. It does take a village to raise a child.  We are all our children’s keepers.  If social workers have claimed territory that they are unable to occupy fully we have all colluded in a hideously flawed paradigm.

What is missing is a systematic, three strand, public health approach built on the secure foundations of full public engagement and  involvement rather than an abdication to a small but dedicated cadre of professionals.  Civic society has been squeezed by the professionalisation of everyday life coupled with the growth of an overpowering obsession with individualism and consumerism.  We have all become bystanders watching and waiting for somebody else to intervene.This has to change if we are serious about safeguarding.The voice of the child must be paramount and we all need to listen and act,  not just those paid to do so.

Secondly, the dysfunctional relationships between agencies has to change. Joining up the dots is impossible if front line workers don’t talk to each other. And thirdly those who have safeguarding in their job description must accept their wider responsibility to share it with the whole community. Whether they be social workers, clinicians, teachers, police or professional groups, these professionals need to be accessible and responsive when their unique skills and powers need to be deployed. Safeguarding must move upstream into prevention, into tackling abusogenic environments and into preparing the vulnerable and at risk to be able to speak out.

Yes, bureaucratic tick box arrangements do have their place. We are entitled to ask: who was ‘It’ for safeguarding on the BBC Board and in each of the NHS, Local Authority and other bodies where Savile was apparently able to prey unchallenged?

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By Mark Weiss, FPH Policy Officer

As the Health and Social Care Bill makes its journey through the Committee Stage at the House of Lords, FPH continues to actively engage with members, key stakeholders, parliamentarians, as well as through its representation on strategic working groups and supported by its wider media work.

Committed to ensuring the Bill will provide the structures and safeguards necessary to protect and improve the health and wellbeing of the people of England, FPH is working hard to ensure a strong and viable public health workforce is maintained and strengthened for the future; and a rigorous framework for the statutory registration and regulation of all public health specialists to protect the public is established. 

As we continue to press hard for amendments to the Bill, at the forefront of our minds the risks to the public posed by the Bill – E.Coli, SARS, pandemic flu, Buncefield, heatwaves, flooding, immunisation and screening – loom large. To meet this challenge, with Lord Patel taking a lead on FPH’s amendments, we maintain a focus on statutory regulation; the role, qualifications and accountability of directors of public health; the organisation independent of Public Health England; public health expertise in the new NHS Commissioning Board; employment conditions for public health professionals at parity with the NHS.

Over the past few months, FPH has developed and implemented a firm lobbying strategy. We have written to all MPs and peers taking part in the Health Bill readings in both the House of Commons and Lords, setting out a clear case for our amendments to the Bill. We have the support of a broad range of peers from across all political parties – and have regular meetings with peers to discuss the possible impacts of the Bill in the context of public health.

We are also working with other health and public health organisations through our chairing of the PHMCC task group, and actively engaging with local government colleagues – including producing a joint statement with the Local Government Group. We also have representatives on key strategic groups, including the Public Health England Group (feeding into the development of the PHE Outcomes Framework) and the Workforce Advisory Group and have taken an active involvement in the NHS Future Forum Process with a submission recently sent in for the Second stage. FPH also maintains close working relationships with other faculties, Royal Colleges and stakeholders to share information and horizon-scan.

Informing our position, three member surveys have been conducted to ensure that we are engaging our members in a full and meaningful dialogue. At present we are in the process of analysing the results of our latest survey of members’ views of the Health Bill, with a full analysis to follow shortly. In addition, FPH works closely with its Local Board Members to encourage their active engagement with local MPs and relevant stakeholders.

Our lobbying work around the Bill has been supported by our wider media work, delivering news articles including a recent response to the Health Select Committee 12th Report on Public Health appearing in the Guardian (a copy at this link); and letter to the Times outlining our key concerns with the Bill. In turn our monthly bulletin continues to keep all of our 3,500 members abreast of the latest developments.

For all the latest news on our work on the reforms visit www.fph.org.uk

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Plenary session 2 at the Faculty of Public Health annual conference, on Wednesday 7 July.

Chaired by Dr Liz Scott, Treasurer at Faculty of Public Health, and panel members Tony Jewell, Chief Medical Officer Wales, Laura Donnelly, Health Correspondent of the Sunday Telegraph, Sarah Boseley, Health Editor of the Guardian, and Lindsey Davies, Former National Director of Pandemic Influenza Preparedness.

 

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