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Fifteen years ago, in March 2003, the US invaded Iraq. The legality of this war continues to be debated and whether the world is a safer place as a result is also controversial. Meanwhile, the country continues to struggle with fighting terrorism, the economy is devastated and the lives of millions severely impacted.

Saif* was only 5 years old when the first American troops entered Baghdad on 9th April 2003. Whilst many children in the developed world would be learning to read and write, Saif was experiencing the “shock and awe” strikes by the coalition forces. Unable to attend school, with his family lived in a dark, cold and damp house. Growing sectarian violence in the power vacuum left behind following the deposition of the Ba’athist regime led Saif’s family to leave their home in Baghdad, living in a tent to avoid violence.

Saif is now 6 and used to death. His father was killed in a suicide bombing attack and he is forced to work in order to provide for his family. Saddam Hussein has been captured but this has no bearing on the trials Saif must endure. Clean water, electricity and food are a luxury. Saif sleeps in his tent not knowing if he may wake up the next morning.

A few years later and the new Iraqi government has reopened the schools near Saif’s new home. Scarred by bombing, riddled with bullet holes and lacking teachers and equipment, Saif attends school in the hope of educating himself to improve his life. Despite being a bright student, Saif is often seen distracted in class as he gazes at the walls remembering how a recent bombing left 155 dead. Saif has flashbacks of the bodies in the street, the blood smeared against the walls and the screaming that left his eardrums ringing.

In 2008, aged only 10, Saif fell ill with severe gastroenteritis and ended up in isolation in hospital for 2 weeks. He was diagnosed with cholera similar to 4696 other cases. The outbreak struck again in 2015 affecting over 2000 individuals. There are only 0.8 doctors per 1000 people in Iraq compared with 2.8 in the United Kingdom so the untrained nursing staff did their best to care for Saif.

After decades of conflict the region is littered with unexploded landmines and Explosive Remnants of War (ERW). Saif lost an arm fiddling with ERW, the only toy he could find in the neighbouring field, and had retrain himself in writing with his left hand. It is estimated ERW caused over 30 thousands casualties by end of 2015.

At the age of 16, ISIS took over large swathes of Iraq. A few of Saif’s friends, frustrated and disillusioned with their lives join their ranks. None are heard from again. Saif is working on a market stall and counts himself lucky to do so, with unemployment officially at 15%. All the money he earns is spent on caring for his now bed-bound mother and siblings. She coughs badly and lost weight, she was diagnosed with tuberculosis. There are an estimated 20,000 tuberculosis patients in Iraq with increasing levels of multi-drug resistant tuberculosis. Saif’s mother is one of the 4,000 Iraqi people that dies from this preventable disease this year.

In 2018, Saif is the oldest surviving member of his family, raising his two siblings. According to the WHO the probability of Saif dying between 15 and 60 years old is 224 per 1,000 population. If lucky Saif is expected to live up to 66 years.

The UN estimates that 4 million children in Iraq are in need of at least one form of humanitarian assistance in 2018. Despite this, the Iraqi government has deprioritised healthcare, slashing the healthcare budget by 25% in 2016. Iraq remains a public health disaster with clear scope for improvement should healthcare be prioritised. As per the Transparency Index, Iraq is consistently within the worst 10% of countries.

Saif is 20 years old now, with a traumatic history, interrupted education, mentally and physically damaged and the sole breadwinner in a young family. All he wants is a normal life, but has no job or marital prospects on the horizon. His only hope is that if he does have children, that they can live a full and healthy life like the one taken away from him.

* Saif is not a real person, but this is an example of what life has been like for many children growing up in Iraq in this period.

Written by Dr Bayad Nozad, FFPH co-chair of Global Violence Prevention SIG, and Dr Ahmed Razavi, Academic Clinical Fellow in Public Health

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By Neil Squires, the elected International Registrar on FPH’s Board and member of FPH’s Brexit Advisory Board

Neil Squires web cropI am very pleased to have been re-elected for a second term as International Registrar. The past 3 years have helped to demonstrate the real potential of FPH members to contribute to public health development in other countries and opportunities for members to engage globally are now beginning to increase. Over the last couple of years we have delivered training in Odisha, India, which has provided public health leadership skill training to 300 senior personal in the Government of Odisha. That work sparked requests for similar support in other States and an invitation for FPH and PHE to support the development of India’s MPH curriculum – an important in-road in to developing the next generation of public health leaders in India.

Similarly, the Pakistan Special Interest Group (SIG) has been increasingly active, working alongside PHE, developing a mentorship programme for health leaders in Pakistan. Stronger links have been made with both the National Institute of Health and with Academic Schools of Public Health, laying the foundation for future capacity building work. This programmes of work were commissioned using Overseas Development Aid (ODA) funding, and respond to needs identified by host countries. In addition, the Africa SIG has made strong connections with the Public Health Foundation of Africa, meeting public health leaders from across Africa in Nigeria, and has developed a network of health professionals who will be the cornerstone of future efforts to build on African Public Health Assets to strengthen Regional capability.

In addition to work with resource poor countries, there are an increasing number of requests to FPH from wealthier countries wishing to build stronger public health systems and adopt competency based training. A recent funded mission to Kuwait has created opportunities for potential future collaboration, where we hope to draw on a number of FPH members who have expressed interest in supporting training and public health capacity development. These funded opportunities both allow FPH to support our partners to develop their public health capacity and also generated the necessary income to enable FPH members to work internationally, helping to cross-subsidise work in the poorest countries.

At a time when it seems even more important that the UK remains actively committed and engaged internationally, the work of the Global Health Committee provides a real opportunity to productively engage in support of our colleagues in other countries as we collectively strive to achieve the Sustainable Development Goals (SDGs). In June FPH will organise a global session for the Association of Schools of Public Health in the European Region (ASPHER), where we hope to promote a coming together of a number of international networks committed to strengthening public health training and capacity globally, linking this to support of stronger national public health agency development. There is a significant opportunity and appetite for the international public health community to come together to tackle common concerns linked to poverty reduction, inequality, to global threats such as climate change, and to tackle global challenges such as violence.

Collaboration with other Royal Colleges remains an important objective, and strengthening relationships across the UK health system in support of global public health a priority. We are actively seeking committed members to join one of a number of causes that have global dimension, where there is a real opportunity to shape the future work and growing global profile of the Faculty of Public Health. These are opportunities we encourage all interested members to engage in, with a growing international membership to serve and an expansion in our practitioner members, who can help us champion multi-disciplinary public health globally.

To find out more about FPH Special Interest Groups specialising in global public health, click here.

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By Stevie Benton, Communications Manager at ASH (Action on Smoking and Health)

As smoking prevalence continues to fall, NHS and public health organisations are taking things to the next level with the NHS Smokefree Pledge. 

Co-ordinated by the Smokefree Action Coalition, the NHS Smokefree Pledge is a commitment to help smokers in their care to quit for good and to create smoke-free environments that support them to do so. By signing the Pledge, organisations agree that they will take a number of actions to reduce smoking prevalence and help smokers quit. The commitments in the pledge include:

  • Treat tobacco dependency among patients and staff who smoke, as set out in the Tobacco Control Plan for England
  • Ensure that smokers within the NHS have access to the medication they need to quit in line with NICE guidance in secondary care
  • Create environments that support quitting through implementing smoke-free policies as recommended by NICE

Smoking remains the single greatest cause of premature death and disease in our communities. Around 79,000 people die because of smoking in England every year and for every death, another 20 smokers suffer from smoking-related diseases. Smoking imposes a huge burden on the NHS. Stopping smoking is the single most effective action a smoker can take to improve their health.

Signing the pledge is simple and a visible commitment to a smoke-free NHS. This No Smoking Day, if you’re a director of public health, why not take that crucial first step and encourage your Trust to sign up?

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John Middleton 2 webBy Professor John Middleton

Last month I let you know about the progress we’ve made in our Public Health Funding campaign. A new FPH project group – made up of staff and registrars – will be focussing its efforts on making the case for greater investment in public health services in local government and moving the dial towards prevention in the health and care system.

I’m blogging today to let you know about the Government’s recent response to the House of Lords Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care and what it means for our new campaign.

In their response, the Government dismissed recommendations to reverse past cuts and cancel future ones to the public health grant and to extend the ring-fence for the next decade.

The Government’s argument rested on four central planks.

Firstly, the Government argued that ‘public health is about far more than the services funded through the grant’. With the transfer of public health to local government, prevention interventions are now delivered by many other local services, such as housing, which are not necessarily funded by the grant. These types of joined-up services are exactly what public health reform has sought to achieve.

Secondly, the Government argued that public health teams are now ‘demonstrating real innovation’ to achieve more with less. Now that local authorities have the autonomy to redesign services in a holistic and place-based way, councils are achieving better value for money while still producing good outcomes. These innovations are very welcome.

Thirdly, the Government argued that despite a challenging period for public finances overall, local authorities will still receive more than £16 billion for public health over the 2015 spending review period. This is not an insubstantial amount.

Lastly, the Government argued that any conversation about public health funding must include the role of the NHS. Local authority public health spend is bolstered by ‘well over £1 billion a year’ that the NHS spends on key public health functions, alongside the commitments to prevention outlined in the Five Year Forward View. Prevention is a core priority for the whole health system.

So what does the Government’s response mean for our campaign?

Firstly, we think the public health community needs to be able to respond to the Government’s key arguments if we are to make an effective case for greater investment in public health. We’re pleased that the focus of our campaign is seeking to address these points.

We are calling for increases to public health spending, but we’re not simply asking for greater investment in current services for ‘business as usual.’ We agree with the Government’s point that public health teams achieve great results when they are able to innovate. While recent reforms have provided local authorities with the autonomy and the responsibility to innovate, they have so far not provided proper funding in order to enable this to happen in a systematic or equitable way.

That’s why we’re calling for investment in an ‘Innovation and Transformation Fund’ to enable local authority teams to transform services to match the needs of their fast changing local populations. This investment is needed now in the short-term to allow public health teams to respond to the challenges of the future. We believe that investment in public health innovation needs to be placed centre stage during the next spending review period if public health reforms are to be viable for the long-term.

We know that the £16 billion allocated to local authorities for public health over the 2015 spending review period is no small figure when placed within the context of overall central Government funding for councils. We would contend, however, that when compared to the over half a trillion in funding allocated for NHS treatment and care over the same period, £16 billion for public health is a modest investment.

This is why our campaign will also be driving forward a programme of work around prevention activity within the NHS. The Government is right to point out that local authorities are not alone in providing prevention interventions. Around 40% of all accounted-for public health spending originates from the NHS, on Section 7A services like immunisations as well as other initiatives like the national diabetes prevention programme. The NHS itself, with its long reach into every community, is also a wider determinant of health.

But we believe that to deliver the ‘radical upgrade’ the NHS needs to make better use of its existing preventative spend and also explore further opportunities for targeted increases in investment. In order to achieve this, we first need to know what the health system actually spends on prevention. While most estimates of public health spend place it at between 4-5% of total government spending on health, according to PHE’s Chief Economist, ‘we do not actually know what the whole health and social care system currently spends on prevention’.

That’s why our campaign is calling on the Government to conduct a review into NHS spending on public health and prevention. We need to know where we are now before we’re able to move forward and ensure that the NHS and local authorities are truly providing the kind of joined-up care envisioned in Sustainability and Transformation Partnerships.

Finally, we believe we’ll have the best chance of securing increases in public health investment if we’re able to tell our story in a compelling way to policy-makers and the public. We’re proud of the work our members do every day in their communities to protect and improve the health of the public. We have a good record, as demonstrated by major successes in our screening, immunisation, and smoking cessation programmes.

And that’s why we’re supporting PHE’s work on their new public health dashboard. This dashboard will enable a lay audience to understand and see the incredible range of services that public health teams provide and allow us access to up-to-date evidence that we can use to support our calls for greater investment in services.

In my last blog I asked for your help in marshalling our arguments, developing our policy thinking, and spreading the word to your networks. I’d like to say a big thank you to members and partners across the public health community who have already been in touch to say they would like to be involved in the campaign.

The strategic case for investment in prevention and investing in better outcomes has lessons which can apply in all four nations of the UK and indeed anywhere in the world. We will build on our four nations work as this campaign takes shape.

If you’d like to contribute to our campaign and help shape our thinking then please contact policy@fph.org.uk.

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By Wendy Nicholson, National Lead Nurse – Children, young people & Families & Deputy Head of World Health Organisation Collaborating Centre for Public Health Nursing and photo_wn_5Midwifery.

Clearly, nursing is a diverse and far-ranging profession. The traditional stereotype of nursing and nurses is changing and the drive to provide care closer to home and really get serious about prevention has quite rightly put public health nursing in the spotlight.

When I pulled on my crisp new student nurse uniform in the early 1980s I could never have imagined I would find myself working in public health, as the focus and direction of travel for most nurses was gaining experience in hospitals before venturing into the ‘community!’ Like my peers and other nursing colleagues, I recognised that many of those hospital admissions were avoidable and many of the A&E visits could have been prevented.

Shifting the balance to upstream prevention and public health was certainly not a new phenomenon. Probably the most well-known nurse, Florence Nightingale, was a pioneer for prevention and indeed the use of evidence to underpin practice.

So much of Florence Nightingale’s legacy reinstates today with public health nurses and we know that there are many public health challenges, particularly for children and young people. We know giving children the best start in life and building resilience across the life course can improve outcomes – and this is where my passion lies.

For myself, moving to public health and focusing on prevention was a huge shift, I had my PICU mapped out. The catalyst for change was a small child who sadly will never know the difference she made to my nursing career. She arrived in A&E after being hit by a car. Her injuries were severe and she died soon after arrival. Like so many unintentional injuries her death was preventable and this made me re-think my career choices.

Public health nursing and the prevention agenda is vast. I have been fortunate to lead the development of new projects such as Sure Start and Teenage Pregnancy Prevention. Both have been challenging, but working with communities to support behaviour change and cultural norms was indeed rewarding!

Today, I find myself working for Public Health England as the National Lead Nurse for Children, Young People and Families and a Deputy Head of World Health Organisation Collaborating Centre for Public Health Nursing and Midwifery, working within the Nursing, Midwifery and Early Years directorate. This is an incredible role, and provides an opportunity to advocate for public health nurses who make a huge difference to individuals, community and population health.

Being a WHO Collaborating Centre for Public Health Nursing and Midwifery is an amazing opportunity to contribute to the global Sustainable Development Goals and to influence globally – ensuring prevention is a clear focus with public health nursing driving improvements.

It is quite apt that today I am with 400 nurse leaders at the Chief Nursing Officer summit in Liverpool – this city which is steeped in the history of public health. On International Women’s Day, we should take the time to reflect on great leaders such as Florence Nightingale. She was so much more than ‘the lady with the lamp’ – clearly a visionary for public health, nurses and prevention.

Let us never consider ourselves finished nurses….we must be learning all of our lives.
Florence Nightingale

Read more about All Our Health here

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On January 24th 2018 the Turkish Medical Association (Türk Tabipleri Birliği, or TTB) released a brief, non-partisan statement titled “War is a public health problem”. The statement highlighted the numerous negative health impacts of warfare, and expressed the principle that as members of a profession sworn to protect and preserve health the TTB were opposed to armed conflict.

Since the release of this statement, the TTB central council have been publicly denounced as traitors, received multiple death threats, and many of them have been arrested.

We, the undersigned, support our Turkish colleagues’ freedom of speech and wholeheartedly endorse their message. War is a public health emergency, and as such health professionals have a right and a duty to speak about it. Both the direct effects of physical and psychological trauma, and the indirect consequences (such as displacement, malnutrition, infrastructure damage and infectious disease outbreaks), are extremely harmful to human health and must not be ignored or neglected by those in positions of power.

We welcome the TTB’s statement on this matter, and call upon all parties to support the development of a political climate in Turkey in which health professionals can speak out on important public health topics without fear of violence, persecution or imprisonment.

Daniel Flecknoe [Chair of the Global Violence Prevention special interest group]
on behalf of the following organisations:
British Medical Association
Faculty of Public Health
Primary Prevention of War Public Health Working Group

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By Grace Norman, Specialty Registrar in Public Health  

In August 2017, I saw an email looking for public health registrars to work on one of two policy campaigns with the Faculty of Public Health (FPH): public health funding and Brexit. While both have broadly similar objectives at their core (ensure public health is protected and prioritised at a national level and members’ voices are heard and acted upon), I was drawn to the Brexit role because it seemed like an opportunity to try out one of my career options – making lasting health improvements through upstream, national-level policy change: embedding health in all policies.

I was lucky to be selected to join the 10-strong team and, since November, we’ve been working together to agree the three policy asks: 1) calling on the Government to amend the EU (Withdrawal) Bill with a ‘do no harm’ clause; 2) maintain a relationship with the European Centre for Disease Prevention and Control (ECDC) and; 3) secure health-focused post-Brexit trade agreements enabling the UK to improve health.  I’m currently working on the first of these projects and needless to say, this isn’t an ordinary placement.

As Brexit negotiations started last year, the project has been fast-paced. Two weeks ago, I was listening to Lord Crisp talk about the importance of Brexit on public health and since then, ‘do no harm’ has been tabled as a possible amendment to the EU (Withdrawal) Bill and will be discussed at Committee Stage in the House of Lords in the next couple of weeks.  This is genuinely upstream public health and it’s rewarding to see decision makers taking public health seriously.

The timescales for the project are incredibly tight, so there’s often a sense of urgency and a need to get things done now, which I enjoy, and with an increasing work-load, we are always prioritising to maximise impact. To date, we have had meetings with Peers, and written briefings and proactive and reactive press statements. Next up on my list of things to do is writing a speech for a Peer; this isn’t an opportunity I would have got elsewhere.

The potential health consequences of Brexit are so wide-ranging that it needs a team with varied expertise working collaboratively – I’m giving public health input into comms messages while learning about the parliamentary process. This is a genuine example of ‘the whole is greater than the sum of its parts’.

The FPH Policy and Communications team is a very hard working team, but the office ethos is light and fun, so coming to work is a real pleasure.  I feel like part of the team – my (terrible) hand-drawn self-portrait is on the office wall alongside the others’.  Not only am I gaining evidence for policy and management learning outcomes, but I’m learning how to motivate others, develop teams and chair meetings.  I feel that my self-development is prioritised and the office is a safe environment to learn how to be the best version of me.

It’s been incredibly exciting to be so closely involved in this project so far and I’m looking forward to the work that’s still to come this year.  If this sounds like something you’d like to get involved with, the FPH Policy and Communications team is on the lookout for more people like me to get involved in the campaign on a regular basis. The kind of things they’d be looking for help with are:

  • Asking for your views as they develop policy
  • Helping to decide which campaign messaging works best
  • Championing FPH campaigns on social media
  • Speaking up at conferences and events you’re attending
  • Responding to questionnaires and surveys that they will be doing throughout the campaign

If you’d like to find out more, please contact Mark, FPH’s senior policy officer, at MarkWeiss@fph.org.uk. And finally, don’t forget to keep an eye on Twitter over the coming months to follow progress on the ‘do no harm’ amendment and wider Brexit campaign. You can follow FPH here and you can follow me here.

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