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By Gill Rawlinson, Advanced Physiotherapy Practitioner, Salford Royal NHS Foundation Trust 

Earlier this year I was proud to win the Advancing Healthcare FPH and PHE Award for contributions to public health for our innovative service which embedded NHS health checks and diabetes checks within NHS physiotherapy services in Salford.

The project, which was funded by Salford CCG’s innovation fund, allowed us to take a more focussed approach on embedding health promotion principles with the aim of supporting our patients with musculoskeletal problems to make positive lifestyle changes.

Salford Royal NHS Foundation Trust provides physiotherapy services to some of the most deprived parts of England where health inequalities are large and health and lifestyle factors contribute greatly to ill health and premature mortality. From the initial project aims of creating a culture where patient’s health and lifestyle was central to their care, and where physiotherapists were encouraged to support behaviour change with individuals, the project quickly grew and partnerships developed with both public health at Salford City Council and the Salford National Diabetes Prevention Project (NDPP).

This allowed us to share our common goals and work collaboratively to deliver NHS health checks and diabetes check within routine physiotherapy appointments, the first service of its kind in England. This approach not only puts public health principles and prevention at the core of clinical assessment, but allows the opportunistic delivery of supportive interventions, such as motivational interviewing, at a time when patients are seeking help with a health problem and are often keen to make positive behaviour changes.

Helen Slee, Project Manager for the Salford NDPP, supported me to collect data which facilitated the identification of eligible patients and to collate a health profile of our patients. This data allows us to record our public health interventions and to evaluate our impact as a public health workforce. The project supports the Five Year Forward View NHS England strategy which challenges us all to put prevention at the heart of what we do and also illustrates the use of physiotherapists and wider Allied Health Professionals as an untapped public health workforce. Since the pilot project we have been supported by our Public Health team and Salford CCG to develop and scale up the project. We plan to evaluate the data further and publish the findings in the coming months.

Winning this award has allowed me opportunities to share and disseminate our project with many other organisations across the country.

It has also allowed me to meet many other people with a passion for public health who want to change things for the better, including leaders in AHP services and quality improvement. Most importantly it gave welcome appreciation and recognition to our many staff who embraced change and challenges to deliver an improved service, supporting our patients to live longer and healthier lives.
Why not think about entering for the award this year to share your great public health practice and celebrate your team’s successes? You never know where it may lead!

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By Dr Lesley Graham, Associate Specialist, Public Health for Alcohol, Drugs and Health in Justice, ISD, National Services Scotland, and Faculty of Public Health Representative, SHAAP. Dr Harpreet S Kohli, Retired DPH, Co-opted Member, SHAAP.

The UK Supreme Court has  unanimously ruled that the Scottish Government’s legislation on Minimum Unit Pricing is legal. This is a landmark moment for public health and the end of a long journey. However, it also marks the start of a new journey to implement MUP to reduce alcohol-related harm in Scotland. When implemented this will mean that no alcohol can be sold in Scotland for less than 50p per unit.

Although the Alcohol (Minimum Pricing) (Scotland) Act 2012 was passed 5 years ago by the Scottish Parliament without opposition, global alcohol producers headed by the Scottish Whisky Association took the Scottish Government to court. There followed a lengthy and costly battle (in terms of lives lost, time, and money) all the way to the European Court of Justice and back to the highest court in the UK. This victory has been a huge collaborative effort from many players with public health at the heart of it.

Just over 10 years ago, an alcohol advocacy group, Scottish Health Action on Alcohol Problems (SHAAP) was set up and we were the Faculty of Public Health representatives. SHAAP was established due to concerns about the epidemic levels of alcohol harm in Scotland being driven by increasingly cheap alcohol.

Our report, Price Policy and Public Health was the first public call for action to introduce a minimum price for alcohol. The incoming SNP Scottish Government took up that call. As well as targeting the Scottish Parliament, SHAAP reached out to build alliances at global levels. By 2010, WHO (World Health Organisation) were recommending MUP as a policy ‘Best Buy’.

The broad scope of the role of public health has allowed us to contribute in a variety of ways, including:

  • Production of routine national statistics
  • Policy development
  • Advocacy
  • Research
  • Evaluation of the implementation of MUP in terms of what alcohol-related harm means for health boards in Scotland such as service provision

Here are some of our reflections of that journey

First, the importance of a sound evidence base. Although MUP had never been tried and tested before, we had based the rationale on the evidence of the relationship between price, consumption and harm. The more price falls, consumption rises and so does harm. That sound evidence base proved its worth in the sometimes stormy debate that was to follow.

Second, we had ‘reframed’ the problem with a public health paradigm, if average population consumption would fall, so would harm. This helped move the narrative away from being the problem of a minority of individuals or one of anti-social behaviour.

Thirdly, those from the most disadvantaged backgrounds experienced greater levels of alcohol related harm, indeed, those inequalities were widening. It was a matter of social justice. We had champions, both political and public health who went out and campaigned hard and did not give up.  Other countries now are poised to follow Scotland’s lead.

Lastly, we think it is more than about alcohol policy. It shows that public health can trump private profit and the alcohol industry. A great moment indeed!

 

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The Chief Nursing Directorate at Public Health England (PHE) and the Florence Nightingale Foundation (FNF) are offering a bespoke scholarship a bespoke scholarship named after an inspirational public health nurse who sadly died in 2016.

The award is in memory of Nana Quawson, a dedicated school nurse and practice nurse who sadly passed away last year. Nana was passionate about improving the health and wellbeing of children and young people through evidence based public health interventions. She spent time with the Nursing Directorate in the Department of Health and Public Health England sharing her expertise, ideas and enhancing her public health leadership skills.

The FNF scholarship builds on Nana’s journey and aims to provide a fabulous opportunity for a public health nurse to enhance their leadership and become a strong leader with the skills and self-confidence to contribute positively and make a tangible difference to the outcomes for children, young people and families. As part of the scholarship we are delighted to also offer a work based placement within the Chief Nurse Directorate at PHE and work with the team on raising the profile of public health nursing, prevention and improving the health and wellbeing of children, young people and families.

This scholarship remembers the dedication, passion and drive of Nana Quawson (1972-2016), a valued colleague and school nurse. The scholarship provides the opportunity for other public health nurses to follow in Nana’s footsteps and make a difference to children, young people and families.

For further information please visit the FNF website. To find out more about our work at PHE please contact Wendy Nicholson or Penny Greenwood.

 

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By Dr Samia Latif, member of the Global Violence Prevention special interest group at the Faculty of Public Health

Pakistan, Afghanistan, Syria and Nigeria have something common between them other than being third world nations. They are the only remaining countries where polio, amongst other infectious but preventable diseases, still ravages and raids childhood and the dreams of an entire generation.

Vaccinations have been one of the single most effective public health interventions known to mankind but in order for a good immunisation programme to take root there needs to be a safe and stable environment to deliver the vaccinations alongside a good understanding of the political context in which these immunisation programmes operate. These countries have been in a state of conflict recently and as such, Polio triumphs along with other childhood infectious diseases.

Wars, insurgencies and conflict drive resources away from the basics such as health, education and societal structures. Ways of life are disrupted which is further compounded by forced migration, displaced populations and a breakdown of trust. It comes as no surprise then that polio’s final strongholds are some of the most complicated places in the world to deliver vaccination campaigns.

There is evidence that hostility to immunisation programmes may not necessarily be the result of insurgents’ theology, rather it arises from suspicion and mistrust. For example, in Nigeria, the last African country harbouring endemic polio, many believed that the vaccine contained anti-fertility drugs and cancer-causing viruses. Similar misconceptions were rife in Pakistan where the Taliban insurgents propagated rumours that led to the targeting and killing of healthcare workers delivering the vaccinations; such can be the indirect and uncalculated costs and victims of conflict! It did not help of course that America had used the immunisation programme as a cover up for its spying operations.

Trust is key to the acceptance and success of any public health intervention but more so for an immunisation programme that involves inoculating apparently healthy individuals with weakened strains of microbes or antibodies to the same.

Access to healthcare is a major determinant of health; war and conflict destroy the routes and health and social care structures to access so it is no wonder then that war and infectious diseases are such good comrades. Add to the picture of already exhausted and fragmented health and social care the genetic evolution of bacteria and viruses causing infectious diseases and you have a recipe for disaster that cooks for many years even after the conflict or war has ended. Lack of access to immunisation programmes, antimicrobial resistance and changing strains of microbes may have very long lasting effects that are witnessed by subsequent generations as herd immunity falls below optimal levels. Bosnia and Herzegovina being a case study in time where the recent measles outbreak was a consequence of the conflict 20 years ago.

In today’s global context, when borders are increasingly porous and diseases neither respect nor recognise these borders, the challenge posed by global conflict threatens the very premises on which our society’s foundations of health and social care have been laid. A clear example is the resurgence of polio in Iraq 14 years after being disease free due to spread from neighboring Syria.

A problem thousands of miles away does not mean it won’t come knocking on our doors soon. There needs to be a united call to arms by world leaders and all levels of society to advocate for peace, building trust and working with and through communities; something public health does best!

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Dr Alisha Davies, Head of Research and Development, Public Health Wales

We understand the importance of good quality, sustainable employment for health. We also recognise that economic shocks, such as the loss of a high number of jobs in a localised area, can have a detrimental impact on the health, social and financial situation of individuals. In the years following a mass unemployment event workers can experience double the risk of death from heart attack or stroke and even greater increases in problems such as alcohol related disease, alongside detrimental effects on mental health. The impact can extend beyond those directly made redundant to families, local communities, and the effects endure over many generations.

Preparedness to address the health consequences of mass unemployment events is of national and international importance – yet there is very little information on how to better prepare and respond to such events. The public health discipline has emergency planning response frameworks for other events, such as flooding, which have a significant impact on individual and community health, but not mass unemployment.

Working with academic experts and those previously involved in public health responses to mass unemployment events across the globe – from the motor industry in Australia, to mining in New Zealand, Public Health Wales have developed a basic framework to support public, voluntary and private sectors with prevention, planning for and reaction to mass unemployment events.

The recently launched report provides an eight-step framework to support public, voluntary and private sectors with prevention, planning for and reaction to mass unemployment events. Key priorities where public health approaches can help are highlighted including early identification of areas at risk; ensuring the reactive responses address the health and wellbeing needs of all those affected alongside financial and re-employment advice; providing accessible support for families, and the wider community – in particular vulnerable groups, such as the long term unemployed; and increasing awareness through community and third sector links.

Preventative measures identified by those interviewed included longer term consideration of skills development, investment and diversification, social responsibility of employers announcing redundancies, and increasing individual and community resilience.

This report is an important tool to inform action to help prevent and minimise the consequences and harms of mass unemployment events (MUEs) to population health. The work was taken forward following events in Wales, but has national and international reach across many European and International countries.

NOTES:
The report and info-graphic will be available on the day of launch in English and Welsh, and it will be announced on our Public Health Wales website on Friday 30th June (www.publichealthwales.org).

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By Professor Simon Capewell, FPH Vice President of Policy 

Next week, voters across the country will head to the polls to determine the make-up of the next Government. The outcome may be uncertain, but this much is clear: we cannot allow the public’s health to be side-lined over the course of the next Parliament. At FPH, we are committed to ensuring that policy-makers embed health in all policies. Following the announcement of the snap-election, we therefore rapidly produced our short-list of priorities for the next Government. They are:

1) Realising Brexit’s ‘health dividend’
2) Shoring up and increasing public health funding
3) Making sure the specialist public health workforce is adequately staffed and supported

We’re doing all we can nationally to advocate for these issues. But we cannot do it alone.  We need your help to deliver our message to your local parliamentary candidates and get them to commit to our asks. As an FPH member, you are well-placed to do this because Parliamentary candidates are much more likely to listen to the concerns of their constituents- especially when those concerns are presented against the backdrop of local data or case-studies- than they are to national organisations with no concrete links to their community.

Over the next week or so, candidates will be in a mad dash to meet as many of their constituents as they can. What they hear on your doorstep or at a hustings in your community may follow them into the House of Commons. To help you get started, we produced this brief one page guide outlining how you can campaign on behalf of FPH. It includes sample questions to ask, opportunities to take advantage of, and tips for building relationships with your candidates.

Make sure you also visit our General Election webpage to access allStart Well, Live Better front cover of our resources (including our Start Well, Live Better manifesto) to help you campaign and to see the election ‘asks’ from our allied organisations and partners.

Finally, we want to hear from you! Your feedback is invaluable to us. If you do speak to any of your candidates, we would love to hear how it went. Or, if you need help in reaching out to them, please feel free to email FPH’s policy team (policy@fph.org.uk) for some advice and guidance. We want to help as many members as possible build and maintain relationships with their candidates, both in the run up to election and, crucially, with the next government. Thank you for your continued support.

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By Dr Uy Hoang, Chair of the FPH Film Special Interest Group

Following the announcement of a General Election, FPH called for the next Government to think more about our long term health, embed health in all policies, and work with people and communities to focus on preventing ill health and easing pressure on our overburdened NHS.

At FPH’s Annual Conference in Telford (20-21 June), FPH’s Film Special Interest Group (SIG) will bring together public health specialists, academics, and film makers to discuss the role that film can play in helping policy makers locally and nationally perform the type of joined-up thinking that health in all policies demands. We’d love for you to join us in Telford as we screen critically acclaimed films, hear from expert panels of film makers and public health professionals, and open to the floor for wider discussion and debate.

Headlining the FPH Annual Conference will be a screening of I, Daniel Blake, the winner of the 2016 Palme d’Or Cannes award and the latest film from legendary director Ken Loach. The film highlights many issues that are in the fore of this election campaign, including how to best support people with complex health and social needs.

With Brexit and the impact of economic migration likely to dominate this election cycle, we will use film to shine a light on a less discussed aspect of the movement of people- human trafficking- to ensure that that story is not missing from the dominant narrative surrounding immigration. We will screen the award winning film Slaved, followed by a debate with representatives from the police force, public health, and NGOs working within the field. The film brings to life the personal stories behind the public health statistics, shows what our public health workforce is contributing now to tackle these issues, and demonstrates how relevant a public health perspective will be to the next Government as it grapples with these complex problems.

Those of you interested in prevention will find the screening of Up for Air particularly engaging. This award winning documentary follows Jerry Cahill, a 60-year old pole-vaulting coach battling cystic fibrosis. Due to his vigorous exercise regime, Jerry is now 20 years past his expected life expectancy and is one of the oldest living patients with the genetic disease. This film is a powerful and stark example of the benefits of exercise, especially for those living with a chronic disease.

The Global Violence Prevention SIG will highlight the work of public health practitioners, especially women on the front lines of care delivery, with a screening of the film Grace Under Fire. The film follows the story of Dr Grace Kodindo, a leading reproductive health advocate and champion of women’s rights, as she works to expose the horrific toll of the conflict in the Democratic Republic of Congo and rebuild health services for women and children.

As you can see we have a full and compelling programme. We hope you will join us for our ‘film festival’ and contribute to the debate.

For details of the conference and to register please visit http://www.fph.org.uk/fph_annual_conference_and_public_health_expo_2017

For FPH’s election briefing please click here

If you are interested in joining the FPH PH SIG or have any suggestions for films that we could screen, please contact Policy@fph.org.uk

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