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“Refugees are mothers, fathers, sisters, brothers, children, with the same hopes and ambitions as us – except a twist of fate has bound their lives to a global refugee crisis on an unprecedented scale.” Khaled Hosseini

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According to data from UNHCR, displacement has risen to the highest level ever recorded, with an unprecedented 70.8 million people being forced from their homes and 25.9 million living as refugees.1 A growing number of people are living long-term in settlements; raising families, seeking jobs and attending school. Furthermore, NCDs such as cancer, diabetes and heart disease are rising, contributing to 80% of deaths in LMICs.2 This sheds light on the need to develop effective approaches to respond to, and treat the needs of, these populations. Recognising this need, an exploratory study was developed in collaboration with the International Rescue Committee (IRC) to investigate effective interventions for NCD prevention in LMICs, exploring opportunities for such interventions in a refugee setting. This May I spent time in a refugee settlement in northern Uganda conducting research for this study and I want to highlight three personal takeaways from my experience in the camp.

Getting off the small propeller plane in Arua with my colleague to await our vehicle, I wasn’t quite sure what to expect. While I had spent time in Africa before, this would be my first time in a refugee camp. Walking through the Ebola check point I stood still as the worker took my temperature. Next, our bags were loaded, and I hopped in the car as we set off on the hour journey to BidiBidi, one of the largest refugee camps in the world.

It was hard to tell where the town ended and where BidiBidi actually began. But as we neared the centre aid worker flags clearly defined the space. Every person we encountered, from the driver and NGO workers, to the refugees, were kind and welcoming. Eager to start our work, my colleague and I quickly started making plans. However, I was soon to learn the first of my three key lessons!

  1. You will need to be adaptable

While having a plan is nice, you need to have a plan B, C and D and be prepared to think on your feet. Much of the nature of working in international development is dealing with setbacks and this was just as true with my research. In a refugee camp food rations are distributed on certain days, therefore if someone you are meant to interview is due to pick up food, that will be their priority. Additionally, locations will be moved due to other meetings taking place and time works a bit differently. When we wanted to hold our first focus group at 11:00am the health officer would happily tell the participants to meet at 9:00am. However, with a good attitude and entertaining colleagues, the underlying chaos ended up being my favourite part of the experience, as this was a true reflection of the reality.

  1. Context is key

Much of my research was around addressing risk factors such as tobacco and alcohol use, unhealthy diets and lack of physical activity. Therefore, it was critical to understand the population; what are the drivers behind behaviours, what is the availability and accessibility and are there mechanisms in place for regulation? In BidiBidi the majority of the population are South Sudanese refugees who are Muslim; mostly women and children with little education. Shadowing a community health worker as he went into the villages gave me insight on the daily lives of the refugees and how to adapt research findings for this particular context.

  1. Community is everything

Lastly, and most importantly, community is everything. Many of the people I spoke with escaped from war-torn South Sudan, witnessed violence and experienced discrimination. But the way the community remains cohesive, supports each other and stays positive, despite all circumstances, is inspiring. The doctors, health officers and community health workers are a united team working to break barriers and tackle challenges. Hopefully as new research and new technology emerges, it can be introduced in settings like BidiBidi. An advantage of working with the IRC is that they are an implementing organisation; research is put to practice and the people they are serving have a voice. While the current statistics are daunting, the people have the will and the capacity to introduce effective interventions which can prevent NCDs among the refugee community, creating better health for all.

 

Blog written by Lara Kontos, MSc Global Health

 

References

  1. UNHCR (2019) Figures at a Glance. Available at: https://www.unhcr.org/uk/figures-at-a-glance.html (Accessed 14 August 2019).
  2. World Health Organization (2018) Noncommunicable diseases. Available at: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases (Accessed: 18 July 2019).

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Hertfordshire has led the way in improving levels of physical activity in older adults via a social marketing campaign ‘Never Too Late’ which has seen almost 4000 people sign up – 4 times our target.

Never too late photo

The 12-week campaign with a budget of £20,000 launched in April 2018 across social media, local Daily Mile schools (with children inviting older adults to join them for their Daily Mile), and through a wide range of partner organisations.

The campaign formed part of Hertfordshire’s Year of Physical Activity. It reached three quarters of a million people and generated nearly 30,000 hits to our webpage. The evaluation found that of those who reported doing no physical activity at the start of the campaign, 93% reported doing at least 30 minutes of physical activity per week at the end of the campaign. Overall, 79% of participants reported moving from doing less than 90 minutes of physical activity to doing more than 90 minutes per week by the end of the campaign. Just over half of those completing our post-campaign survey have reported meeting or exceeding their physical activity goals.

It targeted over-55s but messaging was tailored for specific behaviours, informed by insight from local focus groups and Sport England research. Key barriers (anxiety, lacking role models, thinking they do enough exercise already) and motivations (keeping up with grandchildren, healthy mind/body, social belonging, confidence, getting more from life) were central to messaging, which also promoted easy ways to fit ten minute activities into everyday life.

In Hertfordshire 42% of 65+ year olds are inactive and 58% do not meet national recommendations for physical activity. We used evidence-based behavioural science techniques (based on the COM-B Model) to encourage behaviour change:

  • Action-planning/progressive tasks: an activity planner enabled people to move from intention to action
  • Behavioural practice: personalised support from trained staff offered in a way that best suited participants’ needs
  • Prompts: twice-weekly text/email messages, targeted by key motivation (health, social, mobility, enjoyment)
  • Incentivisation: free activity pass and entry into prize draw for all participants
  • Nudge theory: sign-up to resident e-newsletter provided ongoing contact beyond campaign

We used a range of tactics and channels to target residents:

  • All traffic driven to webpage, which hosted case studies, information and registration survey. Through this we captured baseline and follow-up data to evaluate success.
  • Creation and sharing of a suite of insight-led online content tailored to different groups, in particular tapping into the over-55s growing love for Facebook. We reviewed and updated regularly to keep fresh and promote best-performing content.
  • Blitzing local and regional media, developing stories and media packages across the county.
  • Developing unique and impactful relationships with partners to maximise reach and success.
  • Identifying key periods of activity (our successful media launch and the 40+ school launch events) and supplementing these with ongoing activity across our own and partners’ communications channels. We cascaded messages, using key hooks and milestones to celebrate success and sharing pictures/videos from events.

Hertfordshire County Council’s director of Public Health, Prof. Jim McManus, said: “This campaign has demonstrated effective use of behaviour science techniques to help older people get closer to the guideline of 150 minutes of physical activity per week. This is an important element of our prevention agenda”.

“As a result of this success, we’ll be running the campaign again from 5th May 2020 in the lead up to the Tokyo Olympics”.

Case study

One person who found the campaign of benefit was Jim Furman who is 69 years old and retired. “I am much more positive than I was, both mentally and physically. I always feel better after any kind of physical activity, especially when it is enjoyable, which the activities I’ve discovered through this campaign are”. He heard about the campaign through the Council’s email newsletter and was very interested in the free day trial offer. “It has made a big difference to activity levels for both my wife and I. She has signed up to be a regular member of Stevenage leisure centre as a result of the free trial and we both now play badminton there together every week. I was very impressed with the gym. I was amazed at the whole set up, the equipment and facilities – I hadn’t realised how good they were. There was one particular activity I really enjoyed – a walking machine with a TV screen – and I’d love to go back to try that again, it was fun and made me feel really positive about exercising”.

 

Written by Nicola Ainsworth, Specialty Registrar (ST3), Hertfordshire County Council

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“The earth is sick. It has a temperature. We know the diagnosis. It needs treatment. If it is not treated it will become sicker – its temperature will go on increasing until it dies. We may have reached a tipping point. Urgent action is needed.”

Following the global launch of the Manifesto to Secure a Healthy Planet for All, Prof. Jo Nurse gave this warning at a recent event in Wessex to support local councils in taking emergency action on climate change.

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With so many local authorities declaring a climate emergency, Prof Nurse collaborated with the University of Winchester and the Wessex Global Health Network to provide an afternoon of speakers and workshops designed to assist councils in taking climate action.

Prof Joy Carter, Vice-Chancellor, was well placed to give the opening address given that Winchester is the University for Sustainability and Social Justice and has itself declared a climate emergency. Dame Yvonne Moores, former Chief Nursing Officer, chaired the event which had over 60 attendees ranging from Public Health consultants to emergency planning officers, local Councillors and NHS representatives.

The scale of the challenge facing local government was illustrated by speakers from Hampshire County Council, Winchester District and from the new unitary authority of Bournemouth, Christchurch and Poole. These were followed by presentations giving practical advice on the steps that authorities can take including 50 actions from Friends of the Earth and Ashden’s co-benefits toolkit.

The afternoon included workshops designed to highlight the key issues and then bring the discussion onto actions to prevent and mitigate climate change.

As a Public Health Registrar, currently working in global health, I found it inspiring to see the enthusiasm and commitment of my local authority colleagues despite the many challenges and barriers to tackling climate change. The scale of the emergency is daunting, and it is easy to feel overwhelmed and helpless. Nevertheless, local areas are coming up with innovative solutions and there is a strong will to engage with the public, particularly with influential grassroots organisations and with young people.

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In the workshop that I attended, there was a focus on the role of behaviour change; local authorities were asking for support from national experts in the social marketing of climate change actions. I was struck that the Public Health community has a strong track record in framing messages in a way that promotes behaviour change and, therefore, this is one area where our profession can really support council colleagues.

Going forward in Wessex, it is hoped that stronger networks will facilitate cross-sector action by allowing the skills and expertise of many different disciplines to come together; Public Health professionals with their competencies in engagement, influencing and behaviour change should be key players in the response to the climate emergency.

Written by Rebecca Wilkinson, Public Health Registrar on placement with the Wessex Global Health Network

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Unlike most visits to Ghana, this trip was particularly special and a “mission” rather than a reunion with friends and family. My yearning to make this a success had me constantly refreshing myself on the terms of reference and action plans for the trip, which, I guess, was the culmination of a partnership ‘journey’ that started in the latter part of 2018 involving various emails, teleconferences, text messages and phone calls!

My first day (and first time) at LEKMA hospital, started with some personal observations (and to have a moment to myself).  Afterwards, on the way to see the Medical Superintendent, Dr. Ameh, I saw one of the pharmacists that I recognised from one video conference call. I called him by his ‘English’ rather than Ghanaian name, thereby giving away who I was, but more reassuring was when he mentioned they were expecting me (as did Dr. Ameh when we met).  This bode well for the visiting team.  With initial introductions over, I went into planning times for the Global Point Prevalence Survey (GPPS) which took place over subsequent days with two Pharmacist colleagues.

Samantha arrived a few days later. The rest of the team arrived after Samantha, but the excitement made me go to the airport. Waiting like it was Christmas!  The next morning, we all met for the first time and were driven to LEKMA Hospital.

Our first day LEKMA was extremely pleasant with the usual warm Ghanaian hospitality.  The enthusiasm was apparent from the get-go.  We ran through the agenda for that day and duration of the visit followed by ward/departmental visits.

 

pic1FPH Africa SIG Ghana Visiting Team (left to right)

  • Mr Edwin Panford-Quainoo, Public Health Pharmacist, Liverpool School of Tropical Medicine
  • Dr Rajesh Rajendran, Consultant Microbiologist, East Cheshire NHS Trust
  • Dr Valérie Decraene, Consultant Epidemiologist, PHE Field Service
  • Dr Sam Ghebrehewet, Head of Health Protection, Public Health England, North West (FPH Ghana Visiting Team and Partnership Project Lead)
  • Dr Saran Shantikumar, Clinical Lecturer in Public Health, University of Warwick
  • Ms Samantha Walker, Lead Nurse – Infection Prevention and Control, Countess of Chester Hospital NHS Foundation Trust
  • Mrs Indu Das, Antimicrobial Specialist Pharmacist, East Cheshire NHS Trust

 

The second day had workshops on Antimicrobial Resistance (AMR), Antimicrobial Stewardship (AMS) and Infection Prevention and Control (IPC), with a fully engaged hospital team who gave frank and honest opinions about their hospital IPC practices and improvements needed. Workshop evaluation provided invaluable information that was consistent with observations.

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On the Saturday, we visited the hospital to get a sense of the out-of-hours services [accident and emergency and out-patient departments (OPD)]. We used this opportunity to review OPD antibiotic prescriptions of the day (revealing interesting findings).  We visited three community pharmacies within walking distance of LEKMA Hospital who had been informed of the project and were fully engaged in completing a knowledge, attitude and practice survey.

We spent the Sunday recapping and reflecting on the previous days’ events in the idyllic setting of Sogakope. Even on our day off, the team could not help but be productive and were able to record a podcast, prepare a WHO grant application for implementing delayed/back-up prescribing at LEKMA Hospital and learn about Ghanaian music.

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Monday was the advisory committee meeting, chaired by Prof. Afari. The morning of Tuesday 18th June, was feedback session with the LEKMA management and Ghana Public Health Association (GPHA).

In summary we were able to deliver:

  1. Agreed and signed off a Memorandum of Understanding and ToR;
  2. Established an AMS Advisory Committee;
  3. Completed a Global Point Prevalence Survey;
  4. Completed a healthcare workers Knowledge, Attitude and Practice survey;
  5. Initiated IPC guidelines review based on the WHO infection prevention control and hand hygiene assessment tools;
  6. Initiated discussion around prescribing guidelines (national) with the view of having simpler and more accessible local prescribing guidelines, i.e. within the context of the National AMR Plan and Prescribing Guidelines;
  7. Initiated the discussion around laboratory data surveillance processes and regular production surveillance outputs, with a focus on drug-resistant organisms;
  8. Agreed to implement delayed/back-up prescribing in the out-patient department of LEKMA Hospital.

We left Ghana with nothing but fond memories of a magnitude that we could not put into words and look forward to our next visit to Ghana.

Blog written by Edwin Panford-Quainoo, Liverpool School of Tropical Medicine

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The Faculty of Public Health Part B Membership exam is the final stage of the route to membership of the Faculty through examination, but by no means the last step of becoming a Specialist in Public Health. Examiners from across the UK and from all domains of Public Health develop scenarios to test candidates’ abilities to understand and explain public health concepts and respond appropriately to questions and challenges in various settings (examples are available on the Faculty website). As examiners, we are committed to maintaining the standards set by FPH, but also committed to developing the next generation of Public Health leaders as excellent communicators and experts in all aspects of Public Health.

I was asked to write this blog, on behalf of my fellow examiners, after I had tweeted some tips based on reflecting on performance in the exam. One of my Registrars wrote a blog on how to prepare and pass the exam – this blog gives the examiner perspective.  As examiners, we wrote an article to help highlight how best to approach the exam. We had become concerned that some candidates are developing an approach to the exam which structures their answers but reduces their chance to succeed. These tips below, buidling on the tweets, are offered to all candidates with the reminder that, as examiners and colleagues: we want you to pass!

  1. Prepare to listen, hear the question, answer in a way that makes sense to that person, be it Director of Public Health (DPH), journalist or MP.

Too many candidates enter the room with their first answer prepared- forgetting to listen to the question. In a role play, examiners are keen to see that you are responding appropriately to the audience and answering the issues they raise. It is better to focus on listening to the question and answering the way you would in real life. Candidates are sometimes so determined to introduce themselves (which is not necessary) that they miss the first question altogether.

  1. Be ready to present/explain tables and charts – it’s what we do – but remember your audience. Don’t treat the DPH like you would a lay person.

If there are tables and charts in the pack, it’s likely you will need to understand what they say, and demonstrate this. This is a core skill of Public Health and we expect this to be done well. A trap some candidates fall into is in guessing the next question: “would you like me to explain confidence intervals” to which a reasonable reply might be “of course not- I’m your DPH!”

  1. Let the role player ask their questions. The pack doesn’t give you the structure, the questions do. Let us lead you through.

There are significant numbers of candidates who struggle because they don’t understand the format of the exam. The role player has a list of questions that they ask in order. These should elicit the information we need to mark the candidate. In general, scenarios are designed to build – so that the role play makes sense. Offering to give a speech, trying to tell us information that has not been requested, and answering questions you wish had been asked are all ways to run out of time and fail to complete the station.

  1. Don’t be just anyone – speak with passion about public health principles. Care about outcomes, inequalities and efficiency.

This is a “show’s how” exam where we are looking to see you have internalised Public Health concepts. Great candidates engage with the role play and come across as advocates for Public Health. This is far better than the trite “This is an important public health problem” statement repeated at every station by some candidates. There are no marks available for this.

  1. Have a good look at any data. Is it numbers, rates, percentages?  Be clear when explaining or answering questions.

Sometimes the scenario makes clear that the data has come from a poor quality source; a student project or similar. Might this mean that there are errors in the data? It’s vital that we use the right terms; confusing number of deaths with death rates is a sign a candidate hasn’t studied the material. Be accurate – the difference matters.

  1. Check the role player is understanding you. Keep eye contact- sometimes role players will look confused or upset- this is part of the station.

There is little scope for conversation in most scenarios- sometimes we really have to rush to get through the questions. Taking notice of how role players respond is an important part of the exam. Picking up on responses is a key skill in the “listening” competency. If you are asked the same question twice, it usually means its important and you did not answer it correctly the first time. Don’t try and skirt round it or just repeat what you said the first time.

  1. If you have to explain a table or graph – share it, show me, point it out.  Be sure I understand your explanation.

Great candidates really do this well. Positioning themselves in a way that allows them to share their papers, point at the information they are describing, and looking at the role player to see if they are understanding the explanation. Done badly, it can appear that candidates are just hoping not to be asked about it.

  1. Be ready to say if you don’t know. No “I’ll email you” or “I’ll get back to you”, sometimes you just don’t know – that’s ok.

The issue with the answer “I’ll email you” or similar is that the question has been asked and needs to be answered. If asked “Do we need to close the shop?” the possible answers are Yes, No and I don’t know. All can be valid, and the mark scheme will make this clear. The questions are scripted to last 8 minutes and the role player strives to complete the station within that time. Sometimes a scenario runs faster and most candidates finish a station a minute or so early. It will be obvious from the role player that the scenario is complete. It is quite okay to use this spare time to look at your next scenario.

  1. Remember to make eye contact. It’s a conversation.  The examiner role players are willing you on. 

Some candidates have clearly not prepared the “acting” side of the exam. Great candidates have a real conversation and engage the role player. This means they pick up on the mood and responses as well as the substance of the questions. Comments like “I know this must be difficult” and “I can see why you might think that” often reflect an understanding of the other point of view.

  1. Be yourself. You have got this far because of who you are.  Serious people think you are amazing.  Show us why.

We really do want you to pass. Many examiners are also Educational Supervisors, they are all involved in training and want to give candidates the chance to shine. We don’t want an act – just you being your best you. Read the material, listen to the questions, engage in the scenario and show us why one day soon, you will be a consultant.

 

Links:

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Do you want to complete some of your CPD and learn about Health and Climate Change and Sustainable Development (SD) at the same time? Well now you can.

The FPH Sustainable Development Special Interest Group (SD SIG) has put together a series of fact sheets. Each resource is a two-page introductory summary of a major topic in sustainable development, with references and signposts to more detailed information. The resources explain the relationships between the work of public health practitioners, the causes and effects of climate change, and health. You can read these fact sheets, learn more about sustainable development and log this activity in your CPD diary.

The topics cover areas of knowledge such as ‘Principles of Sustainable development’, ‘Health benefits of action on climate change’ and ‘Sustainable food systems’ which includes issues such as the contribution of agriculture to greenhouse gas emmissions (GHGE). There are also some ‘action’ resources e.g. ‘Adaptation to climate change’ which gives examples of health impacts and the adaptation required and how the built environment can be more climate resilient.

At the end of each resource there are specific CPD questions as well as the general CPD diary questions and there are model answers so that you can learn as you go and get credits in your CPD diary.

These resources are useful to everyone; whether you are a specialist trainee addressing competency 5.7 or you are a specialist or educational supervisor who wants to learn more about climate change and health or you are supervising your trainee. A survey of both SpRs and educational supervisors showed there was some good work in this area but that SD needed to be more embedded into routine placements and projects and that SpRs should be empowered to be leaders in SD.(1)

We’ve made this link between the resources on the FPH website and CPD as in the last membership survey it was identified that members wished for more CPD support from FPH. CPD is something we all do every day; we learn as we go and don’t always need to go to a specific training course. Over time the aim is for other SIGs to similarly make the explicit link between their intelligence and resources and your CPD.

Why is health and Climate change important?

  • Lancet commission identified in 2009, that ‘Climate Change could be the biggest global threat of the 21st Century’.(2)
  • Climate change science is real, but it is often difficult to get our heads round. The impacts of climate change can seem like a long way off, and we know that politicians and all of us find it hard to recognise this and take action on threats that are in the more distant future.
  • The co-benefits of addressing health and climate change together are clear, for example increasing active travel is good for your health and good for the planet.
  • Health brings home the real story of the impact of climate change; imperative, immediate and life changing. People’s health is being damaged today by climate change through effects ranging from deadly heatwaves in Europe, (I write this on what is being anticipated as the hottest July day in UK ever!) to rising dengue fever in the tropics, major floods and devastating fires.
  • “We cannot delay action on climate change. We cannot sleepwalk through this health emergency any longer.” (3)
  • For trainees and educational supervisors don’t forget the FPH Curriculum competency 5.7 – “Demonstrate leadership in environmental sustainability with a focus on the links to health and climate change”

So click this link, read these resources and chalk up some CPD credits as well as getting yourself up to speed on SD, health and climate change.

References

  1. UK Public Health Registrar Sustainable Development Network. Embedding Sustainable Development in UK Public Health Training: Update Report. November 2018. Available at: https://www.fph.org.uk/media/2268/sdn-report-final-2017-2018-nov1-1.pdf
  2. Lancet Commission. 2009. “Managing the health effects of climate change”. Lancet and UCL Institute for Global Health Commission. April 2009.
  3. Lancet Commission.2018. “Health and Climate Change: shaping the health of nations for centuries to come” Lancet. December. 2018

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No 1. The European National Anthem

There was always going to be music in my presidency. We were still in the EU before the 2016 EU referendum when I played the European National Anthem, ‘Ode to Joy’ at John Ashton’s leaving party.  There’s a taste of it from my leaving party, three years later, still just in Europe here:

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No 2. I almost lost my mind

At the Brighton Conference 2016 where I became President, David Stuckler in his keynote presentation gave me the licence I needed to play, when he said he had the ‘Brexit blues’ , when opinion polls showed Brexiteers in the lead.  Seeing Muddy Waters and Bruce Springsteen on the walls of the conference syndicate rooms, I needed no more excuse to play the Brighton Dome and played a blues with my closing speech.  So, I played my ‘go to’ blues number., the one I learned from Shakey Walter Horton, one of the giants of Chicago blues harmonica,  he called it ‘Easy’, and Dr Harp’s Medicine Band version of it is here . He borrowed it from Ivory Joe Hunter, a blues crooner and piano player; he called the song ‘I almost lost my mind’. His words were sadly prophetic for the Brexit experience.

“Well, I can tell you, people, the news was not so good 
She said, “Your baby has quit you, this time she’s gone for good”

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No 3. Freedom come all ye! 

Scottish colleagues had already booked me for their Autumn conference, but now they expected me to also play the mouthie.  I said I would if they could find me someone to sing the great Scottish anthem, ‘Freedom come all ye!’ in Scots.  And they did: the wonderful Josie Murray stepped up to the mark. ‘Freedom come all ye’.  It is wonderful song, written by Hamish Henderson at the time of the Polaris CND protests at Faslane in 1960. The ‘Come all ye’ is a rallying cry used in political protest, forever, I called my talk to the Scottish conference ‘Health Come All ye.’ , and recounted my time in Dundee, by the silvery Tay. I spoke also to great Scottish public health work, the campaign for rights to health and the Scottish beacon and conscience for health. Henderson saw his anthem as a world anthem, overcoming Imperialism, where ‘no more would our bonnie callants march to war’, instilling fear as the bagpipes played ‘Scotland the brave’.  The tune was ‘The bloody fields of Flanders’, Henderson had heard on the beach of Anzio in the allied invasion of Italy in 1944.  The poetry of this song is important, elegant and worth the effort.

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No 4.  Please see my grave is kept clean

One of my saddest, but ultimately uplifting duties was to commemorate the life of Alwyn Smith, one of our best regarded presidents, which we held at the Christie Hospital in his beloved Manchester.  But he was, at least, a proper Yam Yam, like June Crown, they were  born in the Black Country; I was only adopted ‘Honorary Black Country’. In amongst the remembrances, I performed Blind Lemon Jefferson’s  ‘Please See my Grave is Kept Clean’  more symbolic than literal, the words are a celebration of living, and a plea to remember the achievements of those gone before. I also gave the Faculty Grace that Alwyn composed, passed on to me by John Ashton.  I hope my successors will keep up alive this lovely, simple statement which I say at family meals and now, in European public health gatherings.…

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No 5. Watermelon man

Another great hero of my public health history was Peter Draper.  Peter Draper invented ‘upstream factors’ the things we carelessly talk about not realising this is internal jargon that few outside public health will get without an explanation.  He also compiled the definitive text ‘Health through public policy’ to which we all owe an enormous debt for our pious thoughts on health in all policies. His forensic analysis of how media predicts and hijacks our efforts to communicate health messages, was visionary. It pre-dated anything anyone is trying now with social media and we need to develop this kind of surveillance of media – fortunately Martin McKee and colleagues are on the case.

Peter was a great humanist and a great jazz lover, so when we came to celebrate his life, it was fitting that we went to Conway Hall, home of British humanists, and also a venue in which Humphrey Lyttleton had recorded one of his great jazz live albums. Herbie Hancock’s jazz classic is a blues tune I love to play wherever I get the chance. So where better than Conway Hall?  I also got to play it at the 2016 Gastein conference with the house band. Thanks guys!

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No 6. Juke

Little Walter was the Hendrix of the Chicago blues harmonica. I would take his songs to a desert island hoping I might practice and learn how he did it. I played my version of ‘Juke’ at the brilliant Oxford Registrars public health conference in September 2017. Thank you, Emily Dobell and colleagues.

It was a joy to perform overlooked by Sir Richard Doll, and in the company of the brilliant and chilling presentation of Nigel Hewitt, conscience of the care of homeless people in the UK.

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No 7.  The songs of Ewan McColl

I talked about ‘Dirty Old town’ in my presentation to the Salford University conference on social prescribing in November 2017. I also talked about ‘Kind of Loving’ and Kitchen Sink drama, somehow I didn’t get my organ out though!   But Ewan McColl has been with me since I first learned a few words of the Manchester Rambler in about 1971. McColl was the British equivalent of Woody Guthrie, an extraordinary chronicler of UK working lives and communities, and able to put himself into their heads to sing songs of their experience. We should try to do the same- bringing stories into the tapestry of statistics and policies. So I’ve sung ‘Manchester Rambler’ at the 2017 conference in Telford,  and on my leaving do  It is a song which celebrates the triumph of working class people for the right to roam- started with the Trespass trail in 1934, the ‘Battle of Kinder Scout’; and finally won in 1998 with the Ramblers Association victory in England (Scotland knew the right to roam was there’s!).

I also got to play ‘The Shoals of  Herring’ at the East of England  Conference in October 2018. It is a truly beautiful song, celebrating herring fishers and fishing fleets from Yarmouth to Peterhead: a life, and an industry long gone. Although post Brexit, we will all have to revert to eating the most healthy oily fish, the Herring!

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No 8.  Irish tunes

The Irish have the best tunes.   It’s a fact.  Tunes I’ve been able to play on my travels have been  Dingle RegattaRaglan Road,  the Fields of Athenry, Star of the County  Down, and Tell Me  Ma., though I’ve not recorded that one!   The Green Fields of France, is probably the greatest ever song about war, written by a Scot, Eric Bogle, who became an Australian, about a could be, Scottish, could be Irish, Soldier in WW1, Willie McBride. The Fureys made the greatest version I’ve heard and I commend it to you, but our version, featured in the  November 2018  FPH bulletin, is here.

No 9. Notable public health tunesmiths and the song of the month

In our number are many outstanding songsters and musicians.  Apologies, Alison MacFarlane, but I only learned just after I had passed on the President robes that you have a public health music review- something like ‘the cholera blues’ I believe?  I’d like to sit in on that one!  I tried to get more public health participants into my song of the month feature in the bulletin. So far only had the great Gabriel Scally’s ‘Public Health Call’ and Carole Wood’s  ‘Five in a bar’ acapella piece, ‘Let every spirit fly’.

To mark Fats Domino’s demise in November 2017, I put up the previously unreleased  version of ‘Walking to New  Orleans’ by  Dr Harp’s Medicine  Band.  I also put up the brilliant piece of stand up by John Denver- not a song in sight- and I know, hijacked by the US temperance movement. But this version of Joseph Mallins’ poem- ‘The Ambulance down in the Valley’ is a parable of the plight, and the need for public health.

We had ‘Down to the Doctors’ at the Christmas  bulletin – to remind me of the greatest band to come out of the East of England!

No 10.  Hearts and Minds

I first met Lady Nade, performing for my daughter’s café’s 1st year anniversary party in   September 2016 in Bristol.  I was on stage playing ‘Back to Black’ with her in minutes and we have been working on an album ever since.  Nade is a talented singer songwriter who has just completed her second album launch and tour. We have been cooking the album ‘Hearts and Minds’  over three years. I commend it to you.  We are selling the CD for young people’s mental health and older people’s dementia charities. You can find us on Apple Music, Spotify, Amazon, CDBaby.com, or you can buy a CD form me.  Bill Wither’s great soul anthem, ‘Lean on me’ is also a long-standing favourite of mine. It is a great statement for community development and public mental health. I first heard it played for a health audience by Jackie Lynton at Sandwell’s first public mental health event in 1997!  We featured it on the World Mental Health Day issue of the FPH bulletin in October 2018. Enjoy!

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Written by Professor John Middleton,
Immediate Past President, United Kingdom Faculty of Public Health,
President, Association of Schools of Public Health in the European Region (ASPHER)
Honorary Professor, University of Wolverhampton,
Visiting Professor, University of Chester.

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