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In our research into the oral health inequalities experienced by children in care and young care leavers we knew that we wanted to work collaboratively with children and young people (CYP) to produce the research. We wanted to give them the opportunity to be involved throughout the production process from concept to completion, helping to produce outcomes and services that are relevant and important to them. To support this, we conducted a rapid literature review (to be published Spring 2023) to learn from previous research on how to meaningful involve vulnerable CYP in research.

Co-approaches and participatory research

The terms co-creation, co-design and co-production are often used interchangeably and are ill-defined (1,2).

One study defined co-design as “meaningful end-user engagement in research design”, adding that it includes “instances of engagement that occur across all stages of the research process and range in intensity from relatively passive to highly active and involved.”

“Co-production” refers to much more than “meaningful end-user engagement”. It is committed to working in partnership to generate ideas, evidence and research outputs, recognising the importance and validity of different forms of knowledge. The UK National Institute for Health Research 5 key principles of co-production (3) are:

  • Sharing power;
  • Including all perspectives and skills;
  • Respecting and valuing the knowledge of all those working together on the research;
  • Reciprocity;
  • Building and maintaining relationships; Joint understanding and consensus and clarity over roles and responsibilities.

“Participatory research” goes beyond this. It challenges the power dynamics between researchers and those with lived experience, seeking to democratise research and to question traditional ideas of knowledge and expertise.

Grindell (2) coined the term ‘co’approaches to encompass co-creation, co-design and co-production.

Taking a pragmatic approach

Given the lack of clarity around definitions, we took a pragmatic approach in the rapid review. We defined research ‘co’approaches with vulnerable CYP as “involvement of vulnerable CYP in an explicitly described role contributing to the planning and/or conduct of research”. We used the Children’s Commissioner for England (2017) definition of vulnerability to identify populations of interest (4). These include, those that have safeguarding concerns or are in state care, have health problems and/or disabilities, low income, have challenging family circumstances, are not engaged or excluded from education, are involved in offending or anti-social behaviour, have experience of abuse/exploitation or come from minority populations.

So, what did we learn that would be useful in using a co-approach in our research?

We learnt a lot about the challenges.

Some would apply to involving any child or young person in research, such as maintaining interest and motivation and fitting the research in with their other commitments such as school, work and social activities. Other challenges related specifically to the life circumstances of vulnerable CYP with examples such as childhood trauma, homelessness, poverty, addiction, parenting responsibilities and mental and physical health issues. In research which took an explicitly participatory approach, working with and accommodating the needs of vulnerable CYP called for support beyond that related to carrying out research to encompass aspects of their daily lives.

The need for flexibility and responsiveness to the varying needs and abilities of CYP to facilitate their meaningful involvement in the research has implications for time and budget. The fluidity of what can be a “messy” situation may not sit well with the needs of funders (4). It can also present challenges when trying to navigate the systems for obtaining ethical approval which call for detailed and explicit description of all processes (especially for work with vulnerable CYP). Other challenges concern academic researchers and their ability to engage with the CYP and to relinquish power.

Researchers in the studies we identified tended to write less about how to overcome the challenges. However, some key principles emerged.

There was a strong focus on “building trust” with CYP as co-researchers, especially where CYP may have a history of disappointing encounters with adults and authority. Making the research process interactive and task driven and, where possible, giving CYP the power to decide how to deliver the tasks helped maintain engagement and facilitated a collaborative approach. Identifying motivators, recognising the different skills and strengths of individual co-researchers and supporting them to learn new skills gave them the tools to collaborate on their terms. Team-building activities and regular meetings to support team bonding were an important feature of some studies. It is also important to formally acknowledge co-researchers’ contribution.

The findings from our review echo the 5 principles identified by NIHR (3) and highlight some of the practical hurdles faced in taking a ‘co’approach. We look forward to exploring how, informed by this review, we might work collaboratively together with children in care and care leavers to tackle oral health inequalities.


Dr Jo Erwin1, Post doctoral Research Fellow, Public Health Dentistry, Peninsula Dental School

Ms Lorna Burns1, Lecturer in Evidence Based Healthcare – Information Specialist, Peninsula Dental School

Dr Nick Axford1, Associate Professor in Health Services (Research), NIHR ARC South West Peninsula (PenARC)

Ms Sarah Kaddour2, Inclusion Oral Health Fellow

Ms Jane Horrell1, Research Fellow, Peninsula Dental Social Enterprise CiC, Peninsula Dental School

Prof Jill Shawe1, Professor in Maternal and Family Health, School of Nursing and Midwifery

Dr Hannah Wheat1, Senior Research Fellow in Dementia Research, Peninsula Medical School

Prof. Robert Witton1, Professor of Community Dentistry, Chief Executive Peninsula Dental Social Enterprise CIC, Peninsula Dental School

Prof Paul Brocklehurst3, Professor of Health Services Research and the Director of NWORTH Clinical Trials Unit at Bangor University.

Dr Martha Paisi1, Research Lead, Peninsula Dental Social Enterprise CiC, Peninsula Dental School; Senior Research Fellow, School of Nursing and Midwifery

1 University of Plymouth; 2 Pathway Charity ; 3 University of Bangor.


1. Brandsen T, Honingh M. Distinguishing different types of coproduction: a conceptual analysis based on the classical definitions. Public Admin Rev. 2016; 76(3):427–435.

2. Grindell C, Coates E, Croot L, O’Cathain A. The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res. 2022; 22(1):877.

3. Hickey G, Brearley S, Coldham T, Denegri S, Green G, Staniszewska S, Tembo D, Torok K, and Turner K. (2018) Guidance on co-producing a research project. Southampton: INVOLVE.

4. Slattery P, Saeri AK, Bragge P. Research co-design in health: a rapid overview of reviews. Health Res Policy Syst. 2020;18(1):17.

Acknowledgments: This rapid review is part of a larger project “Dental care for children and adolescents in care- Caring for children and their smiles” funded by The Borrow Foundation (https://www.borrowfoundation.org/ ). Special thanks to members of our PPI and stakeholder groups who have reviewed this blog.

Dr Jo Erwin

February 2023

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Would I like to observe the judging panel of the fourth biannual International Public Health Film competition? There’s only one answer to that question and it’s a big YES! Finally – my chance to be at the table with a veryimpressive line-up of judges, discussing all things international, public health, and film – my favourite ingredients for a great afternoon.

Established in 2016, the International Public Health Film competition (IPHFC) and associated Public Health Film Festival (PHFF) celebrates diversity in public health film. The event, run by a UK registered charity, is one several public health-related film events (see below) that have taken place over the last decade to provide a platform for film makers working in this field to showcase their work, and for health specialists to engage with artists and visual story-tellers about public health topics.

Illustrating the increasing popularity of film as a medium to convey public health messages, the first International Public Health festival received 84 films from 20 countries in 2016. This time around, despite or even because of the recent pandemic, the competition received over 1,400 films from 100 countries! Unsurprisingly, around one in six submissions included a COVID-19 theme, but topics otherwise showcased just how wide the wider determinants of health are.  

The IPHFC has kept its inclusion criteria deliberately broad, allowing submissions from all over world, covering all manner of subjects, and any duration: from a few minutes to well, how long is a reel of film?

In preparation for the judging committee, I spent a weekend on my sofa with suitable public-health-approved snacks, watching the ten shortlisted films. Testament to just how well the films were scripted, acted, filmed, and produced, it was an emotional two days as I joined the characters on their journeys through mental health, physical health, and natural disasters. Moments of light and joy and humour provided an appropriate counterbalance to the call to action running as an undercurrent through many of the films. The cinematography was, at times, absolutely breath taking and I was briefly transported from my mid-terrace in autumnal Wales into others’ lives across the world.

Then, the day arrived! I was honoured (and slightly nervous) to be around the virtual table with an incredibly impressive judging panel, comprising:

  • Dr Uy Hoang, President, Public Health Film Society and Chair of the UK Faculty of Public Health Specialist Interest Group in Film  
  • Professor Kevin Fenton, President of the UK Faculty of Public Health 
  • Linda Bergonzi-King, Chair of the American Public Health Association (APHA) Global Public Health Film Festival, Producer/ Director/ Consultant at TriBella Productions 
  • Nimish Kapoor, Festival Director, National / International Science Film Festivals of India 
  • Dr Olena Seminog, Vice-President, Public Health Film Society and Researcher at Nuffield Department of Population Health, University of Oxford 

But how could we possibly choose the “best” film? What even is the “best” film? The first festival sparked the development of formal public health film judging criteria, based on criteria used by others such as the American Movie Awards. Ten criteria were developed and tested in 2016; it is these criteria that we used in our discussions. They are:

  1. Originality and creativity
  2. Public health importance
  3. Plot and structure
  4. Pacing
  5. Character and storyline
  6. Cinematography and direction
  7. Entertainment value / watchability
  8. Dialogue
  9. Overall quality of production
  10. Use and evaluation of impact

The scoring criteria guided us through critiquing and analysing the relative merits of each film, as well as facilitating increased transparency in the judges’ decision making. However, there is more to decisions than simply numbers, as the shortlisted films were so diverse, tackling different subjects in very different ways, and ranging from 5 minutes’ duration to full feature length. Cue, stage right: the judging panel discussion!

An animated conversation started almost immediately, the judges’ passion for film immediately evident. Judges brought different ideas and perspectives to the virtual table, by virtue of their diversity of background, film, and public health experience, as well as varied life experiences. One film, for example, could have been a Hollywood movie for its cinematic tricks – but fell short with its consistency in health messaging. This demonstrates the importance of a broad array of marking criteria, but mostly the importance of a multi-disciplinary discussion to ensure the winning films contained the right balance between filmic quality and public health messages that were conveyed. Agreement was important: the winning films would be endorsed by the group, and it was essential we were all happy with the group decision. We returned again and again to the importance of a consistent public health message. Enjoying the benefits of a geographically diverse panel, we considered how different films may be received by different communities across the world, and how that influenced the messages contained within the film.

Eventually, consensus was reached! All the winning films were high-scoring, and in our conversations it was clear that we had all earmarked these films as having a je ne sais quoi, films that had stimulated an emotional response in us all.

The judges’ prize went to A Fire Inside, which thoroughly deserves the accolade. A full-length feature film taking on Australia’s devastating “Black Summer” bushfires in 2019/2020, the film sensitively tells the stories of the heroes on the frontline of firefighting and the “heroes in plain clothes” supporting them. Beautifully and respectfully filmed and with incredibly powerful cinematography, we were shown “hell on earth”. Once the fires were dowsed, feelings of abandonment and trauma surfaced amongst those affected. Scenes of utter devastation filled the screen. But, amongst the charred landscape, we saw volunteers overwhelmed by donations, we heard of the kindness of strangers and those who saw an opportunity to help, and so helped. A poignant film which shows the power of healing.

Given the high quality of the entries, the judges deemed three other films deserved an honourable mention given their filmic quality or the impact of their public health message: Hysterical Sisters; Solstice; and A Black Cloud.

Hysterical Sisters is a beautifully choreographed and narrated fusion of art, storytelling, information, and film which tackles stigma head on.  The impact of two common conditions (endometriosis and adenomyosis) on every aspect of the women’s everyday lives – school, relationships, others’ indifference to their pain – and the surrounding silence by society, by the medical profession, by research, is viscerally told.

Solstice broke my heart. Dedicated to Mary and those who didn’t make the night, Mary Baker’s parents tell their story of losing their teenage daughter to suicide. Interspersed with stories told by others who have lost loved ones, the message is clear: different people, different backgrounds – we can all be affected. Mary’s parents, now well known for their advocacy around mental health and suicide prevention, organise an annual event, Solstice, which mobilises the community, supports people affected by mental health concerns to work together towards a common cause, and to campaign: “in community lies strength”. In 2021, Solstice filled out the square it was hosted in, and was watched by 20,000 people across the globe. Mary’s story was invited to join the Museum of Lost and Found Potential in London, as the Australian exhibit. The film provides hope that change is happening, and political space is being made for suicide prevention.

The short film A Black Cloud cleverly uses real patient voices with animations to tell women’s stories of reproductive trauma and bereavement. It is a powerful, moving, sensitive, compassionate, and brave insight into very personal experiences which are often not shared. The film comforts those affected that they are not alone, and encourages them to seek help to start their own journey of recovery.


Thank you very much to Dr Uy Hoang, for inviting me to join the judging panel. I very much enjoyed all the shortlisted films, and our discussions during the competition. I look forward to watching this genre expand over the next few years, and who knows, maybe we’ll be organising the Public Health Oscars one day soon!


For more information on the Public Health Film SIG: https://www.fph.org.uk/policy-advocacy/special-interest-groups/special-interest-groups-list/public-health-film-special-interest-group/

For more information on the International Public Health Film competition: 

Other Public Health Film festivals include:

For more projects offered through the FPH: https://www.fph.org.uk/training-careers/specialty-training/training-placements/fph-projects-scheme/

Dr Emily Clark

February 2023

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Finding this project was striking speciality training gold. Combining my love for international public health, and sexual and reproductive health, the project specification could have been copy-pasted from my wish list of ideal jobs.

The UK Faculty of Public Health (FPH) had been working with their Specialist Interest Groups (SIG) to create new training opportunities for Specialty Trainees for the last few years through the FPH Projects Scheme.

Demonstrating incredibly fortuitous timing, Development Media International (DMI), a London-based NGO who create evidence-based mass media behaviour change campaigns to improve health, advertised a Specialty Training project in collaboration with the FPH Film SIG just when I needed it!

The project involved working on a campaign in the southwest of Côte d’Ivoire called “Pour une family saine et prospère”, which translates to “for a healthy and prosperous family”.

After a virtual interview, I felt very lucky to have been selected for the Project Scheme.

Famille”, as the project was known colloquially, was adapted from a similar DMI campaign in Burkina Faso, which was evaluated using a cluster randomised controlled trial. The results demonstrated a 20% increase in modern contraceptive uptake rate and seemed to be mediated by improvements in attitudes towards modern contraceptives.

For Famille, the Burkina campaign was tailored to the Cote d’Ivoirian context using a thorough literature review and in-person formative research plan to explore barriers, motivators, challenges and enablers to contraception use, and collect any further local intelligence that might be important for our campaign. Having found a fantastic in-country qualitative research consultant, the focus groups and interviews with community members and key informants could begin! What followed was a series of fascinating Zoom calls with the research consultant as she described her findings to us. We learned about changing traditions, as women no longer leave the marital home for a prolonged period of time to give birth and nurse the baby before returning home. The cost of living was putting pressure on families in Côte d’Ivoire too – men wanted their partners at home to help look after other children, and to help with work. This changing tradition, which previously would have ensured a natural and healthy birth spacing between babies, now meant women were more likely to experience high frequency pregnancies, putting both their health and that of their children at risk. We also learned that the unpredictable side effects of hormonal contraception were unacceptable to some couples, where bleeding prohibited women from cooking or sleeping in the marital bed. Differences in side effects experienced by women was fertile ground for rumours and misinformation to spread. Men and women were worried about the risk of lasting infertility following the use of modern contraception.

The report, rich with quotes, together with the literature review provided a strong basis upon which to write the message briefs from which the campaign content was adapted. We focused on three messages for our campaign:

  1. Modern methods of contraception are easy, safe, effective, and reversible 
  2. Men, family planning is your business too. Talk to your partner about family planning, and accompany your wife to the health centre
  3. You can use modern methods of contraception to space child births, and create a healthy, happy and prosperous family

Soon, we had 8 radio spots which conveyed our key messages in a fun, engaging way using humour and storytelling. These were tested with focus groups in Côte d’Ivoire and then recorded in five local languages using local actors. Once approved by the Ministry of Health, broadcasting could begin on the 27 partner radio stations. Each spot aired 10 times per day for up to two weeks based on DMI’s “Saturation+” approach

Next it was time to think about the process evaluation. Many hours of discussion ensued whilst we tried to balance ideal research study designs with pragmatism including budgets, access to villages, and weather conditions in the field (it was the rainy season at the time). We developed a protocol – based on the Capability-Opportunity-Motivation (COM-B) model of behaviour to assess women’s access to radio; social networks; attitudes and norms towards modern contraception use and birth spacing; current and intended contraception use; and their recognition of our campaign. Analysis of findings demonstrated that most women held beliefs supportive of their own reproductive autonomy (that they should be able to make decisions for themselves), however, many concurrently (and contradictorily) believed that other women did not share this belief; that other women would not support their views; and that their husbands believed they should make the decisions on contraception. These findings stimulated plenty of ideas for future campaigns – and the positive feedback received by our partners suggests further campaigns would be very welcome indeed. 

This experience provided me with a smorgasbord of learning. Not only have I discovered a huge amount about sexual and reproductive health and practices in Côte d’Ivoire, I have gained experience of the practicalities of designing a research-based radio campaign for behaviour change. Supported by my supervisor, I provided the research input for an international multi-disciplinary team. The importance of stakeholder engagement was really clear throughout the project – Famille was only possible because of the existing trusted relationships between the organisation, the radio stations, and other partners. Approval was needed at all stages of the project from the Côte d’Ivoire Ministry of Health. Collaboration with the Ivorian Midwives Association yielded benefits for us all – I was incredibly grateful for the opportunity to discuss our emerging findings with very knowledgeable professionals. As I reflect on project, it is clear it has been a fantastic immersive experience with many transferable skills that I will bring back to my day job!  


I would like to say a huge thank you to Development Media International for hosting me, to my supervisor Dr Abbie Clare for all her guidance and support, and to Dr Uy Hoang and Dr Stella Botchway from the FPH Public Health Film Special Interest Group for helping to organise the Project Scheme with DMI.


For more information about DMI, please visit: https://www.developmentmedia.net

For more information about the project (including one of the spots), please visit: https://www.developmentmedia.net/project/pour-une-famille-saine-et-prospere/

Information on the landmark RCT in Burkina Faso can be found here: https://www.developmentmedia.net/project/familyplanningrct/

For more projects offered through the FPH: https://www.fph.org.uk/training-careers/specialty-training/training-placements/fph-projects-scheme/#:~:text=FPH%20projects%20The%20Faculty%20of%20Public%20Health%20%28FPH%29,a%20Special%20Interest%20Group%20%28SIG%29%20within%20the%20FPH.

Dr Emily Clark

February 2023

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As co-chairs of the Faculty of Public Health’s Sexual and Reproductive Health Special Interest Group (SRH SIG) it was a pleasure to attend the All Party Parliamentary Group for Sexual and Reproductive Health’s (APPG SRH) event on ‘Equipping the NHS to deliver for Women’s Reproductive Health’. Healthcare professionals, parliamentarians and community representatives came together for a fascinating discussion about the challenges currently facing the sexual and reproductive health (SRH) workforce, their impact on women’s reproductive health and what can be done to protect the workforce to ensure that women’s needs are met.

Colleagues described the wide-ranging SRH workforce which comprises doctors from genitourinary medicine (GUM), community sexual and reproductive health (CSRH), general practice and infectious diseases; nurses; midwives and other healthcare professionals. It is responsible for providing contraception, termination of pregnancy and testing and treatment for sexually transmitted infections (STIs) and HIV alongside many other services. Clearly, the SRH workforce not only has an important clinical function but also a public health one; and it was concerning to hear about the difficulties filling training and consultant posts, insufficient funding for some training posts and the fragmentation of the workforce due to the disjointed commissioning arrangements.

It is evident that the challenges facing the SRH workforce have significant public health implications. The APPG SRH’s enquiry into access to contraception identified data showing that nearly half of pregnancies and one-third of births in England are unplanned or ambivalent[1]. Abortion rates in England and Wales are rising and, in 2021, reached their highest rate since the introduction of the Abortion Act[2], suggesting an unmet need for contraception. Black women have disproportionately high rates of abortions and rates are higher among the most deprived populations compared with the least deprived2 indicating the health inequalities faced by these groups. In 2021, the number of consultations by sexual health services rose by nearly 16% from 3,460,100 in 2020 to 4,002,827[3], demonstrating the increased pressure that services are under.

The data paints a stark picture and without intervention things will only get worse. So, what can we do in public health to help protect the SRH workforce?

  • With the commissioning of sexual health services being the responsibility of local authorities, it is essential that we consider the impact of our commissioning decisions on the SRH workforce and work with our clinical colleagues when designing service models.
  • Using a public health perspective, we can support efforts to promote entry into the SRH workforce, such as the British Association for Sexual Health and HIV LOVE GUM campaign.

As the Faculty of Public Health’s SRH SIG we are keen to support the work that needs to take place to address this hugely important agenda and look forward to more opportunities to engage with the APPG SRH and other partners.  

Dr Natalie Daley and Dr Rachael McCarthy

Co-Chairs of the Sexual and Reproductive Health Special Interest Group

[1] https://www.fsrh.org/documents/full-report-december-womens-lives-womens-rights/

[2] https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2021/abortion-statistics-england-and-wales-2021#:~:text=Key%20points%20in%202021,-There%20were%20214%2C256&text=The%20age%20standardised%20abortion%20rate,the%20Abortion%20Act%20was%20introduced.

[3] https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2021-report#overall-trends-in-consultations-sti-testing-and-diagnoses-at-shss-among-england-residents

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Public health as a specialty is committed to improving health and reducing inequalities. It can only do this if it is a fair profession: it reflects the population we serve and all in it feel included and treated equally.  While demographic characteristics have been recorded and measured in the past, we are putting a renewed focus on identifying inequalities and working to remove them. This will involve not only looking at data on diversity and progression, but also asking people whether they feel included.

Our initial focus is on ethnic differences but we will be looking at all protected characteristics and wider measures of inequality. Ultimately, we aim to have a Fair Training Culture and fair career structure.

The first detailed report we have made available is on the process of recruitment into public health – we are grateful to Health Education England for commissioning the work and Imperial College London for doing such an excellent study. The stimulus for this was a report in the British Medical Journal in February 2020 highlighting inequalities in recruitment process across medical profession. The work was delayed by COVID but is now complete and looks in detail at the different parts of the recruitment pathway.

These results are a wake-up call. Those working in recruitment are committed to fairness, so it is surprising to see unfair processes built in. Specifically, the assessment centre tests for numeracy, critical reasoning and situational judgement (done on a computer at a test centre) have significant biases. We have previously focused on training interviewers to reduce biases, but now we have identified this specific issue we can start to do something about it. It is not immediately apparent why this is happening but we are revising the SJT with a much more diverse group of assessors, improving the availability of support materials and hope to start exploring alternatives to the current tests.

Further work over the coming months will look at progress through training including exams and annual reviews, and then we will look at appointments and career progress. We are grateful for the work many members in the Faculty are doing in this area, from the Equality, Diversity and Inclusion Committee and Special Interest Group but also are looking for further capacity from members to undertake this work.

Professor Kevin Fenton, FPH President

Dr David Chappel, FPH Academic Registrar

October 2022

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FPH just hosted a conference – “Climate and health: what can we do?” – on 22 September 2022, which Kevin Fenton, the FPH President opened, outlining some of the key issues on climate and health interfaces and acknowledging the importance of climate and health as a public health priority on which we must all take action now.

The conference itself was mainly the brainchild of Cat Pinho-Gomes, one of the specialist registrars who have supported the development and implementation of the Climate and Health Strategy, but it is also thanks to the FPH staff team for all their work to deliver the conference, and of course to the speakers on the day.

This event was part of the Climate and Health Strategy. It commits FPH to developing events “to continuously develop a membership with strong expertise in effective public health action in tackling the climate emergency”. It is one of sixteen initiatives the C&H Strategy has committed to in its first year and most of them are complete or well on their way.

The conference invited presentations from climate and health leaders and advocates from across the globe and the UK, and we heard everything from decolonising climate action and learning from indigenous cultures and the environment in New Zealand (Aotearoa), to devastating oil industry impacts in Niger Delta communities, to nature based solutions in Asian cities, to mental health impacts of climate change, to the ‘Incredible edible’ approach, to responses to climate in Argentina and to what one attendee described as “a master class in climate communication” from an emergency department physician from Canada. They were wonderful, powerful, moving presentations, from which we all learned a lot – the talks were inspirational.

We also heard fabulous case studies from abstracts submitted to the conference, many of them on local work by specialist registrars –clearly our public health leaders of the future. We hope that these speakers at the conference will submit their work as case studies, so that other members of the FPH can benefit from work already done and be able to connect and learn from it.

Even though this was a conference held remotely, the energy generated amongst the 500+ registrants was palpable and the ‘chat’ was full of exciting thoughts, sharing ideas, gems of information and links. I was blown away.

The conference also heralded the re-launch of FPH’s resources on climate and health, put together by the Sustainable Development Special Interest Group (SIG) and covering a range of key science and related reports and topics to help members bring climate issues into their day to day portfolios. Whether that includes working on air quality, food, inequalities, active travel, physical activity, housing, infectious diseases, the environment, green spaces, young people or most other public health topics, there are health impacts and aspects pertaining to climate and health. The “co-benefits” are the health gains achieved from taking climate action. These case studies will also form part of the FPH resources.

The C&H Strategy priorities will be reviewed over the next couple of months so please contribute to that rethink.

What a day. The conference was recorded so, if you were not able to attend you can still take the opportunity to share in the knowledge and awareness raising.

Sue Atkinson

September 2022

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Jim McManus is Executive Director of Public Health for Hertfordshire and President of the Association of Directors of Public Health.

Hertfordshire County Council recently approved its new Public Health Strategy (2022-2027), produced by multiple stakeholders including elected members. One of its main aims is to continue reducing the health inequalities existing in the county, which have been brought into sharp relief and worsened by the COVID-19 pandemic.

Our strategy recognises that Public Health has a major role to play in fulfilling the council’s corporate strategic priority – for our residents to lead healthy and fulfilling lives. We want to ensure we continue to develop and deliver a range of preventative services promoting health and wellbeing for all residents, particularly targeting people most in need. The strategy sets out the role of Public Health in getting there, and means citizens and partners know what they can expect of us.

This is important, because while the county’s health statistics are mostly favourable compared to national figures, there are persistent health inequalities, especially, but not only, in areas of deprivation. To take one example, we have historically significant and large Gypsy, Roma and Traveller populations across 55 sites. The work they are co-leading with us on suicide prevention, education and training and vaccination uptake will reduce inequalities.

The COVID-19 pandemic led to many more people experiencing inequalities through changed economic, employment or health circumstances.   Several new health challenges have also arisen in Hertfordshire, including long Covid, an increase in mental health needs, more widespread harm from drugs and alcohol and increased numbers of overweight and obese adults and children.

The new strategy outlines our vision and priorities and highlights how, informed by best practice and evidence, we will work with colleagues, partners and communities to reduce health inequalities and support healthy lives for all.

A great example of how we are already doing this, is our Shape Up Together programme. Originally launched as Shape Up in 2015 to address inequalities in mens’ access to healthy living support – it was funded by Public Health, the Premier League and Hertfordshire’s district and borough councils, and run by Watford Football Club’s Community Sports and Education Trust. Delivered free, the programme aimed to improve the lives of men with a BMI of above 30 through bespoke programmes. Since its launch, over 1,000 people have collectively lost seven and half tonnes of weight and that’s just one outcome.

Although Shape Up continues to run, last year we identified a need to develop a programme aimed at some of our Black, Asian and Eastern European populations, people with a physical and/or learning disability and people with severe mental health issues. As a result, Shape Up Together was born. Although still in its early days, Shape Up Together (which is open to both women and men) is set to be as successful as its predecessor.

In May, we invited community and voluntary organisations to apply for grants of up to £10,000 each, funded by Public Health, to develop innovative community projects which responded to local needs and focused on promoting mental health wellbeing through physical activity.

With a specific remit to tackle inequalities by building resilience for residents with low to moderate mental health problems, the programme has awarded just over £100,000 to 15 local organisations.  Successful projects included some very creative ideas, from dancing and Nordic walking to horticultural gardening and wild play. We are working on strong pathways between these projects and Money Advice services to reduce financial inequalities too.

Equitable digital inclusion is a corporate priority for us, but lack of availability of online access must not disproportionately exclude lower-income areas. We are using Togetherall, an evidence-based, clinically-moderated, online 24/7 peer-to-peer mental health community, for residents aged 16+ who are feeling low or depressed. It can help prevent mental health unwellness with support and courses, plus the additional benefit of professionals monitoring for signs of distress. This is just one tool in our kit of mental health support, ensuring those disadvantaged by limited access to other services have an option, but at the same time we’re working to make digital access itself more equal.

With the full support of our Executive Member, Morris Bright MBE, who was persuaded that part of our work was identifying what our role was in a world where COVID-19 has worsened health inequalities, we hope the strategy will set us on the road to tackling these inequalities and placing Public Health firmly at the centre of a forward-thinking council whose aim is to help our residents lead healthy, happy, and fulfilling lives. You can read the strategy here.

Jim McManus

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The Commonwealth Games took place in Birmingham 28th July to 8th August in (for once) balmy, sunny weather harking back to the days of the 2012 London Olympics. Here is an account of the final months of a five-year journey that UKHSA was a key part of, through three registrars who worked on the project:

Steve Barlow, ST3

Steve Barlow – Pictured on ‘Black Sabbath Bridge’ in Birmingham, along with Games mascot Perry, and Cassie Gregory, Principal Health Protection Nurse from the West Midlands Health Protection team

When I joined the Registrar training scheme in 2019, I never imagined that there would be a global pandemic. However, this provided me with a unique opportunity to observe mobilisation of a combined local authority (LA), UKHSA (then PHE) and wider healthcare response to an unprecedented public health type incident. Interestingly, this also helped in building relationships which then played out on another global platform: the Commonwealth Games (CWG).

As part of the CWG team, given my previous knowledge and experience, my main workstream was liaising with LAs and Integrated Care Boards (ICBs). As with all CWG work, it required degrees of overlap to ensure that the health protection response was as cohesive and comprehensive as possible. This involved a series of meetings to define and document the whole system preparedness should any health protection issue arise from CWG. Whilst some may consider this business as usual, we needed to streamline the system, to make the response more timely by calling on local relationships built during the pandemic.

Through leadership, advice and influencing, I worked on assessing any opportunities, good practices, and gaps in each area’s health protection response, looking at role and responsibilities, trying to clarify and agree these, and then share this information wider to develop more robust systems. I documented the current situation with a baseline survey and through our discussions, helped to produce formal plans for each local authority area. With support from the team, I then held a workshop for all the LAs in which over 80 individuals attended, to put plans into practise through a series of scenarios.

During Games time we were co-located in the Games Operational Centre (GOC) which was fascinating. Here we worked with a number of commercial partners as well as a few familiar faces. From the beginning, we became established (with our branded UKHSA branded, teal-coloured tops!) and, I believe, added value as we were able to assess and control situations in real-time. As part of the legacy work, I am evaluating the local partnerships workstream and looking longer term to make the health protection planning, commissioning, and response more cohesive in the wider health and social care system.

Clare Brehmer, ST4

Clare Brehmer – Wishing her children goodnight on the phone, with Games mascot Perry in the background, whilst working an evening shift in the Games Operations Centre

As the last member to join the core CWG team (fresh from maternity leave!) I was keen to “hit the ground running”. From the start the team were incredible to work with as there was nothing but positive vibes – all of us had chosen to work on the Games and were excited to showcase our work in the West Midlands.

My main workstream was to help develop operational plans for the laboratory testing during the Games period. One quirk of the Games was that there were pop-up polyclinics at five accommodation sites across the region, with a 24/7 motorbike service to courier samples to our UKHSA public health lab at Heartlands site. These services were set-up by the medical arm of the Organising Committee for the Games and provided routine medical services for all athletes and officials residing at these locations.

At UKHSA, we provided bespoke packs of consumables to each site, to be used in the event of an outbreak. We also developed a pathway for surveillance and reporting of any results related to the Games, and a round-the-clock rota for specialist laboratory technical and microbiological advice. This brought together staff from the public health lab, the local hospital lab, the CPHIs (Consultants in Public Health Infection) and health protection team, in a collaborative effort to streamline the testing and reporting processes for the Games period.

Our UKHSA public health lab also started providing Monkeypox testing for all Midlands samples a few weeks before the start of the Games; a useful addition to cut turnaround times should any potential cases arise.

The workload ramped up quickly, with extended hours starting a week before the actual start date of the Games, to allow for an enhanced public health response as athletes and officials entered the country. This meant we were all well-versed in the “Battle Rhythm” by the start of the Games. I was involved in the early preparations in the Games Operations Centre (GOC), meeting partners and introducing UKHSA to many people for the first time. Event planning is not something we often get involved in as registrars, and it was exciting to collaborate with others in health and safety, venues management and security to ensure all plans were in place. Several people even approached us to ask about careers in public health. During the Games I have to say, it was very quiet! We had heard similar reports from colleagues involved in London 2012 Olympics, but I didn’t want to jinx it. In reality, we had a steady workload of low-risk incidents and cases which rumbled along for the duration of the Games. This meant there was plenty of time for learning as a registrar and even acting-up as the public health adviser to the Games. As expected, there was a certain amount of politics involved and people management, at times with conflicting views. However, we continued to work effectively with our partners while providing sound public health advice and this undoubtedly contributed to ensuring a safe and successful Games.

David Collyer, ST3

David Collyer – With family enjoying the athletics competition at the Alexander Stadium pictured with England 100m sprinter, Imani-Lara Lansiquot

I joined the Commonwealth Games project team in February of this year, and early highlights (and opportunities to meet other team members in person rather than just on Teams!) were visits to the Lee Valley velodrome, and to the prospective athlete villages. Regular meetings of our core project team meant that we all had a chance to discuss our individual workstreams, get help and support, and maintain a good overview of all the work that was taking place.

One of my areas of work was participating in a planning group for ‘Health Protection Operations’ during the Games, which included leading workgroups for 2 areas in particular – plans for how we would work with the ‘polyclinics’ in the athlete villages and plans for how we would make use of the Medical Encounter System (a bespoke computer system being developed for the Games to capture medical data).

My prior experience of health protection work was limited, so this was a very steep learning curve, but planning a health protection response ‘from the ground up’ was an interesting way to get to grips with how the different elements all fit together. I also updated the Birmingham Airport Health Protection Plan (one of the main ports of entry for the Games) which included an appendix to cover the Commonwealth Games, particularly the COVID testing requirements for arrivals/departures.  This required working with numerous stakeholders including the Organising Committee (OC) for the Games, the airport, the local authority, and other UKHSA teams including the Port Health lead, and the International Travel Contact Tracing team. 

However, the most challenging and time-consuming area of work for me was around COVID and our recommendations for testing during the Games. The plans evolved considerably as the Games approached, and it was fascinating to see how decisions made by external stakeholders were influenced as much by politics as by epidemiology! As part of this work, I was able to attend a weekly meeting with the Chief Medical Officers for various UK elite sports, which had been convened early in the pandemic to facilitate a return to competition. This was a brilliant forum for discussing our COVID plans for the Games, as well as an amazing opportunity to hear the collective wisdom of an eminent group of sports medics.

Ultimately there were no big outbreaks during this Games, but I felt reassured that we had all the structures and processes in place to detect an outbreak and respond should it occur. Despite this lack of ‘action’ it was also fascinating just to be in the Games Operational Centre, watching as an event of this huge scale unfolded.

The Commonwealth Games Project Team was great to work with. Although the work was challenging at times, and definitely pushed me outside my comfort zone, I always felt well supported. I learnt so much during the 6 months and will never forget the buzz in Birmingham as the event we had spent so long planning for, finally came to town! I would recommend getting involved with a similar mass-gathering event, to any registrar offered the opportunity.

Caryn Cox, Lead UKHSA Health Protection Consultant for the Commonwealth Games

‘Having public health registrars embedded in the UKHSA West Midlands Commonwealth Games programme team and leading on key workstreams in the planning and preparation phase for the Games was fantastic. Each brought differing skills and knowledge to enhance the core programme team.

Clare, Steve, and David also each voluntarily stepped up in the operational phase of the Games competition time – working both the 6am early morning shifts and midnight finishing evening shifts and across multiple weekends. 

They also undertook a rota slot where they were the Public Health Advisory lead in the Games Operational Centre, sat along with multi-agency colleagues. I hope they were each able to gain the development and learning opportunities they were seeking, as well as enjoying the experience and joy of being part of the largest Commonwealth Games ever held – held by all to be a great success. 

As we capture the lessons learned from this Games to transfer to future events as well as internally in the UKHSA, we have already noted and recorded that registrars should, where possible and relevant to their training, be an integral part in planning, preparation and response, as opportunities such as these do not come along very often.

Our thanks to the triumphant trio, Clare, Steve and David, as well as Dr Alex Cockburn, an ST5 West Midlands registrar who worked on the Games prior to Feb 2022 and laid excellent foundations for other registrars to follow. We now hand over the baton to the State of Victoria, Australia for the 2026 Commonwealth Games’.

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I did it my way

I qualified in 1965 and having sampled hospital clinical medicine in London and Cambridge for 3 years I decided that it was not for me – I neither enjoyed it nor found it particularly challenging (interestingly at University I was told that reading medicine was a waste of talent and that I should do something really scientific!). With a wife and three children by this time I looked for a job that allowed more time with the family and which paid more than a junior hospital doctor’s salary. It never occurred to me to become a GP which would have satisfied these two criteria and instead embarked on a public health career as a Medical Officer at the Birmingham Regional Hospital Board. This post which introduced me to health needs analysis and the planning of hospital services for a population of 5 million was not particularly interesting but it allowed me to embark on the formal training pathway to become a qualified public health practitioner. Although the London School of Hygiene and Tropical Medicine was then offering a brand new 2 year masters training programme, encouraged by my Scottish boss I applied instead for the Diploma in Social Medicine Course in Edinburgh which I obtained in 1971. 

Then I very rapidly climbed the new career ladder in Community Medicine as it was then called and following posts in Wolverhampton, Stoke on Trent and Wakefield I was appointed Regional Medical Officer at the North East Thames Regional Health Authority. Not only was a regional post as high as I could go in the profession, the region I was appointed to was in a class of its own among the 14 regions in England – It was in a very real sense the dream job.

After 7 years in this job I got itchy feet and fortunately another NHS reorganisation saved the day by introducing general management. So, having had a long term interest in management and been sent to the US by the NHS for management training, I applied for and obtained one of the new District General Manager posts in Frenchay, Bristol where I stayed for three years. Falling out with my Chairman who was an import from industry who knew absolutely nothing about the NHS and healthcare – such wrong-headed appointments were all the rage with the Government of that time – I moved back to community medicine and obtained a post as DPH for the Norwich Health Authority which I held for 5 years before moving to Wales, initially as a Senior Lecturer in Applied Epidemiology and then as a locum consultant in public health with the Dyfed Powys, Swansea and Mid Glamorgan health boards and ending my career as the Public Health Director for Ceredigion and Powys Health Boards.

While working in Wales I joined the Labour party, became Chairman of the Socialist Health Association and for a period was a City Councillor in Bristol for a deprived ward in the south of the City.

The only time I felt that I was practicing real public health i.e. public wellbeing, as distinct from applied epidemiology, was when I was a Deputy Medical Officer of Health in Wolverhampton and later a Bristol City Councillor. In both posts I had a real sense that I was working in an organisation that could control at least some of the main levers of public health – or more correctly public wellbeing – for the benefit of the local population.

The main influences on my career were Gerry Morris, Bob Logan and later Julian Tudor Hart. In it’s origins the Faculty was a relatively inaccessible organisation, and as such I was very supportive of the Public Health Alliance and its successor the Public Health Association.

A mistake made by the Faculty at its inception in my view was to limit membership to doctors only, and whilst the Faculty now has a much more open membership, as a young community physician this prevented me from engaging with or supporting the Faculty at that time.

Paul Walker

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Je ne regrette rien

My own experience was essentially positive, probably helped by working as a GP and as an academic in other countries, and away from the PH service work so I came back with new experiences and perspectives.

I qualified first in Dentistry in 1965 determined to continue with Medicine and a career as an oral surgeon or in dental medicine. An oral surgery job in Scotland was interesting but not for a lifetime and returning to Medicine I became fascinated by Social Medicine. The teaching was uninspired, but I got to know Jock Anderson, the Head of Department and he helped me to think things through (everyone else thought I was mad)!

I qualified in 1969 and there were house jobs at Guy’s and Guildford but a desire to go to Africa where Jock advised I could get maximum experience across the spectrum. Wife, 3-month son, we sailed for Cape Town and on to Zambia…. On my return 3 years later he supported my application for the 2-year MSc at LSHTM. The MSC.in Social Medicine was designed for the new Public health role of the 1974 changes, and a different background and content from the DPH. It was two years, a whole year for a research project and enlightened teaching in Sociology, Economics, Epidemiology, Statistics, Management – but best by far the other people on the course, with a good deal of clinical experience but a genuine interest in a community and preventive approach with an understanding of information and to make for efficient and effective services within a cost envelope.

I was appointed to Tower Hamlets as DCP in 1976 and was there until 1981. I was single handed and also managed Infectious Disease/ hazards like asbestos. There were major health issues with homeless alcoholics with TB and Bengali immigrants in sweat shops, in squalid accommodation and with TB, Typhoid, Diphtheria…19th century stuff. Nobody quite knew what a DCP did, so I followed my instincts in a deprived part of London with a famous teaching hospital. I also worked quite a lot in the old MoH model with the LA, attending meetings, medical housing, school health…and the Winter of Discontent plus major industrial action by the Health Unions. Frank Murphy was at Area, you came to Region, Spence Galbraith had set up CDC Colindale – there was HIPE, HAA (neither very useful and full of errors) and RAWP

I persuaded the HA to let me do a year as a P/T trainee GP as the next re-organisation was coming. I had done a lot of locums by then as we had a young family, I was offered a partnership in Bedfordshire where we had done several locums and the practice agreed I spend 2 days a week in PHM my salary going into the practice earnings and I did 2 days a week in Luton working mainly in planning and supporting /deputising for the DCP (the unfortunate David Josephs who became a good friend and took his own life).

After 8 years as a partner we wanted to get away from the London orbit and after a few attempts got the DPH job in North Devon in 1989. We have lived here since. Again (as in TH) I was singlehanded and had time and space to do my own thing. (There were excellent secretaries, a registrar and information expert to help). Again I worked across the interface with the LA and in the MoH mode, this worked well and with excellent GP’s and Consultants, a new Hospital and no serious deprivation it worked well. I got much involved with the health problems of sheep dip in farmers. And the Cinderella services as we worked through Purchaser/Provider, contracts, and a new Trust.

When North Devon joined with Exeter, I did not get the DPH job and after several tries in Britain I went again to Zambia as an academic teaching Social Medicine and an MPH course for 3 years. There was quite a bit of clinical medicine too – I visited a mission hospital alternate weekends where there was no doctor. There was the chance for research too – I have always tried to publish stuff and with moderate success ever since Zambia in the 1970’s.

Returning to Britain in 1998 I could not get a job in PHM – too old, too experienced, a loose cannon… several long locums and the best a long appointment looking at rare diseases which cost a lot and have to be planned and organised at regional or national level. This was fascinating and with computers and enlightened statisticians it was possible to build costed models of care reflecting need, demand, and practice.

However when I had struggled to get work I had applied for an academic job in Papua New Guinea – they tardily got in touch and after some heart searching went again alone (dangerous for wives)  to teach mainly PHM as an MPH but also a whole range of stuff to undergraduates – from biochemistry to forensic psychiatry…

On return, and I had my NHS pension by then, I did 5 years as a GP with the British Army and became involved with various national bodies e.g. NICE. Information Standards. The best things in PH to my mind – The CDC at Colindale, The Cochrane Foundation and NICE

I liked being in the NHS rather than the LA and being able to talk “doctor to doctor” with clinicians. I was working before the purchaser provided split and in North Devon acted as a personnel manager for the Consultants. I liked being between Medicine and Management and trying to explain one to another. On the whole I was lucky with Chairmen and Chief Executives who let me get on with things, more or less unfettered. It is now much more difficult, tight job descriptions not much room to pursue possible problems.

I think there were lessons to be learned for the Faculty in their response to Nuclear weapons and opportunities to challenge Government. The BMA Board of Science produced good science, Brian Jarman measured deprivation and health.

Other doctors in PHM, generally good experiences, (a few rogues, idlers, and villains but so it is everywhere) and excellent registrars, I helped to train. The newer younger GP’s and Consultants seem more open and easier now we need care ourselves!

I have been very fortunate; I am glad not to be working in the NHS now but also miss the struggles and occasional triumphs!

Peter Sims

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