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

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

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

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

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

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

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

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

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By Professor Simon Capewell, FPH Vice President of Policy 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For FPH’s election briefing please click here

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

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By Daniel Flecknoe, Co-Chair of the FPH Global Violence Prevention Special Interest Group

The preliminary report of the Lancet/American University of Beirut Commission Health workers and the weaponisation of health care in Syria [Fouad et al, 2017] was published on 14 March, calling attention to the principles of medical neutrality and unhindered patient access that have been so badly neglected in the ongoing Syrian conflict. Systematic targeting of health workers by ISIS, Syrian and Russian military forces is a war crime committed against civil society, and epitomises a disturbing trend of indifference and impunity to international humanitarian law by warring governments and armed groups over recent years. Established norms in the conduct of war, built up over the past century and a half since the founding of the International Committee of the Red Cross, may be irrevocably degrading, and the public health consequences for civilian populations exposed to such deliberate brutality will be correspondingly more severe.

The Faculty of Public Health’s (FPH’s) Global Violence Prevention Special Interest Group (SIG) is committed to engaging with this neglected and worsening cause of preventable morbidity and early mortality. Its members contribute to research into the health impacts of armed conflict (including the Lancet paper referenced), engage and collaborate with other conflict-prevention organisations and conduct advocacy for arms control, economic/democratic reforms, and respect for human rights and the rules of war. We encourage all public health professionals to give parity to armed conflict along with other major global causes of illness, injury and death, and to lobby (both as citizens and medical professionals) for foreign policies that will protect and preserve health.

The SIG will be represented at the FPH conference in June, and members will be happy to discuss our current workstreams with anyone who might be interested in getting involved.

References:
Fouad FM, Sparrow A, Tarakji A, Alameddine M, El-Jardali F, Coutts AP, El Arnaout N, Bou Karroum L, Jawad M, Roborgh S, Abbara A, Alhalabi F, AlMasri I,  Jabbour S. 2017. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria. The Lancet. Published online 14/07/17 http://dx.doi.org/10.1016/S0140-6736(17)30741-9

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By Ben Barr, Senior Lecturer in Applied Public Health Research, University of Liverpool, and Lee Bentley, Research Associate, University of Liverpool

The Chancellor of the Exchequer is due to deliver this year’s Budget on Wednesday. It is imperative that he provides additional financial support for disabled people affected by the planned cuts to Employment Support Allowance (ESA) – or risk further widening the disability–poverty gap.

One in three working age disabled people are living in poverty. Their risk of poverty is one and a half times greater than for people without a disability. The government’s strategy, however, for improving the lives of disabled people, focuses almost exclusively on the disability-employment gap rather than this disability-poverty gap (1). It is true that the high risk of poverty amongst disabled people is largely because they are less likely to be in work and supporting people into employment is an important strategy for reducing poverty. Welfare benefits, however, also play a crucial role in preventing poverty by limiting the loss of income people experience when they can’t work due to disability.

People who have lost their jobs because of a disability are likely to be out of work for longer than people who become unemployed. For this reason, disability benefits have generally been set at a higher level than unemployment benefits. From April, this will no longer be the case. The government is reducing the level of ESA for disabled people who are assessed as being currently unable to work but potentially capable of work at some time in the future. The benefit will be reduced by 30% to £73 a week – the same level as unemployment benefits. But whilst 60% of new claimants of unemployment benefits will move off the benefit within six months, 60% of people on ESA will still be claiming this benefit two years later (2). This means that many people out of work because of a disability will have to survive for long periods of time without an adequate income.

Levels of poverty are already very high amongst people out of work with a disability and have been increasing since 2010, particularly amongst people who have a low level of education – the group most reliant on disability benefits (see Figure 1). Cutting these benefits will exacerbate this adverse trend.

Percentage of people with disability in poverty

FIGURE 1: % of people with a disability in poverty, aged 16-64, between 2007 and 2014, by employment status and educational level 

The government argues that reducing these benefit levels will incentivise disabled people to stay in or return to work (3), but there is little evidence to support this assumption (4), and some that suggests it may reduce their employment chances (2). Strategies to reduce the disability-employment gap over recent decades have increasingly focused on more stringent assessment criteria for disability benefits, reduced payment levels and requiring claimants to do more to prepare for work or risk losing their benefits (5, 6, 7). These strategies have had little impact on the employment of people with disabilities (8). It remains to be seen whether the government’s new strategy to halve the disability employment gap will be any more successful (1).

Even if the government’s strategy does improve the employment of disabled people, it is likely this will disproportionally benefit disabled people with greater skills and education (9, 10). The planned cuts in ESA will increase the risk of poverty for the most disadvantaged disabled people who remain out of work, and this may increase the disability-poverty gap.

Increasing poverty amongst people out of work with disabilities will adversely affect their health and increase health inequalities. We know that poverty damages peoples’ health, and adequate welfare benefits for people who can’t work can reduce these effects (11). We have seen that in recent years inequalities in health are increasing (12) in part due to disability benefit reforms (13). The severe cut planned by the government will further exacerbate these inequalities, potentially increasing levels of disability.

1    Great Britain, Department for Work and Pensions, Great Britain, Department of Health. Improving Lives: The Work, Health and Disability Green Paper. 2016 (accessed March 2, 2017).
2    Work and Pensions Committee. Disability employment gap. London: House of Commons, 2017 (accessed March 2, 2017).
3    Kenedy S, Murphy C, Keen K, Bate A. Abolition of the ESA Work- Related Activity Component. House Commons Libr Brief Pap 2017.
4    Barr B, Clayton S, Whitehead M, et al. To what extent have relaxed eligibility requirements and increased generosity of disability benefits acted as disincentives for employment? A systematic review of evidence from countries with well-developed welfare systems. J Epidemiol Community Health 2010; 64: 1106–14.
5    Watts B, Fitzpatrick S, Bramley G, Watkins D. WELFARE SANCTIONS AND CONDITIONALITY IN THE UK. York: Joseph Rowntree Foundation, 2015.
6    Banks J, Emmerson C, Tetlow GC. Effect of Pensions and Disability Benefits on Retirement in the UK. National Bureau of Economic Research, 2014 (accessed Sept 26, 2015).
7    Baumberg B, Warren J, Garthwaite K, Bambra C. Rethinking the Work Capability Assessment. London: Demos, 2015.
8    Mirza-Davies J, Brown J. Key statistics on people with disabilities in employment. House Commons Libr Brief Pap 2016; 7540.
9    Burstrom B, Nylen L, Clayton S, Whitehead M. How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework. Disabil Rehabil 2011; 33: 453–66.
10    Clayton S, Bambra C, Gosling R, Povall S, Misso K, Whitehead M. Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people. BMC Public Health 2011; 11: 170.
11    Cooper K, Stewart K. Does money in adulthood affect adult outcomes? York: Joseph Rowntree Foundation, 2015 (accessed July 30, 2015).
12    Barr B, Kinderman P, Whitehead M. Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013. Soc Sci Med 2015; 147: 324–31.
13    Barr B, Taylor-Robinson D, Stuckler D, Loopstra R, Reeves A, Whitehead M. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. J Epidemiol Community Health 2015; : jech-2015-206209.

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claire-beynon-at-fph-conference-2016My name’s Claire Beynon and I’m a registrar in my third year of training.

I went to the Faculty of Public Health (FPH) conference in Brighton last year (above) and I’m going to this year’s event in Telford in June.  So I thought I’d offer some thoughts on the benefits to other registrars of coming along as well.

As a registrar working in Wales I know most of the people in my area really well, but I don’t have much of a chance to find out about what’s happening across other parts of the UK or meet other registrars.

The FPH conference brings registrars from across the UK together.  Last year I met several other registrars from opposite ends of the country and we shared stories and experiences about the different health systems we now work in.

I also bumped into a few people who I hadn’t seen in a long time, and we caught up in the relaxed breaks and mealtimes over the course of the two days.

I was lucky enough to have my abstract accepted last year and I spoke in one of the parallel sessions on childhood obesity.  I shared my work with people who, like me, are really dedicated to tackling childhood obesity.  I found it was a great platform to share work you have finished recently and get some vital feedback and new ideas from other experts in the field.

The thing I liked most about last year’s conference was the atmosphere.  As we all know, people working in public health are fabulous, so perhaps it isn’t a surprise that the conference was fun.

The FPH Specialty Registrars Committee (who represent registrars) also has a dedicated conference session at which registrars will be sharing their experiences of the National Treasure placements.

And there will be time to socialise too.  This year committee members will all be at the conference party at the end of day one.  It’s going to be a fantastic opportunity to get to know people informally who you will very likely end up working with over the rest of your career.  So come along and say hello!

You can register to come to this year’s conference here http://www.fph.org.uk/fph_annual_conference_and_public_health_expo_2017

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By Nadeem Hasan

I’m five months into a year-long stint in Sierra Leone as one of the global health fellows for 2016/17. I hope to blog about the positives of the experience, hence the format ‘in praise of’.

After all, there’s enough negativity around as it is.

I’ll be working in the Ministry of Health and Sanitation (MoHS) in Freetown, supporting their mission to strengthen the health system following Ebola, and learning as much as I can along the way.

Predictably, I’ve already learned a lot more than I’ve contributed.

I’m engaging with the financial and capacity challenges in the MoHS; the political challenges; and the complexity of operating alongside the World Health Organisation, the World Bank, UN agencies, and hundreds of NGOs and private sector implementing partners. And all of that before even getting to the content of the day-to-day work of the ministry.

Accordingly, I don’t feel too bad about the learning overshadowing my own contributions.

Not being sure what to expect when I got to my office, what first struck me was the sheer number of international staff embedded in the MoHS. I found technical experts from the Clinton Health Access Initiative (CHAI), Oxford Policy Management (OPM), Overseas Development Institute (ODI), USAID and others – all with desks inside the ministry, working hand-in-hand with national staff.

Foreigners everywhere. And now here I was adding to their number.

The ability of the ministry to pursue its goals should be improved by international experts working together with their national counterparts: on the face of it, it’s a win-win situation. However, the sheer number of international staff also leads to challenges for sustainability and country ownership of health policies and programmes – and if not managed carefully could have a negative impact in the long-term.

So what’s the appropriate balance?

Three months in, it’s clear that these long-term embedded experts have had the time to build strong relationships with their national counterparts. Through these relationships, they’ve been able to develop a deep understanding of the local context – including the enablers and barriers to successful design and implementation of policies and programmes.

Crucially, a lot of this information isn’t written down anywhere (for very good reasons), and can only be gathered through living in the country.

As a result, these individuals end up being highly skilled in their ability to compare and contrast what the evidence and data says should be done to improve health outcomes, with what can actually be achieved on the ground at any given time. Importantly, this requires taking into account the personal relationships that exist between key individuals.

Compared with short-term consultants that ‘parachute in and helicopter out’, they’re highly valued by senior national staff in the MoHS for their expertise and sensitivity to the local context. And, I think, rightly so.

All of this is fine of course, but what about the questions of country ownership (what happens after external ‘experts’ have done their bit) and sustainability (what happens when they leave)?

Well, I’ve watched how some of the more seasoned experts resist the temptation to look at the evidence and data and write the ‘ideal’ policy or strategy, presented with a shiny bow, only for it to sit gathering dust on a shelf.

Instead, they work on the sidelines; gathering the relevant data on a topic and developing the questions for discussion by national actors. They support the process of convening national actors to discuss the best way forwards without taking too active a role in those discussions themselves. They therefore support leadership by national staff, which in turn generates the momentum and wider ownership required for success.

The ‘capacity building’ aspect is harder to see at the central level than in a health facility, where the traditional ‘teaching and mentoring’ approach is more appropriate.

At the MoHS, knowledge and skills are shared (both ways) through building trusting relationships with national staff and working together on routine aspects of the job. The mutual respect that this generates in turn increases the rate of knowledge and skills transfer.

Accordingly, the longer the expert is embedded in the team, the more effective the process. In this way, the sustainability of the work done and approaches taken by international staff is to some extent ensured.

A major challenge comes in the form of convincing donors focused on results that this long-term, ‘softly, softly’ approach with no concrete ‘measurable’ outputs is worth the investment – but that’s a whole other issue.

This is of course a rose-tinted view, but the blog is, after all, entitled ‘in praise of’.

Thinking back to practice in the UK, I wonder whether there is a broader relevance of this approach for ‘health in all policies’. Embedding public health specialists in non-health teams on a long-term basis can have two major benefits. First, the use of a robust evidence and data-led approach to policy making that considers the health impacts of non-health policies. Second, the contextual understanding of how to do achieve this effectively under the leadership of the host team (thereby ensuring sustainability).

Comparing Sierra Leone to, for example, the Department for Education in Whitehall might seem odd at first glance. However, for a public health specialist they’re both new contexts that have to be learned and understood before being able to operate and influence effectively, and both places where our skillset and approach could lead to significant improvements in health outcomes.

I know this is already happening in some places such as Transport for London. If it is anywhere near as effective as it is in Sierra Leone, then we could do with a lot more of it.

Nadeem Hasan is a public health registrar

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