Tomorrow (11 October) marks a day of mourning and sadness to many Muslims across the world. It is Ashoura – a day which not only has sad connotations for many Muslims but also sees increasing numbers of people making potentially dangerous cuts to their body.

Ashoura means the tenth day of the Islamic month of Muharam. It commemorates the brutal death of Imam Hussain (Muslim prophet’s grandson) in a fierce battle over 1000 years ago. Imam Hussain, his family and his followers were murdered.

This event is observed mainly within the Shiite Muslim community in different ways. The range of responses varies from donating to those in need to, at the extreme end of the scale,  Shiite Muslims showing their repentance through self-inflicting injuries using knives, spiked or bladed chains and other sharp tools.

This practice is well known as Zanjeer Zani. It is most common in Pakistan, Iran, Iraq, Bahrain, Oman, and to a lesser extent, in Afghanistan, Egypt, Lebanon and Syria. However, there have been reports of this practice emerging in Europe and the UK.

While many Islamic scholars are publicly opposing  Zangeer Zani it is impossible to control or ban this deeply rooted cultural practice. Hence a harm reduction approach is best to minimise the risks associated with this ritual.

The main public health risk is Blood Borne Viruses (BBV) and other bacterial skin infections.

Unfortunately, the risks are not well documented and there is nothing published in the literature. The ministries of health of those countries where this practice is common and the WHO-EMRO region have no protocols or guidelines in place in response to this annual practice.

Although I fully acknowledge the challenges in the EMRO region, I would like to call upon clinicians and public health professionals in the UK to raise awareness, encourage testing for BBV and promote contact tracing and Hepatitis B vaccination as interim measures to reduce the risks associated with this ceremony.

Dr Bayad Nozad, FFPH with special interest in Blood Borne Viruses


Last week marked the end of the fifth global World Alzheimer’s Month. It gave us all a chance to reflect on the importance of this international campaign to raise awareness and challenge the stigma that surrounds dementia.

The theme for World Alzheimer’s Month 2016 was Remember Me. Alzheimer’s Disease International asked people to get involved by sharing their favourite memories, or memories of a loved one, on social media with the hashtags #RememberMe and #WAM2016.

Alzheimer associations in more than 60 countries took part in this year’s campaign, raising awareness, and advancing action to make dementia more understood.
FPH members, as part of the leading professional body for public health specialist in the UK, provide sterling service at local and national levels, promoting effective preventative measures to reduce the risk of people developing dementia, and advocating for a more dementia friendly society.

Below is just one example of that work.

Claire Beynon, Registrar and Chair of Specialty Registrars Committee – Dementia Health

Needs Assessment for Cardiff and Vale
Dementia in Cardiff and Vale
Currently in Cardiff and Vale there are estimated to be approximately 5,500 people with dementia, about half of whom have a diagnosis.  Due to a growing and ageing population by 2025 this is expected to rise to nearly 7,000 people living with dementia.  Timely diagnosis can slow the progression of dementia and help individuals identify sources of support.
How has Cardiff and Vale promoted World Alzheimer’s month?
Cardiff and Vale have been running a campaign on social media and have produced three patient stories that have proved popular, see the website for the stories. http://www.cardiffandvaleuhb.wales.nhs.uk/caring-for-someone-with-dementia
So how does my work fit into this?
By undertaking a health needs assessment I hope to raise the profile of unmet health needs in the local area.
One in five cases of dementia may be preventable with exercise, diet, diabetes prevention, and early treatment of depression so we need to consider how we can move more focus towards prevention.  The Welsh Government recently produced a guide on how to reduce your risk in six steps.


Why undertake a Health Needs Assessment for Dementia now?
The Cardiff and Vale 3 Year Dementia Plan is due to end in 2016/17, and there is a need to refresh the information on which it is based and make new recommendations based on the altered circumstances.  The purpose of this Dementia Health Needs Assessment Plan is to outline the process that will be undertaken to assess the health needs of people with dementia and their carers in Cardiff and Vale.
In my role as a Specialty Registrar time I will co-ordinate the Dementia Health Needs Assessment. The needs assessment will be undertaken during the period July to December 2016.  A final report will be prepared in December 2016.


  • By Isabella Goldie

  • Director of Development and Delivery

  • Mental Health Foundation

There are times throughout all of our lives when we are likely to run into difficulty, particularly at life’s pressure points: the crucial times of transition from one life stage to another. From moving away from home for university, to having children or dealing with the loss of a loved one.

If we are to rise to the challenge of reducing the prevalence of mental health problems, we need to be stepping in at these pressure points, taking preventative measures that can support people through times of difficulty and stop mental health problems from developing in the first place.

This will require a societal shift. We will need to begin truly recognising good mental health as a universal asset to be strengthened and protected. We can no longer afford to wait for mental health problems to develop before taking action.

The effective support of people experiencing mental health problems is set to become one of the greatest public health challenges of this decade. Without action on the increasing demand for public services, it will not be possible to absorb the rising costs of providing care and support for those experiencing mental ill health in the long term. We need to act decisively as we have in the past when faced with significant risks to public health.

It is essential that we also draw our attention to preventative approaches so that illness is a rarer event.

The historical approaches to curing illness and responding in crises has left a legacy of health services designed to fix problems. While access to good quality mental health services and support must continue to improve and rapidly, it is essential that we also draw our attention to preventative approaches so that illness is a rarer event, both in recognition of the economic costs and also in the sometimes devastating personal impact resulting from poor mental health and mental health problems.

Last week the Mental Health Foundation published Mental health and prevention: taking local action for better mental health, a report produced with Public Health England which lays out a road map for bringing about a prevention revolutio

n in mental health, delivered in every local area. In addition to the strong theme of mental health across the life-course, taking every opportunity to step in early and prevent the development of mental health problems, the need to improve the mental health knowledge and literacy of the entire public service workforce is highlighted.

Integrating mental health improvement into daily work

This radically different approach encourages all health and social care staff to consider the impact of mental health inequalities and act to reduce them. Staff must react to these inequalities in line with the principles of ‘proportionate universalism’, an approach that progressively applies resources where the greatest risks lie.

In practical terms, this means integrating mental health improvement into daily work, with messages and interventions tailored to meet specific needs of those at highest risk of developing mental health problems.

We need to ensure that high-quality services are both available and easily accessible for those that need them most, while also intervening early to reduce the need for specialist support. We can achieve this by giving individuals, families and communities, the tools to protect and manage their own mental health.

This will only ever be achieved by working alongside communities, listening to people’s stories of lived experience to understand what impacts their mental health and what tools they need.

  • by Bayad Nozad, FFPH
  • Co-chair, FPH’s Global Violence Prevention SIG

Air pollution is a serious public health issue and high on the agenda now. Last year, the Department for Environment, Food and Rural Affairs (Defra) and Public Health England (PHE) collaboratively produced guidance to ensure evidence based actions are taken nationally and locally to improve air quality.

The WHO guidelines states that that there are no safe levels of the main pollutant of concern, Particulate Matter (PM), and impacts on air pollution are observed below levels permitted by EU and UK limits (1). The guidance also states that for long term exposure (over months or years) the levels should not exceed annual average concentrations of PM of 10 μg/m3 of PM2.5 and 20 μg/m3 of PM10 (2):

There is now mounting evidence that long term exposure to air pollutants contributes to the development of lung cancer, cardiovascular disease and respiratory illness. The Department of Health’s (DH) Committee on the Medical Effects of Air Pollutants (COMEAP) estimated the burden of PM air pollution in the UK to be equivalent to nearly 29,000 deaths and an associated loss of population life of 340,000 life years lost (3).

It is not disputed that military conflicts are associated with massive release of pollutants into the environment including air. The war in Iraq associated with hundred thousand tonnes of pollutants from military vehicles and weaponry that continue to adversely affect the public’s health.

A great legislation that contributed to limit the environmental damages from industry is the Polluter Pays Principle (PPP). The PPP is a well-established National, European and International code through which the costs of pollution prevention and control measures should be paid by polluter.

The preventive function of the PPP which is based on the assumption that the polluter will reduce pollution as soon as the costs which he or she has to bear are higher than the benefits anticipated from continuing pollution. The control measures should be decided by public authorities to ensure that the environment is in an acceptable state (4).

In applying the above principle to the war in Iraq, it would be useful to know how much consideration had been given to the air quality and the PPP in the decision making process to invade Iraq. It is less likely that this was an issue for the decision makers but would they now face the consequences and take responsibility to clean up the mess, in particularly following the publication of the Chilcot report?

Further, the health impacts from air pollution are not limited to the residents of the affected area but also to serving military personnel. This should be highlighted to new army recruits as occupational hazard and measures should be taken to reduce the adverse effects.

child at water fountain
Future generations in Iraq and conflict zones need access to clean water

More research is needed to quantify the war-related environmental pollution as a considerable potential contributor to Iraq’s poor health conditions and high rates of mortality from CVD and cancer.

For the sake of future generations of Iraqis and others growing up in former conflict zones, we cannot let winning the peace be at the expense of access to clean water as well as good air quality and health.

(1) Review of evidence on Health Aspects of Air Pollution – REVIHAAP: final Technical Report, World Health Organization Office for Europe, 2013
(2) WHO air quality guidelines global update 2005, World Health Organisation, 2005
(3)  The Mortality Effects of Long-Term Exposure to Particulate Air Pollution in the United Kingdom A report by the Committee on the Medical Effects of Air Pollutants, 2010

  • by Marguerite Regan
  • Policy Manager, Mental Health Foundation

One in four of us will experience a mental health problem each year, representing the largest single cause of disability in the UK. As it stands, the economic and social costs of poor mental health (estimated at £105 billion a year) are too great for our health and social care systems to handle.

We need to invest in upstream interventions in the places where people live, learn, work and play. It is imperative that a public health perspective is taken within mental health to change the current crisis and reactive service model.

The mind-body division has historically mean that public mental health has been a neglected field and perceived to be outside the remit of public health.  The Faculty of Public Health chose to focus on the mental health agenda, making it the core theme of their annual conference this year and collaborating with the Mental Health Foundation to combine expertise and produce some key resource aimed at supporting the development of knowledge and skills in public mental health.

Better Mental Health For All cover

Better Mental Health For All report

The resources include a report, three videos and a Public Mental Health Award. Over 600 copies were distributed to delegates at the Brighton-held conference.

The report examines what can be done individually and collectively to enhance the mental health of individuals, families and communities by using a public health approach and looks to support the development of knowledge and skills in public mental health. The report is an evidence based resource for people who want to create real change in local communities.

It outlines the critical role that public health professionals, commissioners and elected representatives play in leading the necessary reforms. The report gives clarity to the fact that we know how much can be done to promote mental health and wellbeing across all age groups, prevent mental health problems from occurring and to support people to recover their mental health.

Throughout the report, case studies showcase examples of innovative public mental health programmes and projects being run across the UK. These were selected from the thirty entries submitted to the Faculty of Public Health inaugural 2016 Public Mental Health Awards and celebrate the public health professionals who are pioneering role models for public mental health.

Three of these case studies were then chosen to have their work presented in short videos, which were launched at the conference. These three varied examples illustrate clear advocacy for public mental health by public health practitioners, exploring; A mens mental health/suicide prevention project in Torbay;  a project addressing mental wellbeing as part of flood response in Somerset;  and social prescribing in Lanarkshire.

The public health professionals involved in these, and several of the other case studies, were invited to share best practice at two sessions held during the conference. It should be noted that these particular sessions were hugely popular with delegates, illustrated by the room being well over capacity.

FPH’s focus on highlighting public mental health this year was largely driven by outgoing President, Professor John R Ashton CBE. He spoke at length about mental health during the conference and awarded the Faculty’s inaugural Public Mental Health award to Gerry Cadogan, Public Health Principal at Torbay Council, for the Torbay men’s mental health/suicide prevention project. Mental health ran through the whole conference, with the keynote given by Dr Stan Kutcher on increasing mental health literacy of young people.

Collaboration is central to the pursuit of good mental health across society. It is vital that both public health practitioners and mental health professionals become advocates for public mental health to prevent mental health problems and promote mental wellbeing.

This isn’t to say that full responsibility lies with them, and governmental-level action and support is also required. It is our hope that this partnership between the Mental Health Foundation and the Faculty of Public Health will encourage more leadership and advocates for public mental health across the UK.

  • By Dr Sandra Davies, Director of Public Health, Liverpool City Council
sugar cubes image

Sugar Cubes campaign


Most of us think we know the basics about sugar. We know that there is likely to be a lot of sugar in a chocolate bar and less so in a yoghurt. It’s obvious, right? But are we as sugar savvy as we think?

A lot of the sugar we consume isn’t as obvious as we think. Many sugars consumed by families and children come from products that you wouldn’t necessarily expect to have much sugar in them; so called ‘hidden’ sources. Did you know that, on average, there are nine sugar cubes in a can of cola, over five sugar cubes in a sugary yoghurt and six sugar cubes in a chocolate bar? Yet the maximum added sugar intake for four to six year olds should not be more than five sugar cubes per day. There are also lots of hidden sugars in tomato sources, flavoured water, soups and lots of other unexpected items.

One of the problems is that many of us don’t study or understand food labelling. To help us get to grips with it all, Change4Life launched a campaign back in January to help parents and families to become more Sugar Smart and cut back on the amount of sugar in theirs and their children’s diets. The campaign revealed the surprising amounts of sugar in everyday food and drinks and encouraged families to take control and protect their children from the dangers of having too much sugar.

The campaign also advised  on the maximum amount of sugar we should be having each day as recommended by the government and promoted the new Sugar Smart app. The app is a brilliant tool, completely free to use and  download,  designed to show quickly and easily how much total sugar is in the things you’re buying, eating and drinking and to help you spot it more easily so you can make healthier choices. You can just scan any barcode in your supermarket shop and it tells you how much sugar is in the item.

The campaign followed on from the successful Food Active GULP Campaign (Give Up Loving Pop)  supported by North West Directors of Public Health which highlighted fizzy drinks as the biggest culprit in the fight against sugar in the diet of children and young people.

Liverpool Public Health and Liverpool City Council supported both of these campaigns locally which then further alerted us to the size of the health problems related to high levels of sugar in the diets of our children and young people. There are alarming levels of tooth decay in young children in the city, with dentists having to remove teeth from children as young as five under general anaesthetic on a daily basis, and around 2,000 children in the city will have had extractions by the age of five.

More than a third will have suffered from tooth decay.  What’s most shocking, is that tooth decay in particular, in children, is largely preventable by reducing sugar intake and keeping teeth clean. Also, what many people don’t realise is that baby teeth help guide adult teeth into position and persistent infections. Loss of baby teeth can also lead to further problems with the development of the adult teeth in the future.

Rates of overweight and obesity reported through our National Child Weight Measurement Programme were also a real cause for concern, and with research suggesting that children are consuming three times the recommended daily allowances of sugar, largely through sugary drinks, we felt that we had to take some really strong action. As a parent myself, I know how important it is to get children into good habits early on. Whilst many of us might relate too much sugar to a sore tooth or putting on a bit of weight, it can also lead to tooth decay, obesity, diabetes and some cancers in the future.

The Change4Life campaign highlighted the fact that parents found that the labelling on drinks was confusing. Knowledge is half the battle and so we decided to develop a campaign that would clearly display the amount of sugars in drinks popular with children.
We are very fortunate in Liverpool to have an Insight and Behaviour Change team that works with every aspect of public health to come up with creative and outcome driven initiatives.

We decided to go one step further than with previous campaigns, launching our ground breaking ‘Sugar cube campaign’ which shows how much sugar is in popular branded children’s drinks. For the first time, branded drinks, including Lucozade, Capri Sun and Coca Cola, are  explicitly named to show how many cubes of sugar each bottle contains.

The campaign launched on 9th May, and is aimed at families and parents of children aged 5-11. So we could influence this group, we placed campaign materials in areas where we expect parents to visit (e.g. children’s centres, hospitals, dental practices, GP practices, walk in centres etc).

Parents are being encouraged to swap their children’s sugary drinks for water, low fat milk and diet drinks and if they still choose sugary drinks they are advised to keep them to meal times only. As well as displays there will be a range of local family fun community events and regular items on radio. We’ve also used interviews in the local media with local dentists and councillors who are supporting the campaign.

sugar cubes image 2

The hidden sugars in everyday drinks

The campaign will run over the summer, and will be fully evaluated for impact and awareness. We will measure the number of local hits and sign ups to the Change4Life website, the number of hits on the Liverpool Echo digital adverts, twitter engagement  and engagement at the community events. The Campaign has already attracted a great deal of media interest, locally, regionally and nationally, and has led to many requests from other areas of the country who have asked to use the materials to bring this very important message to their own localities.

In developing the communications plan the Insight and Behaviour Change Team in Public Health  worked with the Communications team at the Local Authority, and put together a team of spokespeople and health professionals available for media interviews. This included myself as DPH, the Elected Member for Health and Social Care and The Mayoral Lead for Health and Wellbeing and Consusltant Paediatric Dentists.

Whilst we did expect some media interest, given some of the startling facts that we were presenting, the level of interest up to and on the day of the launch was extensive. The fact that I as DPH was able to front a lot of the media is really testament to the relationship that we have with our Elected Member and mayoral lead for health and wellbeing, and how public health has been supported within the Council as a whole. Whilst it was great as DPH to be a voice for the campaign, it was important that we had Elected Member voices and other health professionals  to add weight to the stance that the Council was taking.
For more information on the Sugar Cubes campaign  please contact Katy.Simic@liverpool.gov.uk


Dr Claudia Allemani

  • by Dr Claudia Allemani, PhD FHEA MFPH
  • Senior Lecturer in Cancer Epidemiology, Cancer Survival Group, London School of Hygiene & Tropical Medicine

In March 2016 I was delighted to receive a letter from Professor John Ashton, President of the UK’s prestigious Faculty of Public Health (FPH), congratulating me on being awarded FPH’s inaugural Global Public Health Award.

I was really happy. In a period during which finding support for public health research is becoming more and more challenging, this award gives me one more reason to pursue my professional goals.

My interest is in international comparisons of population-based cancer survival – much cheaper but far less sexy than clinical trials or molecular biology studies. Clinical trials are the gold standard for testing the efficacy of new treatments by randomised assignment of eligible patients, but they recruit patients selected on criteria of age, stage, co-morbidity, etc.

Population-based cancer survival is the gold standard for public health. It reflects the survival achieved for all cancer patients, regardless of their age, health status, stage of disease and access to care, and after eliminating the risk of death from causes other than cancer. It is a key measure of the overall effectiveness of health systems in the delivery of cancer care.

This award is a great professional honour for me personally as a public health scientist, but it is also an authoritative recognition of the global public health contribution made by the CONCORD programme, the 67-country collaboration that established world-wide surveillance of cancer survival in 2015 (The Lancet).

It also gives me a great opportunity to inform the UK public health community about this unprecedented enterprise, which I have the privilege to lead.

Concord logo

CONCORD: 67-country collaboration

The CONCORD-2 study provided estimates of 5-year net survival for patients diagnosed during 1995-2009 with one of 10 common cancers. We analysed data on 25.7 million individual cancer patients, contributed by 279 population-based cancer registries in 67 countries, 40 of which with 100% national population coverage. The CONCORD Working Group included 496 collaborators.

The Lancet article on CONCORD-2 was covered by 170 TV, radio, press and wire outlets world-wide, with intensive social media attention (Altmetric 770, above 99.98% of 4.8 million articles). Results have now been included in the American Cancer Society’s Cancer Atlas and the Global Lung Cancer Coalition atlas. The article has been downloaded over 43,000 times and cited over 270 times in the first 12 months.

Population-based cancer survival is used by policy makers to plan future cancer control strategies. The US Center for Disease Control and Prevention described CONCORD-2 as the start of global surveillance of cancer survival, with survival estimates “that can be compared, so scientists can begin to determine why survival differs among countries. This could lead to improvements in cancer control programs.”

This has already started. In July 2015, CONCORD-2 results were used to inform England’s new cancer strategy, Achieving world-class cancer outcomes: a strategy for England 2015-2020. In September 2015, the International Atomic Energy Agency’s Programme for Action on Cancer Therapy (PACT) used the results to drive an ambitious world-wide campaign to highlight the global divide in cancer survival, and to raise awareness of persistent inequalities in access to life-saving cancer services.

These unprecedented results still seem insufficient to convince some local charities to support this kind of scientific research, even if is instantly recognised as important by cancer patient bodies such as the European Cancer Patient Coalition, the European Cancer Leagues and national cancer patient associations from Argentina to Poland, Switzerland, Japan and the UK.

FPH’s independent judgement in giving this award for my work on the CONCORD programme may help to persuade these charities that to support global research also means supporting global research in their own country!

I am particularly delighted that this award has been made to an Italian cancer epidemiologist during the run-up to the European referendum – it gives me great pleasure to recognise the open-minded vision of public health professionals in the UK.

We have now issued the data call for CONCORD-3!