Better Health For All

January 22^nd – 28^th 2024 is Cervical Cancer Prevention Week. It is an opportunity to raise awareness of cervical cancer and recognise the symptoms to help women understand how to reduce their risk and prevent illness.

Approximately 14 high-risk types of human papilloma virus account for most cases of cervical cancer. Through regular cervical screening and HPV vaccination, it is a largely preventable disease, and in 2018, the World Health Organization (WHO) called for worldwide action to eliminate cervical cancer (defined as an incidence rate maintained below 4 per 100,000).[1] However, despite it being largely preventable, approximately 3,200 women in the UK, mostly aged 30-34 years old, are diagnosed annually, with more than 800 losing their lives. This equates to nine diagnoses and two deaths a day.[2] Furthermore, data shows that there are ethnic inequalities in the uptake of cervical screening. A YouGov survey (date not provided) commissioned by Jo’s Cervical Cancer Trust found that women from Black, Asian and minority ethnic backgrounds were more likely than White women to report never having attended a screening (12% vs 8%).[3]

The same survey identified barriers to accessing screening for this group of women. These included a lack of awareness about the purpose of the screening test:[3]

• Fewer Asian women aged 20-65 (70%) knew that screening is a test to check cells from the cervix to find pre-cancerous abnormalities than White women of the same age (91%).
• Just over half (53%) of Black, Asian and minority ethnic women aged 55-65 think screening is a necessary health test compared with 67% of White women in the same age group.
• Twice as many Black, Asian and minority ethnic women as White women said better knowledge about the test and its importance would encourage them to attend a screening appointment (30% against 14%).

Women from an ethnic minority background (28%) were also less likely to be comfortable talking to a male GP about cervical screening.[3]

This was reinforced by the findings from another study which found that some women, mostly of Asian ethnicity, would not attend if the option for a female was not there.[4]

Other barriers to cervical screening that have been identified as potentially being more common among women from ethnic minority backgrounds include:[4]

• Considering themselves low risk due to not having a partner or being married.
• Lack of familiarity with the terminology used to describe the test, even among English-speakers.
• Shame and stigma of cancer in some ethnic minority communities.
• Embarrassment among women from older generations.

Addressing ethnic inequalities in screening uptake is an important part of achieving the WHO’s goal of elimination. Targeted education to improve understanding and awareness of cervical cancer and cervical screening among women from ethnic minority backgrounds is likely to play a crucial part in this⁴. Delivery of such education in community settings may be of benefit, particularly for older women, and it should include translating screening invitation leaflets/letters into different languages. Furthermore, it should address the shame, stigma and embarrassment that is experienced by some women from ethic minority backgrounds.[4],[5]

The Faculty of Public Health’s Sexual and Reproductive Health Special Interest Group will continue to seek out opportunities to raise awareness of sexual and reproductive health inequalities, including ethnic inequalities, in line with the Faculty’s anti-racism framework and action plan.

[1] https://www.who.int/initiatives/cervical-cancer-elimination-initiative

[2] https://www.jostrust.org.uk/sites/default/files/jos_cervical_cancer_trust_elimination_report_2023-2_june_1.pdf

[3] https://www.jostrust.org.uk/sites/default/files/bme_survey_website_final.pdf

[4] Barriers to cervical cancer screening among ethnic minority women: a qualitative study | BMJ Sexual & Reproductive Health

[5] https://www.gov.uk/government/publications/health-matters-making-cervical-screening-more-accessible/health-matters-making-cervical-screening-more-accessible–2

“Try being nice first, but accept you may need to escalate.”

“Our best guess is that the average person needs to see and hear about climate at least 80 times a month — potentially even more — to become an active supporter of significant climate action.”

“People believe they will be protected from harm – they think if things were really that bad [with climate emergency], they wouldn’t be allowed to continue.”

These three pearls of wisdom were shared in FPH’s recent series of webinars on advocacy for climate and health, organised by us as members of the Sustainable Development Special Interest Group. In case you missed them, this blog summarises our work in this area, to help all public health professionals reflect on and sharpen their own advocacy skills, and apply them to the ‘biggest threat to global public health in the 21st century’: climate change.

What we did

In 2021, the Faculty of Public Health (FPH) published its first Climate and Health Strategy (2021-25). Advocacy was one of the core priorities and we, along with several others, signed up from the special interest group to work it. We quickly identified the need for actions across five main areas, which included: 

1. Some scoping, reviewing and learning from others and the past
2. Develop focused proactive advocacy on a very small number of issues
3. Develop mechanisms for reactive advocacy
4. Skills programme and networks and other support for members and SIGs doing advocacy
5. Developing our Theory of Change for advocacy

This blog focuses in particular on areas (1) and (4) in order to support FPH members to develop the skills for advocating on climate change, environment, and health, specifically for those most affected by climate change and environmental breakdown. To deliver this, we first conducted an ally mapping exercise, followed by a ‘quick and dirty’ literature review. This was to inform the FPH’s five advocacy work areas within the climate and health strategy, and lay a foundation for future work on building advocacy skills specifically. We wanted our work to be useful and built on over time, so we produced a full reading list, a slide set summary which we shared at a webinar, and resources for colleagues building proactive advocacy campaigns around climate and health (like the current campaign to prevent fossil fuel expansion).

To start a skill–building programme, we conducted a survey of members of the FPH to understand what colleagues felt were key skills gaps in this area. Confidence and skills around communications came out as a major gap, so we set about putting on webinars that shared knowledge and enabled peer learning. These webinars also included feedback and evaluation which added to our understanding about advocacy skills needs. Once finished, we brought learning from all steps together to form a set of recommendations for advocacy skills training.

What we found

In addition to communications, other skills gaps among FPH members in the climate advocacy space included negotiating for resources, how to make use of a vast evidence base, building useful networks, and achieving and maintaining change. The literature review also suggested that social change / social movement theory, critical analysis and systems thinking were topics about which public health professionals would benefit from learning.

The existing literature demonstrated that advocacy can be effective at achieving population and planetary health improvements, and also identified some key ingredients for successful advocacy in this area. Whether it’s collaborating with diverse stakeholders, using strategic framing, or using theory to inform campaigning, we know there are ways we can increase our chances of success in advocacy, and we know these approaches and tactics can be learned and practised.

There were also more detailed lessons extracted from webinars on what has worked in the past for FPH presidents, internal and external communications for climate and health, which you can explore here under the Advocacy CPD and learning resources section: https://www.fph.org.uk/policy-advocacy/special-interest-groups/sustainable-development-special-interest-group/resources-on-climate-change-and-health/

Across everything we did, we identified three key messages: 

1. Advocacy is an important public health skill
2. We don’t get sufficient opportunities to learn and practise advocacy skills
3. We’ve explored advocacy (and specifically skills for advocacy) through a climate and health lens but our findings are more widely applicable

What next for the FPH as an organisation?

Across the board, it’s important that the FPH looks for more opportunities to incorporate advocacy into curriculum and continuing professional development. Over the last year or so, we have scratched the surface of what an advocacy training programme could do with our climate and health webinars. It is therefore essential that a longer term programme of advocacy training and learning is put in place for all public health professionals, who can then apply these skills to a variety of different contexts (including climate change and health). This could take many possible forms, but we know from our work so far that it needs to (1) help people learn about key topic areas (which are current gaps), such as systems thinking, gaining political commitment, policy support and social acceptance for climate action, and (2) apply their learning through practice. This is not only in line with the ASPHER competencies that the FPH has already endorsed, but it also overlaps with the skills and actions required to counter the commercial determinants of health, and pushes professionals towards bolder approaches such as the planetary health education framework.

What can public health professionals do now?

If you weren’t able to join the webinar sessions, you can catch up now on YouTube with the external communications session here, and the internal communications and persuasion session here. Visual summaries from the sessions can also be found on the FPH resource pages here. The summary of the scoping work (including findings from the literature review and the reading list) can be found here.

Practice is another key aspect of strengthening advocacy skills, so if you would like to join small, informal groups of FPH members who are working to improve their communications and advocacy skills in relation to climate change and health specifically, please email anna.brook1@nhs.net.

Advocacy is an essential skill for all public health professionals, so we hope you will join us as we work to strengthen training around this topic.

Anna Brook and Emily Loud, members of the FPH Sustainable Development SIG

The Faculty of Public Health (FPH) prioritises tackling health inequalities and promoting anti-racism to address racial and ethnic health disparities. Anti-racism has been a focus for the FPH since 2020, following the murder of George Floyd and the renewed sense of injustice, combined with the racial disparities exposed by the COVID-19 pandemic.

As FPH President, I am committed to addressing the persistent racial and ethnic health disparities that plague our society. These disparities manifest in higher rates of chronic diseases, maternal mortality, and lower life expectancy among minority ethnic groups.

The roots of these disparities lie in systemic racism, a pervasive societal ill that has shaped our institutions, policies, and practices for centuries. Racism has created inequities in access to education, employment, housing, healthcare, and other essential resources, ultimately resulting in poorer health outcomes for minority ethnic populations.

FPH as an Anti-Racist Organisation

Anti-racism is the practice that recognises pervasive racism in society and actively combats racial prejudice and discrimination to promote racial justice and equality. It requires systemic change to dismantle the structures that perpetuate racial inequities and create an environment where everyone has an equal opportunity for good health.

FPH is committed to being a leader in anti-racism in public health. In line with our new Framework on Anti-Racism we will continue to raise awareness, develop new resources, promote anti-racism in our profession, and advocate for policies and practices that promote health equity.

We believe that together, we can create a world where everyone can live a healthy life, regardless of their race or ethnicity. In this blog, I highlight some of the recent work of the Faculty on anti-racism and what is next for the organisation and our members.

Visible Leadership

FPH has taken a leading role in championing anti-racism and addressing racial and ethnic health disparities, and have prioritised this as one of our eleven Board Led Focus Areas for action between 2022-2025. We have also declared racism a public health crisis, emphasising the need for a comprehensive public health approach. We will provide this leadership and advocacy wherever we can – internally, in our work supporting our members, in how we work with other organisations, and in our external communications.

Providing visible leadership within the public health family and across the Medical Royal Colleges is critical. FPH has raised awareness through publications, events, and advocacy efforts. We hosted the first FPH Distinguished Lecture with Professor Camara Jones, a leading expert on racial and ethnic health disparities. Professor Jones’s lecture provided a critical analysis of the issue and highlighted the importance of anti-racism in achieving health equity.

Policy and Programmes

This year, we have developed our new Framework on Anti-Racism to shape FPH policy and action on anti-racism. This ground-breaking document outlines a comprehensive framework for embedding anti-racism into public health practice, research, and education. It calls for a multifaceted approach that includes addressing unconscious bias, promoting diversity and inclusion, and advocating for structural change.

This work is critical to public health practice today and in the future. As public health professionals, we have a moral and ethical obligation to address the root causes of health inequities and promote health equity for all. By embracing anti-racism, we can transform our public health systems and create a healthier, more just world for all.

With the publication of the Framework, FPH is ensuring a comprehensive approach to our anti-racism work, ensuring robust governance and oversight for progress, defining appropriate metrics for monitoring and evaluation, and being transparent about our priorities for action.

Partnerships

Deepening and developing strategic partnerships at home and abroad on this important agenda is critical. As well as delivering our role as a convener, the Faculty brings a unique voice and perspective to an important and challenging area of public health practice.

Our participation in the O’Neill-Lancet Commission on Racism, Structural Discrimination and Global Health will identify and promote the implementation of anti-racist actions and strategies by states, civil society actors, and global health institutions, in order to reduce structural discrimination through targeted research and collaborations that will foster policy dialogue within and across sectors that impact health and wellbeing.

We will recognise and support the important work being done by public health partners across the UK on anti-racism. We are exploring opportunities to strengthen our collaborative work with the NHS Race and Health Observatory to amplify the emerging evidence, promote promising practice, and facilitate continuing professional development and education. The Faculty supports work from ADPH on racism as a public health issue, and the London Health and Care System’s work on anti-racism as part of the Mayor of London’s Health Inequalities Strategy.

These collaborations have strengthened our resolve to address racial and ethnic health disparities and have amplified our impact on a national and international scale.

Training and Capacity Building

FPH is committed to ensuring that the training and examination process for public health registrars is fair and equitable for all. We are working to identify and address any instances of structural discrimination that may be preventing minority ethnic candidates from achieving their full potential.

In our report with the UK Recruitment Executive Group of Health Education England and Imperial College London, we have made a number of recommendations to address structural discrimination in public health training. These recommendations include:

• Collecting and analysing data on the ethnicity of public health registrars at all stages of the training and examination process.
• Developing and implementing targeted interventions to support minority ethnic public health registrars.
• Reviewing the recruitment and selection process for public health training schemes to ensure that it is fair and equitable.
• Working with public health training providers to create a more inclusive and welcoming environment for all public health registrars.

We updated our progress with our actions in a recent FPH President’s blog and this remains a key area of our work to tackle wider structural discrimination.

Summary

Anti-racism is not just a moral imperative; it is also a critical component of effective public health practice.

We cannot achieve health equity without addressing the root causes of health disparities, and those root causes are deeply intertwined with racism. FPH’s work on anti-racism is centred around creating a more just and equitable future for all. By dismantling the structures of racism, we can create a society where everyone has the opportunity to achieve their full potential and live a healthy life.

Professor Kevin Fenton CBE FFPH
FPH President

The crisis of overcrowding in our prisons has led to some drastic and potentially unsafe changes to sentencing practices. So far there has been less attention to preventing people being in prison when they shouldn’t be there. There is extreme unfairness, injustice, and indeed cruelty in our system of punishment, with prisons full of inadequate, vulnerable, mentally ill and addicted people, largely from poorer social backgrounds. These incarcerations need to be prevented, and alternative methods of support, and fair punishment, needs to be found.  The gross inequalities in sentencing suggest it really is a crime to be poor.  

In the health field, we have become acutely aware of inequalities in health outcomes, and in access to health care. Our efforts to overcome these inequalities have been hampered by 13 years of austerity policies which have seen inequalities in life expectancy worsen. In the environment field, the concept of environmental justice has become an important policy goal in seeking to secure for people in poor environments, equal treatment under the law.  In the world of law enforcement, enlightened police forces are pursuing trauma-informed processes when dealing with some of the most vulnerable and disadvantaged people in our society, recognising the complex life experiences which disable people physically, mentally and socially , leaving them simply, unable to cope. Court diversion, crisis intervention teams and mental health training for police forces, harm reduction approaches to drugs and other problems, give hope that alternative models of policing are possible. It seems only in the world of criminal justice, that there is little appreciation or allowance for the problems individuals acquire through a lifetime of poverty and disadvantage. In the eyes of the law, when a crime is committed, a due process and judgement must be reached, a sentence must be passed.  But these processes of justice are not dispensed even-handedly. Unconscious biases are applied. The most defenceless individuals are victimised the most severely, and unable to recover from the consequences; the costs fall not only on the individual, the societal costs of incarceration and the health and care consequences are amplified.

Disparities in sentencing operated by the courts, apply adversely to the poor, the ill and the addicted. Epstein and Hunter reported on breaches of Anti-Social Behaviour Injunctions (ASBIs) and other injunctions found on the official site of judgments. There were 307 cases in all, with 33 in which the judgment of the court mentions mental health issues and/or addiction. The judgements came from 52 different county courts out of the 170 in England and Wales. Two thirds of cases were men, one third women. 46% resulted in immediate sentences; 32% suspended sentences. The convicted people were frequently unaware of their rights, and many were unrepresented.

One example, the case of Floyd Carruthers, illustrates the problem, in the most extreme way, as sadly, it resulted in Mr Carruthers’ collapse in prison, neglect by prison staff (the coroner’s conclusion) and then death shortly afterwards in hospital.

Floyd Carruthers was diagnosed with schizophrenia in 2003. In April 2021, the Court found he had breached his ASBI by banging twice on his neighbour’s door; he was remanded in custody. When the case was again before the Birmingham County Court on 6 May 2021, he was committed to prison for 66 days. He had an infected heart valve and did not eat in the prison for four days. No medical personnel were called. When prison officers entered his cell, they found he had collapsed. He died in hospital on 14.6.2021. The sentencing remarks show that Mr Carruthers did not understand the court proceedings, including his right to appeal. Mr Carruthers should not have been in prison custody when he died as he had completed the custodial part of his sentence on 7 June. He was in hospital by this time, but his family would have been able to visit him without the presence of prison officers if he had been released when he should have been. 

Imprisonment is not the solution to the problems posed by anti-social behaviour. Imprisonment contravenes the basic legal principle of proportionality. The Civil Justice Council reported on this subject in July 2020, pointing out the disproportionate punishments imposed and their finding that half the defendants had no legal representation, and that many were extremely vulnerable. They made 15 recommendations to improve the system; none have been implemented.

Contempt of Court imprisonment raises basic questions of social justice. The rich get sent to rehab: the poor go to prison. It is an anomaly that people are given a criminal sanction of imprisonment for behaviour that is not criminal. This is in contradiction to the law as set out in S.230 (2) of the Sentencing Act 2020: imprisonment is a last resort to be used only when ‘an offence was so serious that neither a fine alone nor a community sentence can be justified for the offence’. In the criminal law there are protections for the defendant: pre-sentence reports, referral to probation service for support, for example. Furthermore, in criminal cases there are out-of-court disposals, diversion, and pre-court measures available to the police to deal with less serious low-level crime. There is evidence that these measures have been largely successful and have kept people subject to them out of the criminal justice system, for example, in the West Midlands New Chance scheme. Help with drug and alcohol problems, housing and employment issues, and mental health problems have proven effective in curbing criminal activity and lessening the harm to communities. These approaches which have been found to be effective in the criminal system should be applied to anti-social behaviour, which although not criminal, may lead to custody.

We require a more just approach to the problems posed when mental illness and addiction leads to anti-social behaviour, one that respects human rights, with a welfare, not a punitive approach to social problems. Prison sentences for ASBIs are not appropriate treatments and they are not effective in preventing the behaviours they are applied to. Consequently, they are not cost-effective in delivering improvement for money spent on the penal system, and they only perpetuate misery, ill health and injustice for the victims, and the misery for victims of their antisocial behaviour. In the present overcrowding crisis, there is no room for them in prison.  Alternative approaches are long overdue.

Rona Epstein, Honorary Research Fellow, Coventry Law School, Coventry University

John Middleton, Honorary Professor of Public Health, Wolverhampton University

Postscript: There are many other examples of the unfair system of criminal justice we have in the UK and the criminalisation of poverty. Many of these are covered on the website: https://crimetobepoor.org. There is also a group of researchers who come together to look at these issues. The UK Faculty of Public Health Special Interest Groups, especially those for mental health, drugs, alcohol and poverty should find this work of relevance to their agendas. Surprisingly, perhaps we do not yet have a UKFPH special interest group for prisons? Criminal justice? Or Policing? 

Equity and fairness in post-graduate training are essential for a number of reasons. When done well, they help to attract and retain the best, diverse and brightest talent. When everyone has a fair chance to succeed, more people will be motivated to pursue a career in public health. This is essential for ensuring that the public health workforce is able to meet the growing demands of a complex and ever-changing world. 

Equity and fairness in post-graduate training also ensures that the specialist public health workforce is representative of the population it serves. This is important because it allows public health professionals to better understand the needs of the communities they work with and to develop more effective interventions. When everyone has the same opportunity to reach their full potential, society as a whole benefits. 

Our report on Fairer Training Culture highlights the disturbing level of discrimination present in the recruitment process for public health training in the UK, particularly in relation to ethnic differences at the Assessment Centre. This is unacceptable and we must work together to eliminate discrimination from all aspects of public health training.

In this blog we provide an update on our progress thus far and our continued actions to address the situation. 

In October 2022, we noted the first step to develop a Fairer Training Culture with the publication of an in-depth report examining recruitment processes in detail. This report highlighted some concerning issues of differential attainment in the recruitment process, particularly in relation to ethnic differences in tests used at the Assessment Centre, but it has also galvanised activity and debate across the system. 

In the 2023 recruitment round (starting November 2022) NHSE’s Recruitment Executive Group:

• Revised the Situational Judgement Test (SJT) with a broader, more diverse, group of question setters and reviewers, to make sure they are fairer questions. This should also allow the availability of more example questions for candidates to look at in advance.

• Moved all available information on recruitment from the Faculty of Public Health (FPH) and Health Education England (HEE) to a single site. This ensures improved consistency of information and allows us to develop better information for all applicants.

• Continued to train assessors to reduce bias in the selection centre.

HEE’s merger into NHS England’s Workforce, Training and Education Directorate has delayed a proposed review of available numerical reasoning and critical reasoning tests for the assessment centre, but they will be trying to ensure this happens this year.   

The way in which ethnicity of applicants and appointments is monitored was improved to increase the number of categories in this round. Whilst positive, this means that we do not have a comparison to measure the impact of changes, though we will be able to do so better in the next round.

FPH’s Equality and Diversity Special Interest Group has been working closely with NHSE’s Recruitment Executive Group to publish an options appraisal of future actions, develop an action plan, and prioritise next steps.

The FPH itself is also currently developing an anti-racism strategy and action plan.

Further changes are planned for the 2024 recruitment round starting November 2023, including:

• Separating the scoring for the Assessment Centre (AC) from the Selection Centre so there is no carry-through of any potential biases at AC into final scores.

• Further developments in the information hub, including links to regional recruitment events.

• In the South-East, trainees themselves are leading the development of targeted support to disadvantaged groups.

We will continue to report on developments in this area, as well as reporting on other aspects of a fair training culture such as exam success rates later in the year.

In summary, we are encouraged to see the progress that has been made to improve equity and fairness in the recruitment process for public health training. However, there is still more work to be done. 

We call on all stakeholders to work together to create a system where everyone has the same opportunity to succeed in public health training. This includes: 

• Continuing to review and revise recruitment processes to reduce bias. 
  
  
• Providing training and support to assessors to reduce bias. 
  
  
• Collecting data on the ethnicity of applicants and appointments to track progress over time. 
  
  
• Developing targeted support to disadvantaged groups. 

We urge you to join us in the journey for greater equity and fairness in public health training. Together, we can make a difference. 

Please continue to contact the FPH or ourselves directly if you have any ideas or suggestions for how we can improve equity and fairness in public health training. We look forward to hearing from you. 

Professor Kevin Fenton CBE FFPH
FPH President

Dr. David Chappel FFPH
FPH Academic Registrar

Fatai Ogunlayi, Hadjer Nacer, Fatumo Abdi Abdillahi, Diane Ashiru-Oredope, Victor Joseph, Aliko Ahmed on behalf of FPH Africa SIG

Black History Month, celebrated in October in the UK, is an annual celebration of the impact  and contributions that Black people have had on British culture and heritage. The theme for this year’s Black History Month is “Saluting our Sisters,” highlighting the remarkable contributions of Black women in British history and communities.

In this blog post, we celebrate some of the Black pioneers, especially Black women, who have had significant impact on health and wellbeing for people in the UK. These pioneers, despite facing the challenges of racism and discrimination, persevered and made significant contributions to public health in the UK.  The efforts of these pioneers have not only impacted the health and wellbeing of Black communities, they have also improved the health and wellbeing of the UK and global population. They paved the way for a more equitable and inclusive society.

Mary Seacole

Mary Seacole is now a commonly celebrated iconic figure in Black history but this wasn’t always the case and her story highlights the importance of documenting and celebrating the rich history of Black people in the UK. Seacole, a British-Jamaican nurse, is known for her contributions to public health and nursing in the Crimean War during the 1850s. Seacole who was initially rejected to serve as a nurse because of her race funded herself to travel to Crimea where she established the British Hotel as a place of respite for British soldiers. Prior to the Crimean war, Seacole was involved in public health response to the cholera and yellow fever epidemics in Jamaica and cholera epidemic in Panama.

Following her death in 1881, Seacole’s contribution to UK history faded into near “oblivion” for almost a century, but through societal efforts, she is now rightfully remembered and celebrated and was voted the greatest Black Briton in 2014.²

Dame Elizabeth Anionwu

Professor Dame Elizabeth Anionwu, of Nigerian/Irish heritage, is a health visitor and the first sickle-cell and thalassemia nurse specialist in the UK. She helped establish the first nurse-led UK Sickle & Thalassaemia Screening and Counselling Centre.

Anionwu, whose upbringing was scarred by racism and abuse has said that she is motivated by the need to see “gaps in service for BME patients and health professionals addressed. In addition to her clinical public health work, substantial amount of Anionwu’s time was spent tutoring Black and Minority Ethnic communities in London. In the late 1990s, she established the Mary Seacole Centre as a way to promote diversity in nursing education, research, and training. Following her retirement, Anionwu has continued to promote the work of Mary Seacole by serving as a life patron of the Mary Seacole Trust. Anionwu was honoured with the Order of Merit in 2022 and a Damehood (DBE) in 2017.

John Alcindor

Dr John Alcindor was born in Trinidad and attended medical school at Edinburgh University in Scotland, graduating in 1899. Alcindor led pioneering research on influenza and tuberculosis in the early 20th century. His research set the groundwork for the correlation between poverty, low-quality food, and poor health. Alcindor was keen to use his skills to help the war efforts during the First World War but like Mary Seacole before him, he was also denied by Royal Army Medical Corps because of his race – something that has been described as a “both racist and self-defeating” Alcindor would later sign up as a British Red Cross volunteer to support the war efforts and was later awarded a Red Cross Medal for his life-saving work.  Alcindor would continue to be an activist for racial equality and his contributions to public health in the UK were instrumental in advancing the cause of health equity and fighting against racial disparities.

The above are just some few examples of black people who made significant contributions to improve the health of the UK population and many more continue to do so to this day.

We must also remember that whilst we celebrate the far-reaching contributions that Black people have made to public health in the UK over the centuries, there is much work to be done to dismantle the structures that maintain disparities in health & wellbeing. For example:

• Black women are almost four times more likely to die in pregnancy or childbirth than White women.
  
• Black babies have almost double the stillbirth rate of White babies in England & Wales
  
• Black African and Caribbean women are up to two times more likely to receive a late stage diagnosis for a number of cancers than White British women.

Black women in the UK experience health at the intersection of racism and gender inequality, and a racial justice lens is essential to understanding and addressing the racial disparities in their health outcomes.

We welcome the Faculty of Public Health’s leadership in advocating for a public health approach to tackle racism as a core area of work.

We must continue to dismantle structures of racism and inequalities that exist in our society. We do this by first shining a light on it, recognise it as a public health crisis and work collectively to achieve this goal. Everyone has a role and we can all take personal actions to be inclusive in our daily lives. 

Throughout Black History Month 2023, we will continue to celebrate the outstanding contributions of Black people in the UK, with a focus on women, who lead the way and break barriers to advance the public health agenda in our society.  You can find out more about them via the social media posts available here:

• Post 1 – October 16^th
• Post 2 – October 23^rd

Welcome to the first blog of this new series from the President of the UK Faculty of Public Health.

I am so pleased to be able to communicate with you through this medium and hope to use it to share updates on the Faculty’s work, my thoughts on current public health issues, and to engage with our members and the wider public. It is so important that the Faculty remains a strong and credible advocate for the public’s health; a champion for impactful public health programmes; and a thought leader on the current and future challenges and opportunities for our profession.

But first, let me take this opportunity to thank our FPH members and our wider public health colleagues for your dedication and continued hard work through very challenging times. Public health professionals are at the forefront of protecting and improving the health of our communities and play a vital role in preventing disease, promoting health, and reducing inequalities. I am inspired by your dedication and continued accomplishments at home and abroad as you work to make meaningful and positive differences in the lives of others.

As we emerge from the acute phase of the COVID-19 pandemic whilst adapting to health system transformations and grappling with the cost-of-living crisis, we face significant challenges in all domains of public health practice – from responding to prevalent and emerging infectious diseases, to dealing with the rising tide of NCDs, responding to widening inequalities, rebuilding community-centred approaches to improving health, tackling climate change, and encouraging a greater health system and cross-governmental focus on prevention and population health. There is much work to be done, and working alongside our partners, we will relentlessly champion better, well-funded public health policies and programmes with a laser focus on improving health and reducing inequalities.

As I approach the mid-way point of my Presidency, I am proud to reflect on what we have achieved together so far. As part of our revamped FPH priorities, the Board has identified 11 priority focus areas aligned to 5 strategic priorities. These priorities align with, and build upon, the FPH’s 2020-2025 Strategy and provide an opportunity to engage and mobilise all our members as we work to raise the profile of public health and the vital work that public health professionals perform.

First, we are committed to supporting the development of a high quality, resilient, diverse and inclusive public health workforce. A workforce that is fit for the future, clear and confident in our training and career development pathways. A workforce where our wellbeing and work-life balance is supported and prioritised. We will continue to advocate for the wellbeing of our members; provide support to members who are struggling; and work with employers to support the wellbeing of their public health staff. We are redefining and streamlining career development opportunities for our members and in the past year, we have conducted a review into fair training culture; developed a new curriculum and CPD diary, and launched a new workstream on membership wellbeing. In the year ahead, we will continue to work to ensure that public health training is fair and inclusive and harmonise the Faculty’s Membership and Fellowship accreditation.

Second, the Faculty is revamping our approach to strategic partnerships, prioritising deeper collaboration with UK public health bodies and Royal Colleges while developing new relationships with organisations allied to public health. Over the past 18 months we have launched a new collaborative membership offer with the Chartered Institute for Environmental Health; developed a new dual accreditation programme with the Royal College of General Practitioners; and have actively built on joint learning and development opportunities with the UK Health Security Agency, the Local Government Association, and Public Health Scotland. Our ambition is to both broaden and strengthen the public health family whilst identifying innovative areas for collaboration and impact.

Third, the Faculty will be a clear and unequivocal advocate for the public’s health, at a time when so many are struggling with poorer health, economic insecurity, and increasing societal polarisation. Over the past year we have championed the public health role within ICSs; supported intersecting policies on health, sustainability and climate change; advocated for stronger policy action to support the public’s health; developed new programmes on poverty and the cost-of-living crisis, including advocacy on child nutrition, and have continued our strong advocacy on climate change, anti-racism, drug policy, tobacco control and many other areas. In the next year, we will advocate for robust, evidence-informed public health policies and programmes, raise the profile of public health and the vital work of public health professionals, and build partnerships with other organisations to amplify our voice.

Fourth, we have launched new FPH programmes focused on raising the profile of public health professionals as well as connecting conversations on the future of public health. The world is changing rapidly, and public health needs to not only keep up, but be a step ahead. I am so proud to have launched the Faculty’s new ‘The Future of Public Health’ distinguished lecture series and new SIGs on Digital Health and Artificial Intelligence among others. Our new ‘What is Public Health’ multi-year campaign launched in September 2023 aims to increase the understanding and visibility of the critical work performed by health professionals, promoting the vital and varied contributions of the public health workforce. All of this is supported by a stronger digital and social media presence, a new membership portal, and refreshed FPH website coming in November, all geared towards improving the experience of how members engage with FPH to support their career journeys.

Fifth, I am proud of the work that the FPH does internationally – through our various Special Interest Groups and in partnership with other organisations. I see this as an important part of the FPH’s contribution to global public health and we are expanding the Faculty’s activities in this arena. In the past year, we have signed an international MOU with IAPH; led work with WHO to support global public health system capacity; and launched a new disasters and humanitarian response SIG to support both domestic and international efforts in emergency settings. There is more to do with our global public health partners as we share our expertise and knowledge with public health professionals in other countries and support the training, development and accreditation of public health professionals globally.

Finally, one of the highlights of my first year has been the increasing involvement of our members in the work of the Faculty with so many colleagues agreeing to serve in various roles. This is a positive sign of the vibrancy and visibility of the FPH and I want to encourage more of our members to become involved by joining one of our Special Interest Groups (SIGs); serving on one of our many committees; volunteering to be an FPH examiner, or mentoring and coaching to help support the current and next generation of public health practitioners.

Without doubt, serving as the President of the Faculty of Public Health is one of the most exciting and humbling opportunities I have had in my career. I am keen for others to join me in ‘paying it forward’ and giving back to the profession that we love and are passionate about. I am confident that together, we will continue to make a real difference to the health of our communities and look forward to working with you to build a better future for all.

Professor Kevin Fenton CBE FFPH
FPH President

Current situation in Yemen

Yemen is nearly in its ninth year of war which has destroyed much of the infrastructure in the country including health facilities. After eight years of prolonged conflict in Yemen, the country’s health system continues to fall short of meeting the population’s needs. Only 54% of health facilities are fully functioning, while 46% are only partially operating or entirely out of service. 

Some of the health facilities have been used either as shelters by Internally Displaced People (IDP) or by the warring factions as military bases. This has resulted in many of the health workforce either leaving the country, moving to a new area, or taking other jobs to support themselves and their families.

Mentoring programme

Three partners were involved in this project: Yemen Special Interest Group (SIG), Faculty of Public Health, Peoples-Praxis, and the Health Professionals for Yemen (HPY-UK). The latter was a newly registered charity organisation in the UK.

The programme had two aims:

-offer mentoring support for public health professionals in Yemen who were either  studying or working in public health and needed support to develop their careers in public health

-encourage applicants to use the public health resources free of charge on the Peoples Praxis’ website.

A leaflet was produced in both Arabic and English announcing the programme launch on the 2^nd February 2023. It was sent to individuals through WhatsApp networks inside and outside Yemen. Interested practitioners were encouraged to apply online via Peoples Praxis website. All applications were added to the Peoples-Praxis’ ‘MentorCity’ platform database. Two weeks later more than 60 people applied for the programme. This took all the partners by surprise, and they had to figure out how to handle the situation and who to include in the programme or put on hold. The vacancies in the Mentor City platform were only 5!

Yemen Public Health Praxis group was set up and a lead coordinator identified. To manage the large number of applicants a traffic light system was created:

Green group: – ready to join the mentoring programme,(strong candidates as judged by profiles and areas of interest)

Amber group: not quite ready and so had to wait until there were vacancies in the programme,(profile not completed fully, not clear on areas of interest for mentoring)

Red group:  not eligible or further info was needed from participants before making further decisions.

Additional funding was secured and we were able to increase the number of places on MentorCity for the Yemen group to 10.

Mentor City Platform is an online facility it has a dashboard where you can see what groups exist, mentors, mentees and who is matched with whom. It also has the capability of sending individual emails to mentors and mentees or organising Zoom meetings individually and in groups.

The whole Mentoring City Platform system was new to partners, mentors, and mentees alike. So there was a lot of learning for all concerned as outlined below.

What worked well

Key lead partners met monthly, spending an hour on average in every meeting. Most attendees in these meetings are either mentors in different countries or trustees in the Peoples-Praxis. These meetings were organised and chaired by the chair of Peoples-Praxis. Additional tasks and follow-up actions would be identified and reported back into this monthly meeting.

The Mentor City platform has a search for the profiles of both mentors and mentees which helps the matching process. People who have not completed their profiles are recognised easily and encouraged to update their profiles. The system keeps email exchange messages in one place and mentors could quickly check their messages.

What were the challenges

The initial message to mentees informed them that they would be matched to a mentor once their application is completed and that they would be matched to a mentor who will get in touch with them. This task was delegated to one of the Peoples-Praxis’ team which did not work. Mentees waited a long time to be contacted, and when they did not hear what was happening, some contacted the Yemen lead who happened to have his WhatsApp number from the first leaflet for the programme. After several months this process was updated and changed mid-September 2023. Mentees were now encouraged to contact their own mentors for their sessions. This process is still in progress and needs to be evaluated.

All other communications by individual emails, WhatsApp, or Google Meet were not in the system. Mentors were encouraged to contact applicants through Mentor City platform or via Zoom. A few messages were sent to a whole group inviting them to a meeting but no response was received by the lead or mentor. This is understandable given the time zone differences between mentor and mentees which could be 9 or 11 hours.

A common challenge for the Yemen group was the concept of mentor and mentee. Most of the candidates have had didactic education. Mentoring is based on building a relationship between mentors and mentees, and in this programme with the aim of supporting mentees in their public health careers. In future, we may change our terminology from the unfamiliar concept of mentoring to offering support for professional skill development in the field of ‘global health’.

Unexpected outcomes

Although, there is a feedback form each mentor and mentee should fill out and send back to Peoples-Praxis. The feedback is about the sessions and the relationship between mentors and mentees. This process has not been well used and did not pick up soft successful anecdotal stories about the mentoring programme. Below are a few examples.

Individuals

While the Yemen lead was talking to one of the participants on WhatsApp, he asked him, “How did you know about the programme”? The mentee said, “I was on a demonstration for Peace in Yemen in Aden and a colleague gave me a copy of the announcement and said this is for you”.

One participant described how she valued her own mentor who has supported her with what she was looking for. Her mentor was in Australia, and she was in Yemen. The Yemen lead received this message via WhatsApp.

One participant joined the Yemen SIG as a result of his involvement with the mentor programme. He described to the Yemen SIG group how he valued the support he got and was going to pursue his PhD career.

One participant contacted the Yemen lead and told him that he was not interested in the mentoring programme but would like advice on suitable Primary Health Care (PHC) courses. A few links for courses of his choice were sent to him. He wrote back and said that he found these courses extremely helpful. He then wanted some advice on a research topic for his dissertation. This case is still unfinished.

Taiz Health Institute

The Yemen lead and the Dean of the Taiz Health Institute formed a new group in Taiz to explore how can the Yemen Public Health Praxis support the institute in rebuilding the health training after the institute building was destroyed by the war. One of the team members in Taiz needed a mentor to support him with his research and he was immediately connected with a mentor to support him.

Taiz Health Institute has a plan for future courses they want to run. However, they don’t have the financial resources to do so. After various discussions and communication about the introduction of a public health course, they agreed, designed, and advertised the course to the public. There were zero applicants and one of the reasons cited was that ‘public health’ will not get them employment or bring cash for the trainee after she/he finishes the training. A challenge for many Low and Middle Income (L&MI) countries.

Yemen Dental Public Health

The Yemen Public Health Praxis had a few applicants who had dental health training or were graduates of dental health studies. The chair of Peoples-Praxis suggested creating a Yemen Dental Public Health Group. The chair of Yemen SIG contacted the PH Dental SIG to see if there were opportunities for collaboration.  The response was positive, and we had our first meeting exploring what needs to be done. A few months later, a team of five (in Yemen, Germany, and UK) formed the first Yemen Dental Public Health Team. Their task was to conduct a literature review on dental health in Yemen which will guide the group on what to do next. The story goes on.

PH resources

The Yemen lead has identified two online public health courses that would be potentially useful to Yemeni candidates. The first provided by Peoples-Praxis would be more useful if translated into Arabic. The second was developed by the International Academy of Public Health (IAPH) https://iaph.org/en/learning-paths/all-courses/. is available in both Arabic and English.

Recently the Yemen lead met with IAPH management team and explored the potential cooperation between the partners. It was agreed they would work on one of the Praxis courses, and explore the technical issues and the possibility of translating the material into Arabic. A memorandum of understanding would follow for partners to agree on the scope of work.

In conclusion

This blog summarises learning points from a recent collaborative pilot mentor project using the online Mentor City platform The Yemen Praxis project has been running now for seven months and we have learnt a great deal about who is interested in joining a mentoring programme , and what they want out of the programme. We’re conscious about our terminology of the unfamiliar concept of mentoring to offer support for professional skill development in the field of ‘global health’.

We were able to offer some support to some participants but unfortunately not all. We have had significant positive unexpected outcomes, and we hope we will learn more about other new unexpected outcomes as we move forward.

Although bombing in Yemen has stopped that does not mean the country has achieved peace. The need for support and mentoring in one form or another will be needed for years to come. It’s up to the mentoring team to continue with the learning, understanding, and adapting to what works and what doesn’t. We are pleased we have had some positive feedback from some of the mentees that this programme is working for them.

Taher Qassim

Dr Ann Hoskins

The Academy of Medical Royal Colleges (AoMRC) has today published a manifesto setting out high level priorities for improving the health of children in the United Kingdom.

Development of the manifesto “Securing our healthy future: Prevention is better than cure” has been led by The Faculty of Public Health (FPH) and The Royal College of Paediatrics and Child Health (RCPCH).

One of the ways that the FPH and RCPCH collaborate on an ongoing basis is through the British Association for Child and Adolescent Public Health (BACAPH). BACAPH act as a special interest group on child public health to both the FPH and RCPCH, providing a vehicle for paediatricians and public health professionals to work together on this critical area.

FPH and RCPCH joined with AoMRC to deliver this manifesto because we know that childhood, including pregnancy, is the most impactful and cost-effective period to target public health interventions. Our organisations, along with the wider health workforce as represented by AoMRC, share a concern that current political and health service strategies and plans, including the new Major Conditions Strategy, do not sufficiently prioritise child health.

Securing our healthy future has identified five priority themes for action. One of these is nutrition and healthy weight as we see the number of overweight and obese children in England rising. This has implications for the current and future health of our children, for the demand on our health service, and for our wider society.

One of the report’s recommendations to help address rising obesity and access to good nutrition is an expansion of free school meals in primary schools in England. This ask builds on a letter sent from the Faculty of Public Health to the Prime Minister earlier this year and would bring England in line with Scotland and Wales. In the time since our letter was written, front line public health colleagues have shared an increasing number of concerning stories of young people struggling to access food. We are doing more work on the evidence around food insecurity in children that will be published next month.

Other key calls made in the report to protect and promote better child health include action on the climate crisis, childhood vaccination, oral health, and mental health.

The climate crisis is the greatest public health challenge we face. Many of its impacts – including air quality – disproportionately impact children, particularly those who live in the most deprived areas. We’re asking Government to do more to reduce emissions of the most harmful pollutants.

Childhood vaccination is hugely effective in preventing infectious disease as well as protecting against cancer in adulthood. Rates of childhood vaccination in the UK are declining and protection against measles is at the lowest it has been for a decade. We are asking the Government to publish and implement plans to reverse these trends.

The report also highlights the importance of oral and mental health. Both of these issues are strongly influenced by deprivation and share challenges around timely access to services. There are opportunities to do more in these areas – we are asking the Government to invest in prevention and workforce.

The full support of the Academy of Medical Royal Colleges to this report demonstrates how the importance of these issues is recognised across the full range of medical specialties. Please read the report and join us in calling on the Government to secure our healthy future.

Joe Williams, Speciality Registrar, British Association for Child and Adolescent Public Health (BACAPH)

Ann Hoskins, Independent Public Health Consultant, British Association for Child and Adolescent Public Health (BACAPH)

Professor Kevin Fenton, President, UK Faculty of Public Health (FPH)

In May 2023, the Faculty of Public Health (FPH) arranged a virtual network event where colleagues from public health, the wider health system and academia came together as a community of practice to discuss how equality, diversity and inclusion (EDI) principles and practice are being adopted in their organisations and areas of work.

A Key Public Health Issue

Increasing the diversity and inclusivity of the public health workforce is widely seen as desirable by UK Public Health organisations, and has been identified as a necessary action to address health inequalities. In their BMJ article “A diverse public health workforce is more important than ever”, Kazim Beebeejaun and Kerry Littleford identify three key reasons as to why greater workforce diversity and inclusivity is a key public health issue. Firstly, cultural competence is essential in gaining a rich understanding of the perspectives, needs, and concerns of marginalised communities. Cultural competence rooted in lived experience is a powerful tool for positive change. A workforce with real world experience that reflects the diverse society it is serving is key to tackling the challenges ahead.

Secondly, a more diverse workforce is more innovative. Covid-19 shone a light on decades of existing health inequalities amongst ethnic minorities and the need to urgently address critical gaps in capabilities of the health system to tackle ethnic health inequalities. Different perspectives informed by the lived experience of the health workforce can prevent tunnel vision, and bring to light problems or solutions that would not otherwise have been considered. Moreover, inclusive working environments can help to create a sense of psychological safety and belonging, enabling public health professionals to be more open and honest in sharing their experiences and ideas, and in turn to think more radically and innovatively when designing strategies and interventions[1, 2].

Thirdly and most importantly, building trust requires consistency in our values as a profession. We cannot advocate for our core values of equity and social justice in health without tackling inequalities within our own community. Certain populations have historically been systematically excluded or represented minimally from professional occupations such as public health, and ongoing inequality of opportunity continues to limit access. If current and future decision makers are drawn only from certain areas of society, how do we expect to build genuine trust with marginalised communities?

Sharing Experience and Gaining Momentum

Whilst there is clearly a strong argument for greater workforce diversity and inclusivity in public health, much of the current work in this area is occurring in siloes. In May 2023, members met in a virtual networking event to share ongoing projects, areas of good practice and future aspirations. These included:

• FPH Equality & Diversity Special Interest Group. The group is co-chaired by Public Health Registrars Kerry Littleford and Kazim Beebeejaun and reports to the Equality & Diversity Committee. The current priorities of the SIG include evaluating differential attainment throughout recruitment and training, and exploring mentoring and training opportunities for those currently undertaking specialty training. 
• FPH Fair Training Project. This project is being undertaken by Rachel Fardon and Amoolya Vusirikala, Public Health Registrars. The Fair Training Project is a programme of work organised by the FPH following earlier work on recruitment to the specialty training programme and examines the public health specialty training journey through a diversity and inclusion lens. It includes three sub-projects focusing on the demographic makeup of Registrars and Registrar’s progress through training, specifically examining for differential attainment in examinations and ARCP outcomes.
• Exploratory research project: Removing structural barriers to representation in recruitment, progression and retention. This project is undertaken by Dr Asta Medisauskaite, Senior Research Fellow, UCL Medical School; Researcher in Residence, OHID London region. This project is set to review metrics to monitor how equitable and inclusive the health and care workforce is & identify interventions that improve diversity in the workforce. To get in touch, email Asta Medisauskaite at a.medisauskaite@ucl.ac.uk or OHID representative, Robert Pears, Public Health Consultant at robert.pears@dhsc.gov.uk
• Public Health Speciality Registrar Committee Reasonable Adjustments Working Group. This project was presented by Ruth Hoggett, Public Health Registrar. The Working Group has recently explored the experiences of Public Health Registrars around the reasonable adjustments process. This has informed the production of a report providing best practice recommendations on key roles, responsibilities and clear pathways for requesting, implementing and monitoring reasonable adjustments.
• Scottish Public Health Registrars Disability Forum. The work of the Forum was presented by a Public Health Registrar. The Forum provides peer support and advocacy for Public Health Registrars who are neurodiverse or registrars with a disability. The Forum is attended by the regional disability specialty advisor. Recent work includes plans for an inclusive leadership series. 
• Growing a Diverse Public Health Workforce. This work was presented by Amarjot Gill, Future Leaders Fellow. The secondment, offered by the School of Public Health in Yorkshire & the Humber, aims to understand and implement steps towards achieving maximum diversity in Public Health programmes (specialty and practitioner). The focus is on increasing equality, diversity and inclusion in these programmes through three key areas: recruitment (broadening access, reviewing pathways), whole school approach (identifying national health needs) and CPD development (regular EDI training).
• ADPH London: Diversifying the Workforce and Encouraging Systems Leadership: This workstream is led by Dr Nike Arowobusoye and Dr Natalie Daley, Consultants in Public Health, and forms a part of the Public Health: Tackling Racism and Inequality Programme. The workstream will take a systems approach to tackling health inequalities with recognition of addressing the lack of diversity within the public health workforce (entry to senior level). It will lobby, monitor, review and provide training to dismantle norms and go beyond unconscious bias training, working towards cultural shifts associated with inclusive practices. 
• Exploring the lived experiences of Public Health registrars with disabilities in workplace learning settings. This project is undertaken by Fiona Simmons-Jones as part of her academic work for her Masters in Medical Education with the University of Cambridge. An invitation to take part in this research through sharing lived experiences has recently been circulated by the FPH, following academic ethical approval. For more information on this planned research project please contact Fiona Simmons-Jones at fms50@cam.ac.uk.
• The Lancet Series on racism, xenophobia, discrimination and health presented by Delanjathan Devakumar, Professor of Global Child Health and Consultant in Public Health.

A Call for Action; This is a matter of leadership!

Meeting attendees emphasised the importance of moving beyond verbal commitments to workforce diversity and inclusivity, and instead providing leadership at the highest levels across the health system to drive visible and meaningful change.

Identified areas for action included:

• Providing opportunities to learn from one another’s experiences.
• Ensuring parity of esteem across protected characteristics in all EDI focused work.
• Recognising the value of storytelling and using lived experiences to initiate change.
• Improving the collection and sharing of EDI data to enable progress to be monitored.
• Addressing recruitment practices.
• Developing videos for the FPH and other organisations and institutions to showcase ongoing work in this area.
• Developing workforce EDI training materials and toolkits that go beyond unconscious bias.
• Decolonising Public Health training programmes and curricula.

The community of practice will meet again in September 2023 to co-ordinate our action to address public health workforce diversity and inclusivity. We would welcome any interested colleagues also working in this area to join us. Please contact the FPH’s Assistant Academic Registrar, who is supervising the Fair training programme at samia.latif@ukhsa.gov.uk.

Written by: Rachel Fardon, Samia Latif, Kazim Beebeejaun and Kerry Littleford

REFERENCES

1. Coronado, F., et al., Understanding the Dynamics of Diversity in the Public Health Workforce. J Public Health Manag Pract, 2020. 26(4): p. 389-392.

2. Böbel, S., et al., Diverse and inclusive leadership teams in public health schools: the change agents for sustainable and inclusive public health education. South Eastern European Journal of Public Health, 2023.