Feeds:
Posts
Comments

The Public Health Dashboard is an online, easy to use tool providing information at your fingertips on a number of indicators related to local activity to improve the public’s health and wellbeing. You can learn more about the tool, the data it presents, and how to use it here.

Tools like this one are aimed at local decision-makers, such as senior council officers, to help inform their investment decisions. This will be especially useful when, at some future date, the public health grant fence is removed. At the moment, the tool includes the following local authority service areas:

  • Best start in life
  • Child obesity
  • Drug treatment
  • Alcohol treatment
  • NHS Health Checks
  • Sexual and reproductive health
  • Tobacco control
  • Air quality (interim indicator)

Based on feedback, PHE (Public Health England) and the Faculty of Public Health (FPH) have embarked on a partnership to consider the inclusion of wider determinants of health indicators in the tool and ensure that the voice of the public health workforce is reflected in the final outcome. Our members believe that if this tool is really going to help them make the case in their local authority for more investment for the interventions or services that keep us healthy and well, then indicators that speak to places, sustainability, good jobs, and community cohesion need to be included alongside the mandated services.

However, there are potentially hundreds of ‘wider determinants of health’ (WDOH) indicators that could be included in the tool. To come up with a manageable list of indicators to consider in more detail, we surveyed FPH members about influence and impact. Here is a summary of what they told us:

The Top 5 indicators that councils can influence

  • Active transport
  • Number of premises licensed to sell alcohol per square kilometre
  • Density of fast food outlets within 400 metres of schools
  • Density of fast food outlets
  • Access to parks and recreation spaces

The Top 5 indicators that impact health and wellbeing of local residents

  • Overcrowded households
  • Social isolation in adult social care users
  • Fuel poverty
  • Statutory homelessness
  • Active transport

The survey findings provided us with a wealth of information about influence, impact, and future priorities for our members in terms of the work that they are currently doing locally and also what they think will become more important over the next 2-3 years.

We then used our survey findings to inform two workshops held in London and Birmingham in early November. The workshops were attended by FPH members working in local authorities. Over the course of two afternoons, we had lively and interesting debates about the indicators and how a simple tool like the dashboard could best represent a complex area, such as the wider determinants.

The PHE team is still considering the next steps in terms of how – or indeed if – to incorporate the WDOH indicators into the tool. We hope to use the findings from this work to do a larger project, examining how our members and others working public health can better influence spending in their local authority to tackle the wider determinants of health.

If you would like to get involved in our work or learn more about this project, please email policy@fph.org.uk or click here.

Written by Lisa Plotkin, Senior Policy Officer, FPH

Advertisements

A thread that runs through the entire Public Health Funding Campaign is the need to demonstrate the value of public health and the vital work public health professionals do. As Steve Brine, Minister for Public Health and Primary Care, said earlier this year:

The competition for resources isn’t getting less fierce. We all need to get better and smarter at making the case for our share of resources.

As well as gathering and generating the evidence we need to make the case for investing in public health across our three policy ‘asks’, we wanted to find a way to visually bring it to life as well.

As you’ll know from this blog, it’s challenging to find photos that communicate what public health is and the diverse nature of the work our members do, so we decided to change that.

We launched a photo competition to challenge our members and wider public health community to take a photo that illustrates what ‘public health looks like’ through their eyes. The aim was to celebrate the breadth, diversity and importance of public health in the UK and around the world, and we were blown away by the entries.

From the moment we launched the competition in mid-July, we were overwhelmed by the positive responses we received, so it’s important to take this opportunity to thank absolutely everyone who helped us make it such a success. When we closed the competition in October we’d received over 200 entries, including some spectacular images covering a whole range of public health activity from community outreach programmes combating loneliness to immunisation clinics in the Middle East. A large chunk of the entries we received were from non-members, indicating how many people are engaged in FPH and the valuable work our members and other public health professionals do.

The story is not over yet though. Our judging panel, made up of both public health and photography experts, met on 13 November to narrow the impressive array of entries down to a final shortlist. Before beginning the judging, the panel agreed that they wanted each of the selected photos to tell a public health story in its own right and be visually arresting as well as technically proficient. They also wanted the final shortlist as a collection to showcase a broad and diverse range of public health activity. In the end the standard was so high that, instead of 20 photos, this shortlist ended up including almost 30.

Vote for your favourites!

It’s now down to you, our members, to decide on the ten photos that will be displayed at FPH’s first ever photography exhibition. The winning photos will also have a permanent home on our website, and will be used as a travelling exhibition, displayed at key events throughout the year.

Please get involved by taking a look at the shortlisted photos, then voting for your five favourites via this link.

We are so excited to hear your views on the final photos, which we can all use to celebrate public health as we see it and strengthen the case for increased funding of our vital public health services. We hope they make you proud to work in public health because they make all of us at FPH proud to represent you.

To cast your vote, click here!


Written by Rachel Thomson, Specialty Registrar and member of FPH’s Public Health Funding project group. You can follow her on Twitter @rachel_thomson. If, like Rachel, you’re a Specialty Registrar and want to get policy & comms experience by joining our Registrar Project Scheme, email policy@fph.org.uk to find out how you can apply.

cof

As part of FPH’s Public Health Funding campaign, we are undertaking a project examining the role that NHS organisations play in prevention.

We have received an award from the Health Foundation to carry forward a varied work programme over the course of 9 months, involving our members from across the UK and other key partner organisations. The project aims to:

  • Build a better understanding of how the NHS currently delivers prevention
  • Understand what ‘good’ prevention in the NHS looks like
  • Explore the barriers and enablers for NHS organisations seeking to take a more preventive approach
  • Determine initial priorities for increased investment or focus – including interventions, approaches, and workforce needs

As part of our work so far, we have commissioned an evidence review exploring prevention in the NHS, which looks at 3 main topics:

  1. What are the main types of prevention work researched in various NHS settings?
  2. What are the benefits of prevention programmes in the NHS?
  3. What helps and hinders prevention in the NHS?

The review is a unique and fantastic overview of prevention approaches in different NHS settings. It looks at impact, what works and what doesn’t, and what might improve current approaches if done well. The review highlights the importance of a systems approach, and engaging with both staff and the public. For a summary of some of the main takeaways please have a read of this blog or have a read of the review itself.

We also held a stakeholder workshop in October gathering expert opinions on prevention in the NHS, which we used to inform part of FPH’s submission to the NHS long term plan consultation. Attendees at the workshop included representatives from NHS England, Public Health England, Cancer Research UK, and the Royal College of Physicians.

A key takeaway from the day was that this is a complex topic, but colleagues across the health field are committed to supporting the NHS to do more, better, and system-wide prevention. We will soon be publishing our first in a series of discussion papers, summarising our learning so far and discussing some of the tensions we still need to reconcile. We’ll also be posing some key questions around the evidence base and priority areas for action that we will need our members to help us answer. We then plan on hosting two more workshops in the Spring to continue building our evidence-base and drawing together expert advice and consensus.

This is a really exciting piece of work and has been expertly supported by the wider FPH team and our Public Health Funding Advisory Board, who graciously give up their time to contribute. Please stay tuned to the FPH blog and follow FPH on Twitter to hear more about the progress of the campaign. If you wish to comment, contribute, or donate to the campaign please contact policy@fph.org.uk or visit the public health funding page of the FPH website by clicking here.

Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group

We’re calling for the UK Government to invest in a Prevention Transformation Fund to support the upgrading of prevention and early intervention activity in local authorities in England in next year’s Comprehensive Spending Review. (This is the Treasury-led process to allocate resources across all government departments.)

The recognition that local authorities have a much greater influence on the wider determinants of health was the reason for the transfer of public health from the NHS to local authorities in 2013, and we were pleased to see local authorities again acknowledged as “leaders in local health improvement” in the Department of Health & Social Care’s (DHSC)’s recently published vision for prevention.

The vision recognises that the enormous potential of councils to improve the health and wellbeing of their residents rests largely on their ability to “tailor public health services to local need, to support economic growth, and to influence the wider determinants of health through policies on housing, leisure and other services”.

However, in recent years, local authorities’ ability to do just this has been severely curtailed by extensive cuts to the public health grant and wider council budgets. Most authorities have just about coped with budget cuts while maintaining a high level of standards, but our members working in local public health teams have told us they have reached the absolute limit of the savings they can make without adversely impacting the wellbeing of their residents.

Local authorities have enormous potential to improve the health and wellbeing of their residents, but to achieve it, they need both the funding and the freedom to do exactly what is asked of them: tailoring services, developing new and innovative ways of working and of engaging with their communities in order to best meet local needs.

We believe a dedicated Prevention Transformation Fund, separate from and in addition to the ring-fenced grant, would give local authorities back the ability and freedom to do just this. Our recently published discussion paper, developed following extensive consultation with our members and other stakeholders, outlines why we believe a Prevention Transformation Fund is the right approach, as well as initial ideas about how large the fund should be, what it should pay for and where the money for it could come from.

The ultimate aim of this work is to change national policy to benefit the health of the public and, in doing so, we want it to reflect your voices. We’re very keen to continue to get feedback on the paper from our members and other stakeholders, including answers to the following questions:

  1. What should the high-level objectives of the fund be?
  2. What conditions should be attached to the fund?
  3. What should we expect to get from this investment and in what timeframe?
  4. What are the accountability arrangements?
  5. What would the likely consequences be if we didn’t invest in prevention transformation?

We will be publishing a revised version of the discussion paper next month, including answers to the questions posed above, so please do have a read and send your comments to policy@fph.org.uk.

This is your campaign and your chance to influence national policy, so please get involved and help us make local government public health the national priority it deserves to be.

Written by Andrew Turner, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group.

John Middleton 2 webIt’s the season of goodwill and I wanted to write a special extended version of my regular monthly column as a Christmas gift to you all. This month is packed with significant celebrations. Today (10 December) is the final Day of the Hanukkah Celebrations and it is also the 70th Anniversary of the Universal Declaration of Human Rights.

For all of us December is a time to reflect and enjoy precious moments with our family and friends. May we each, according to our beliefs, enjoy, mark, reflect, share and give in our December festivals. I wish you all a very Happy Christmas, Hanukkah, Bodhi day, Pancha Ganapati, Omisoka, Kwanzaa, Yalda, Zaratosht No Diso, Yule, Winter Solstice, and more.

Please do come back restored, refreshed and revitalised for the uncertain times we face. There has never been a more necessary time to protect and improve the health of the public and there has never been a more important time for the work of our public health community. Happy New Year!

Prevention is better than cure

On 5 November, Matt Hancock, Secretary of State for Health and Social Care, published his Prevention Vision. I welcomed this vision which paves the way for a Prevention Green Paper. You can read my full statement here. 

It is the first time that anyone has seriously talked about cross-governmental health in all policies since the 1999 ‘Our Healthier Nation’ white paper. We will be working closely with the Government on the publication of the Green Paper with the aim of making the case for prevention to help tackle inequalities, a commitment to health in all policies and to protect the well-being of future generations.

The right to health is a growing and significant idea which needs to feature in all our lobbies for health in every nation. Scotland is leading the way on rights to health, and the FPH in Scotland conference in November was a triumph showcasing clear thinking on the place of rights, law, and values in our work to improve the public’s health. I congratulate the FPH in Scotland convenor, Julie Cavanagh, the FPH in Scotland Committee, our colleagues at the NHS in Scotland and everyone involved in putting the event together. You can read more about the conference below and anyone interested in viewing my presentation can click here.  

Invest in public health and prevention

There is a swelling tide of bold public statements about the need to invest in prevention and public health. Amongst them, The Academy of Medical Royal Colleges in its response to the NHS 10 year plan, the President of the Royal College of Physicians of London, and the Association of Directors of Public Health. The Health Foundation argues the Government should invest £1.3 billion in 2019-20, reversing cuts since 2015 and investing according to need, with the most deprived areas benefiting early, but they also call for £1.9 billion in new investment by 2024.

The Kings Fund has added to this sea-change of thinking, in their call for investment in prevention and addressing the wider determinants of health. The King’s Fund name checks our emerging policy call for a ‘Prevention Transformation Fund’ to inject new funding into local government prevention services of between £1-2 billion per annum. We will be arguing strongly for this in the comprehensive spending review lobby and in our contributions to the public health green paper. On such a full sea are we now afloat. And we must take the current when it serves, or lose our ventures.

Poverty, destitution and health inequalities

The UN rapporteur Philip Alston’s hard-hitting report on poverty was published earlier this month. Despite receiving some negative critiques, we should all be deeply shocked – he was holding up a mirror for us and we should not blame the mirror for what we see. The inequalities in health I have fought against most of my professional career have taken a new low, a new level of injustice. For example, Universal Credit was meant to simplify the benefits system but in some cases has seen people wait for up to six weeks to receive their payments, meaning they’ve had to rely on foodbanks to eat. The Joseph Rowntree Foundation Report on destitution earlier this year showed us how national and local government are now the biggest creditors on the poor – not loan sharks and the gambling industry.

Fracking, sustainable development, climate breakdown and FPH disinvestment 

Our Sustainable Development Special Interest Group responded to two government consultations on fracking last month which you can read here and here. Our view on fossil fuels is ‘leave it in the ground.’ 

Professor Patrick Saunders and I visited the fracking pad at Little Plumpton in Lancashire to talk to locals and witness first-hand the disruption, stress and uncertainty they are experiencing. If you believe we don’t need shale gas because we have to prevent climate breakdown, it also follows that no community should be subjected to this. And as Greenpeace’s UK director said earlier in the month:

“After all the many millions invested, the changes in the law, the removal of local democracy and property rights and weeks of earth tremors, the industry has produced a deep hole in a muddy field with a small amount of very expensive gas at the bottom. Over the same period, onshore wind became the cheapest source of power in the UK.”

Also on the climate breakdown front, I bought a new electric car this month. And no I don’t see them as an answer to our air pollution problems. In my paper to the RCP History of medicine conference I described the Spice Wars of the 1600s, involving private armies and private corporations from the superpowers, England and Holland, plundering local wealth, destroying local culture, enslaving local people, mutilating and torturing as they went, in order to supply the treasures and everyday comforts of the wealthy back home, who were oblivious to what lives were destroyed to get them what they wanted. The modern day parallel with cocaine wars is obvious, but the parallel with more commonplace consumer trade today is only just coming into focus. Conflict minerals required for all our latest devices, and now with the growth of electric cars, it seems we will create newer bigger and better conflicts in the grab for lithium and cobalt.

News in brief

  • Along with Presidents of the other medical royal colleges, I signed a letter to NHS England’s Chief Exec Simon Stevens calling for tobacco control measures to be part of the NHS’s Long-Term Plan
  • I presented at the East of England’s Public Health Conference this month – you can take a look at my presentation here
  • Chris Packham, our Chair of the Health Services Committee has published a thoughtful piece on population health on the RCP London website – it is very much in keeping with our aspirations for greater involvement and commitment to public health skills and thinking in acute healthcare
  • Look out for BMJ opinion pieces on ‘The Nanny State’ and NHS charging migrants for healthcare

FPH in Scotland Conference, Nanny State report, Universal Declaration of Human Rights, migrant health

Scotland is leading the way on rights to health and their conference in November was a triumph of clear thinking on the place of rights, law and values in our work to improve the public’s health. I congratulate FPH in Scotland’s convenor Julie Cavanagh, the rest of the Committee of the FPH in Scotland, and everyone involved in putting the event together.

The conference also saw the launch of our Nanny State report by John Coggon, Professor of Law at Bristol University. The public health community needs to grow its understanding of law and how to use it and apply it across the full range of our work. High level intervention, through regulation and taxation are far more effective than exalting individuals to change and victim blaming. Our ‘Do No Harm’ campaign briefing shows how we should be pushing these legal protections in future trade deals.

At the Scottish conference many of the speakers, including myself, highlighted the significance of the Universal Declaration of Human Rights. This month also marks the 80th Anniversary of the arrival of the first Jewish refugee children to escape Nazi oppression on the Kindertransport. It is timely to reflect on our country’s honourable pedigree as a haven for people displaced by war and intolerance and to reassert our respect for human life and rights. With other Royal Colleges we will be calling on the Department of Health and Social Care to review the provisions for migrant charging, which we see as hostile, unhelpful and uneconomic. We have already published our own statement. Thank you to Robert Verrechia, Liam Crosby and Farhang Tahzib for their work on this.

Song of the month

Not particularly festive, but certainly party-time, good time blues. At the East of England conference I asked what was the best music to come out of the East of England? No-one said Benjamin Britten, someone said Pink Floyd, and someone was too shy to say ‘Ed Sheeran’. I played ‘The Shoals of Herring’, Ewan MacColl’s great song inspired by the Yarmouth herring fishers. But the answer to the question was ‘Doctor Feelgood’, the Canvey Island delta bluesmen. This is our version of one of their songs, ‘Down at the doctors’. 

Written by FPH President Professor John Middleton. You can follow John on Twitter @doctorblooz.

Yemen image 1One Saturday afternoon 2 years ago, not long after I had joined the Public Health training scheme, a WhatsApp message came through from one of my childhood friends. The remarkable thing about this was that my childhood friends are all from Yemen, and therefore all in the middle of ‘the War’, and so did not often have WiFi. The message meant that someone had managed to get hold of some increasingly unaffordable diesel, to power up a WiFi mast.

I rang her; she said there was no point video-calling as they had no electricity and all 8 of them were huddled around one solar-powered desk lamp in the basement, which also charged their phone. I felt a little unsure of what to say, so I switched my video on and walked them around my roomy house and we laughed at how many electrical appliances I had and how useless I would be should I also find myself in the middle of ‘the War’. I think they were just relieved to hear someone else’s voice, to have a sense that there was a part of the world where things were calm enough for things like toasters to exist, but after I had rung off my mind was buzzing and I felt a strange ache. What could I do? I felt far away and helpless.

Yemen image 2But it made me think that is these very things that compelled me to pursue public health in the first place. I want to use whatever drop of energy I have in things that challenge my mind, but also give me heart ache; that bizarre human feeling of being both strong and weak all at once.

I felt it again today, while I sat on a train going to work reading a new report by Martha Mundy for the World Peace Federation; “Strategies of the Coalition in the Yemen War”. It is a fine piece of public health work. It collates and displays a range of data and information to generate patterns, from which to draw evidence-based conclusions, which are to motivate change that would save many many lives.

In general the war in Yemen, despite being in its fourth year, gets little press. However, as the civilian death toll in Yemen rises, there has been increasing international scrutiny of the Coalition, which consists of Saudi, backed by its allies the UK, France and the US. Are so many non-military hits justifiable?

It seems not.

This new report profiles large amounts of data on Coalition attacks in Yemen between March 2015 to March 2018. It describes the geography and changes in tactics of attacks over time, along with mapping out the proportion of attacks on civilians in the different governorate regions, shown in Figure 1 below.

Yemen image 3

Proportion of civilian, military and unknown targets in governorates of Yemen. YDP data March 2015 – March 2018.

“From August 2015 there appears a shift from military and governmental to civilian and economic targets, including water and transport infrastructure, food production and distribution, roads and transport, schools, cultural monuments, clinics and hospitals, houses, fields and flocks.”

In particular, the report maps the targeting of agricultural land and fisheries, and explains the consequences for a country on the brink of famine, that relies on small scale farming and fishing for survival.

The report describes some of the recent attacks with high civilian death counts, such as a school bus target from August this year, and then states:

These atrocities receive attention from the UN Humanitarian Affairs Coordinator and the international press, but shielded by allies, the Coalition remains exempt from any independent investigation to determine legal responsibility and from significant international mobilization to stop the war in Yemen.

Yemen 4.jpg

Figure 2. All Agricultural targets

The conclusion that the report comes to is a clear one, as colluding in war crimes is not an allegation to make lightly:

If the Coalition war in Yemen is not to mark the erasure of legal referent in war, other forces and institutions will need to call into question the blanket ‘legitimacy’ accorded the Coalition to date by the world’s highest legal body, the UN Security Council. If UN Security Council resolution 2417 (24 May 2018), condemning starvation of civilians in wartime, is to be meaningful, then it is necessary for the UNSC and its member states to halt such crimes in Yemen, to investigate them, and to call to account those responsible for perpetrating them.

I wish I could tell my friends, that people who are out there, with toasters, feel that humanitarian laws should apply to Yemen.

You don’t need to be an expert on Yemen, just have a mind, and a heart. It’s in these challenging times that we are invited to exercise what is important.

If you are interested in knowing or doing more, please get in touch with the Yemen Special Interest Group via this link. Depending on what you are like, you can also write to your MP, share the report, or even write a song.

Written by Rachel Handley, member of FPH’s Yemen Special Interest Group

Duncan SelbieThe Secretary of State for Health and Social Care, Matt Hancock, has launched his prevention vision; confirming it as one of his key priorities alongside technology and workforce. PHE’s Chief Executive Duncan Selbie discusses why this is a transformative moment for public health.

Investing in public health is the smartest thing we can do – good health underpins a strong economy.

For years we have known that prevention is better than cure and that we should be moving away from a system that prioritises treatment, to one that can also predict and prevent poor health.

Up until now efforts to invest in prevention within our healthcare, workplaces and communities have fallen short. The NHS Five Year Forward View had genuine ambition to reverse this, but it failed to deliver with short term priorities taking precedence.

The Secretary of State, through publishing his prevention vision has shown he is determined to move more resources into prevention. And he has signalled the NHS Long Term Plan as one way to fund this.

We welcome this, as a promise of prioritising prevention is meaningless without investment.

Good health is of course about more than only healthcare. Wider determinants, including income, remain the most important thing.

But we all have a part to play and there are actions the NHS can take, as part of its Long Term Plan, which will help everyone to live for longer in better health.

Using bedside moments to promote wellbeing and avoid future illness is one step the NHS could take. For example, a smoker who comes into hospital for any reason should be helped to quit smoking. And then when they are ready to leave hospital, this support should continue in the community and at home.

The opportunity that we have now as a public health family is to embrace the energy and commitment of the Secretary of State, and to see more investment going into improving the public’s health.

A promise of radical action with no commitment, where nothing gets done is not an option. Realistic and tangible movement where we can actually achieve something is what we want to see.

This shift in focus is an exciting milestone and should signal a synchronised effort to place prevention at the heart of national and local government, and the NHS.

Written by Duncan Selbie, CEO, Public Health England (PHE). You can follow PHE on Twitter @PHE_UK.


If you’re an FPH member and want to play a bigger role in our Public Health Funding Campaign, please consider joining our membership ‘sounding board’. To find out more, email us via policy@fph.org.uk.