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Tackling health inequalities must involve addressing lesbian, gay, bisexual and trans inequalities

Posted in Healthcare, HIV, LGBT, Mental Health, SIG, tagged , , , , on July 7, 2017| Leave a Comment »

By Dr Justin Varney, National Lead for Adult Health and Wellbeing, Public Health England

Public Health England estimates that between 2-5% of the population identify as lesbian, gay, bisexual or other – comparable to many ethnic minority and faith populations. Despite legislative reform many LGBT people continue to experience discrimination, marginalisation and harassment.

  • 38 per cent of trans people have experienced physical intimidation and threats and 81 per cent have experienced silent harassment (e.g. being stared at/whispered about)
  • One in five (19 per cent) lesbian, gay and bi employees have experienced verbal bullying from colleagues, customers or service users because of their sexual orientation in the last five years
  • Almost 1 in 4 trans people are made to use an inappropriate toilet in the workplace, or none at all, in the early stages of transition. At work over 10% of trans people experienced being verbally abused and 6% were physically assaulted.

The impact of this discrimination on mental health is easy to understand, however the stark data on suicide and self-harm demonstrates the depth of the impact that this discrimination can have:

  • 52% of young LGBT people reported self-harm either recently or in the past compared to 25% of heterosexual non-trans young people and 44% of young LGBT people have considered suicide compared to 26% of heterosexual non-trans young people
  • Prescription for Change (2008) found that in the last year, 5% of lesbians and bisexual women say they have attempted to take their own life. This increases to 7% of bisexual women, 7% of black and minority ethnic women and 10% of lesbians and bisexual women with a disability
  • The Gay Men’s Health Survey (2013) found that in the last year, 3% of gay men have attempted to take their own life. This increases to 5% of black and minority ethnic men, 5% of bisexual men and 7% of gay and bisexual men with a disability. In the same period, 0.4% of all men attempted to take their own life
  • The Trans Mental Health Study (2012) found that 11% of trans people had thought about ending their lives at some point in the last year and 33% had attempted to take their life more than once in their lifetime, 3% attempting suicide more than 10 times.

The impacts aren’t limited to mental health, and the level of inequalities in lifestyle behaviours such as smoking and substance misuse will almost certainly play out in a great burden of chronic disease and premature mortality over the life course.

The evidence base of inequalities affecting LGBT populations continues to grow as we get better at incorporating sexual orientation and gender identity into the demographics of research and population surveys. Positively, as the NHS rolls out the sexual orientation monitoring information standard this year, this understanding will no doubt continue to grow.

As public health professionals we have a responsibility to advocate for the populations in our care, and this should include advocating for LGBT populations. Lesbian, gay, bisexual and trans communities are diverse, vibrant and varied and have many assets, although the LGBT community sector has faced fiscal challenges due to the economy there remain many small local LGBT organisations that are keen to work with public health teams to address these inequalities.  This is population who clearly need our professional expertise, advocacy and support to co-produce solutions for change and one where we could have a real impact.

So during this lesbian, gay, bisexual and trans Pride season please take up the opportunity to engage, empower and partner with your local LGBT community.

FPH is committed to improving the health and well-being of the LGBT population. If you would like to join us in our work please consider joining our Equality & Diversity Special Interest Group or our LGBT Health Special Interest Group. To express an interest in joining please email policy@fph.org.uk and we can help you get started!

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Update on our General Election campaign and how you can help

Posted in Brexit, General Election, Uncategorized, tagged , , on June 1, 2017| Leave a Comment »

By Professor Simon Capewell, FPH Vice President of Policy 

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

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

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

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

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

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

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How health professionals, organisations and systems can invest in a healthy future

Posted in Uncategorized, tagged , , , on March 5, 2015| Leave a Comment »

by David Pencheon, FPH member

This blog is part of a series of posts to promote discussion and debate around the priorities in Start Well, Live Better: FPH’s manifesto for the 2015 General Election.

"Never in human history has the health and welfare of so many people (already living and yet to be born) depended on so few people who know so much and are doing so little."

Our behaviour is more influenced by our surroundings than we think.  Our behaviours are a function of what surrounds us – physically, socially and culturally,  We are shaped by norms more than we shape them.  Consequently, when an influential group of people have the chance to re-set norms in visible and newsworthy ways, where results benefit almost everyone both immediately and long term, why wouldn’t we seize the opportunity?

Well, health professionals and health organisations now have such a chance.  The case for divesting from fossil fuel is now very strong.  The British Medical Association (BMA) is committed to this journey and since its 2014 Annual Representatives Meeting (ARM) is actively investigating how best to send out a powerful message on health and social justice.

This very welcome move will hopefully start a trickle and then a tidal wave of divestment from the fossil fuel industry which, like the tobacco world, has spent outrageous sums of money on sowing doubt about the harmful effects of a high carbon world and the beneficial health and equity effects of a low carbon society. Read Oreskes book: Merchants of Doubt.

In retrospect, the data now strongly suggest that the fall in smoking levels amongst many groups did not really happen until health professionals (particularly doctors) stopped smoking.  We all have bizarre habits where our creative energy is used more to justify them than to address them.  If we struggle to justify our smoking habit to our peers or to ourselves, where better to reassure one’s self than by pointing to a health professional smoking.

Change does happen though, often quickly, although rarely planned (witness the banning of smoking on the London Underground).  Such changes are often not driven primarily by the law (smoking on planes and overground trains).  If health professionals and organisations simply all say: no, we do not invest any assets we have supporting an industry which knowingly perpetuates an addiction (to fossil fuel) and does not actively attempt to address this threat in the radical ways needed.

Fossil fuel companies need to understand that their so called wealth is largely based on resources still in the ground – which the incontrovertible evidence (supported by the UN, the World Bank; The Pentagon, the UK Ministry of Defence, and the CIA) says needs to be left there.  City investors are already having doubts about the real worth of some fossil fuel companies if their so-called assets are theoretical.

We should therefore welcome the move of the BMA to be the first large health organisation to tread this path.  A full description of the background to why we should actively divest from the fossil fuel industry is in MedAct’s latest report. What we will do in future might appear odd and different now, but in retrospect nearly always appears normal surprisingly quickly
We have a duty and responsibility to help shape the future as much as we are shaped by it.

The great mystery to historians at the end of the 21st century (if there is anyone left to write our history) any of us left) is why, at the beginning of the century, we did so much talking and research on what is happening and took so little action.  Never in human history has the health and welfare of so many people (already living and yet to be born) depended on so few people who know so much and are doing so little.  Do something good today and write a letter to the President, CEO, Chair and Treasurer of the BMA and congratulate them for at least actively and publicly committing themselves to this journey.

And ask your own organisation how much is invested in the fossil fuel industry. These are not easy questions. What constitutes a fossil fuel company? Are any savings I have ethically invested? But they are not impossible. We must not let perfection be the enemy of pragmatism and we must start today not tomorrow.  This is all happening on our watch and will be our legacy.

When our great grandchildren say to us: what did you do at the beginning of the century, let us all try and do more than just mumble we that we knowingly and passively conspired with circumstance. Health professionals, rightly or wrongly, are still well respected, are numerous and interact with all members of society every day and in every community in the land.

Numbers matter: one person is a crackpot, two is a pressure group, and three is a social and political movement. If health professionals don’t draw a line in the sand, then who will? And if we don’t do it now, then when will we do it?

Further reading:
1.    Oreskes and Conway: Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming.  2013.
2.    MEDACT’s call for Fossil Fuel Divestment by the Health Sector. “Unhealthy Investments”
3.    BMJ 2014;348:g2407  Why doctors and their organisations must help tackle climate change: an essay by Eric Chivian
4.    The Faculty of Public Health “Sustaining a Healthy Future – taking action on climate change” 2009
5.    The Global Climate and Health Alliance Civil Society Call To Action at the World Health Organisation Conference on Health and Climate August 2014

A version of this blog was first published on the BMJ website.

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Nudge or fudge?

Posted in Alcohol, Health Protection, Obesity, tagged , , , , , , , , on March 16, 2011| Leave a Comment »

By Alan Maryon-Davis

Health Secretary Andrew Lansley wants to encourage people to eat healthily, drink sensibly, stop smoking and get more active without lecturing or hectoring them. People don’t like being told what to do or not do – least of all by the Government – so Lansley says we should provide them with information and incentives and let them choose for themselves – nudging rather than nannying. Hence the Great Change4Life Swapathon with its supermarket discount vouchers for healthy options. Lots of carrots, no sticks.

There’s also much nudging behind Lansley’s Responsibility Deal with the food, drink and fitness industries. Double nudging – Lansley nudging them to nudge the public. Industry will “pledge” to provide information and incentives encouraging healthier choices.

So where’s the fudge? In return for industry cooperation (and cash) Lansley has said he’ll go easy on mandatory regulations around such things as marketing, labelling, availability and pricing. To be fair, he doesn’t rule these threats out completely. He talks about the Nuffield Ladder of Interventions, with the least intrusive (information, education and incentives) at the bottom and the most intrusive (regulation and legislation) at the top. But he’s made it clear he doesn’t want to climb that ladder unless he absolutely has to. It wouldn’t fit his political philosophy.

So there’s a big fudge around how he’ll monitor adherence to voluntary approaches, assess progress and judge when to bring in mandatory controls. The food and drink industries are notoriously slippery, evasive and foot-dragging – just look at labelling and marketing. Meanwhile the health lobby is going along with the Responsibility Deal in the hope that things might be different this time – well aware they risk being be-smudged as part of the fudge.

I’d like to see a solid pledge by the Government to regulate or legislate if voluntary approaches fail and to be crystal clear about how and when such judgements will be made. Without an explicit commitment to use force if necessary, the deal will be seen as no more than a charade letting Big Business off the hook.

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Listen to Andrew Lansley’s speech from FPH conference

Posted in Public Health Events, tagged , , , on July 8, 2010| Leave a Comment »

Secretary of State Andrew Lansley’s speech plus short Q&A, Wednesday 7 July at the Faculty of Public Health annual conference

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Alcohol costs £2.25m per year – FPH conference told

Posted in Alcohol, tagged , , , on November 12, 2009| Leave a Comment »

One in 20 deaths in Scotland is linked to alcohol, said Dr Lesley Graham at the Scottish FPH conference.

Scotland has the fastest growing rate of liver disease in the world, said Graham, public health lead for alcohol and on the policy team for alcohol in the Scottish government.

The estimated cost to Scottish society was £2.25m per year, she added.

Price and consumption were linked, she argued. “Tackling price is so important,” she said.

Education is not powerful enough on its own, she said, putting the argument for minimum alcohol pricing.

Graham’s speech at the annual FPH Scottish conference, being held in Peebles, caused a call for a vote from the floor in support of minimum pricing.

The ad hoc vote was massively in favour of the proposal.

 

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