Keynote presentation to the annual inter-island public health conference, Jersey, July 6th 2018, 170706 v5 middleton j public health conference

1. Inter-Island Public health
conference 2017.
A tonic for directors of public health
John Middleton
President
UK Faculty of Public Health

3. Salus populi suprema
lex esto
Cicero
‘The health of the
people is the highest
law’

5. Middleton J, Saunders P.
20 years of local ecological public health: the
experience of Sandwell in the English West
Midlands
http://www.sciencedirect.com/science/article/p
ii/S0033350615003303

6. The Iron Bridge, 1781

7. Coalbrookdale by night, Loutherbourg, 1801

8. Wednesbury by night, unknown, c1850 museum of
Iron, Ironbridge Gorge Trust

9. The ‘Natural
Philosophers’
of the ‘Midlands
Enlightenment’
including Wedgwood,
Boulton,Watt,Darwin,Prie
stley
Met by the light of the
full moon
studied chemistry, botany,
zoology, geology,
engineering with a view
to making things, and
making a profit ….

10. Joseph Priestley, ‘Inventor of air’ and
soda water

11. The Birmingham Riots 1791

27. Sandwell Valley,
King George
Playing fields
2014

31. New leisure
centres Tipton

32. PHE Public
health
‘fingertips’ data
- good local
profiles on many
conditions: are
we interpreting
these
intelligently ?

33. Long term
conditions
Kidney
disease
Standardised
prevalence
ratio for
haemodialysis

34. Long term
conditions
Kidney disease
Access to pre-
emptive
transplantation

36. Table 2a
Preventable
causes of
hospital
admission,
Sandwell &
Western
Birmingham
Clinical
commissioning
group, 2012-13

39. ‘Towards 2010’ the Sandwell and Western
Birmingham Health partnership 2003-2009
‘Right care right here’ 2009- present
A hospital development idea 2002
A partnership 2003
Involving public health 2005
Major public consultation 2006
Major health impact assessments 2006
Strategic models of care 2009
Relocated acute and elective surgery 2011
Relocated maternity and closure of one unit 2011
Progressive relocation to primary care,
and reduction of outpatient work
Midland Metropolitan Hospital approved 2014

40. The new Midland Metropolitan hospital
Opening 2018

41. My presidency
Build local authority relationships
Build relationships in health and public health
services in four nations of the UK
Do things jointly where possible - policy statements,
conferences
Implement new curriculum: personal effectiveness
and values and ethics; rebuild health protection and
health care public health
Develop member involvement
Ensure solid member services, build special interests
Develop faculty governance
Pursue 12 asks of the Manifesto
Planetary health
A Public health curriculum for young people
Brexit, drugs, air pollution, AMR, violence prevention
‘Don’t just fight for the profession of public health
fight for the public’s health’

45. President gets cross on Childhood
obesity strategy- August 2016

46. Scottish conference sings ‘Freedom
come all ye’

47. With Northern Irish colleagues in
Belfast for the public health walk
William Drennan- patriot,
radical, poet, obstetrician
and champion of public
health

48. President’s visit to Wales, January 2017

49. The globe from the South Pacific
10m people
1/3 of earth’s surface water
Greatest prevalence of diabetes in
the world
80 %of world’s tuna fish comes from
there
‘canary in the coal mine’ for climate
change:
Sea level rise
Acidified oceans
Warming oceans
Death of marine ecosystems,
including the coral reefs
Nowhere in the planet is exempt
from global health and
environmental problems - caused by
humans

50. A role for our climate
change special
interest group

52. The Birmingham Tornado,
2005

55. Interconnectedness:
conflict over natural
resources: oil, water

56. Interconnectness
:
Climate change
refugees

58. Interconnectedness : acidifying Oceans kills the Coccolithophore
(diatom) producer of 50% of the world’s oxygen – multiplying global
warming

59. Interconnectness: Loss of agricultural land through global
warming, crop failure, food riots, Arab Spring, Syrian war

60. ‘Saving lives with solar’ Royal
North midlands Hospitals, Stoke.

61. Thinking globally,
acting locally:
Coventry and
Warwickshire
University
Hospitals Jubilee
Nature Reserve –
managing water
run off from
hospital car parks
- promoting
biodiversity,
saving money

62. ‘Protecting
resources from one
generation to the
next’
The Welsh
Wellbeing of
Future
Generations Act,
2015

64. Public
health
and the
EU post
Brexit

65. Public
health
and the
EU post
Brexit

66. https://www.sustainweb.org/news/oct16_city_food_symposium_2016/
Public health and the EU post Brexit
A country fit to live in:
 Can the UK feed itself ?
 A new Food Act to protect health and improve the
enviornment
 Would reward farmers better and be job creating
 Reduce £24B food imports deficit

67. Public health and the EU post Brexit
A country fit to live in… where
 Britain can power itself ? and
 House itself ? and
 Employ itself ?
http://www.campaigncc.org/sites/data/files/Do
cs/one_million_climate_jobs_2014.pdf

68. Public health and the EU post Brexit
A country fit to live in… where
 Prosperity is possible without
conventional economic growth
 A beacon for sustainable development
and
 Champion tackling climate chaos
 Creates better wellbeing for the future
generations…

69.  The epidemiology of violence
 Evidence-based violence prevention: a life course
approach
 Asset based community development
 Primary, secondary &tertiary prevention role of the
public health community as primary preventers of violent conflict,
through healthy public policies and tackling major social inequalities in
health; and as early reactors, mitigaters and responders to violence.
 New public mental health approaches
 A role for public health in conflict resolution with
aid agencies, political scientists, theologians and international lawyers
 A role for public health educational bodies
 A leadership and partnership role for public
health
www.fph.org.uk/uploads/Violence%20report.pdf
Areas of action for the public health
community in preventing violence

70. Global & local violence-
epidemiology and evidence
www.euro.who.int/violenceinjury
www.who.int/violence_injury
www.who.int/gender
◀️Middleton
J, Sidel V.
Terrorism &
public
health. In
Promoting
Public
Health.
Open
University
and Sage,
2007
Global deaths from interpersonal and collective violence,
2005 and 2015
0
100000
200000
300000
400000
500000
600000
2005 2015
Numberofdeaths
Collective violence
Bellis,
M. A.et
al.
London:
NHS
and
Dept. of
Health,
2012▶️
Source: GBD 2015 Mortality and Causes of Death
Collaborators, 2016

71. Crucial importance of early years, the first
1001 days and adverse childhood experiences
An evidence based approach – Good systematic reviews re
early years interventions, parenting training, youth
mentoring; good modelling of alcohol pricing, control of
access and enforcement.
A life course approach- new concerns about adverse
childhood experiences (ACES) impacts on violent behaviours,
poor communication and poor mental health in later life
A public mental health approach- linked to ACEs, the
neurobiological hardwiring of young brains in the first 1001
days; Reinforcing positive mental attributes: self-confidence,
self-esteem, self-expression and positive communication
A public health approach to violence prevention
Early Death
Social, Emotional and
Learning Problems
Adopt Health Harming
Behaviours and Crime
Disrupted Nervous, Hormonal
and Immune Development
ACEs Adverse
Childhood Experiences
Non Communicable Disease, Disability,
Social Problems, Low Productivity
LifeCourse
Death
Birth
Adverse Childhood Experiences (ACEs): impacts across
the life course. adapted from Felitti et al, 1998

73. http://www.bmj
.com/content/3
57/bmj.j2676

74. UK Faculty of Public Health General election statement
 Health in all policies
 Address health inequalities
 Create conditions for the health and wellbeing of future
generations
 Brexit: defend our rights to health and ensure trade
deals aspire to better health not less
 Public health funding – restore cuts and increase
investment
 Redevelop and secure the public health workforce
 Support our members and partners to achieve the
outstanding policy asks of ‘Start well live better’

75. Preparedness and
safeguarding - key functions
of public health

76. And to conclude ……

79. it's not who
your doctor
is, it's who
you vote for,
that most
affects your
health

80. Thank you
Professor John Middleton
Faculty of Public Health
president@fph.org.uk

81. • Middleton J, ISIS, crop failure and no anti-biotics:
what training will we need for future public
health? European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/7
35
• Middleton J. Public health in England in 2016—the
health of the public and the public health system:
a review Br Med Bull (2017) 1-16. DOI:
https://doi.org/10.1093/bmb/ldw054 and
http://academic.oup.com//bmb/article/doi/10.109
3/bmb/ldw054/2871226/Public-health-in-England-
in-2016the-health-of-
the?guestAccessKey=8f7a33a1-bdbf-4db4-948c-
fd6b6293a259

82. References and resources
Resources :
REWIND http://www.rewind.org.uk
http://www.quilliamfoundation.org/about/
Institute for Strategic Dialogue
http://www.strategicdialogue.org
WAVES Trust www.wavestrust.org.uk/home.html
Parent Infant Partnership http://www.pipuk.org.uk
ECPAT http://www.ecpat.org.uk
TASC http://tascwheel.com
Centre for Nonviolent Communication www.cnvc.org
Medical peace work. Online course work, course
part Health professionals, conflicts and peace.
Berlin: Medical Peace Work, 2015.
http://www.medicalpeacework.org/teaching-
resources/mpw-presentations.html
References
Bellis, M. A., Hughes, K., Perkins, C., Bennett, A. M.,
Protecting people, promoting health: a public health
approach to violence prevention for England. London:
NHS. and Department of Health, 2012.
World Health Organization. (2014). Global status report on
violence prevention 2014.
http://www.who.int/violence_injury_prevention/violence/status
_report/2014/en/ update on WHO (2002). World report on
violence and health. Geneva, WHO
Galtung J (1996). Peace by peaceful means: peace and
conflict, development and civilisation. London, Prio/Sage.
Mercy J et al. (1993). Public health policy for preventing
violence. Health Affairs. Winter:7-29.
Rosenberg M (2003). Nonviolent communication: a
language of life. Encinitas, CA, Puddle Dancer Press.
Santa Barbara J, MacQueen G (2004). Peace through
health: key concepts. The Lancet 364:384-5.

83. • Middleton J, ISIS, crop failure and no anti-biotics: what training will
we need for future public health? European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/735
• Middleton J, Weiss M. Still holding on: public health in the UK after
Brexit. Euroheathnet journal 2016; 22:no 4: 33-35. (ISSN 1356–1030)
http://www.euro.who.int/__data/assets/pdf_file/0010/325945/Euro
health-V22-N4-2016.pdf?ua=1
• Middleton J. Public health in England in 2016—the health of the
public and the public health system: a review Br Med Bull (2017) 1-
16. DOI: https://doi.org/10.1093/bmb/ldw054 and
http://academic.oup.com//bmb/article/doi/10.1093/bmb/ldw054/287
1226/Public-health-in-England-in-2016the-health-of-
the?guestAccessKey=8f7a33a1-bdbf-4db4-948c-fd6b6293a259