Presentation to the first East of England Public Health conference, Radison Hotel, Stagnated. 30th October 2018 181029 east of england presentation vr 2

1. www.fph.org.uk
Big sky thinking: leadership in public health
from the East of England
Professor John Middleton, President, UK
Faculty of Public Health

2. Who we are and what we do
• The United Kingdom Faculty of Public Health is a faculty of
the three Royal Colleges of Physicians of London, Edinburgh
and Glasgow (Physicians and Surgeons)
• FPH is a membership organisation for nearly 4,000 public
health professionals across the UK and around the world
• We also have a growing number of student, associate and
international members in more than 80 different countries
To improve and protect the public’s health:
through standards, advocacy, training and
knowledge
www.fph.org.uk

3. ‘Don’t just fight for
the profession of
public health fight
for the public’s
health’
Public health
professionals are not
here to make
decisions easier, it is
to make things better

4. 330/10/2018
1)The public’s health: global burden of disease, multi
morbidity, NHS plan, Brexit
2) Violence conflict and public health at home and abroad
3) Planetary health: environment, loss of biodiversity, food
and ecosystems balance, climate change.
4) The public health system : the Faculty role today
5) the Faculty strategy to 2025
6) new challenges for public health training
7) new challenge for the public health professional.
8) Big sky thinking - East of England at the forefront of
public health

5. The public’s health

6. The public’s health
There’s never been a
better, or more
necessary, time to be
in public health

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1)The public’s health: global burden of disease, multi
morbidity, NHS plan, Brexit

9. Globally, mortality rates have decreased across all age groups
over the past five decades, with the largest improvements
occurring among children younger than 5 years. However, at the
national level, considerable heterogeneity remains in terms of
both level and rate of changes in age-specific mortality;
increases in mortality for certain age groups occurred in some
locations.
Countries have saved more lives over the past decade,
especially among children under age 5, but persistent health
problems, such as obesity, conflict, and mental illness, comprise
a “triad of troubles,” and prevent people from living long, healthy
lives.
Total deaths in children younger than 5 years decreased from
1970 to 2016, and slower decreases occurred at ages 5–24
years. By contrast, numbers of adult deaths increased in each 5-
year age bracket above the age of 25 years.
Global burden of disease study, 2017

11. These 10 Corporations Control Almost Everything We Eat

12. http://www.bmj.com/content/358/bmj.j4443?sso=

13. Strategic
alliances:
A ‘one
health’
approach

14. A future without antibiotics?
A future with only public health ?

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2) Violence, conflict and public health at home and abroad

16. 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

17. 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

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

20. Interconnectness
:
Climate change
refugees

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

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3) planetary health: environment, loss of biodiversity, food
and ecosystems balance, climate change.

23. A role for our climate
change special
interest group

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GW1.5 main findings

29. Aleksandrowicz et al., PLoS ONE 2016
Systematic review on impacts of shifting from current
(Western) diets to more environmentally sustainable
dietary patterns:
Environmental
Impact
Relative differences compared to
current diets
Healthy dietary
guidelines
Vegetarian diets
Greenhouse gas
emissions
12% reduction 31% reduction
Land use 20% reduction 51% reduction
Water Use 6% reduction 37% reduction

31. Coccolithophore (diatom): Produces 50% of the
world’s oxygen
Algal blooms photosynthesising off
south west coast of Britain

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4) The public health system : the Faculty role today

34. 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

35. Achieved 2015-2017
Plain packaging of
cigarettes
Sugar sweetened drink
tax
Personal health and
social education
reinstated in scholls

36. FPH workforce strategy 2018
1. FPH will champion the unique value of Public Health
Specialists and work with employers, commissioners, decision-
makers and other stakeholders to ensure the specialist role is
understood, recognised, valued and deployed to best effect to
meet employer needs, the needs of an efficient health system
and the needs of the public
2 - FPH will ensure that a flexible Public Health Specialist
workforce is trained, developed and strengthened to meet
employer and the public’s health needs in the future
3 - FPH will work with partners to ensure clear and appropriate
data is available on the current workforce and to ensure that
effective longer term workforce planning is undertaken
4 - FPH will work in partnership with the public health
community to support the development of an effective public
health practitioner workforce and enable the wider workforce to
deliverimprovements to the public’s health

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5) the Faculty strategy to 2025
Outline to Board November 2018
Evolutionary
Enablers :
Partnerships
Membership
International
Finance
Activities :
Advocacy,
Standards,
Knowledge,
Workforce

38. This is a looming disaster and
priority is to limit damage

39. Racist attacks
reported in the
month following
2016referendu
m

40. Brexit policy programme: Three areas
of focus short-listed
1. Protecting the European Centre for Disease
Prevention and Control (ECDC) (and other key
institutions)
2. The Great Repeal Bill – FPH calls on the
Government to introduce a ‘do no harm…and
do better’ clause
3. Free Trade and Investment Agreements, a
transitional agreement and World Trade
Organization rules

42. ‘Do No Harm’ Lord Warner Public Health
amendment to the EU Withdrawal bill
64 Health organisations support, representing over 1 million health workers

43. ‘Do No Harm’ Lord Warner Public Health
amendment to the EU Withdrawal bill
At Report stage Lord Duncan made clear to the House that “the
effect of Article 168 in the domestic law of this country before exit
will continue after exit by virtue of Clause 4…Article 168…will be
available in the future to UK courts to draw upon, both its
elements and its interpretation, and those elements will be
available afterwards…we are now in a good position to offer
certainty.”

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46. https://www.fph.org.uk/media/1961/fph-
dept-for-international-trade-consultation-
response-final-26-oct-2018.pdf

47. ‘Valuing public health’: Three areas of
focus short-listed
1. Making the case for prevention (return on
investment; affordability; value for money; a call
for the ‘radical upgrade to be made real)
2. Investing more in prevention through the NHS (
including secondary prevention; rebuilding health
care public health)
3. Investing for outcomes (Developing the public
health outcomes dashboard, assuring the future
of public health investment)

48. NHS 10 Year Plan
National expectations : Prevention: Alcohol, smoking, diet.
But FPH Health Foundation workshop: Health of staff; strategic and
local leadership, capacity building in health-care related public
health
Then priority services and client groups Early years, tobacco,
alcohol
https://www.fph.org.uk/media/1918/nhs-plan-fph-response.pdf30/10/2018 47

49. 4830/10/2018

50. • 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, Saunders P. 20 years of local ecological public health: the
experience of Sandwell in the English West Midlands
http://www.sciencedirect.com/science/article/pii/S0033350615003303
• Public health and trade
• Public health law, rights, ethics, values
• Genomics
• New technology
6) new challenges for public health training
7) new challenges for the public health professional.

51. 5030/10/2018
Leading the Faculty’s Genomic Special interest
group

52. 5130/10/2018
8) Big sky thinking - East of England at the sentinel of
public health

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61. Anvils - Economy: Workplace Health

62. www.fph.org.uk
Suffolk – ‘Anchors, Anvils and Hammers of Inclusive Growth’
Abdul Razaq - Director of Public Health & Protection,
Suffolk County Council
Inclusi
ve
Growth
Health
and
Care

63. 181016 Armed organised violence and public health BCU

64. 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/D
ocs/one_million_climate_jobs_2014.pdf
MiddletonJ The public's health and the public health system 180530

65. http://www.bmj.com/conten
t/357/bmj.j2676
Inequalities in health cost
£65bn (€74bn; $83bn) in lost
productivity and taxes and
increased benefits payments
plus
£5.5bn for direct NHS
treatment in 2010.5
MiddletonJ 'Public health low down with the Solent Delta
Blues’

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

67. MiddletonJ 'Public health low down with the Solent Delta
Blues’

68. MiddletonJ 'Public health low
down with the Solent Delta
Blues’

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https://youtu.be/8dyvDwZaIwQ
www.drharp.co.uk

71. 7030/10/2018
Great Yarmouth Herring fleet

72. Thank you
John Middleton,
President
UK Faculty of Public Health
president@fph.org.uk
30/10/2018 71

73. www.fph.org.uk
30/10/2018 72

74. • 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/Eurohealth-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/ldw054/2871226/Public-health-
in-England-in-2016the-health-of-the?guestAccessKey=8f7a33a1-bdbf-4db4-948c-
fd6b6293a259
• 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/pii/S0033350615003303

75. • Saunders P, Middleton J. Sustainability and transformation
plans for the NHS in England: radical or wishful thinking?
BMJ 2017;356:j1043 Available at:
http://www.bmj.com/content/356/bmj.j1043/rr-1 (accessed
May 25th 2017) and paper published short version:
Saunders P, Middleton J, Lloyd S. Survey of directors of
public health suggests that STPs may be falling short of
ambition. BMJ 2017; 357 doi:
https://doi.org/10.1136/bmj.j2552 (Published 25 May 2017)
Cite this as: BMJ 2017;357:j2552 Available at:
http://www.bmj.com/content/357/bmj.j2552?rss=1&utm_sou
rce=feedburner&utm_medium=feed&utm_campaign=Feed
%3A%20bmj/recent%20%28Latest%20from%20BMJ%29&v
ariant=short&sso= (accessed May 25th 2017)
• Middleton J. Public health and the general election 2017.
https://www.lgcplus.com/services/health-and-care/public-
health-and-the-general-election-2017/7017915.article
• Middleton J. Time to put health at the heart of all policies.
BMJ 2017; 357:
http://www.bmj.com/content/357/bmj.j2676?sso.

76. • Quantz D, Jenkin D, Stevenson E, Pencheon D,
Middleton J. Sustainable development in public
health consultant education. The Lancet Planetary
Health, DOI: http://dx.doi.org/10.1016/S2542-
5196(17)30114-6 Available at :
http://www.thelancet.com/journals/lanplh/article/PIIS
2542-5196(17)30114-6/fulltext (accessed October 6th
2017).
• Bellis M, Hardcastle K, Purkis-Garner A, MiddletonJ.
Interpersonal, collective, and extremist violence are
public health problems BMJ opinion, October 30th 2017.
Available at:
http://blogs.bmj.com/bmj/2017/10/30/interpersonal-
collective-and-extremist-violence-are-public-health-
problems/ accessed November 1st