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Stand together, or fall apart : the role of partnership in improving the public's health


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A lifetime journey in looking to improve public health with lessons for future practice

Published in: Health & Medicine
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Stand together, or fall apart : the role of partnership in improving the public's health

  1. 1. Oxford Regional Training Conference Stand together, or fall apart John Middleton President UK Faculty of Public Health
  2. 2. Public ‘ealth Scottish FPH Annual Conference, Health come all ye! J Middleton October 27th 2016
  3. 3. The science and art of promoting health, preventing disease and prolonging life through the organised efforts of society Acheson 1988, after Winslow 1927 , WHO 1948
  4. 4. Health, hygiene and councils …
  5. 5. Salus populi suprema lex esto Cicero Oxford Public Health Training conference
  6. 6. Working with long time constants
  7. 7. Sandwell Valley, King George Playing fields 2014
  8. 8. New leisure centres Tipton
  9. 9. Working with long time constants
  10. 10. Improving outcomes
  11. 11. Oxford Public Health Training conference
  12. 12. CHD Mortality 2000-2005 PERSONS, Less than 65 years 0.00 10.00 20.00 30.00 40.00 50.00 60.00 2000 2001 2002 2003 2004 2005 Rateper100,000 West Midlands England Sandwell
  13. 13. 28
  14. 14. 29
  15. 15. Long term conditions
  16. 16. Figure 1, Teenage Conception 1998 - 2012 Sandwell's reduction since baseline (44%) is higher than England & Wales's reduction of 40.8%. The West Mildands reduction has also been lower than Sandwell at 42%. Figure 1, above, show that the gap between Sandwell and England is reducing further.
  17. 17. • Maximise the capabilities and control young and adults people have over their lives : reduce the social gradient of skills and qualifications
  18. 18. Working together, March 2015: John Middleton Vice president Faculty of Public Health
  19. 19. Working together, March 2015: John Middleton Vice president Faculty of Public Health
  20. 20. Marsch Addiction 1997
  21. 21. Domestic burglary Sandwell 2001-2005 Full implementation drug intervention project doubling numbers of drug users in treatment 1300 fewer domestic burglaries 33% fall
  22. 22. A box plot of the Baseline SAP measures for the Sandwell MBC housing stock, 1st April 2001, by housing type, n=25,595 dwellings
  23. 23. A box plot of the Baseline SAP measures for the Sandwell MBC housing stock, 31st March 2011, by housing type, n=25,595 dwellings
  24. 24. Housing and health -Results: Significant relationship of improved thermal efficiency with reducing excess winter deaths Adjusting for all of the other variables there is negative association between improved thermal efficiency and the odds of being admitted as an emergency People in warmer homes appear to be admitted less for serious illnesses The result is statistically significant The effect size appears large
  25. 25. Table 2 a Preventable causes of hospital admission, Sandwell and Western Birmingham Clinical commissioning group, 2012-13
  26. 26. Asset based community health ‘Strengths’ not ‘deficits’
  27. 27. Options for life self-built community centre
  28. 28. Thinking global, acting local Urban agriculture in Sandwell, UK A beacon for food growing, jobs and skills creation and environmental protection
  29. 29. 51 Sandwell Youth Cabinet
  30. 30. Agewell-Sandwell Agewell -Sandwell
  31. 31. i- House, demonstration house West Bromwich 2008
  32. 32. Good corporate citizen award 38 apprentices Rationalisation of offices : 6 leases surrendered 890 tonnes of CO2 reduction £200k saved
  33. 33. 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’
  34. 34. 1001 critical days Personal health and social relationships education, PHSE in all schools 2 hours physical activity per week reinstated
  35. 35. Stop marketing of foods high in sugar, salt and fat, before the 9pm watershed and tighten marketing restrictions Introduce 20% duty on sugar sweetened beverages Tackle alcohol related harm by introducing a minimum unit price for alcohol of at least 50p Rapidly implement standardised tobacco packaging 20 Mph speed limits
  36. 36. A living wage Reaffirm commitment to universal health care system free at the point of need funded through general taxation
  37. 37. Invest in active transport to promote good health and reduce our impact on climate change Implement a cross national approach to meet climate change targets, including a rapid move to a 100% renewables and a zero carbon energy system
  38. 38. President gets cross on Childhood obesity strategy- August 2016
  39. 39. Scottish conference sings ‘Freedom come all ye’
  40. 40. With Northern Irish colleagues in Belfast for the public health walk William Drennan- patriot, radical, poet, obstetrician and champion of public health
  41. 41. President’s visit to Wales, January 2017
  42. 42. ‘Protecting resources from one generation to the next’ The Welsh Wellbeing of Future Generations Act, 2015
  43. 43. ‘Protecting resources from one generation to the next’ Examples : Life time homes Active travel & Town planning Early years support and education Renewable energy schemes Zero carbon housing
  44. 44. Health Futures University Technical College West Bromwich,UK k
  45. 45. The Iron Bridge, 1781
  46. 46. Coalbrookdale by night, Loutherbourg, 1801
  47. 47. Wednesbury by night, unknown, c1850 museum of Iron, Ironbridge Gorge Trust
  48. 48. 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 ….
  49. 49. Joseph Priestley, ‘Inventor of air’ and soda water
  50. 50. The Birmingham Riots 1791
  51. 51. UK Faculty of Public Health Priority setting : ‘Valuing public health’ Health implications of Brexit Public health workforce development
  52. 52. Public health and the EU post Brexit
  53. 53. 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’
  54. 54. http://www.bmj .com/content/3 57/bmj.j2676
  55. 55. Public health and the EU post Brexit
  56. 56. UK has an estimated 25million houses 18.9 m families, but … 27.1M households (7% up on 2006)… 2.9 M lone parent families We need more dwellings, more living spaces.
  57. 57. homelessness_in_finland Mra_3en_2015.pdf
  58. 58. Inclusive growth or degrowth A role for our economics special interest group ?
  59. 59. Public health and the EU post Brexit A country fit to live in… where  Britain can power itself ? and  House itself ? and  Employ itself ? one_million_climate_jobs_2014.pdf
  60. 60. 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
  61. 61. A new approach to public mental health
  62. 62. ment/publications/preventi on-concordat-for-better- mental-health-consensus- statement/prevention- concordat-for-better- mental-health
  63. 63. • 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 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
  64. 64.  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 Areas of action for the public health community in preventing violence
  65. 65. The future Interconnectedness Stand together….
  66. 66. A role for our climate change special interest group
  67. 67. The Birmingham Tornado, 2005
  68. 68. Rockefeller Lancet Planetary Health commission
  69. 69. Interconnectedness: conflict over natural resources: oil, water
  70. 70. Interconnectness : Climate change refugees
  71. 71. IPPNW/MEDACT Health through peace Prof John Middleton, UK Faculty of Public Health Coccolithophore (diatom): Produces 50% of the world’s oxygen
  72. 72. Inclusive economic growth  Corporate citizenship by the health and local authorities
  73. 73. The new Midland Metropolitan hospital Opening 2018 – corporate citizenship offers of construction employment, low carbon footprint, local health service employment , key worker housing and relocation of services to community
  74. 74. Thinking globally, acting locally: Coventry and Warwickshire University Hospitals Jubilee Nature Reserve – managing water run off from hospital car parks - promoting biodiversity, saving money
  75. 75. Thinking globally, acting locally: ‘Saving lives with Solar’, Royal North Midlands Hospitals, Stoke
  76. 76. And to conclude……
  77. 77. Preparedness and safeguarding - key functions of public health
  78. 78. it's not who your doctor is, it's who you vote for, that most affects your health
  79. 79. Oxford Public Health Training conference Stand together, or fall, apart Thank you Professor John Middleton Faculty of Public Health
  80. 80.
  81. 81. Thank you Professor John Middleton Faculty of Public Health
  82. 82. • Middleton J, ISIS, crop failure and no anti-biotics: what training will we need for future public health? European J Public Health 2016; • 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) urohealth-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: and 871226/Public-health-in-England-in-2016the-health-of- the?guestAccessKey=8f7a33a1-bdbf-4db4-948c-fd6b6293a259
  83. 83. Interconnectedness: Negative feedback loops  Acidification of the oceans - Reducing oxygen supply by Algae  Reducing fish supply by destroying natural habits  Loss of the ice caps- reducing reflection of UV light adding to global warming  Sea level rise reducing freshwater environments for fish and agriculture  Warming of Arctic Tundra liberating CO2 and NH4, increasing global warming  Petroleum products and food production, feeding human grade cereals to animals, adding to climate change  Loss of pollinators through pollution, pesticides and loss of water  Carbon footprint of military conflict barely acknowledged  Aviation fuel and marine fuel not included in the Paris agreement  Land grabs by multinationals and by super powers in Africa evicting people from their land and creating enforced migration