My inaugural lecture for Wolverhampton University, presented at the University Technical College 'Health Futures', West Bromwich, 15th November 2017 171113 middletonj wolverhampton

1. The future’s bright, the future’s public health
Inaugural lecture for the University of
Wolverhampton
Professor John Middleton
Honorary Professor of Public Health
President of 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. Health,
hygiene and
councils …

4. John Middleton Inaugural
Lecture November 15th 2017
What is public health?

5. John Middleton Inaugural
Lecture November 15th 2017

6. John Middleton Inaugural
Lecture November 15th 2017
What is public health?

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Lecture November 15th 2017

8. John Middleton Inaugural
Lecture November 15th 2017
What is public health?

9. John Middleton Inaugural
Lecture November 15th 2017

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Lecture November 15th 2017

11. Public health is :
The science and art of promoting health,
preventing disease and prolonging life through the
organised efforts of society
Acheson 1988, after Winslow 1920, WHO 1948

12. “ Medicine is a social
science and politics is
nothing else but
medicine on a large
scale.
“Medicine as a social science, as the
science of human beings, has the
obligation to point out problems and
to attempt their theoretical solution;
the politician, the practical
anthropologist, must find the means
for their actual solution”
Rudolf Virchow
John Middleton Inaugural
Lecture November 15th 2017

13. it's not who your
doctor is, it's who
you vote for, that
most affects your
health
John Middleton Inaugural Lecture November 15th 2017

14. John Middleton Inaugural
Lecture November 15th 2017
Three legends of public
health improvement
1- John Snow on cholera

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Lecture November 15th 2017

16. John Middleton Inaugural
Lecture November 15th 2017
John Snow on cholera

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Lecture November 15th 2017

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Lecture November 15th 2017

19. The Times in 1856: ‘The doctor is
no better than the meanest
herbalist, the product of the
longest conversation with a doctor
is simply to reinforce the
uselessness of medicine’.
John Middleton Inaugural
Lecture November 15th 2017

20. • 19th Century: early
practitioners were multi-
disciplinary: John Snow
(Surgeon/Anaesthetist),
Florence Nightingale
(Nurse); Edwin Chadwick
(Lawyer); Joseph
Bazalgette (Engineer);
Mary Seacole (nurse)
Multidisciplinary public health

21. John Middleton Inaugural
Lecture November 15th 2017
Three legends of public
health improvement
2- Joseph Goldberger and
pellagra

23. Pellagra
dermatitis-
dementia
and
diarrrhoea
are
symptoms

24. Dr Joseph
Goldberger,
discoverer of the
cause of pellagra,
in the uniform of
the US Public
Health Service

25. A prison farm from
whence a ‘holler’
about cornbread peas
and black molasses
came

26. Goldberger arranged
for handouts of
yeast extract ‘Vegex ’
through the Red
Cross Stores

27. The eventual eradication of
pellagra came about through
adding yeast extract to
cornbread flour

28. John Middleton Inaugural
Lecture November 15th 2017
Three legends of public
health improvement
3-Richard Doll, Bradford
Hill on smoking and lung
cancer

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Lecture November 15th 2017

30. John Middleton Inaugural Lecture November 15th 2017
http://www.bing.com/videos/search?q=youtube+advert+for+c
amel+cigarettes&&view=detail&mid=70789494855D72F0D8B
D70789494855D72F0D8BD&FORM=VRDGAR

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Lecture November 15th 2017

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Lecture November 15th 2017

33. John Middleton Inaugural
Lecture November 15th 2017

34. John Middleton Inaugural
Lecture November 15th 2017

36. John Middleton Inaugural Lecture November
15th 2017
http://www.bmj.com/
content/358/bmj.j444
3?sso=

37. John Middleton Inaugural Lecture November
15th 2017
Just as car manufacturers now producing electric motor vehicles have not
abandoned the production and sales promotion of fossil fuel powered cars,
no tobacco company would do the equivalent with its combustible tobacco
products. But progressive governments like France, Germany, India, and
Norway have set dates after which the sales of new fossil fuel powered
vehicles will be banned. Many more will follow.
Over many decades, governments have acted to ban a huge range of
unsafe, deadly products (thalidomide, asbestos, chlorofluorocarbons,
countless unsafe consumer goods), and exploitative practices (slavery,
people trafficking, child labour). With tobacco companies now embracing
the rhetoric of the end of smoking, it is time for governments to take the
industry at its word and set those dates when combustible tobacco products
will be banned.
http://www.bmj.com/content/358
/bmj.j4443?sso=

38. John Middleton Inaugural
Lecture November 15th 2017
A life in local public health

47. Sandwell Valley,
King George
Playing fields
2014

50. New leisure
centres Tipton

51. 51
Life expectancy & disability free life expectancy at birth,
by neighbourhood income level, England and Sandwell 1999-2003
Neighbourhoods by income deprivation (population percentiles)
Age

53. 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

54. 54

55. 55

56. 56

57. A life course
Improving outcomes

58. A life course – 24th annual report for
Sandwell

59. 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.

63. Marsch Addiction 1997

64. Domestic burglary Sandwell 2001-
2005 Full implementation
drug intervention
project doubling
numbers of drug users
in treatment
1300 fewer
domestic
burglaries
33% fall

67. Housing and health

68. A box plot of the
Baseline SAP
measures for the
Sandwell MBC
housing stock,
1st April 2001, by
housing type,
n=25,595 dwellings

69. A box plot of the
Baseline SAP
measures for the
Sandwell MBC
housing stock,
31st March 2011,
by housing type,
n=25,595
dwellings

70. John Middleton Inaugural Lecture November 15th 2017
The Health dividend:
The NHS as corporate citizen

72. John Middleton Inaugural Lecture November 15th 2017
Middleton J. The hospital of the future comes to the West Midlands. BMJ blogs October 1st 2014.
http://blogs.bmj.com/bmj/2014/10/01/john-middleton-the-hospital-of-the-future-comes-to-the-west-
midlands/

73. John Middleton Inaugural Lecture November 15th 2017
• 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. Health Futures
University
Technical College
West
Bromwich,UK
www.healthfutures.co.u
k

75. John Middleton Inaugural
Lecture November 15th 2017
Lessons in the age of austerity and
globalisation

76. 76
The Marmot Review
• Early years
• Young adults
• Workplace health
• Income inequality
• Physical environments
• Reduce the gradient of
unequal access to healthcare

78. 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

82. COP21 Paris
AgreementParis COP
settlement
December
2015

83. Rockefeller Lancet
Planetary Health
commission

85. Lancet Rockefeller Commission on Planetary
Health Lancet, 2015

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

87. Interconnectness
:
Climate change
refugees

89. From Alcamo and Heinrichs, 2002. In: Dialogue on Water and Climate, 2003.
Water critical regions
Medium water stress today & future increase in stress plus HDI>0.8
A2 scenario, ECHAM4, 2020s

91. Coccolithophore (diatom):
Produces 50% of the world’s
oxygen

94. Strategic
alliances:
A ‘one
health’
approach

95. John Middleton Inaugural
Lecture November 15th 2017
Global health Media project: The Story of Cholera
http://www.youtube.com/watch?v=jG1VNSC
sP5Q

96. John Middleton Inaugural
Lecture November 15th 2017

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

98. http://www.bmj.com/content
/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

99. John Middleton Inaugural
Lecture November 15th 2017
BREXIT and the public’s health
Loss of health and care workers
Loss of research grants and networks
Loss of leadership role in areas such as tobacco control and
antimicrobial resistance
Loss of international agencies which protect health –European
Communicable Disease Centre; The European illegal drugs
monitoring centre; European Medicines Agency; Pulling out of
Euratom Access to Medical isotopes for cancer treatment and shared
safety procedures for nuclear power stations;
Loss of protections for health - in the workplace, the Social chapter;
environmental protections; soil, beaches and air quality; equality
provisions;
Shared Security?

101. 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/Docs/
one_million_climate_jobs_2014.pdf

102. John Middleton Inaugural
Lecture November 15th 2017
BREXIT and the public’s health
Loss of health and care workers
Loss of research grants and networks
Loss of leadership role in areas such as tobacco control and
antimicrobial resistance
Loss of international agencies which protect health –European
Communicable Disease Centre; The European illegal drugs
monitoring centre; European Medicines Agency; Pulling out of
Euratom Access to Medical isotopes for cancer treatment and shared
safety procedures for nuclear power stations;
Loss of protections for health - in the workplace, the Social chapter;
environmental protections; soil, beaches and air quality; equality
provisions;
Shared Security?

103. William Beveridge designed
a welfare state for the UK in
the deepest point of the
Second World War.
‘We should regard want,
idleness , ignorance,
squalor and disease as
enemies of us all. That is
the meaning of a social
conscience; that we
refuse to make our
separate peace with evil.’

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

107. Salus populi
suprema lex
esto
Cicero

108. John Middleton Inaugural
Lecture November 15th 2017
THANK YOU
John Middleton
President@fph.org.uk

110. John Middleton Inaugural
Lecture November 15th 2017

111. The 2017 Milroy Lecture: Secure, healthy, inclusive and green – four dividends of a healthier future Professor John Middleton
Appendix 1
The Faculty of Public Health

112. 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

113. Our role is to improve the health and wellbeing of local communities and
national populations. We do this in six ways:
1. We support public health professionals through training and beyond
2. We enable members to meet up and share ideas and best practice
3. We give members the chance to discuss new policy ideas via our
growing network of Special Interest Groups (SIGs). Each one specialises
in a different issue, from mental health to housing
Who we are and what we do

114. 4. We seek to improve public health policy and practice at a local,
national and international level
5. We campaign for change and work in partnership with local and
national governments
6. We encourage and promote new research and understanding of
public health via our Journal of Public Health, Public Health Today
magazine, blog and events programme – and we’re always looking for
new stories!
Who we are and what we do

115. Our future
• We’re determined to do even more to improve people’s health and
wellbeing and give everyone the best chance to live a healthy life, no
matter who they or where they live.
• We want to continue to improve the training and development of
public health professionals so that our members are even better
equipped to tackle the many new health challenges facing our local
communities
• And we want to play an even bigger role in shaping public health
policy across the UK and around the world

116. • We can only realise our ambitions with the help and support of our
members
• If you’re already a member, get in touch to find out how you can join
a Special Interest Group. If you’re not a member, go to
www.fph.org.uk/fph_associates to find out more or Tweet us @FPH
• From Student Membership to Fellowship and Membership by
Distinction (which you can self-nominate for with two references!),
there are different membership grades available

117. 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’