A manifesto for health

West Midlands Annual Public Health Conference 2019
A manifesto for health
Professor John Middleton
President, the Association of Schools of Public Health in the European Region
Immediate Past President, UK Faculty of Public Health
Honorary professor of Public Health, Wolverhampton University

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

28/11/2019 4
If the policy is wrong, money will not make it
right; and if the policy is right, money may not in
fact, present an unduly difficult problem.
EF Schumacher, Small is Beautiful, p 162

A manifesto for health, J Middleton November 28th 2019

Austerity kills
Climate breakdown
Service cuts
Brexiting health

Austerity kills

David Taylor
Robinson et al -
‘Child health
unravelling’
BMJ March
2019

Images of post
recession Britain

The politics of austerity is the politics of cruelty. On an average
day in the UK, 3700 people are forced to visit a food bank, 5400
suffer domestic violence, 4750 sleep rough on the
streets…There are daily stories of children being hungry in
school and in school holidays. Food bank usage continues to
rise.
John Middleton. Past President’s end of term report – Part two: The health of the public. FPH website. Posted July 30th
2019. https://betterhealthforall.org/2019/07/30/past-presidents-end-of-term-report-part-2-the-health-of-the-public/

Marmot Big six
recommendations:
Early years
Adolescent health
Workplace health
Reducing inequalities in income
Improving built environment
Reducing inequalities in access to
health services
Still waiting…….

Public Health Problems are multidisciplinary: why do we train for them
separately? John Middleton, LEPH 2019

Public Health Problems are multidisciplinary: why do we
train for them separately? John Middleton, LEPH 2019

Policing and Public Health
9 in 10 police
contacts complex
welfare, safety &
vulnerability (South Wales)
One call every five
minutes relating
directly to mental
health (Metropolitan Police 2017)

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

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

Climate breakdown

A role for our climate
change special
interest group

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

Service cuts

‘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)

Commissioning Public Health
Services Conference - June 2017

1. Introduce free personal social care
for over 65s
(£3.2Billion or £350 if assets under £200k
only)
2. Move to full personal social care
funding
(£17B today rises to £36B by 2030)
3. Fully integrated care trusts
(saves £4.5B)
https://www.i
ppr.org/files/2
019-05/social-
care-free-at-
the-point-of-
need-may-
19.pdf

4728/11/2019
The public’s health: global burden
of disease, corporate anti-health
interest,

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

Burden of disease attributable to 20 leading risk factors in 2010
expressed as a percentage of global disability-adjusted life-years
Global Burden of Disease Group. www.thelancet.com 2012 380 2245
Diet ≈ 40%

These 10 Corporations Control Almost Everything We Eat

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

28/11/2019 53
What have
you got
against
nannies?

Scotland’s National Action Plan
for Human Rights

Brexiting health

This is a looming disaster and
priority is to limit damage

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?

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 to the public’s health’
clause
3. Free Trade and Investment Agreements, a transitional
agreement and World Trade Organization rules

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

‘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.”

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.’

Thank you
john.middleton@aspher.org

References
Middleton J. Past President’s end of term report – Part two: The health of
the public. Posted July 30th 2019.
https://betterhealthforall.org/2019/07/30/past-presidents-end-of-term-
report-part-2-the-health-of-the-public/
Middleton J, Rae M. Health, wellbeing, and care should be top of
everyone’s political agenda. BMJ 2019;367:l6503 available at:
https://www.bmj.com/content/367/bmj.l6503#;

A manifesto for health

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