Presentation to the WHO-ISPED Public Health leadership course, November 24th 2023 20231124 middletonj WHO-ISPED.pptx

1. WHO-ISPED European Public Health
Leadership Course
My life course in public health leadership
Professor John Middleton

2. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton

3. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Get and disseminate good data
 Tackle more difficult initiatives first
 Find,fight and win winnable battles
 Support and hire great people
 Manage communicable and environmental threats
 Do not cede the clinical realm
 Learn and manage the budget cycle
 Manage the context
 Never surprise your boss
 Follow core principles
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

4. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Get and disseminate good data
 Write annual reports – for your population’s health, or
for your service - fill them with data, and sound
actions
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

5. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Annual reports on the health
of your community/ service

6. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Improving
outcomes

7. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
A life course – 24th annual report for Sandwell

8. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton

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

10. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Tackle more difficult initiatives first
 ‘Culture eats strategy for breakfast’ Peter Drucker
 Culture requires vision
 Vision leads to a strategy, manifestos, calls to action
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

11. Where there is no vision the
people suffer
Andrija Stampar,
Yugoslavian Public health
pioneer and WHO founding
father
After Proverbs/29-18.

12. it's not who
your doctor is,
it's who you
vote for, that
most affects
your health
First Annual public
health report for
Sandwell,
and a strategy for
Health for Sandwell
by the year 2000

13. Achieved 2015-2017
Plain packaging of cigarettes
Sugar sweetened drink tax
Personal health and social
education reinstated in schools
Minimum unit price for alcohol
(MUP) in Scotland and Wales
UK Faculty of Public Health, Manifesto
for the UK election, 2015

14. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Global vision
and strategy :
WHO
roadmap for
public health
workforce

15. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Find, fight and win winnable battles
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

16. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Support and hire great people
 Also, find great colleagues and partners ….
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

17. A Presentation for ASPHER Association of Schools of Public Health in the European Region,
2006
The wider public health workforce: is there a training role for schools of public health?
Hire great people Ali Al-
Osaimi
Biomedical sciences degree
Drugs and young people
study in the Yemeni
community, reported 2001
Yemeni community
association health needs
profile 2001-02
Community health network
manager 2003-
Senior PH manager, 2014-
present

18. Hire great people:
Michele Lawrence,
community nurse
PH nurse,
immunisation team
Senior nurse
consultant PHE,
UKHSA 2013 to
present
A presentation for ASPHER, Association of Schools of Public Health in the European Region,
2006
The wider public health workforce: is there a training role for schools of public health?

19. Working with great colleagues :
Maggie Rae
Head of Dept of Health Inequalities
Unit
FPH Registrar, 2017
President of the UK Faculty of Public
Health, 2019-2022

20. Working with great colleagues : Selma Sogoric, Andrija
Stampar School of Public Health
Co-author, Wounded healthy cities report Croaita War, 1992.

21. A life in public health, influences and chunes. John Middleton ASSETS, Brussels July 2023
Working with great colleagues : Jose-Maria Martin-Moreno
Personal mentor for me during my ASPHER presidency
Outstanding contributor to the work of ASPHER COVID-19 task force
with over 100 papers published
Major contributor to WHO developmental work 2007-2017 on
Essential Public Health functions, (below centre) leading to WHO
global road map on Public Health workforce capacity (right)

22. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Manage communicable and environmental threats
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

23. Measles in
Sandwell
2000+cases
in 1988.

24. 41 foundaries in
Sandwell, 1987 air
quality formerly an
issue of SO2 and
NO2 of industrial
origin: now a major
public health
concern from road
traffic pollution

25. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Multi-professional
team local and
national, public and
environmental health
tackles legionnaires
outbreak, 2002 Source
from large local

26. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Do not cede the clinical realm
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

27. 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/

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

30. Kidney
disease
Standardised
prevalence ratio
for
haemodialysis

31. Kidney disease
Access to pre-
emptive
transplantation

32. Systematic
primary care in
the prevention of
coronary disease :
an essential
compnonent of
Public health

33. Health care facilities reducing their carbon
footprint: ‘Saving lives with Solar’ Royal
North Midlands Hospitals, Stoke.

34. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton

35. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Learn and manage the budget cycle
 Be nice to your accountants
 Help them to understand the lives saved and the
disease prevented behind their money management
 ‘The value of everything, not the price of everything’
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

36. 19/04/2024 36
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

37. The value of prevention

38. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Manage the context
 ‘The public’s health – so involve the public
 Community assets- better service providers
 Understand and respect what people believe
 Partnerships
 Multidisciplinary nature of public health
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

39. 39
Context: community
assets- Sandwell
Community health
network

41. By 2003 the mixed use site was in production…
Ideal For All’s Salop
Drive community
garden
Accessible
sutainable
development

42. ‘Do No Harm’ Lord Warner Public Health amendment to the EU Withdrawal bill 2018: A strong
health and care partnership in the lobby to protect health in the ‘Brexit Bill’
64 Health organisations support, representing over 1 million health workers

43. Multi-disciplinary public health : the
need for partnership with climate
scientists, ecologists, and polticial
scientists

44. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Never surprise your boss
 Sound advice – say no more
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

45. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things ‘ Tom Frieden
 Follow core principles
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

46. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Five core principles CDC, which form the agency’s “Pledge to the
American people”
1.Be a diligent steward of the funds entrusted to your agency.
2.Provide an environment for intellectual and personal growth and
integrity.
3.Base all public health decisions on the highest quality scientific
data, openly and objectively derived.
4.Place the benefits to society above the benefits to the institution.
5.Treat all persons with dignity, honesty, and respect.
Dowdle WR. Science,
politics, and CDC.
1990. Joseph W.
Mountin Lecture.
Available
at: http://www.garfie
ld.library.upenn.edu/
essays/v14p165y199
1.pdf.

47. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
What other ways have you got to improve the public’s health ?
Apart from chasing the money?

48. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Troops,
money,
or influence?
I’ve had them all
The greatest of these is influence
‘Sapiential authority’

49. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Control the information
Control the knowledge
Control the agenda
Hold a wide network of partners
Applying the law?
Human rights ?
Understand the geopolitical world we live in

50. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Geopolitical health’:
The epidemiology of corruption? privacy?
transparency? state of democracy?
Democracy? Organised crime? Trade?
‘The prevention of bad behaviour in politics:
the prevention of dictatorship'

51. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
‘Ten things‘ Tom Frieden
 Get and disseminate good data
 Tackle more difficult initiatives first
 Find,fight and win winnable battles
 Support and hire great people
 Manage communicable and environmental threats
 Do not cede the clinical realm
 Learn and manage the budget cycle
 Manage the context
 Never surprise your boss
 Follow core principles
‘Four things‘ John Middleton
 JM: Think global, act local
 JM ‘Planetary Health’; ‘One Health’
 JM Think ‘First Nation Health’
 JM Understand the geopolitical world in which we live:
 Neoliberalism; Oligarchy and the rise of the super-rich; the rise of
Populism; Industrial-scale disinformation; Culture wars ; Conflicts
Frieden Tr.
Am J Public
Health. 2016
July; 106(7):
1214–1218.
Published
online 2016
July. doi: 10.2
105/AJPH.20
16.303204

52. WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
The sanitarian must become the ecologist
John Ashton BMJ 1990
The public health specialist must also become
the political scientist
John Middleton 2023

53. You can change
her environment
through public
health advocacy!
120 high rise
blocks in Sandwell
1988 (left) - less
than 30 in 2014

54. WHO-ISPED European Public Health
Leadership Course
My life course in public health leadership
Professor John Middleton
Vice President Global Network for Academic Public Health,
Immediate Past President, Association of Schools of Public Health in the
european Region ASPHER
johnmiddleton@phonecoop.coop

55. Middleton J, Biberman D, Magana L, Saenz R, Low WY, Adongo P, Kolt GS and Surenthirakumaran R (2021) Global Governance for
Improved Human, Animal, and Planetary Health: The Essential Role of Schools and Programs of Public Health. Public Health
Rev 42:1604610. https://www.ssph-journal.org/articles/10.3389/phrs.2021.1604610/full
WHO-ISPED European Public Health Leadership, 24 /11/2023 John Middleton
Middleton J. (2022). The Historical Public Health and Social Work Role of the Police. In: Bartkowiak-Théron, I., Clover, J., Martin,
D., Southby, R.F., Crofts, N. (eds) Law Enforcement and Public Health. Springer, Cham. https://doi.org/10.1007/978-3-030-83913-
0_2
Middleton J. The 2017 Milroy Lecture: Secure, healthy, inclusive and green – four dividends of a healthier future.
January 19th 2022. https://betterhealthforall.org/2022/01/19/the-2017-milroy-lecture-secure-healthy-inclusive-and-green-four-
dividends-of-a-healthier-future/ Accessed February 22nd 2022. https://www.fph.org.uk/media/3437/20220112-final-full-
including-references-jdm-lecture-2.pdf
Middleton J. Tradition, leadership and innovation in public health education. Commemorating the 100th anniversary of ESPM. Salud
Publica Mex. 2022; 64: 606-611. https://doi.org/10.21149/13778 https://saludpublica.mx/index.php/spm/article/view/13778/12321 In:
https://saludpublica.mx/index.php/spm/issue/view/539
WHO Geneva. Road map for PH workforce. Webpage: https://www.who.int/publications/i/item/9789240050402
Some References