Public health systems and the health of the public (full)

www.fph.org.uk
Public health systems and the health
of the public
Professor John Middleton, President United
Kingdom Faculty of Public Health
2nd Arab Public Health Conference, Casablanca, April 4th and 6th 2019 – full
version, incorporating plenary presentation, and discussion of role of UK
Faculty of Public Health, Lunchtime workshop, 4th April

12/04/2019 1
Dedicated to absent
friends: Professor
Yehia Abed,
Professor Hamad
Abu Bassam, Al
Quds Campus, Gaza.
Public Health
Department; Mo
Professor Motasem
Hamdan, Al Quds,
East Jerusalem

Association of Schools of Public Health in the European Region(ASPHER)
Delegation to Gaza, June 5,6,7th 2015
•Prof. Vesna Bjegovic-Mikanovic,
president of ASPHER (chair)
•Prof. Anders Foldspang, past
president and chair of ASPHER's
Honours Committee
•Prof. Ulrich Laaser, past president,
member of the ASPHER Honours
Committee
•Dr. John Middleton, vice-president
for policy, UK Faculty of Public
Health
•Mr. Robert Otok, Director, ASPHER
•Ms Marine Buissoniere, Open
Society Foundations
•Colleagues from Al Quds, Gaza

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
MiddletonJ The public's health and the public health
system 180530

www.fph.org.uk
European Public Health observatory workshop; Organisation and finance of public health systems: England Prof John Middleton
Public health definition in England
2010 government white paper on public health
‘Healthy lives, healthy people’
‘The science and art of promoting and
protecting health and wellbeing,
preventing ill health and prolonging life
through the organised efforts of society.’
(This is an adaption by the UK Faculty of
Public Health from that used by Acheson
1988, WHO, 1948 and Winslow 1927).

‘Don’t just fight for
the profession of
public health fight
for the public’s
health’
Alwyn Smith, President of
the UK Faculty of Public
Health, 1981-1987
Public health
professionals are not
here to make
decisions easier, it is
to make things better

The public health function
‘the public health system’
The public health profession

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

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

Salus populi
suprema lex esto
Cicero
A motto of 14 local
authorities in England :
this example the former
Tipton Town council,
now part of Sandwell
Public health departments
moved (back) to local
government in 2013

system 180530

These 10 Corporations Control Almost Everything We Eat
system 180530

12/04/2019 13
Pepsi sales van at
Beit Hanoun, Gaza,
June 2015
Gaza has massively contaminated
water supplies and drinking water is
difficult to obtain. Coca-Cola,Pepsi,
7-Up and Sprite are not hard to
find….
Levels of diabetes are very high….

http://www.bmj.com/content/358/bmj.j4443?sso=
system 180530

Public Health 2040 : ISIS? Crop failure? and
no antibiotics?
Public health problems are interconnected :
Economics-environment- human health and
social problems
Violence and conflict / environmental
degradation/human over - consumption and
ill health/ inequalities in health / more conflict
https://eurpub.oxfordjournals.org/content/26/5/735
16

MiddletonJ The public's health and the
public health system
And my take on 2040
training 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.oxfordjour
nals.org/content/26/5/735

12/04/2019 18
Cement : a public health problem
https://blogs.bmj.com/bmj/2015/07/08/john-
middleton-cement-gazas-forgotten-public-
health-need/

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

A role for our climate
change special
interest group

https://phys.org/news/2017-09-climate-lessons-arabian-gulf-coral.html

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

Interconnectedness:
conflict over natural
resources: oil, water

This is a looming disaster and
priority is to limit damage

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
system 180530

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

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

MiddletonJ The public's health
and the public health system
180530

12/04/2019 34
Now available on itunes
And
http://store.cdbaby.com/cd/doctor
harpsmedicineband

Thank you
JOHN MIDDLETON
president@fph.org.uk

References and further reading
12/04/2019 36

• 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/Eurohe
alth-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

• 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.

• 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

Appendix
The Faculty of Public Health

• 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 and
international members in more than 80 different countries.
• We want everyone to have the best chance to live a
healthy life, no matter who they are or where they live

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

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!

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

– 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

4612/04/2019
European Public Health observatory; Organisation and finance of public health systems: England Prof John Middleton
• Public health workforce issues
• Public health role specialist, practitioner and wider workforce
• Multidisciplinary public health, Specialty is competence based
• UK Faculty of Public Health is the standard setting curriculum development,
recruitment into specialist training & specialist posts
• Regulation/registration/ licensing and appraisal by General Medical and
General Dental Councils and UK Public Health Register
• British Medical Association, Royal College of Nursing, Unite and Unison
Major trade union roles
• Absence of adequate or accurate data on roles and numbers
• Loss of staff during latest reorganisation
• Massive interest in PH and over-subscription for specialist training posts

John Middleton, President UK Faculty of Public Health
President @fph.org.uk
4712/04/2019
European Public Health observatory; Organisation and finance of public health systems: England Prof John Middleton

Appendix 2
My presidency
12/04/2019 48

My presidency
Build local authority relationships
Build relationships in health and public
health services in four nations of the UK
All areas of the UK visited by April 2018
Strong participant in the English Public
Health System Group
Supported Scottish Call to Action and
CFPHS in Scottish PH reforms
United Kingdom Public Health Network

My presidency
Do things jointly where possible -
policy statements, conferences
UK Public Health Network
Developing relationships with major
Public Health national partners
Joint policy development with RSPH
on Taking a new line on drugs
Major contributors to ‘Every breath
we take’ RCP/RCPCH report
Conference/meetings strategy

My presidency
Implement new curriculum: personal effectiveness and values
and ethics; rebuild health protection and health care public
health
Major workstream on ethics and values: ESRC grant for course
development , working with law depts in 6 universities;
proposal for Legal training for English Public health in local
authorities
Funded Work on credentialing with PHE to develop the public
health in all specialities capacity
Re work our DFPH qualification as the basic qualification for
public health in other clinical specialities
Funded development work with PHE on personal
effectiveness /leadership/ management

My presidency
Develop member involvement; Ensure solid member
services; build special interests
Workforce strategy agreed November 2017
Learn from recent member survey
New website
Developing content offer online and through social media
Develop member database and apply to member services
Staff development and customer care
Policy development and member involvement through
>30 special interest groups

My presidency
Develop faculty governance
Failed effort to incorporate - exploring alternative
models for faculty governance
Modernisation of Board and Executive
New Strategy for 2019-2025
Start new curriculum work for 2020-2025

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 deliver improvements
to the public’s health

Future training modes ?
Asset-based community development, and public
health generally
Address anti-health forces
Inter-professional learning
Ecological public health
Public health in all clinical specialties
Management training, leadership, personal
effectiveness
Using the law for the public’s health
Widen the base of public health recruitment
Strategic, global alliances
system

www.fph.org.uk
Appendix 3 European Public Health
observatory Organisation and finance
of public health systems : England
John Middleton
Honorary Professor of Public Health,
Wolverhampton University, West midlands,
England

www.fph.org.uk
European Public Health observatory workshop Organisation and finance of public health systems : England Prof John Middleton

www.fph.org.uk
European Public Health observatory workshop Organisation and finance of public health systems: England Prof John Middleton

www.fph.org.uk
European Public Health observatory workshop; Organisation and finance of public health systems : England Prof John Middleton
Main public health actors
Secretary of State, Department of Health, Chief
Medical Officer
Local Authorities
Public Health England
NHS England
Academia
Voluntary/’third sector’ / ‘NGOs’
Private Sector

www.fph.org.uk
European Public Health observatory workshop; Organisation and finance of public health systems : England Prof John Middleton

www.fph.org.uk
European Public Health observatory workshop; Organisation and finance of public health systems :England Prof John Middleton

www.fph.org.uk
European Public Health observatory workshop ; Organisation and finance of public health systems : England Prof John Middleton

Public health systems and the health of the public (full)

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