Professor John Middleton discusses the role of the Association of Schools of Public Health in Europe (ASPHER) in enhancing public health education and practice globally. He emphasizes the importance of addressing social determinants of health, the interconnectedness of public health with issues like violence and climate change, and the need for collective responsibility and action in improving public health outcomes. The document also critiques responses to the COVID-19 pandemic and calls for a renewed focus on equitable health systems post-crisis.

1. Save the planet, or save the NHS?
Professor John Middleton Hon FFPH, FRCP,
President, Association of Schools of Public Health in the European
Region

2. What is ASPHER ?
The Association of Schools of Public Health in the European
Region (ASPHER) is the key independent European
organisation dedicated to strengthening the role of public
health by improving education and training of public health
professionals for both practice and research.
We have 120 member schools of public health in Europe and
associates globally.
We are developing our partnerships with sister public health
organisations in America, Africa, Asia, Australasia and the
Arab world

3. 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 1927, WHO 1948

4. What is public health?
The public’s health
And
The public system, services and profession

5. What is public health?
Public health practice is population-based
It emphasises collective responsibility for health, health protection and
disease prevention
It recognises the key role of the state, linked to a concern for the underlying
socio-economic and wider determinants of health, as well as disease
Public health practice also emphasises partnership working with all those
who contribute to the health of the population.
Good Public Health Practice UK Faculty of Public Health 2016

6. What is public health?
Three domains of public health :
Health protection
Health improvement
Health care related public health
UK Faculty of Public Health, 2016

7. A medical specialty…
but a multidisciplinary profession, service and system
UK Faculty of public
Health
Careers in public
health

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

9. Louis Pasteur,
Chemist

10. “ 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

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

12. Strategic
alliances:
A ‘one
health’
approach

13. 13
05/04/2022
The public’s health: global burden
of disease, corporate anti-health
interest,

14. 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, 2019

15. Global burden of disease 2019

16. Global burden of disease 2021

17. 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%

18. These 10 Corporations Control Almost Everything We Eat

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

20. 20
05/04/2022
Violence, conflict and public health

21. 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

22. Interconnectedness:
conflict over natural
resources: oil, water

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

24. 24
05/04/2022
Planetary health: environment, loss of
biodiversity, food and ecosystems balance,
climate change

25. A role for our climate
change special
interest group

27. 27
05/04/2022

30. Coccolithophore (diatom): Produces 50% of the
world’s oxygen
Algal blooms photosynthesising off
south west coast of Wales

31. Climate
breakdown
is here
now!- 1 fire

32. • Climate breakdown is
here now!- 2 floods
Indonesia
floods
Climate
breakdown is here
now!- 2 floods

33. Climate
breakdown
is here
now!- 3
marine life
extinction

35. John Middleton:Planning for an outbreak of health

37. 05/04/2022 37

39. Infodemics:
misappropriating
personal information
to sway opinion and
behaviour – in this
example in elections

40. Infodemics: misappropriating
social media - to sway opinion
and behaviour – in this example
in vaccine hesitancy

43. 43
05/04/2022
The COVID-19 pandemic

45. Selected
European
countries ,
with Peru (hi)
and New
Zealand (low)
for
comparators

46. 05/04/2022 46

47. 05/04/2022 47

49. Public mask wearing
mandated early on-
Czechia, Slovakia,
Slovenia, Poland

72. The pandemic is over?
But….high levels of infection
High levels of infection in children
High levels of childrens admission
High levels of hospital activity, preventing other treatments
Still high levels of unvaccinated young adults
High levels of sickness absence in key sectors
Reduce isolation periods allowing second spike of omicron infections …
Next variant due March ?
Abandoned basic measures in plan B that are protective against Covid and other
respiratory pathogens :
‘Protections’ – not ‘restrictions’

73. 05/04/2022 73

74. 05/04/2022 74
ASPHER COVID-19 task force
Members in 30 countries
Actions:
• Reports on testing
• Masks
• Inequalities
• Second wave and winter planning
• How to count illness
• Basic terms of inequalities in health
• Herd immunity
• Five vaccination statements including the latest
Vaccine internationalism, vaccine passports and
vaccine diplomacy
https://www.aspher.org
/covid-19-task-
force.html

76. Vaccine
Waiver
needed
now

77. Vaccinations: saving lives in millions

78. Vaccinations: saving lives in millions

79. https://www.forbes.co
m/sites/niallmccarthy/2
021/05/06/which-
companies-received-
the-most-covid-19-
vaccine-rd-funding-
infographic/?sh=eef64e
a4333d

80. Vaccinations: saving lives in millions
There is no place for intellectual property protection
during a humanitarian crisis
But there must be fair assessment of how industry
should be properly paid for their work and their
products and to protect and ensure investment for
future new life-saving products

82. Planning for an outbreak of health

83. Planning for an outbreak of
health:
The public health system,
services and profession

84. https://epha.org/public-
health-must-be-
strengthened-for-a-
healthy-post-covid-world/
Global governance for health

85. John Middleton:Planning for an outbreak of health

86. John Middleton:Planning for an outbreak of health
Renew the mandate of the UN and
WHO in global health governance
The new Treaty for pandemic
preparedness
Governance
Transparency and information
sharing
Resources and capacity
New continental/WHO regional
structures with response capacity
Ceded authority to supranational
structures

89. John Middleton: Planning for an outbreak of health
Planning for an
outbreak of health:
The public’s health

90. What personal behaviours might we usefully
keep for a post pandemic future?
• Wash our hands more ?
• Where masks in closed spaces especially in winter
• Work at home when we can, not because we must
• Don’t go out when we have symptoms

95. Build back health care

96. 96
05/04/2022
The COVID-19 what went well UK ?
Initial efforts on social welfare/furlough/ increased universal credit/ hotels for
the homeless?
Vaccine development, commitment global collaboration of science and
Technology, commitments to shared intelligence, research and delivery ‘COVAX’
Vaccination policy and delivery ‘December 2020-April 2021’
Clinical research: rapid assessment of effective and ineffective treatments
including the Recovery Trial
Rapid set up of major prospective studies REACT, ONS community infection,
ZOE
Genetic sequencing of virus and development of Genomic Surveillance

97. 97
05/04/2022
The COVID-19 what went (well) UK ?
Not ‘well’- but ‘heroic’, ‘admirable’, ‘selfless’, ‘professional’,
‘caring’, ‘compassionate’
NHS services response
Social care unsupported and unprotected
Local public health services – undervalued, unrecognized, snubbed
Community responses: volunteering, ‘mutual aid’, in food delivery,
in the vaccine delivery programme
National public health professional organisations working together

98. John Middleton [lecture title]
[date]
Upsides
of
lockdown
1 :
Decline in
air
pollution

99. Upsides in
lockdown 2:
interest in
more active
travel

100. ‘Build back’ ?
Working practices and relationships ?
Reducing inequalities? Minorities?
Vulnerable groups? Women? Older
people?

101. John Middleton:Planning for an outbreak of health
https://www.health.org.uk/sites/default/files/upl
oad/publications/2020/Build-back-fairer-the-
COVID-19-Marmot-review.pdf
Build back
Fairer?

102. John Middleton:Planning for an outbreak of health
Build back
Fairer?
The richest billionaires could
give $139,300,000,000 away
and still be as rich as they
were in 2020. These
billionaires could end global
hunger for about $300 billion.
A fraction of their overall
wealth.

103. ‘Build
back’?

104. ‘Build back’ ?

105. ‘Build back’ ?

106. ‘Build back’ ?

107. ‘Build back’ ?
To what austerity, poverty and
unfairness? Environmental squalor and
health and wealth for some?
Plan for an outbreak of health….

108. 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.’

109. Science knows no country,
because knowledge belongs to
humanity, and is the torch which
illuminates the world.
Louis Pasteur

110. Thank you
John Middleton,
President
Association of Schools of Public Health
In the European Region
John.middleton@aspher.org