A presentation to the students of the Governance and leadership in public health course, Maastricht University, December 13th 2019. 191213 middletonj maaastricht final

1. www.fph.org.uk
John Middleton
Maastricht Public Health Leadership course
December 13th 2019
The best job in the world: practicing
public health, past, present, future

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

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

4. 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.’

5. Human rights are everyone’s
business
“Where, after all, do universal
human rights begin? In small
places, close to home … they
are the world of the individual
person; the neighborhood he
lives in; the school or college he
attends; the factory, farm, or
office where he works”
Eleanor Rooseveldt

7. ‘Don’t just fight for the
profession of public
health, fight for the
public’s health’
Public health professionals
are not here to make
decisions easier, we are
here to make things better

8. www.fph.org.uk
The best job in the world: practicing
public health, past, present, future
The public’s health

9. www.fph.org.uk
A life in local public health
The best job in the world: practicing
public health, past, present, future

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

18. Improving
outcomes

20. Sandwell Valley,
King George
Playing fields
2014

21. www.fph.org.uk

23. New leisure
centres
Tipton

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

25. Teenage Conception 1998-2012
Sandwell's reduction since baseline (44%) is higher than England & Wales's
reduction of 40.8%. The West Midlands reduction has also been lower than
Sandwell at 42%. Figure 1, above, show that the gap between Sandwell and
England is reducing further.

27. Marsch Addiction 1997

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

32. 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/

33. www.fph.org.uk

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• Asset based public health
• Community assets

35. 34
Community health network

36. 35
Sandwell Youth Cabinet

37. www.fph.org.uk
Agewell-Sandwell
Agewell -Sandwell

38. • Reducing social inequalities: UK Marmot review
• Create fair employment and good quality work for all and improve
quality of work across social gradients

39. www.fph.org.uk

40. www.fph.org.uk
By 2003 the mixed use site was in production…

41. www.fph.org.uk

42. 41

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• Asset based public health
• ‘The health dividend’

45. 44
Birmingham
Sandwell /
Urban Living
Smart
housing
manifesto
2004

46. 45
i- House, demonstration
house West Bromwich
2008

48. www.fph.org.uk
Health Futures
University
Technical
College
West
Bromwich,UK
www.healthfutures.co.
uk

49. www.fph.org.uk
The best job in the world: practicing
public health, past, present, future
Ways to manage

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• Troops,
• money,
• or influence?
I’ve had them all
The greatest of these is influence
‘Sapiential authority’
What other ways have you got to improve the
public’s health ? Apart from chasing the money?

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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

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What other ways have you got to improve the public’s
health ? Apart from chasing the money?

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Control the information
Control the knowledge
Control the agenda
Hold a wide network of partners
Applying the law?
Human rights ?

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Manage, control the information
Apply the knowledge

55. Kidney
disease
Standardised
prevalence ratio
for
haemodialysis

56. Kidney disease
Access to pre-
emptive
transplantation

58. Table 2 a
Preventable
causes of
hospital
admission,
Sandwell
and
Western
Birmingham
Clinical
commissioni
ng group,
2012-13

60. www.fph.org.uk
Wider global concerns for the public’s health
The best job in the world: practicing
public health, past, present, future

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

62. 6120/12/2019
The public’s health: global burden
of disease, corporate anti-health
interest,

64. 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

66. 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%

67. These 10 Corporations Control Almost Everything We Eat

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

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71. 7020/12/2019
Violence, conflict and public
health at home and abroad

72. 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

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

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

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Planetary health: environment, loss of
biodiversity, food and ecosystems balance,
climate change.

77. A role for our climate
change special
interest group

79. •
7820/12/2019

80. 7920/12/2019

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

86. www.fph.org.uk
Climate breakdown
A manifesto for health, J Middleton November 28th 2019

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88. Climate
change
policing:
protests
and
disasters

89. Climate
breakdown
is here
now!- 1 fire

90. Bianca Nogrady BMJ 2019;367:bmj.l6914
Climate
breakdown
is here
now!- 1 fire

91. • Climate
breakdown is
here now!- 2
floods

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

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

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

97. www.fph.org.uk
The best job in the world: practicing
public health, past, present, future
After 2016…

98. This is a looming disaster and
priority is to limit damage

99. 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?

100. 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

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

102. ‘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.”

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106. ‘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)

107. www.fph.org.uk

108. Effectiveness Hierarchy
Effects of different policy options
(evident for tobacco control, alcohol control, dietary salt & transfats etc)
107
Downstream Upstream
Sizeofpopulationhealthbenefit
INTERVENTIONS

109. www.fph.org.uk
Mason R,
Capewell,S,
et al

110. www.fph.org.uk
Commissioning Public Health
Services Conference - June 2017

111. www.fph.org.uk
Austerity kills
Climate breakdown
Service cuts
Brexiting health
A manifesto for health, J Middleton November 28th 2019

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

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

115. www.fph.org.uk
Appendix
References

116. • 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/Eurohealth-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
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#; (accessed November 16th 2019).