Where there is no vision the people perish

www.fph.org.uk
Where there is no vision the people perish
Professor John Middleton, President, UK
Faculty of Public Health

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

‘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

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

628/11/2018
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

These 10 Corporations Control Almost Everything We Eat

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

Strategic
alliances:
A ‘one
health’
approach

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

1428/11/2018
Violence, conflict and public
health at home and abroad

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

Crucial importance of early years, the first 1001 days and
adverse childhood experiences
An evidence based approach – Good systematic reviews re
early years interventions, parenting training, youth
mentoring; good modelling of alcohol pricing, control of
access and enforcement.
A life course approach- new concerns about adverse
childhood experiences (ACES) impacts on violent
behaviours, poor communication and poor mental health in
later life
A public mental health approach- linked to ACEs, the
neurobiological hardwiring of young brains in the first 1001
days; Reinforcing positive mental attributes: self-confidence,
self-esteem, self-expression and positive communication
A public health approach to violence prevention
Early Death
Social, Emotional and
Learning Problems
Adopt Health Harming
Behaviours and Crime
Disrupted Nervous, Hormonal
and Immune Development
ACEs Adverse
Childhood Experiences
Non Communicable Disease, Disability,
Social Problems, Low Productivity
LifeCourse
Death
Birth
Adverse Childhood Experiences (ACEs): impacts across
the life course. adapted from Felitti et al, 1998

Interconnectedness:
conflict over natural
resources: oil, water

Interconnectness:
Climate change
refugees

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

2428/11/2018
Planetary health: environment, loss of
biodiversity, food and ecosystems balance,
climate change.

A role for our climate
change special
interest group

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

3528/11/2018
The public health system: the Faculty
role today

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

Achieved 2015-2017
Plain packaging of cigarettes
Sugar sweetened drink tax
Personal health and social
education reinstated in schools
MUP in Scotland and Wales

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

3928/11/2018
The Faculty strategy to 2025
Outline to Board November 2018
Evolutionary
Enablers :
Partnerships
Membership
International
Finance
Activities :
Advocacy,
Standards,
Knowledge,
Workforce

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…and
do better’ 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.”

https://www.fph.org.uk/media/1961/fph-
dept-for-international-trade-consultation-
response-final-26-oct-2018.pdf

‘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)

NHS 10 Year Plan
FPH Health Foundation workshop: Health of staff; strategic and local
leadership, capacity building in health-care related public health
Then priority services and client groups Early years, tobacco,
alcohol
https://www.fph.org.uk/media/1918/nhs-plan-fph-response.pdf
28/11/2018 50

28/11/2018 52
• Poverty and inequality
• Early years
• Harmful substances
• Healthy weight and physical activity
• Mental wellbeing
• Healthy places and communities
CFPHS priorities
Scottish Government Public
Health Priorities

28/11/2018 53
What have
you got
against
nannies?

http://www.un.org/en/un
iversal-declaration-
human-
rights/index.html
28/11/2018 54
December 10th 2018: 70th anniversary of
the universal declaration of human
rights

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

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.’

Assets for the public’s health in Scotland
A belief in human rights

Scotland’s National Action Plan
for Human Rights

Human rights – from the top
The impact of inequality on health holds
Scotland back …Our goal is to ensure that
the evidence we provide and the practical
support we offer leads to everyone in
Scotland achieving the highest attainable
standard of health. That can only be
achieved by maintaining a sharp national
focus on the right to health and on those
experiencing the worst inequalities”.
“

http://www.bmj.com/content/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

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

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

• 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, 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
• Public health and trade
• Public health law, rights, ethics, values
• Genomics
• New technology
New challenges for public health training
New challenges for the public health professional.

Thank you
John Middleton,
President
UK Faculty of Public Health
president@fph.org.uk
28/11/2018 67

Scottish conference sings ‘Freedom come all ye’
https://www.dropbox.com/s/kqi3b62otfosh1i/1610%20freedom%20come%20all%20ye%20.wav?dl=0

Roch the wind in the clear day’s dawin
Blaws the cloods heelster-gowdie ow’r the
bay, But there’s mair nor a roch wind
blawin
Through the great glen o’ the warld the
day.
It’s a thocht that will gar oor rottans –
A’ they rogues that gang gallus, fresh and
gay – Tak the road, and seek ither loanins
For their ill ploys, tae sport and play

Nae mair will the bonnie callants
Mairch tae war when oor braggarts crousely
craw,
Nor wee weans frae pit-heid and clachan
Mourn the ships sailin’ doon the Broomielaw.
Broken faimlies in lands we’ve herriet,
Will curse Scotland the Brave nae mair, nae
mair;
Black and white, ane til ither mairriet,
Mak the vile barracks o’ their maisters bare.

So come all ye at hame wi’ Freedom,
Never heed whit the hoodies croak for doom.
In your hoose a’ the bairns o’ Adam
Can find breid, barley-bree and painted room.
When MacLean meets wi’s freens in
Springburn A’ the roses and geans will turn
tae bloom,
And a black boy frae yont Nyanga
Dings the fell gallows o’ the burghers doon.

7328/11/2018
https://youtu.be/8dyvDwZaIwQ
www.drharp.co.uk (Dr Feelgood’s ‘Down to the doctors’ is on Dr Harps
first album)

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

• 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

• 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

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