In this issue > Interview: US public health guru Georges Benjamin > FPH Annual Conference: catch up on what you missed

The magazine of the > Learning from the AIDS crisis in dealing with Ebola UK Faculty of Public Health www.fph.org.uk

September 2014

Loud and clear The advocacy edition Public Health Today FROM THE PRESIDENT UP FRONT The magazine of the UK Faculty of Public Health www.fph.org.uk ‘Health in every News in brief September 2014 Welcome policy’ dropped from Double vaccines ‘hasten the end of polio’ Contents Using both types of polio vaccine could Welsh white paper speed up efforts to free the world of the Up Front 3 E WAS responsible for the disease, research suggests. The oral vaccine traditional environmental is leading the fight to eradicate polio, but services of water supply, trials in India show an additional injection ‘H n THE Welsh Government’s public health Stagnant incomes among the low paid – of inactivated virus boosts immunity, Interview with Georges Benjamin 4 sewage disposal, food control and hygiene; for the public whitematters paper, Listening to you – your health actually a fall in real terms, the first according to the journal Science. health aspects of housing; for the , sets out wide-ranging proposals, substantial decrease since the 1960s. control and prevention of infectious including action to reduce the harms Read FPH’s response :http://bit.ly/1pcVJT4 ‘Sugar intake must be slashed further’ caused by smoking, alcohol misuse and The target to reduce sugar consumption Special feature: Advocacy 6 disease; for the maternity and child welfare clinics and their attendant health obesity, and strong practical actions that EU-US Trade agreement should be much more ambitious, health Make yourself clear 6 visitors and midwives; he was will have a positive impact on health and Most FPH members believe that experts say. The latest official advice is that responsible for the TB dispensary and the wellbeing. overwhelming international evidence sugar should account for 5% of energy Scotland’s battle to lead the world in VD clinic; then... he was in charge of The Faculty of Public Health’s (FPH) key points to a universal health service intake – down from 10%. But a study banning cheap alcohol 7 school health. Now to all this was added concern, responding to the plans, is to available to all, free at the point of need published in the BMC Public Health journal responsibility for the management of the highlight part of the preceding green paper and funded through general taxation, as said the target should be no more than 3%. Online network fighting gender local hospital. The Medical Officer of that didn’t reach the white paper: being the cheapest and most effective way stereotyping 7 Health [MOH} was at the height of his We have a choice of role models for proposals to ensure that health was built to deliver healthcare. Most of us in public Guide dog owners ‘fearful’ of cyclists into all Welsh Government policies. FPH health believe in integrating health and A charity for blind people has said guide Debate: Should your advocacy power; this was the peak of his career.” the practice of public health, most said that a framework for health in all social care; and in setting the best possible dog owners are scared of going out in organisation accept industry funding? 8 I quote here from Sidney Chave’s seminal notably Edwin Chadwick and John Snow policies should form a central pillar of legal, regulatory and fiscal conditions to London because of cyclists. The Guide essayOfficer on of The Health Rise and Fall of the Medical at the national level and William Henry Land of the living 9 . I quoted it previously Duncan and his equivalents around the an eventual Welsh public health bill, promote and protect the public’s health. Dogs for the Blind Association said it had in a paper for the AGM of the Faculty of UK at the local. During my career, I have ensuring strong collaborative links That is why FPH sees the Transatlantic seen more reports from guide dog owners How a thank-you letter became Community Medicine in 1988 entitled been privileged to sit at the feet of a across different sectors, and a strategic Trade and Investment Partnership (TTIP), a who had been hit by a cyclist or come a filmscript 10 Where have all the troublemakers succession of colleagues, friends and national approach supported by local free-trade agreement under negotiation close to a collision. Rob Harris from the initiatives. between the EU and USA, as a threat to group said some visually impaired people Personal stories can shape policy 10 gone?. I lamented, with one of the citizens who have made major fathers of the Faculty of Public Health, contributions to public health and the Read FPH’s response: http://bit.ly/1nQwVAX the health and livelihoods of all the were “fearful” about going out. Girls on film 11 Huw Francis, the passing of the robust human condition. Very few have made populations involved. FPH predicts several tradition of “the breadth and richness of that contribution by remaining seated Food poverty on the increase threats to public health from TTIP: Children flock to hospital to have teeth out Many voices of health 12 n classical public health” as articulated by behind their desks. Perhaps most vivid There is known to be a gap in health It will reduce the sovereign ability of The number one reason for children of Data bombshell proves new law Sir John Simon and quoted by Huw. The has been the example of my friend circumstances and outcomes between rich governments to legislate to protect health, primary school age being admitted to packs a punch 13 latter went on to eavesdrop on Sir John Slobodan Lang, City Medical Officer for and poor people in the UK. The reasons for safety and the working conditions of their hospital is to have multiple teeth taken Simon reflecting in 1890 on his annual Zagreb, whose practice of public health inequalities are complex, but many people out. The number of children aged five to n Use meetings briefings and reports as MOH of the City of London extended to him standing between working families are now living in poverty It will hinder the ability of governments nine needing hospital treatment for dental hard evidence 13 from 1849 onwards: “After a lapse of so Serbian tanks and striking miners in – and do not have enough income for a to protect the environment and to prevent problems has risen by more than 3,000 in decent diet. That was the FPH’s message to global warming, by limiting regulation of the past three years, according to figures Do media campaigns improve health? 14 many years... I rejoice to remember that, Kryena and mediating. Slobodan is even in those early days, I did my best to certainly out of the mould of ‘classical the All Party Parliamentary Inquiry into industry and commerce analysed by the Health and Social Care n make clear to the commission, what public health’; there are many more from Hunger and Food Poverty, led by Frank It will interfere with national policies on Information Centre. sufferings and degradation were a wide range of backgrounds and not Field MP. The submission focused on three provision of health and social care. incurred by the masses of the labouring necessarily with public health in their job problems: Read FPH’s response to the recent Kerala plans to ban alcohol The Secret DPH’s Diary 14 n population through the conditions under title. Somebody who had a profound Increasing food poverty and increasing European Commission consultation on Authorities in the southern Indian state of which they were so generally housed in effect on my personal approach to public use of food banks – a marker of pressure TTIP: http://bit.ly/1pWQMxG Kerala have outlined plans to ban the sale courts and alleys they inhabited: not only health was the Governor of for emergency food aid and consumption of alcohol to tackle the n Volatile food prices which are proving Mark Weiss state’s drink problem. The first phase of the FPH Annual Conference 2014 15 how unwholesome were those Visagapatnam in India. Every night at the conditions, but how shamefully end of the working day, he would go increasingly hard for lower-income Policy Officer ban would see more than 700 bars and inconsistent with reasonable standards with his driver to the main station and households to manage Faculty of Public Health some shops selling alcohol shut down, of civilisation; and how vain it must be scoop up all the newly arrived children with more alcohol-free days introduced. The government aims to enforce total Books & Publications 19 to expect good social fruit from human and deposit them at the municipal life running its course under such orphanage. Clearly he was acting on an prohibition in 10 years. conditions.” Neither Sir John Simon, understanding of proactive public health. who became the country’s first Chief So we must ask “will we prove worthy Breast cancer test ‘Angelina effect’ found Referrals to breast cancer clinics more than Endnotes 20 Medical Officer, nor Edwin Chadwick, successors or are we to be reduced to president of the Board of Health, were petty clerks and bureaucratic doubled in the UK after Angelina Jolie shrinking violets. They stood up for the commissioners? The wheel turns and we announced she had had a double poor, the dispossessed and those whose are once more having to define what we mastectomy. The actress revealed in May last year she had had the surgery, after Noticeboard 23 health was threatened. The Times stand for and whether in future years famously stated that it would rather our efforts will attract the approval or being told she had an 87% chance of the “take its chance with the cholera than the approbation of our great disease. The news encouraged women be bullied into health by Mr Chadwick”. grandchildren. Let us rise to the task! with concerns about their family history to Truly we stand on the shoulders of get advice, a study by Manchester The Final Word 24 FOOD FOR THOUGHT: Many working families do not have enough income for a decent diet giants. John Ashton University found.

SEPTEMBER 2014 3 INTERVIEW INTERVIEW

Georges Benjamin has been executive director of the American Public Health Association since 2002. He was secretary of the Maryland Department of Health and Mental Hygiene and earlier served in Washington DC in various roles including director of the ambulance service. Here he talks about the differences between US and UK public health

‘I’ve learnt a lot about my span of control’

How HIV and violence shaped Georges’ career BE PREPARED: By 9/11 Georges and his team had already put in place systems to cope with large-scale terrorist attacks Looking back over your long career in public health, of work was done with our colleagues in the region to build ‘ from happening in the first place. Prevention is a central tenet of our what would you say were your proudest moments biosurveillance systems. It was good we had built a regional health reform and is persuasive throughout the law. I’m hoping we so far? response system because our first case of anthrax was a Maryland The worst thing in the don’t become complacent to the cost-value equation. Covering During my time in Washington DC we had two major problems. resident who was exposed to anthrax in Washington DC and people with insurance is the beginning, not the end, of our quest. One was a lot of firearm violence in the city and the second was hospitalised in the state of Virginia. This was a regional event that world is to be HIV and AIDS. At that time, AIDS was beginning to actively was picked up, not by a fancy surveillance system, but by an exchanging business What do you regard as the real priorities in tackling manifest itself in some of the poorest parts of town, and we were astute clinician. Over the years, tragically, we’ve all learnt a lot health inequalities in the US? beginning to try to redistribute resources and find innovative ways about terrorism. cards in the middle of We are beginning to see progress, most recently with infant to get into communities. a disaster mortality through insurance coverage, particularly children who are We had health workers working with everyone including the sex Which experience do you think you learned most ‘ born with congenital malformations. Social determinants of health industry to try and get the message out that everybody was at risk. from? make an enormous difference, and we hope to address more of We made some substantial inroads, working with community We all make mistakes, and I’ve made a few. And I’ve learnt from those. For example, many of our low-income children are fed foods outreach workers, beauticians and barbers, all sharing information them. They’ve taught me to be better prepared in communications in nurseries and schools that contribute to obesity. Our task will be about safe sex. We actively engaged school-age children and got and to be more thoughtful about the ramifications of what I say. What do you think ordinary Americans would make of getting everybody on board with tackling these issues. recognition for our work from the city and community. That was I’ve also learnt a lot about my span of control and how to focus on our NHS? very rewarding. what I can actually do something about. Sometimes that means The average American doesn’t have a clue about the What’s your perspective on how public health issues During my tenure with the state health department in Maryland, waiting a few days until you get the facts so you can solve a accomplishments of your health system. The more we begin to differ here in the UK? our department built the infrastructure to address biological problem: there are no permanent friends and no permanent move into a broader system that provides care for all, there will be In the US, we are talking about a very distinct entity from clinical terrorism and weapons of mass destruction. By 9/11 we had enemies. If you do what’s in the best interests of the public’s a greater appreciation of what your universal healthcare system has care in most cases. In the UK, you have a much more integrated already put in place systems to address some of the tragedy that health, regardless of how difficult it is, you are probably going to accomplished. system. For many people in the United States, public health is only we’re now seeing around the world today. do well. for people on low incomes. Public health is seen as either What are your hopes and fears for ‘Obamacare’ in government related [for people on low incomes], or the clinical What kind of scenarios do you plan for when you What have you found to be the main hurdles in 10 years’ time? preventive services provided by the private sector. don’t know what the threat is yet? translating evidence into public health practice in Hopefully to achieve our goals, which were to improve on the cost- There are a lot of simple things such as making sure that people the US? quality equation. We spend twice as much as the other industrialised How do you relax and find some work-life balance? know one another. The worst thing in the world is to be While we may be comfortable with the evidence we have, others nations of the world, and we get poorer results overall. We are not My journey to work is about an hour each way, and I listen to exchanging business cards in the middle of a disaster. We asked may not be. We have to spend a lot of time convincing others that as healthy as we could be. It’s a challenge: I’m overweight and books on tape or the radio. There was a time when my idea of a ourselves: what would happen if we could not operate out of the evidence is correct. We have to be lot more critical of the struggling with my weight all the time. As a nation we have too vacation was going to a medical meeting and dragging my family our major headquarters? We worked on communication so that evidence. The biggest hurdle is that we often take something that much of that, and we also have over 100,000 people who die along with me. I now realise there’s a value in resetting your brain we could tell people about the level of threat without scaring is in line with our own beliefs and run with it, versus questioning it prematurely because of medical errors. We are also trying to get rid and going on vacation and leaving everything behind. Nobody is them. We worked on lab infrastructure and training in a very broad to see if it’s truly correct. I’m not talking about changing our of the variability in quality in our healthcare. My biggest hope is that indispensable, and I have an amazing staff. way. At that time, no-one would have thought that airplanes or values, but the evidence may mean we have to be open-minded we move from a system that is designed to fix things when they the mail system would be used as weapons of mass assault. A lot about the solution. break, to a system that is predominantly designed to prevent things Interview by Liz Skinner

4 PUBLIC HEALTH TODAY SEPTEMBER 2014 5 SPECIAL FEATURE: ADVOCACY SPECIAL FEATURE: ADVOCACY Scotland’s battle to Online network fighting gender lead the world in stereotyping banning cheap alcohol

IT IS well acknowledged that play is a crucial part of children’s social and THE story of minimum unit price (MUP) for educational development. Games and alcohol in Scotland has been one of toys offer the chance to practise skills success in highlighting a problem and they will need for the rest of their lives, building professional, political and public from turn-taking to spatial awareness. support for a health policy. It is also one of Yet toys remain an area rife with gender frustration at the prolonged process of stereotyping. Walk into a toy shop and implementation, due to the opportunities you will likely find toys split down the afforded to well-funded litigants to delay middle, with one side for boys and the legislation through legal action. other for girls. Sometimes this split is Early progress was rapid. Scottish Health explicit, with huge signs declaring who Action on Alcohol Problems (SHAAP) was should play with what; sometimes it is founded in November 2006 and first much more subtle, using pink/blue colour recommended MUP in a report in coding or with themes such as Pirates September 2007. The Scottish Government and Princesses. supported the policy in a consultation in This less explicit division is particularly Make yourself clear May 2008. Further discussion built political difficult to counter. When raising these support, and MUP legislation was passed in issues, we are often told: “But there’s May 2012 without opposition. nothing to stop a girl buying the boys’ Advocacy can be problematic, but it remains one of our key activities and The measure, with MUP set at 50p per deliberate approach of using frontline version.” This is of course true, but should evolve with the changing landscape, says Alan Maryon-Davis unit with a commitment to evaluate staff to highlight the range and extent of children are well versed in the gendered rigorously, would have come into force in alcohol problems, and SHAAP worked messages they receive from marketing and May 2013 but for legal action by the closely with national and local alcohol peers. We regularly hear of girls being told Scotch Whisky Association, and some charities to coordinate our messages. by other children that their favourite space European trade bodies. The legal findings There are also parts of the alcohol toys are for boys, or of little boys told that government in England has been that, in about relationships, trust and respect. It’s have favoured the health and government industry which support price regulation. their beloved dolls are for girls. many if not most cases, politics trumps also more challenging and certainly case so far. The options for appeal and These tend to be independent publicans These messages limit children, turning public health. requires a different set of skills. pace of the legal process is such that the who see that the sustainable future for them away from toys and games that they This is most acute with media advocacy This edition of Public Health Today introduction of the measure is unlikely to their business is one which limits harm, once loved through a desire to fit in and – talking to the local press, reacting to a looks at many different facets of advocacy. be before the end of 2015. and small brewers who struggle in a ‘stick to the rules’. Let Toys Be Toys is

hot news topic, running a campaign. Peter Rice outlines the bruising battle to Aside from the need to be patient, what supermarket-dominated market. Health trying to change this. We want retailers Without strict adherence to the party line, get minimum unit pricing for alcohol are the other lessons from the Scottish advocates need to find ways to work with and manufacturers to make packaging and speaking out can all too easily prove to be actually happening in Scotland, and we experience of minimum unit price? A case these supporters. marketing inclusive to boys and girls.

a career-limiting move. hear about the British Lung Foundation’s built on sound data is essential. An Outside support was important. While Ours is part of a new breed of But advocacy can take many forms. It work in pushing for implementation of a otherwise disappointing national alcohol the key role of price and availability has campaign based almost entirely on social ban on smoking in cars with a child on strategy in 2002 established a group of been well recognised among public health media. Our volunteer campaign team WHAT a pickle we public health people are board. There’s a piece on the plain packs epidemiologists then known as the are spread across the country, and not ‘ specialists for decades, there are few in when it comes to advocacy. Without strict saga in Australia, another on using National Alcohol Information Resource international examples of this approach all of us have met in person. Being online On the one hand, we regard it as our adherence to the personal stories to influence policy and a (NAIR). NAIR undertook the ‘old school’ being systematically implemented. allows us to fit campaigning around work lifeblood – fundamental to our role as party line, speaking third on gender equality in the world of public health role of data analysis, and this Recognition that MUP was a logical and family lives. We’ve checked in champions for the people’s health. toys. We also have Roy Head talking about provided the basis for campaigners such as approach and that Scotland was being everywhere from the daily commute and Whether we work in health improvement, out can all too easily a study to evaluate the effectiveness of SHAAP to make the case that rates of innovative were strong reinforcers for the school run to the gym and the health protection or health service ‘ prove to be a career- health education via community radio in alcohol harm were rapidly rising and action Government. MUP was part of a number supermarket. development, we see advocacy as core. It’s limiting move Burkina Faso." was needed. Information on mortality of evidence-based measures, in line with Using social media does bring our job to speak out, to put the case for Our Big Debate considers whether rates, hospital admission rates, World Health Organization ‘best buy’ challenges. Whilst Twitter and Facebook translating evidence into policy and advocacy organisations should accept consumption and inequalities provided recommendations including a national are hugely popular, we struggle to reach practice. The Faculty of Public Health (FPH) doesn’t have to be by loudhailer. It can be funding from vested interests, such as regular press stories. The media likes screening and brief intervention offline audiences or those less confident has advocacy up there as one of its three more subtle, behind-the-scenes, pharmaceutical companies or the food alcohol stories and a steady momentum programme, marketing and display with social media. Despite this, social strategic pillars, along with knowledge and influencing and negotiating with partners industry. And we have articles on the was built. restrictions, and server training. media has provided a platform for professional standards. and stakeholders in an effort to make Living Wage Campaign and the innovative The role of the medical profession is While we are not yet at our destination, campaigns such as ours, allowing us to But, as participants in the media good things happen. As someone outlined use of social media and film as advocacy important. Doctors are well placed to the journey has been an interesting and campaign together and reach hugely workshop at this year’s FPH annual at the media workshop, this is how many tools. deliver messages that are initially fruitful one. diverse audiences, all from the comfort of conference made very clear, many of us of those working in local government, All in all, a piquant mix – a pickle no unpalatable and present solutions that are our own homes. work for organisations that restrict our Public Health England or other politically less. But in a nice way. beneficial in the long run. Doctors are also Peter Rice freedom to speak out publicly on matters sensitive organisations will have to do popular with the public, trusted by the Chair Sally-Anne Betteridge concerning our populations’ health. One of advocacy now. It’s a different way of being Alan Maryon-Davis media and politicians and hard for Scottish Health Action on Alcohol Campaigner the consequences of moving into local heard, understood and acted upon. It’s Editor in Chief opponents to attack. There was a Problems Let Toys Be Toys

6 PUBLIC HEALTH TODAY SEPTEMBER 2014 7 SPECIAL FEATURE: ADVOCACY SPECIAL FEATURE: ADVOCACY

DEBATE: Should your advocacy organisation accept industry funding? Liz Carroll says she just needs to keep full control, while Katherine Brown says it could distort her goals

happening to them. Our income is about £650,000 a year, Money from We campaign for better information and roughly £90,000 of which is from support, particularly compensation for pharmaceutical companies. We have pharma is our people who received contaminated blood sponsorship through almost every products in the 1970s and 80s. Unlike with pharmaceutical company that treats bleeding lifeblood other charities, a whole generation of our disorders. We are very careful that we don’t community was lost due to contaminated favour one company over another and YES, advocacy organisations can accept blood. ensure we have total decision-making industry funding without compromising We would not be able to provide services control over any work that is funded by a their values. that benefit patients and families without pharmaceutical company. We are the only UK-wide charity that We work with our members and clinical supports people with bleeding disorders. The advisers to set our objectives and plans for NHS provides fantastic clinical support, but the year; these could include renewing our many families affected by bleeding disorders patient information, creating a new website feel very isolated. Bleeding disorders are or developing new services for our members. genetic, but we believe that around a third We will then ask pharmaceutical companies of cases are spontaneous. Some parents YES if they are interested in supporting our are falsely accused of child abuse at the plans. We maintain full editorial control of time bleeding first occurs, before finding funding from pharmaceutical companies. services that would otherwise not exist. out their child has a bleeding disorder. As an organisation, we find many of the For us, the priority is delivering services People with a bleeding disorder often more traditional methods of fundraising that our members need in the most cost- have home treatment for a lifelong are more difficult. Most people in the effective way. We are not guided or led in Land of the living condition that has a massive impact on general population will not know someone any way by pharmaceutical companies in their daily lives. We enable people to feel who has a bleeding disorder or the impact what we deliver. less isolated by providing services that they can have on people’s lives. We don’t The twin arguments of morality and sound business sense have been key in allow them to meet up and get peer have the benefit of being in the public’s Liz Carroll support. We help people understand their mind. We need to make sure we are Chief Executive persuading employers to implement the living wage, says Gillian Owen rights and make sense of what is sustainable and funded for the long-term. The Haemophilia Society

Society Healthy Lives DURING our economic ‘recovery,’ when enjoys cross-party support. There are more a result of receiving the living wage. over half the families living in poverty are than 850 accredited living wage employers, Professor Sir Michael Marmot’s Fair they use divergent ways of framing concerning are the obstructive activities in work, there’s a long way to go before including NHS Trusts and more than 30 states that getting

Beware the alcohol harm. The industry argues that of drinks industry bodies, opposing those earning the least feel optimistic that local authorities. These public sector people into work is of critical importance alcohol is a problem for a small minority public information campaigns about a recovery is even happening. With low- organisations are now outnumbered by in reducing health inequalities and that wolf in sheep’s of irresponsible drinkers, stressing the alcohol and cancer and mounting legal paid jobs increasing and the cost of living private sector employers who see the living those jobs should offer a minimum level of

importance of protecting the rest of the challenges to price controls – all very squeezing household incomes, the wage as a moral and sound business quality to include a decent living wage. clothing population from heavy-handed state reminiscent of tobacco company tactics. reported 5.24 million people in the UK decision, with household names including Poverty wages create a depressing hand- regulation. For public health, alcohol In an environment with abundant being paid less than the living wage is an Nationwide, HSBC and Nestlé all to-mouth existence. The best part of the TODAY’S tough economic climate affects society as a whole, with everyone resources for public health programmes issue to be addressed. accrediting as living wage employers. These Living Wage Foundation’s work is meeting makes funding for public health paying the costs to public services. and a comprehensive framework of The earliest written evidence in support organisations agree to pay all staff on their ‘ people who, through the impact of the living organisations a massive challenge. In the Industry policy solutions tend policies to regulate the upstream drivers of a living wage dates back to factory wage, can now plan their future, contribute field of alcohol, turning down additional therefore to be orientated towards the of alcohol harm, engaging in drinks worker conditions in the 1890s, with to and be a part of their community. resources would seem inconceivable. irresponsible minority, whereas public industry partnerships would be less of a Liberal MP for Dewsbury, Mark Oldroyd, Public health specialists play a vital role While there are no hard and fast rules threat to public health goals. However, pressing the need to “maintain the Poverty wages create in highlighting the negative health impacts on accepting drinks industry funding, it the real situation is very different, with worker... in the highest state of industrial a depressing hand- low wages have on society. Adding this is essential that public health the current government reluctant to efficiency, with decent surroundings and to-mouth existence information to the argument that the living professionals are fully aware of the risks introduce evidence-based policies, such sufficient leisure”. The current living wage wage is both a moral and sensible business associated with working in partnership as minimum unit pricing, while affording is a voluntary measure and the result of a ‘ decision can only strengthen the case for with an industry whose profit motives the drinks industry responsibility for decade of campaigning by low-paid implementation. Professional bodies from present a direct conflict of interest with NO delivering public education programmes workers questioning why it is you can premises, including subcontracted workers, across the sector should show leadership, public health goals. World Health via Drinkaware. Engaging with industry work several jobs, forsake all your free time no less than the living wage. accredit as living wage employers and Organization (WHO) Director General Dr health solutions focus on the product partnerships in this context not only and still not have enough to live A study examining the business benefits champion living wage contracts through Margaret Chan has said: “The alcohol itself and regulating the supply chain. diverts resources away from independently. of implementing a living wage policy in their commissioning roles. industry has no role in the formulation The evidence to support such industry implementing evidence-based policies, This year’s UK living wage rate was London found that more than 80% of The best employers are voluntarily of alcohol policies, which must be initiatives as education programmes and but also adds legitimacy to industry’s calculated at £7.65 per hour by the Centre employers believed that the living wage signing up to pay the living wage now. The protected from distortion by commercial responsible drinking messages is thin, claim to be part of the solution, rather for Research in Social Policy and is based had enhanced the quality of work of their living wage is a robust calculation that or vested interests.” whereas price controls and regulating than part of the problem. on the Minimum Income Standard for the staff, while absenteeism had fallen by reflects the real cost of living, rewarding a Given that the alcohol industry and the availability and promotion of UK. The living wage does not have room approximately 25%. hard day’s work with a fair day’s pay. public health community have alcohol are identified by the WHO as Katherine Brown to include lavish luxuries; it is a social Two thirds of employers reported a competing interests in influencing the three ‘best buy’ interventions for Director consensus about what people need to significant impact on recruitment and Gillian Owen alcohol policy, it is not surprising that tackling alcohol harm. Perhaps more The Institute of Alcohol Studies make ends meet. retention, while 75% of employees Head of Communications The living wage is a voluntary rate and reported increases in their work quality as Living Wage Foundation

8 PUBLIC HEALTH TODAY SEPTEMBER 2014 9 SPECIAL FEATURE: ADVOCACY SPECIAL FEATURE: ADVOCACY Personal stories can shape policy if well handled

I HAVE been a researcher in mental health for more than 20 years and currently lead a specialist mental health research charity. In all this time I have been challenged to make sure research work has practical relevance to everyday lives, informing policy developments and practice decisions. I have learned that, for policy-makers, lived

Hillary’s Story: case worker Eileen Brown and Hillary Fleming (right) with her two children experience accounts are very important. In academic research networks this is known as ‘public and patient involvement’, and there is guidance on how to do this How a thank-you letter well (see www.invo.org.uk) to ensure that research studies are designed to address things that matter most to individuals and became a film script develop recommendations tailored to the policy challenges of the day. Another crucial element in translating Girls on film research into policy and practice is SINCE we all tend to advocate for our own To the Public Information Department, the networks of influence. Across the mental self-interest, how should a local letter was the script for a client orientation health sector, policy networks involving With advances in technology, filmmaking, once the preserve of professionals, is governmental agency ‘advocate’ for its video. The author of the letter, Hillary, coalitions of professional bodies, third- now open to all and can be a highly effective campaigning tool, says Pamela Luna services without the perception of bias? agreed to tell her story through video, sector organisations and other providers Recent advances in communication theory photos and her own words. have become the ‘go to’ networks that the Pamela Luna views a scene from Girl Rising suggest that sometimes the messenger is An audio recording was made of Hillary Department of Health, Public Health the message. reading her letter, her photos and England and NHS England approach to THE use of film is becoming widely conference featured films with public informed and engaged. The mission of Mecklenburg’s Child documents scanned, and some more co-produce strategies that are informed by recognised as an effective tool for health impact that focused on the portrayal Girl Rising has a plethora of practical tools Support Enforcement Department is to photos and several video clips shot to the views and experiences of people on promoting population health and reaching of girls and women in the media. I was for anyone who wants to host a screening enhance the quality of life of children and round out the story. The emotion in her the ground. millions of people worldwide. The honoured to consult with FPH in organising of the film. The Representation Project has families by providing child support services voice and her tears of relief and joy spoke Lived-experience accounts anchor policy American Public Health Association’s film this session and serve on the expert panel. successfully taken on sexist media to families affected by divorce or directly to the heart of the viewer. decisions in real-life challenges, provide festival began to showcase films last year Two of the films screened, Girl Rising and separation. Special judges and courts set Questions were answered and fears allayed, support for initiatives and translate that serve as catalysts for large-scale social Miss Representation, have become models the amount of financial support the non- and new clients entered the process better complicated messages into stories that change. This year in the UK, the Public for launching global movements. custodial parent is required to provide to equipped to handle their own situation. ordinary people can relate to. But we have Health Film Society and the Faculty of These films are worthy of closer the parent with custody. The amount is The video was first shared across North to proceed with caution. Case material has Public Health (FPH) made films and examination because they are proving to

based upon interviews, wage information Carolina, and then across the US by the limitations and can alienate people as well storytelling a focal point for their annual be successful in the trickiest part of using and need. If the non-custodial parent does Federal Office of Child Support. The video as draw support for a policy. Personal meetings. Meanwhile, the Royal Society of films in public health: creating and not comply with court-ordered child was awarded a coveted Telly Award for experiences may be received as biased, Medicine has announced plans for a global sustaining significant and scalable change.

financial support, Child Support Social Responsibility and a National partisan, lacking credibility or not public health film festival. Both films are well made and have received Enforcement’s task is to act on behalf of Association of City and County Information sufficiently ‘on message’. The systematic What is fuelling this use of film is critical acclaim in the documentary film the children. Officer’s Award. nature of research can help in identifying debatable. Certainly the widespread access world. Girl Rising has been screened in 50 Anecdotal data collected by the Hillary’s Story is a good example of how suitable personal stories for use in policy countries, and Miss Representation has advertising by creating the #notbuyingit department indicates a high level of to achieve one of the key principles of work, and working carefully with the ‘ reached millions in 48 counties. app designed to stop offensive marketing anxiety, ambivalence, uncertainty and health communication: giving a voice to narrator on producing these accounts can Both films are well They both artfully frame the issues, campaigns worldwide. Strategic mistrust in custodial parents who need to your audience. Rather than designing, ensure both policy messages and personal made and have deliver facts, tell compelling stories and partnerships with key organisations, request child support enforcement services. testing and sending messages, we are narratives are not distorted. present interviews that capture attention alongside ongoing promotional The department approached the county’s charged to support the people affected by It is clear this strategy takes time to received acclaim in and prompt the viewer to act. Both are components to keep them current and Public Information Department for help in an issue and let them have their say. develop and sustain but can lead to change. the documentary centrepieces in action-oriented initiatives visible, are a hallmark of these initiatives. developing a communication strategy that Hillary’s Story allowed us to be a more I have seen this through the funding of the ‘ film world and offer readily accessible tools and Films prompt people to take action. After would reduce client anxiety. Child support effective advocate for children by reducing Time to Change anti-discrimination support for those inclined to take the next the conference film session, FPH members staff shared a letter from a client who was the fear associated with a difficult and programme, setting up early intervention in step. Social media fuels the initiatives along enthusiastically voted to create a Special a mother of two children. She thanked the stigmatising process. psychosis teams and inclusion of parity of to, and consumption of, films on varied with well-designed instructional tools for Interest Group on the use of film in public department for the sensitive, personal care esteem in the national mental health digital platforms is significant. Filmmaking, use in schools, universities and community health. To join, visit http://bit.ly/1whrSCj and attention she had received from her Gary Black strategy No Health Without Mental Health. once the domain of seasoned settings. The initiatives drive people to case manager. Public Information Specialist professionals, is now accessible and cost- websites and social media platforms in Pamela Luna To staff, the letter was proof that they Mecklenburg County Vanessa Pinfold effective for creative amateurs using order to be a part of the ’movement’ and Co-Chair were advocates for children, providing a North Carolina Research Director smartphones and personal computers. take a pledge to promote change. Both American Public Health Association good service under difficult circumstances. USA McPin Foundation All of this is why the FPH annual have extensive mailing lists to keep people Film Festival

10 PUBLIC HEALTH TODAY SEPTEMBER 2014 11 SPECIAL FEATURE: ADVOCACY SPECIAL FEATURE: ADVOCACY Data bombshell proves Use meetings, briefings and new law packs a punch hard evidence

THURSDAY 17 July 2014 is unlikely to be a date that the global tobacco industry will Like Monty Python’s ever forget. At 1am in the Australian morning an Black Knight talking embargo was lifted on a set of numbers about “just a flesh ‘ Many voices of health that drove a stake deep into the heart of wound” after losing Big Tobacco’s best efforts to deny that all four limbs, this is plain tobacco packaging had made any ‘ impact on Australians’ smoking. It showed not likely to be the that this was a public health policy that last round of denials worked. from big tobacco The Australian Institute of Health and Welfare released the results of its latest survey of tobacco use, involving 23,855 people. These surveys have been in England preceding a final decision on a conducted every three years since 1991, stated intention to introduce plain packs. FOR more than three years the British when 24.3% of Australians aged 14 and The mystery data purported to claim a Lung Foundation (BLF) has been leading over smoked on a daily basis. 0.3% increase in consumption following the campaign to ban smoking in cars In December 2013, this figure had plain packs, with British American Tobacco carrying children. Finally, in February of almost halved to 12.8% with another 3% stating in a press release that the fall was this year, after the Labour Party came out The PHE conference sent out the message that the very future of the NHS smoking less than daily. Together, this “in line with historical trends”. It wasn’t. in support of the campaign, the makes Australian smoking prevalence the Between 2010 and 2013 the fall was a amendment to the Children and Families depends on effective prevention and public health, writes Alan Maryon-Davis lowest in the world record 15.2%; the biggest percentage fall Bill was voted through with a majority of So what caused the most recent dive? ever recorded since the surveys commenced. 269 votes in the House of Commons and Other than routine twice-yearly tax Public opinion is firmly in support of the is now in the process of being increases, bans on point-of-sale retail legislation, which is also supported by both implemented into law. THERE was a terrific buzz about this year’s “think health”. Sharon Sawyers, Lead reliable information to enable informed displays, a continuation of anti-smoking the new Coalition (conservative) We used a variety of tactics to achieve Public Health England (PHE) conference at Officer for Health at the Trading Standards choices: “The public should be part of the campaigning throughout the period in government and the Labor opposition this successful outcome. We worked with Warwick University. Jeremy Hunt had to Institute, observed that public health and conversation.” Her other theme was question, and measures such as smoke-free which introduced it. Global investment politicians from all parties to persuade pull out of making the opening address, trading standards people should learn more accentuating the positives in life, rather restaurants and pubs that have been in advisers Citi wrote that the figures them of the necessity and practicality of a

but PHE chief executive Duncan Selbie deftly from each other’s knowledge and culture. than constant finger-wagging: “We place for years, the elephant-in-the-room provided “the best data” to support the ban, meeting and briefing many MPs filled the 45-minute slot with sage words Quick cup of coffee, dash round the mustn’t let public health be put in the explanatory variable was the British government’s imminent decision on ahead of every debate. The BLF press and pregnant pauses: “I do silences well.” plethora of exhibits and posters, then into killjoy pile.” She was avowedly passionate implementation of plain packaging in plain packs and that it would “substantially team worked to keep the issue in the

He seamlessly ranged over the big another parallel session. Hilary Burton of about the issue of female genital December 2012. undermine” the industry’s argument that media and public eye. We also employed lifestyle risk factors and health inequalities, the PHG Foundation was talking about mutilation (FGM): “FGM is very much my In the weeks before this data bombshell, there was no good evidence that plain social media and digital platforms to touched on TB and antimicrobial resistance genetic susceptibilities to risk factors and mission issue.” Her pay-off challenge was the Australian newspaper ran a campaign packaging would work. grow public support for the issue, making Like Monty Python’s Black Knight talking and homed in on giving children “the best how genomics could hugely improve risk ‘ for PHE “to be the engine of change in involving three front-page stories, and a it easy for as many people as possible start in life”. He observed that the harm public health, and to make the messages full page of articles by journalists and about "just a flesh wound" after losing all to contact their local MP expressing from alcohol was the leading cause of resonate with the public”. contributors, some of whom are affiliated four limbs, this is not likely to be the last support, right at the end of the campaign. premature death in working-age adults Harm from alcohol is Packed lunches in the sun and lots more to Big Tobacco. They drew on internal round of denials from Big Tobacco; and for Being part of existing networks such as and “the one long-term problem going in the one long-term parallel sessions on subjects ranging from tobacco industry data that was never made countries such as the UK that stand on the the Smokefree Action Coalition was the wrong direction”. Selbie went on to emerging infections to sustainability, and available for public scrutiny. The timing brink of legislating, following the also important, as many organisations talk about tackling dementia and enthused problem going in the from loneliness to public health leadership. coincided with a final consultation period Australian example to counter Big rallied behind us when we needed about new horizons in social media: “The wrong direction Finally, the closing address by Simon Tobacco’s claims is vital. In doing so, a them most. most exciting thing is to be working in the Stevens, the new chief executive of NHS ‘17 July’ moment in Britain may only be a However, the campaign was only behavioural sciences in the digital age.” ‘ England, asking why the NHS spends more few years away. possible because it was underpinned by To a parallel session on the Licensing Act stratification. She also outlined the on bariatric surgery than preventing type 2 compelling evidence on the scale of the 2003. James Nicholls, Director of Research potential in terms of personalised diabetes: “Obesity is the new smoking… it problem and its impact on children’s and Policy Development at Alcohol medicine, variations in response to could bankrupt the NHS if left unchecked.” Simon Chapman health. Using newly-published government Research UK, described the current treatments, drug tolerance and efficacy. He rammed home the importance of a Professor of Public Health data, the BLF found that nearly half a licensing regime as “permissive” (the vast Despite these rapidly evolving health-conscious NHS workforce promoting Sydney University million children in England were exposed majority of applications are granted). He developments, Burton was still struggling public health in local communities. In Matthew Day to smoke in their family car at least once a noted how ill-suited it is to tackling issues to get public health into genomics summary, Stevens declared: “The Consultant in Public Health Specialised week. This was invaluable information to around the meteoric rise in supermarket thinking. Even today the approach was sustainability of the NHS... depends on a Commissioning use during both parliamentary debates on sales, the focus being very much on predominantly biomedical, she said. radical upgrade of prevention and public Public Health England the subject and in the media. particular pubs and bars and driven mainly Back to another plenary. Jane Ellison, health.” by the crime and disorder agenda. The Minister for Public Health, focused on Music to our ears – all the way home. Adapted from an article that previously Tamara Sandoul challenge for public health in England, said personal responsibility for health and the appeared on Australia’s ABC The Drum Public Affairs and Policy Officer Nicholls, is to get regulatory authorities to importance of providing the public with Alan Maryon-Davis website British Lung Foundation

12 PUBLIC HEALTH TODAY SEPTEMBER 2014 13 SPECIAL FEATURE: ADVOCACY THE SECRET DPH’S DIARY ANNUAL CONFERENCE HIGHLIGHTS

which estimates the number of lives saved The FPH Annual Conference 2014 Do mass media when coverage of interventions such as Well, at least breastfeeding or malaria treatment was one of the most successful of campaigns increases in a given country. The model we’ve got some predicted that comprehensive campaigns recent years. Held at the University of improve health? could reduce child mortality in most sun cream now Manchester, it attracted more than African countries by 16%-23% at a cost per disability-adjusted life year (DALY) in 400 delegates and speakers from all the $2-10 range. These were dramatic predictions: the cost per life saved was as over the world. On the next four OUAGADOUGOU, Burkina Faso: we are a low or lower than any existing health SO GLAD I managed to get the Local pages, those who couldn’t make it year away from proving that a radio intervention. Resilience Forum to take on an adverse campaign promoting healthy behaviours We now needed to prove that the model weather plan – thanks in part to this can get a taste of what they missed can reduce the burden of under-five worked in practice. We selected Burkina summer’s heatwave. In fact the council has mortality by 15%. How did we get to Faso, which combines high child mortality been quite good about our skin cancer this point? with a localised media environment, prevention work. They even regard public Aid organisations have used radio and health as being truly integrated – ever television to promote health in Africa for since we bought all those giveaway sun decades, promoting condoms and bed nets hats and sun cream through their as well as the uptake of services when Procurement Team. needed. There is no doubt that mass media Reflecting on the latest advice on hot campaigns reach large audiences in Africa, weather from Public Health England, I Making a world of difference even in rural areas. But do they really wonder whether this might spawn yet improve health outcomes? another network to help us DPHs meet our The evidence is remarkably thin. local challenges? Given the plethora of Film Special Interest Group virtual group at http://new.fph- Education for sustainable Evaluation designs are rarely robust, with a succouring networks already created by launches with world premiere groups.org.uk/groups/ or email the FPH healthcare reliance on before-after studies, no our PHE mother ship, I’m not sure how screening network administrator at comparison groups, and dependence on many more we can cope with without [email protected] THERE are tremendous opportunities to reported rather than observed behaviours. having to give up the day job. THE Faculty of Public Health (FPH) Film build on the synergies between human Yet decisions about which interventions to Unfortunately, I’ve not yet managed to Special Interest Group (SIG) was launched Ruramayi Rukuni health and the environmental sustainability fund are taken by professionals strongly get our key councillors to meet with PHE – at the annual conference with a screening Chair of health systems. In 2013, UK academics, influenced by the rigour and discipline of partly because they have other things on put on in association with Pamela Luna and Faculty of Public Health Public Health doctors and healthcare students conducted epidemiological research. their minds, like the 30% cut to the Gary Black, co-organisers of the American Film Special Interest Group an international consultation on how to I founded Development Media council’s budget. But, I’m sure when it Public Health Association’s Film Festival. integrate learning objectives for sustainability International (DMI) in 2005 to redress this does happen they’ll be fascinated to hear The films shown highlighted the into the medical curriculum, resulting in a imbalance. I had spent eight years at the how PHE is successfully metamorphosing sexualisationGirls Wanted of the media and its consensus of three priority learning areas: BBC World Service Trust running health Community radio station in Bogande, Burkina Faso from an organisation in ‘transition’ to one importance for public health, and included Setting up FPH Special Interest n How the environment and human health campaigns on radio and television in in ‘transformation’. the world premiere of a short trailer for Hot Groups interact at different levels countries such as India, Vietnam and Brazil. permitting a randomised controlled trial I have to confess I’m not entirely sure , a hard-hitting documentary Human dependence on ecological systems; Although I’d developed a system of (RCT). The RCT, funded by the Wellcome myself what kind of organism will about the exploitation of girls and young THERE are two kinds of Special Interest the contribution of human activity and ‘comprehensive campaigns’, broadcasting Trust and Planet Wheeler Foundation, eventually emerge from the PHE primordial women in the amateur sex industry. The Groups (SIGs). In one, FPH works closely population size to climate change, on multiple health issues on a rotating randomly divided 14 areas into seven soup. But I’ve no doubt it will provide all screening was followed by a panel debate, with an external organisation; for example, biodiversity loss and resource depletion; basis to maximise impact, we had no idea intervention zones and seven control sorts of tools and templates to help make chaired by Professor Sue Bailey, past the Transport SIG works with the Transport the mechanisms by which environmental how many lives were being saved. So I zones. We are broadcasting radio spots 10 my population a little healthier and my life president of the Royal College of & Health Study Group (THSG). At the changes affect human health; the features

worked with epidemiologists at the times per day (and radio dramas every a little easier. Psychiatrists, and covered in a subsequent conference I gave an account of how THSG, of a health-promoting local environment in London School of Hygiene and Tropical evening) for three years on seven And the real bonus? This embarrassment issue of the British Medical Journal. which I co-chair with Jenny Mindell, built community and healthcare settings. Medicine (LSHTM), creating a mathematical community radio stations. LSHTM is of riches will doubtless free up time for me Dr Luna said the films highlighted how itself up since its initial meeting of seven n How to improve the environmental

surveying mortality (100,000 children) and to engage with some of PHE’s supportive “we have left our kids vulnerable; as adults members in 1989 to its present position as sustainability of health systems behaviour (5,000 households) before and networks. Plenty to look forward to then. we’ve missed something, which is what is an organisation with a European committee Definitions of sustainability; effects of Although I’d after the intervention. Our midline results happening in the media”. She called for spanning six EU member states, our own demographic, technological, climatic and developed a system ‘ show that the net improvement in the public health community to come parliamentary advisers and our own journal, resource availability trends on healthcare behaviours (the ‘difference in difference’, together as a top priority to tackle the as well as a link with FPH, whose Transport provision in future; environmental impacts of comprehensive subtracting control zone changes from media’s sexualisation of youngsters. SIG we manage. At the conference there of healthcare provision; ways to improve campaigns, we intervention zone changes) is substantial Another panellist, Jacqueline Smith, a were a number of ideas for new SIGs the environmental sustainability of health had no idea how (8.5% to 23.3%) for 6 out of 10 film maker working with the charity Best jointly established with other organisations, systems; synergies between sustainability ‘ such as Visual Impairment with the RNIB many lives were behaviours. This is the first RCT to Beginnings, said: “We can perhaps create a practices and those that promote health. demonstrate that mass media can change different set of imagery to change the and Economic Policy with MEDACT. n The duty of a doctor to protect and being saved behaviours. We will have final results in context in which these images exist and In the other type of SIG, a number of promote health late 2015, including the impact on perhaps to connect with audiences in ways FPH members get together and organise a Personal values and ethical tensions in model to estimate this. mortality (predicted to be 15.7%). If we that show them that this is one world you group entirely under FPH’s aegis. At the resource allocation and the unequal The model combined the impact of are successful, we hope to persuade could inhabit, but there are others.” conference, I attended the inaugural distribution of impacts of environmental previous media campaigns on behaviours, donors to fund the scaling up of this Conference delegates were also able meetings of Public Health Africa and a change; legal and organisational policies the media audience in each country and approach to 10 African countries, saving to take a tour of the BBC’s Mediacity in healthy ageing SIG, both of them for reducing carbon emissions. local supply-side constraints that might one million lives in five years. Salford and attend a workshop run by enthusiastic and committed. limit impact (such as access to primary Mr Black about making films with mobile Stefi Barna healthcare). It applied these behaviour- Roy Head phones. Stephen Watkins Co-Director change predictions to the Lives Saved Tool, Chief Executive Officer For more information about the FPH Director of Public Health Sustainable Healthcare Education developed by Johns Hopkins University, Development Media International Public Health Film SIG, please join the Stockport Metropolitan Borough Council Network

14 PUBLIC HEALTH TODAY SEPTEMBER 2014 15 ANNUAL CONFERENCE HIGHLIGHTS ANNUAL CONFERENCE HIGHLIGHTS

community and military settings Manifesto for the North West The arts: respectively. A range of evidence-based Just tell it how for Number Ten: A Public Health Manifesto ( approaches were piloted in an area of high Urgent message from JULY 2014 saw the publication of Top Ten authenticity mental health need and were tailored to it happened –

community, employer and college settings: http://phlive.org.uk/phmanifesto/) from the and exchange n Short bespoke plays and forum theatre end of story RNIB: you must not North West Directors of Public Health. The n Mental Health Ambassador scheme report listed the 10 public health priorities

(providing meaningful ‘social contact’ with potentially the biggest impact on opportunities with the public) lose sight of sight loss health and wellbeing. n Mental health awareness educational There has been significant work THE idea of arts and health has been sessions – with input from ambassadors. MAG Connolly [Faculty of Public Health undertaken over the past 10 years on growing exponentially over the past 30 Pre- and post-intervention questionnaires Head of Corporate Affairs] invited Narativ ‘ improving public health, but clearly there is years, arguably born in Manchester, from a included validated knowledge and attitude to give an experiential workshop on AT THE FPH conference, the Royal National a great deal more work to do, for example tradition of radical thinking and grassroots measures used by the Time to Change storytelling at the annual conference. More Institute of Blind People (RNIB) challenged Effective eye care the implementation of standardised activism. The field has evolved from its early campaign. Results showed statistically than 40 people signed up, but at 1pm the FPH to become an exemplar organisation pathways can help packaging and continued discussions about days of humanising clinical environments significant improvements in participants’ corridor outside the room was quiet. At that is accessible to and inclusive of blind price and taxation policies for both tobacco to its current affiliations with the public knowledge, attitudes and confidence in 1.01pm a bearded man came in and said: and partially-sighted people. We are reduce unnecessary and alcohol. Substantial health inequalities health agenda. The director of Arts for “We can start now.” Over the next 10 confident that with the commitment to eye sight loss still exist in the North West and national Health, Clive Parkinson, introduced this minutes, people arrived and all the chairs health shown by FPH President John policy is really important in helping to drive session at the FPH conference by offering in the circle filled up until I gave up mine Ashton and CEO David Allen, FPH will take ‘ improvements. delegates a focus on the “science and art” and was standing in the middle. I began: up this challenge. The manifesto was presented at the of public health, emphasising knowledge, “There is a reciprocal relationship between Preventable sight loss needs to be more creating an inclusive society and preventing Festival of Public Health held in Manchester political advocacy and imagination. listening and telling. What that means is of a public health priority. Around 1.8 avoidable sight loss. We do this through on 1 July and at the FPH conference and The foundation of the National Alliance that the way you are listening to me now million people are currently living with influencing government, industry and service received a very positive reaction with lots for Arts, Health and Wellbeing and the is going to create what happens in the significant sight loss in the UK. By 2050 providers on issues such as healthcare, of discussion and debate both about the recently established All-Party Parliamentary next hour.” this number is expected to double. Half of treatments, travel, technology and retail. priorities identified and how they are to be Group for Arts, Health and Wellbeing The objective was to give a taster of this sight loss is preventable. Our influencing work is informed by the progressed. signals that a political appetite for re- Narativ’s methodology. I began by People with sight loss are significantly research we undertake and commission to imagining public health is clearly emerging focusing on this idea that listening more likely to suffer from depression and develop evidence about the needs of blind Matthew Ashton in the UK. But advances in this multi- creates telling, and, using a listening have an increased risk of falls. Effective eye and partially-sighted people and those at Director of Public Health disciplinary field require continual meditation, we discovered the multiple care pathways can help reduce risk of sight loss. We provide a wide range Knowsley intellectual engagement which moves obstacles people have to listening openly unnecessary sight loss, and effective social of services and support through products, beyond the dehumanised forces of the and being present. I told a personal story care support can help individuals a telephone helpline, and face-to-face and market and addresses complexity. In her to model a specific way of telling. successfully adapt to a life with sight loss. online support. We also run residential care paper, Exploring the Longitudinal Together, with a lively discussion, we Improved detection and treatment of eye homes, schools and colleges. Relationship between Public Health and Arts Nurses at the forefront deconstructed it, enabling me to introduce conditions can improve other health At www.rnib.org.uk/healthprofessionals Participation A scene from Acting Out Productions © Flashpoint , Dr Rebecca Gordon-Nesbitt, our method of simply telling what outcomes for condictions such as stroke, RNIB provides valuable resources and tools IT WAS great to have the opportunity to Principal Investigator in Arts for Health at happened, removing judgement, dementia and learning difficulties. With the for FPH members such as the Sight Loss highlight at the FPH conference the value the Manchester School of Art, launched an supporting people with mental health interpretation and comment. preventable sight loss indicator in the Data Tool, guidance on commissioning eye of nursing to public health. This is widely evidence base that informs research into problems. Mental health ambassadors This technique makes a story as vivid and Public Health Outcomes Framework, the care services, prioritising eye health and acknowledged, but more needs to be the relationship between arts engagement reported increased confidence and sense of memorable as possible by pulling the Department of Health in England has addressing it in Joint Strategic Needs done to engage with nursing and and public health. purpose through their public contacts. listener empathetically into your begun to recognise that more needs to be Assessments. midwifery staff in all areas and to promote This evidence base was compiled as part The play was effective in making an experience. I gave a story prompt, and done. Prioritising eye health will ultimately Working together, RNIB and FPH can do its role and value. of a six-month project, funded by the Arts impact and generating interest in and participants worked in pairs, practising reduce health and social care expenditure much to reduce avoidable sight loss and Nurses and nursing teams are often at and Humanities Research Council, and uptake of the project. Comprehensive telling a story of their own. The energy in and improve outcomes for people with or create a more inclusive society for blind the forefront as the biggest clinical involved extensive scoping and evaluation helped secure roll-out funds from the room was buzzing as people wrestled at risk of sight loss. and partially-sighted people. workforce. It is however essential that we consultation in the UK and the Nordic partners. Reflective practice from the pilot with this simple yet surprisingly difficult RNIB is the leading charity for everyone make sure we work together across countries. The process yielded 14 of the helped to improve the quality of the roll-out. technique. John Ashton came in with affected by sight loss in the UK. We aim to Helen Lee professional and organisational boundaries. key studies that have explored the This session explored research and Dame Tessa Jowell, took me by the arm make every day better for everyone affected Evidence & Service Impact – Prevention The Royal College of Nursing (RCN) has relationship between engagement in practice, linking the arts, health and and said: “This is fantastic, isn’t it?” by sight loss: by being there when people Manager a membership of around 415,000 diverse cultural activities – far beyond the authenticity. If public health success is as Afterwards someone reflected: “It felt need us, supporting independent living, Royal National Institute of Blind People registered nurses, midwives, health visitors, clinical environment – and a range of much about imagination as it is about boring to speak without interpretation.” nursing students, healthcare assistants and public health outcomes over time. knowledge and advocacy, public health Her partner jumped in: “But it was actually nurse cadets. It is the voice of nursing Delegates were presented with a brief practitioners must regularly interrogate their the opposite, much more interesting, more across the UK. The RCN has a very dynamic overview of the approaches used and motivation, reconnect with their values and powerful.” Another woman said: “I stuck and committed Public Health Nursing findings reported, together with a dare to confront inequalities. In this effort, to the ‘what happened’, but my listener Forum with members from a wide variety consideration of the physiological the arts and culture offer a powerful made really insightful interpretations – so of areas of practice. mechanisms thought to underlie any vehicle for precipitating social change. he was getting it even though I wasn’t One of the key challenges is to help positive associations observed between arts saying it. That was powerful.” people adopt healthier lifestyles. The RCN engagement and health. The constructively Clive Parkinson At the end of the session John Ashton has just launched a resource for anyone critical response received at the conference Director asked Dame Tessa if she would like to say who has a role in motivating them to has helped to shape further dissemination Arts for Health anything. “I don't want to say too much change their behaviour: www.rcn.org.uk/ of this international resource. Rebecca Gordon-Nesbitt actually,” she replied. “There’s a real sense development/practice/cpd_online_learning/ Maya Twardzicki, Public Health Lead at Principal Investigator in Arts for Health here of an explored magic.” support_behaviour_change Surrey County Council, shared two projects Manchester School of Art that evaluated the use of drama and Maya Twardzicki Jane Nash Helen Donovan comedy in raising awareness and Public Health Lead Director Public Health Nursing Adviser challenging the stigma of mental health in Surrey County Council Narativ, Inc Royal College of Nursing

16 PUBLIC HEALTH TODAY SEPTEMBER 2014 17 ANNUAL CONFERENCE HIGHLIGHTS BOOKS & PUBLICATIONS

Undergraduate Curriculum for ‘My conference’: a delegate Whitehall Studies. UK Medical Schools 2014 writes... You will wish This book gives readers the basic foundation knowledge needed in each GUIDANCE from the General Medical FOR several reasons, 2 July 2014 was a you had read area covered and then develops this to Council, Tomorrow’s Doctors 2009, unique day. It took me back 36 years, to provide a greater understanding within the outlines the knowledge, skills and when I was engaged in my postgraduate it ages ago context of ageing. This is so for all behaviour that medical students must studies at Manchester University. It gave chapters, from genetics and various demonstrate by the time they graduate. me the opportunity to visit the department THIS book combines a life-course approach research methods to more practical but While each medical school can design its and my former supervisor, Professor Tim with various metabolic, physiological and complex issues such as diet and lifestyle. own curriculum to suit its own Lee. My wife and I enjoyed reminiscing genetic aspects of ageing using a range Part II of the book moves rapidly through circumstances, the overall curriculum must about our days in Manchester. of qualitative and quantitative research different methods of studying ageing from allow students to meet the outcomes More importantly, I was humbled to be methods and has even included some a life-course and interdisciplinary FPH CEO David Allen (left) with Professor Jamil specified in Tomorrow’s Doctors. awarded Fellowship by Distinction by key health improvement chapters perspective. These chapters move from Public Health Educators in Medical Professor John Ashton, President of FPH. experiences. This opportunity was invaluable. addressing wider determinants of health basic methods into more complex Schools, in collaboration with FPH, I can’t express enough how honoured I am I was able to tell people about an such as where we live. The layout modelling and statistics. Part III provides launched a consensus statement that FPH has recognised my academic and ongoing project I have been working on: encourages the reader to continue on several chapters addressing different body every key area of public health but (http://tinyurl.com/nsvlkn8) at the FPH community work. This award signifies my the National Iraqi Public Health Project. An and learn more, and it maintains interest systems, organs and cells and somehow never manages to lose sight of conference to facilitate this public health persistence in and commitment to example of international collaborative work throughout some really heavyweight demonstrates how these alter during the its main focus: healthy ageing. education in medical schools. This enhancing the field, in particular for my to expand the field of public health into topics. life course and how they affect the ageing document is a comprehensive guide that beloved country, Iraq, which has been the third world countries, this proposal, which Each chapter is self-contained, with an process. The genetics and epigenetics Ruth Goldstein identifies core curriculum content to subject and inspiration of my work. Dr has the potential for collaboration between introduction, main body of text, future chapters are both fascinating and, if you support and enhance the development of Wasan Al-Alwan, health attaché at the Iraqi my department at Wayne State University, directions/conclusions and a reference struggle with genetics like your reviewer undergraduate public health education and Embassy in London attended the ceremony FPH and the American Public Health section. This means that the reader can does, a little scary, as they link more A Life Course Approach to describes potential educational approaches on behalf of the Iraqi Ministry of Health. Association, aims to change the attitudes dip in and out or read from cover to cover general concepts of genetics to the ageing Healthy Ageing and assessment methods, and During my visit, I had the opportunity of and behaviour of Iraqi people toward to gain the full experience of the life- process. The final section of the book, Edited by Diana Kuh, Rachel Cooper, opportunities for introducing public health getting in touch with colleagues and public health. course approach to ageing. The text is entitled ‘The way we live’, explains how Rebecca Hardy, Marcus Richards and throughout the clinical curriculum. possibly building future collaboration broken up by diagrams and figures to help healthy ageing relies upon healthy living – Yoav Ben-Shlomo highlighting the World Health Organization Hikmet Jamil explain the concepts being discussed. and makes the reader wish they had Veena Rodrigues mission of ensuring the health of Department of Family Medicine and Furthermore, the material used and thought about their old age earlier! Published by Oxford University Press Clinical senior lecturer individuals across the globe. Events such as Public Health Sciences referenced is, on the whole, up to date but Overall, this is an excellent book. It is a ISBN 9780199656516 Norwich Medical School the dinner helped me learn about others’ Wayne State University, Detroit, USA also includes some of the early relevant comprehensive public health text book RRP: £44.99 seminal pieces of work such as the which exposes its reader to just about

communities, where health facilities were The perfect cure ill-equipped to distribute it. Research led to for our fallacies the development of an approach in which FPH Annual communities designed their own distribution and were empowered to do so. Faculty of about Africa “Within four years of community Conference 2015 Public Health directorship the number of people who African Health Leaders is an excellent received treatment increased from 1.5 to Annual antidote to popular European notions that 20.4 million… Community-directed Conference 2016 what Africa needs are Western experts distributors would go from household to introducing modern strategic programmes household and from village to village – an invitation and logistics, community engagement, delivering ivermectin on an unpaid 22-24 June research design and health leadership, voluntary basis.” while sick villages passively languish. There are many more examples. These Dozens and dozens of vivid examples African health leaders achieved amazing The Faculty of Public show that African health leaders’ outcomes in the face of difficulties and health programme leads… though it may Health is looking for a achievements often dwarf what we do on shortages that many of us would find hard well tempt you to head for Bamako or venue for its UK health and wellbeing boards. We could to imagine. Africa still has a huge chunk of Johannesburg to work alongside these 2016 annual conference. learn a lot from them. Uche Amazigo, for the world’s burden of disease, but how people and learn. example, led the development of much larger would it be without the community-directed treatment for river success stories told here? Andy Beckingham If you would be Sage blindness, “a devastating blinding disease You can open this book at any page and interested in hosting it, that has afflicted some of the most remote learn how African public health people, please contact villages… but can be prevented…” Yet government health advisors and senior African Health Leaders: NewcastleGatesheadNewcastelGateshead Mag Connolly, FPH Head “more than half a million community doctors faced the most enormous resource Making Change and Claiming of Corporate Affairs, at distributors have delivered more than 600 shortages, epidemiological, political and the Future [email protected] million treatments to prevent blindness and programme-management problems, and Edited by Francis Omaswa and Nigel or tel 0203 696 1469 thereby saved an estimated 2.5 million social, economic and cultural barriers and Crisp Look out for further details on the FPH website disability-adjusted life years”. The still succeeded in improving health and Published by Oxford University Press www.fph.co.uk manufacturers provided the drug free of reducing inequalities. It made me feel a bit charge but the biggest problem was like the village policeman reading about ISBN 9780198703327 developing and implementing a way of the work of the entire Metropolitan police RRP: £24.99 © Mark Savage getting it to massive numbers of remote force. It is essential reading for public

18 PUBLIC HEALTH TODAY SEPTEMBER 2014 19 ENDNOTES ENDNOTES

They helped to organise a conference in Christopher Parish FFPH In memoriam Maputo in 1990 in an attempt to persuade 1917 – 2014 But I came across another sort of the expertise of a select few officers and African governments to take HIV/AIDS advocacy last month, when I accepted members – we need to act collectively. more seriously. They were also appointed Mr Christopher Parish was a pioneering an invitation to spend some time with a In my first eight months in post I have as joint directors of the newly-founded cardiothoracic surgeon at United group of folk practising asset-based tracked more than 30 different Africa Centre for Health and Population Cambridge Hospitals. community development (ABCD). ‘advocacy’ topics as they have come Studies in KwaZulu-Natal carrying out an Christopher qualified from Manchester in Members came from a variety of through the FPH office, from alcohol to extensive research programme in HIV 1940 and served as a surgeon to the backgrounds, but all with a core belief work capability assessment. And yet this prevention and control. Eighth Army in the desert and northern that the spirit of ‘association’ is more barely scratches the surface of the Across his career Mervyn Susser Italy during the Second World War. On powerful than that of ‘institution’ – and range of subjects and topics that FPH produced more than 350 peer-reviewed landing at Salerno in September 1943, he that well-channelled community action members feel passionately about. papers,Epidemiology more than 100 occasional papers worked through 36 hours non-stop derives both health and practical So here is the opportunity: as well as a and 12 books – his last being Eras in operating on wounded soldiers on the benefits for those who engage. It is an professional body, you are an association : the evolution of ideas, front line. The Germans were attacking interesting idea – based as it is on a – a community. You have told us you jointly with Zena in 2009. It is fair to say and at one point a Brigadier handed him a positive identification and use of assets, want to engage and give your time – that his and Zena’s enduring and incredibly rifle and told him to get into a ditch. He rather than a more perhaps traditional particularly to advocate on issues about productive partnership has formed the showed his Geneva Red Cross identity card From the CEO ‘deficit’ or ‘needs-led’ approach. which you are passionate – and now bedrock of much of our public health and refused. His batman was killed a few People are drawn together by common we have a mechanism to do just that. thinking today. yards away. On another occasion, he SO, what is the best way to deliver concern and interest to act collectively; Without significantly greater funding found himself having to perform an effective advocacy? There are of course such groups have a capacity to respond – or a growth in capacity drawn from emergency heart operation in a poorly multiple answers and unsurprisingly, in times of crisis; it is self-empowering the membership – it is difficult to see equipped field hospital, at a time when they don’t always agree with each other. and self-multiplying; and it can be a how we can deliver ever wider, effective John Bryden FFPH few chest surgeons would dare to touch FPH has tended to ‘do’ advocacy truer and more inclusive representation advocacy. We need help. Mervyn Susser FFPH 1932 – 2012 the heart. The patient survived, and this through its elected officers and of ‘democracy in action’ than the work Let FPH use the assets that you bring 1921 – 2014 experience convinced Christopher that committee structures – with support of many an elected politician. to advocate for the kind of world we all We have only recently been informed of heart surgery was his true metier. from a small Health Policy and This is not a million miles away from seek: a fairer, more equal, more Dr Mervyn W Susser, world-renowned the death of Dr John S Bryden, a true Back in the UK after the war he was Advocacy team based at St Andrew’s the concept of Special Interest Groups – sustainable, humane and ethical world South African epidemiologist and civil pioneer in the emerging field of appointed thoracic surgeon at what was Place. Views are debated, consensus drawn from the UK Public Health which has ‘better health for all’ as its rights activist, began his career running a computerised health databases who played then a tuberculosis sanatorium in sought (and sometimes reached) and Association – which we want to re- focus. clinic in Alexandra, a black township in a key part in the early development of Papworth, Cambridgeshire. It was ‘positions’ stated and communicated on introduce into FPH as a basis for advocacy Johannesburg, where, together with his Scotland’s system of healthcare informatics. Christopher who, virtually singlehandedly a UK or national basis. engagement. We can no longer rely on David Allen doctor-wife Zena Stein, he developed close After qualifying in medicine at Glasgow in the 1950s, fought to transform the small links with Joe Slovo, Walter Sisulu, Nelson in the 1956, John did his National Service isolation hospital into a thriving Mandela and other pioneers of the in the Royal Army Medical Corps, cardiothoracic centre, recruiting and emerging Anti-Apartheid Movement. specialising in trauma orthopaedics, developing skilled surgeons and taking on In 1955, political pressures forced followed by a spell of general practice in ever more complex cases. The first Mervyn and Zena to leave South Africa for Govan, before settling into a 35-year successful British heart transplant was their results earlier. random sample of 20% participants is England where their close friend Professor career in public health, medical performed at Papworth, as was the world’s Changes to FPH The following are now requirements of selected for audit. To ensure that Jerry Morris helped them find academic management and, his main passion, first combined heart-lung-liver transplant. the CPD policy and will form part of the participants are motivated to maintain their posts in the Department of Social & computerised health information systems. Later in his career, Christopher was CPD policy – standards assessed at audit: documentation every year, an additional Preventive Medicine at Manchester During the early 1970s, back in the days increasingly involved in medical education, n At least 50 CPD credits must be random sample of 2% is audited. Anyone University. Whilst there, Mervyn took on of punched cards and optical character becoming director of postgraduate key advice undertaken each year who fails to submit an annual return or the role of Medical Officer of Mental recognition, John pioneered an innovative education for East Anglia Regional Hospital n There must be a balance of types of CPD who had an unsatisfactory audit the Health for Salford and, jointly with Zena, computerised database for a large Glasgow Board and dean of postgraduate medicine activities with no single type of activity previous year is automatically included. This set up a psychiatric registry which led to health centre and, as chief administrative at Cambridge University. His main normally accounting for more than half means that a small proportion of the first large-scale study of the incidence medical officer for Argyll & Clyde (1973- contribution to public health was his CPD credits claimed participants may be selected for audit in of mental disorder in an urban population. 81) the first ‘community health index’ for steady support for community medicine IN APRIL 2014 the new Faculty of Public n At least 25 CPD credits must directly consecutive years. Also at this time, with anthropologist Dr his local population. He also helped to training in the early days of the specialty. Health (FPH) Continuing Professional relate to a professional development phase It is not compulsory to use the online CPD William Watson, he co-authored the shape the first hospital patient Development (CPD) policy came into force. (PDP) for the relevant period log which is available to all members via the pioneering textbook, Sociology in Medicine administration system in Scotland. Later, his Some members will have already been n There must be reflective notes for all FPH website, but it is strongly recommended (1962). epidemiological research and informatics producing CPD documentation that meets CPD credits claimed that you do so. It facilitates the production Ten years later, Mervyn was appointed attention focused on head injury disability Deceased the requirements of the new policy, but n At least 40 credits must be supported by of reflective notes; there is a facility to link professor and head of epidemiology at and care, and he was involved in others will need to take action now to reflective notes assessed as ‘good’. There is your CPD directly to your PDP; and, if you Columbia University New York where he developing a national database for Scotland. members ensure that their CPD for 2014/2015 is guidance in the CPD policy as to how are selected for audit, you can download subsequently founded and directed the Following his retirement from the NHS, documented adequately. reflective notes are assessed. There is also documents for submission. Sergievsky Center for the study of John continued as a freelance consultant in The following members have From 2015, your annual CPD return useful guidance on writing reflective notes I encourage you all to look at the FPH developmental disorders of the nervous health informatics and was a prominent also passed away: must be with FPH by the end of April. on the FPH website CPD policy now so that you can ensure system until his ‘retirement’ in 1991. A member and fellow of the British Computer This is the return which states how many n A reflective note must only cover up to you are meeting FPH requirements during series of lectures at Columbia became the Society, chairing its health informatics Luke Collins MFPH CPD credits you will be claiming for five CPD credits. If you attend an event the year and for more information on the basis for arguably his most famous book, committee for several years. Alongside his John Davies MFPH the previous year. In earlier years, lasting several days, write a separate audit standards. Further guidance is Causal Thinking in the Health Sciences work in Scotland, he had been influential John Hutchby FFPH participants had until 30 June to submit reflective note for each day. available from the FPH website (click on (1973), among the first to expound the at the European level for several years and Anthony Lane FFPH their annual returns or claim exemption As part of its quality-control procedures, the ‘CPD’ tab) and from CPD Advisers – concept of social determinants of health from 1998 to 2008 John was Executive Manmohan Matharu FFPH from CPD. The change brings forward the FPH audits a proportion of participants http://www.fph.org.uk/faculty_advisers inequalities. Officer for the European Federation for David Paterson FFPH audit process so that those selected for each year. There is a requirement that In his later years, Mervyn, together with Medical Informatics. In 2009 he was David Weeks MFPH audit will not be submitting during the everyone is audited at least once in each Lorraine Lighton Zena, became increasingly involved in the awarded an honorary fellowship of the Elizabeth Whiteley MFPH main holiday season and will receive five-year cycle, and therefore a non- FPH Director of CPD struggle against HIV/AIDS – initially in New federation in recognition of his considerable York and later in their native South Africa. lifetime contribution to this important field.

20 PUBLIC HEALTH TODAY SEPTEMBER 2014 21 ENDNOTES NOTICEBOARDNOTICEBOARD

Welcome to new FPH members New public FPH BALLOTS We would like to congratulate and welcome the following new members who were health admitted to FPH between May and September 2014 specialists

Proposal to convert FPH to a charitable company Honorary Fellows Honorary Members As advised on 20 May 2014, FPH is now balloting members Georges Benjamin Claudia Allemani Congratulations to the following on on a number of changes to Standing Orders. Ballot papers James Chauvin Ali Batarfi achieving public health specialty have been sent by post to all members in good standing. Lindsey Davies Robert Dingwall registration: Please complete and return the ballot paper no later than Karen Dunnell Anita Donley noon on 11 November 2014 to the Independent Scrutineer. Tessa Jowell Danny Dorling UK PUBLIC HEALTH REGISTER Contact 020 3696 1469 if you have any questions or Timothy Lang Rhiannon Edwards queries. Wei Gao Training and examination route Fellows through distinction Nicholas Harding Ian Ashworth Elections Badreyya Al Harmi Roger Harrison Alisha Davies Elections are to be held over the coming months to fill the Jeffrey Braithwaite Iona Heath Siobhan Farmer following posts which will become vacant from the FPH Benjamin Cowling Karen Hughes Amanda Fletcher Annual General Meeting in 2015: Maznah Dahlui Eileen Kaner Ruth Harrell n Vice President for Policy Benedict David David Kidney Sion Lingard n Assistant Academic Registrar Noran Hairi Martin O’Flaherty Susan Matthews n Local Board Member, Yorkshire & the Humber Hikmet Jamil Lucy Reynolds Suzanne Meredith n Local Board Member, Scotland Jasvindar Kaur Donna Sager Mary O’Brien n Local Board Member, Northern Ireland Ahmed Mandil Richard Smith Donald Read Full details of the elections timetable for 2014-15, together Monica Medina Paul Ward Hamira Sultan with nomination papers, can be found in the FPH online Ziad Memish Sarah Theaker members’ area or are available on request from Caroline Sok King Ong Members through distinction Jayne Thomas Wren ([email protected], 020 3696 1464). Antonella Sammut Nadhim Ghazal Noaman Dean Wallace Nominations opened on15 September 2014 for the election Judit Simon Toni Williams of a Vice President for Policy and close on 27 October 2014. Karen Vincenti Members Dong-Qing Ye Sarah Addiman Defined specialist portfolio route Liann Brookes-Smith Sundus Hashim Fellows Elizabeth Crowe Karen Fitzgerald Victor Aiyedun Rose Dunlop Rabia Khan Charles Beck Samantha Fox Mary Lyons Jonathan Cox Ashley Gould Campbell Todd Helen Elsey Mary Lyons Irfan Ghani Angelique Mavrodaris Stephen Gunther Oyinlola Oyebode GENERAL MEDICAL COUNCIL REGISTER Fiona Hamilton Rachel Scantlebury Matthew Harris Martine Usdin Sarah Couper Baldish Kaur Emma Waters Elizabeth Crowe Samia Latif Iain Kennedy Lise Llewellyn Diplomate Members William Maimaris Janice Lowndes Simona Baracaia Muhammad Sartaj Barbara Paterson Victoria Hall Sonya Scott Mohit Sharma Stuart Keeble Katrina Spence Rebecca Nunn Sharon Stoltz Yat Hung Tam Specialty Registrar Members Jayne Taylor Leslie Jones Were you in a senior public health Ruth Twiggins Julie Northcott post in the 1970s or 1980s? Louise Wallace Oliver Quantick Lawrence Wong Jenny Wright, FFPH, is researching women doctors working in public health in the 1970s and 1980s for a PhD at Oxford Brookes University. She would be Chair, Part A MFPH examiners gaining exposure to personal development interested in talking to women who were opportunities. Criteria for appointment can Specialists/Consultants in Community FPH is recruiting for the role of Chair of be found in the job description and person Medicine/Public Health during that period Part A MFPH Examiners. Accountable to specification on the FPH website at in England. the Academic Registrar and Head of http://www.fph.org.uk/work_for_fph If you would like to speak to Jenny Education and Training, the Chair plays a If you are interested in applying, please to tell her about your experiences from vital role in the delivery and maintenance send your CV and a citation (no longer this time, please email her at of the standards for the Part A than 500 words), explaining why you feel [email protected] and examination. This is an opportunity to take you would be suitable, to [email protected] she can provide you with further a lead in the examination process while by 31 October 2014. information.

22 PUBLIC HEALTH TODAY SEPTEMBER 2014 23 ‘THE FINAL WORD’ The AIDS epidemic taught us that stigma can seriously hinder effective disease control and treatment. We need to remember those lessons when dealing with the Ebola outbreak, says Rachael Jolley

“STIGMA remains the single most “The epidemic of fear, stigmatization and faster. In some societies infections such as important barrier to public action. It is a discrimination has undermined the ability HIV or Ebola are considered a moral main reason why too many people are of individuals, families and societies to judgement on lifestyle, or a religious afraid to see a doctor to determine protect themselves and provide support judgement on some kind of wrongdoing. whether they have the disease or to seek and reassurance to those affected.” Medical ethicist and barrister Daniel treatment if so. It helps make AIDS the Despite South Africa’s formal recognition Sokol told the BBC that there was a long

silent killer, because people fear the social of gay rights, a 2013 survey found only history of stigma related to Ebola, with disgrace of speaking about it or taking 32% of respondents agreeing that survivors being chased from their easily available precautions. Stigma is a homosexuality should be accepted by communities and their homes being

chief reason why the AIDS epidemic society. Condom use fell in South Africa burned. It is no wonder then that people continues to devastate societies around the who may have Ebola symptoms might be world.” wary of reporting them. These are the words of UN Secretary Where societies shun Clearly, good public information and General Ban Ki Moon in 2008. And six or make moral ‘ encouragement of open discussion can years on, as reported cases of the Ebola judgements about conquer fears and address stigma, virus rise swiftly in West Africa, those those with particular breaking down barriers to reporting illness. words feel just as relevant today, not only But that journey can be a long one, with to AIDS work, but just as pertinently to ‘ health conditions, shifts in public attitudes often taking public attitudes to Ebola. individuals are less decades. Frank discussions by national, Where societies shun or make moral likely to come forward regional and religious leaders, debunking judgements about those with particular myths about Ebola, as has happened with health conditions, individuals are less likely HIV/AIDS in many countries, may hopefully to come forward and seek help. They may from 2008 to 2012, and this was linked by go some way towards dispelling stigma delay reporting illness, so action is delayed. some to perceived societal attitudes to and encouraging people to report They may deny to themselves they are masculinity and sex, prompting men not to symptoms. infected and continue to travel and risk wear condoms. infecting others. As with AIDS and HIV, those with Ebola Rachael Jolley Again and again, the way people are face societal stigma if they seek healthcare, Editor treated by their wider community has and if their condition becomes publicly Index on Censorship impact on the ability to treat diseases. A known. So they self-censor, they fail to 2005 International Center for Research on report, don’t check in with a doctor or Rachael Jolley writes here in a personal Women report on HIV and stigma said: clinic, and the outbreak spreads even capacity

Editorial board Address Information Andy Beckingham Faculty of Public Health Stella Botchway 4 St Andrews Place Matthew Day London ISSN – 2043-6580 David Dickinson NW1 4LB Jenny Hacker www.fph.org.uk Editor in chief Rachel Johns Alan Maryon-Davis Frances MacGuire Submissions Helen McAuslane If you have an idea for an article or special Managing editors Sally Millership feature, please submit a 50-word proposal Lindsey Stewart and Mag Connolly Thara Raj and suggested authors to: [email protected] Leonora Weil The proposed subject of the special feature Commissioning editor in the December edition is technology and Liz Skinner Contact us social media. Email: [email protected] Production editor Health Policy, Media & PR: 0203 696 1452 Richard Allen Education: 0203 696 1451 All articles are the opinion of the Professional Standards: 0203 696 1453 author and not Public Health Today is distributed to Business & Corporate Services: those of the Faculty over 3,200 public health specialists. 0203 696 1455 of Public Health as To advertise please contact Richard an organisation Allen at [email protected]