Presentation to University of Maastricht, International Masters in Public Health leadership and management course, December 14th 2018. 181214 middletonj maastricht

1. www.fph.org.uk
The best job in the world: practising public
health, past, present, future
John Middleton

2. Who we are and what we do
• The United Kingdom Faculty of Public Health is a faculty
of the three Royal Colleges of Physicians of London,
Edinburgh and Glasgow (Physicians and Surgeons)
• FPH is a membership organisation for nearly 4,000 public
health professionals across the UK and around the world
• We also have a growing number of student, associate and
international members in more than 80 different countries
To improve and protect the public’s health:
through standards, advocacy, training and
knowledge
www.fph.org.uk

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

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

5. William Beveridge designed a welfare
state for the UK in the deepest point
of the Second World War.
‘We should regard want,
idleness , ignorance,
squalor and disease as
enemies of us all. That is
the meaning of a social
conscience; that we refuse
to make our separate
peace with evil.’

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

8. The public’s health

9. A life in local public
health

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

18. Improving
outcomes

20. Sandwell Valley,
King George
Playing fields
2014

21. www.fph.org.uk

23. New leisure
centres
Tipton

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

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

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

30. Marsch Addiction 1997

32. Middleton J. The hospital of the future comes to the West Midlands. BMJ blogs October 1st 2014.
http://blogs.bmj.com/bmj/2014/10/01/john-middleton-the-hospital-of-the-future-comes-to-the-west-
midlands/

33. www.fph.org.uk

34. 04/01/2019 33
• Asset based public health
• Community assets

35. 34
Community health network

36. 35
Sandwell Youth Cabinet

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

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

39. www.fph.org.uk

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

41. www.fph.org.uk

42. 41

44. 04/01/2019 43
• Asset based public health
• ‘The health dividend’

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

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

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

49. www.fph.org.uk
04/01/2019 48

50. 04/01/2019 49
• Troops,
• money,
• or influence?
I’ve had them all
The greatest of these is influence
‘Sapiential authority’
What other ways have you got to improve the
public’s health ? Apart from chasing the money?

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If the policy is wrong, money will not
make it right; and if the policy is right,
money may not in fact, present an unduly
difficult problem.
EF Schumacher, Small is Beautiful, p 162

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

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

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Manage, control the information
Apply the knowledge

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

56. Long term conditions
Kidney
disease
Standardised
prevalence ratio
for
haemodialysis

57. Long term conditions
Kidney disease
Access to pre-
emptive
transplantation

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

61. http://www.un.org/en/un
iversal-declaration-
human-
rights/index.html
04/01/2019 60
December 10th 2018: 70th anniversary of
the universal declaration of human
rights

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

63. Scotland’s National Action Plan
for Human Rights

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What have
you got
against
nannies?

65. Effectiveness Hierarchy
Effects of different policy options
(evident for tobacco control, alcohol control, dietary salt & transfats etc)
64
Downstream Upstream
Sizeofpopulationhealthbenefit
INTERVENTIONS

67. www.fph.org.uk
04/01/2019 66

68. 6704/01/2019
The public health system: the Faculty
role today

69. My presidency
Build local authority relationships
Build relationships in health and public health services in
four nations of the UK
Do things jointly where possible - policy statements,
conferences
Implement new curriculum: personal effectiveness and
values and ethics; rebuild health protection and health care
public health
Develop member involvement
Ensure solid member services, build special interests
Develop faculty governance
Pursue 12 asks of the Manifesto
Planetary health
A Public health curriculum for young people
Brexit, drugs, air pollution, AMR, violence prevention

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

71. FPH workforce strategy 2018
1. FPH will champion the unique value of Public Health Specialists
and work with employers, commissioners, decision-makers and other
stakeholders to ensure the specialist role is understood, recognised,
valued and deployed to best effect to meet employer needs, the
needs of an efficient health system and the needs of the public
2 - FPH will ensure that a flexible Public Health Specialist workforce
is trained, developed and strengthened to meet employer and the
public’s health needs in the future
3 - FPH will work with partners to ensure clear and appropriate data is
available on the current workforce and to ensure that effective longer
term workforce planning is undertaken
4 - FPH will work in partnership with the public health community to
support the development of an effective public health practitioner
workforce and enable the wider workforce to deliver improvements to
the public’s health

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

73. 7204/01/2019
The Faculty strategy to 2025
Outline to Board November 2018
Evolutionary
Enablers :
Partnerships
Membership
International
Finance
Activities :
Advocacy,
Standards,
Knowledge,
Workforce

75. www.fph.org.uk
04/01/2019 74

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

77. 7604/01/2019
The public’s health: global burden
of disease, corporate anti-health
interest,

79. Globally, mortality rates have decreased across all age groups over
the past five decades, with the largest improvements occurring
among children younger than 5 years. However, at the national
level, considerable heterogeneity remains in terms of both level
and rate of changes in age-specific mortality; increases in mortality
for certain age groups occurred in some locations.
Countries have saved more lives over the past decade, especially
among children under age 5, but persistent health problems, such
as obesity, conflict, and mental illness, comprise a “triad of
troubles,” and prevent people from living long, healthy lives.
Total deaths in children younger than 5 years decreased from 1970
to 2016, and slower decreases occurred at ages 5–24 years. By
contrast, numbers of adult deaths increased in each 5-year age
bracket above the age of 25 years.
Global burden of disease study, 2017

81. Burden of disease attributable to 20 leading risk factors in 2010
expressed as a percentage of global disability-adjusted life-years
Global Burden of Disease Group. www.thelancet.com 2012 380 2245
Diet ≈ 40%

82. These 10 Corporations Control Almost Everything We Eat

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

84. 04/01/2019 83

85. 04/01/2019 84

86. 8504/01/2019
Violence, conflict and public
health at home and abroad

87. The epidemiology of violence
Evidence-based violence prevention: a life course
approach
Asset based community development
Primary, secondary &tertiary prevention role of the
public health community as primary preventers of violent conflict,
through healthy public policies and tackling major social inequalities in
health; and as early reactors, mitigaters and responders to violence.
New public mental health approaches
A role for public health in conflict resolution with
aid agencies, political scientists, theologians and international lawyers
A role for public health educational bodies
A leadership and partnership role for public
health
www.fph.org.uk/uploads/Violence%20report.pdf
Areas of action for the public health
community in preventing violence

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

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91. 04/01/2019 90

92. 9104/01/2019

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

94. Interconnectness:
Climate change
refugees

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

96. 9504/01/2019
Planetary health: environment, loss of
biodiversity, food and ecosystems balance,
climate change.

97. A role for our climate
change special
interest group

99. •
9804/01/2019

100. 9904/01/2019

104. The globe from the
South Pacific
1/3 of the world’s water surface
Drinking water shortage
10 million population
World’s highest % diabetes
Supplies 80% of the world’s tuna
Canary in the coal mine for:
ocean acidification
Ocean warming
Reefs dying
Marine ecosystems disrupted
Watch the price of your tuna bagette
rise…

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

107. Strategic
alliances:
A ‘one
health’
approach

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

109. ‘Saving lives with solar’ Royal
North midlands Hospitals, Stoke.

110. Thinking globally,
acting locally:
Coventry and
Warwickshire
University
Hospitals Jubilee
Nature Reserve –
managing water
run off from
hospital car parks
- promoting
biodiversity,
saving money

111. www.fph.org.uk
04/01/2019 110

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

113. BREXIT and the public’s health
Loss of health and care workers
Loss of research grants and networks
Loss of leadership role in areas such as tobacco control and
antimicrobial resistance
Loss of international agencies which protect health –European
Communicable Disease Centre; The European illegal drugs
monitoring centre; European Medicines Agency; Pulling out of
Euratom Access to Medical isotopes for cancer treatment and shared
safety procedures for nuclear power stations;
Loss of protections for health - in the workplace, the Social chapter;
environmental protections; soil, beaches and air quality; equality
provisions;
Shared Security?

114. Brexit policy programme: Three areas
of focus short-listed
1. Protecting the European Centre for Disease
Prevention and Control (ECDC) (and other key
institutions)
2. The Great Repeal Bill – FPH calls on the
Government to introduce a ‘do no harm…and
do better’ clause
3. Free Trade and Investment Agreements, a
transitional agreement and World Trade
Organization rules

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

117. ‘Do No Harm’ Lord Warner Public Health
amendment to the EU Withdrawal bill
At Report stage Lord Duncan made clear to the House that “the
effect of Article 168 in the domestic law of this country before exit
will continue after exit by virtue of Clause 4…Article 168…will be
available in the future to UK courts to draw upon, both its
elements and its interpretation, and those elements will be
available afterwards…we are now in a good position to offer
certainty.”

118. 11704/01/2019

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

122. ‘Valuing public health’: Three areas of
focus short-listed
1. Making the case for prevention (return on
investment; affordability; value for money; a call
for the ‘radical upgrade to be made real)
2. Investing more in prevention through the NHS (
including secondary prevention; rebuilding health
care public health)
3. Investing for outcomes (Developing the public
health outcomes dashboard, assuring the future
of public health investment)

123. www.fph.org.uk

124. www.fph.org.uk

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

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

127. NHS 10 Year Plan
FPH Health Foundation workshop: Health of staff; strategic and local
leadership, capacity building in health-care related public health
Then priority services and client groups Early years, tobacco,
alcohol
https://www.fph.org.uk/media/1918/nhs-plan-fph-response.pdf
04/01/2019 126

128. http://www.bmj.com/content/357
/bmj.j2676
Inequalities in health cost
£65bn (€74bn; $83bn) in lost
productivity and taxes and
increased benefits payments
plus
£5.5bn for direct NHS
treatment in 2010.5

129. Public health and the EU post
Brexit
A country fit to live in…
where
 Britain can power itself ? and
 House itself ? and
 Employ itself ?
http://www.campaigncc.org/sites/data/files/D
ocs/one_million_climate_jobs_2014.pdf

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

133. Thank you
John Middleton,
President
UK Faculty of Public Health
president@fph.org.uk
04/01/2019 132

134. • Middleton J, ISIS, crop failure and no anti-biotics: what training will we need for
future public health? European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/735
• Middleton J, Weiss M. Still holding on: public health in the UK after Brexit.
Euroheathnet journal 2016; 22:no 4: 33-35. (ISSN 1356–1030)
http://www.euro.who.int/__data/assets/pdf_file/0010/325945/Eurohealth-V22-N4-
2016.pdf?ua=1
• Middleton J. Public health in England in 2016—the health of the public and the
public health system: a review Br Med Bull (2017) 1-16. DOI:
https://doi.org/10.1093/bmb/ldw054 and
http://academic.oup.com//bmb/article/doi/10.1093/bmb/ldw054/2871226/Public-health-
in-England-in-2016the-health-of-the?guestAccessKey=8f7a33a1-bdbf-4db4-948c-
fd6b6293a259
• Middleton J, Saunders P. 20 years of local ecological public health: the
experience of Sandwell in the English West Midlands
http://www.sciencedirect.com/science/article/pii/S0033350615003303

135. 04/01/2019 134
• The public’s health, and the public health
service*
*Public health in England in 2016—the health of the public and the public health system: a review
Br Med Bull (2017) 1-16. https://doi.org/10.1093/bmb/ldw054

136. • Saunders P, Middleton J. Sustainability and transformation
plans for the NHS in England: radical or wishful thinking?
BMJ 2017;356:j1043 Available at:
http://www.bmj.com/content/356/bmj.j1043/rr-1 (accessed
May 25th 2017) and paper published short version:
Saunders P, Middleton J, Lloyd S. Survey of directors of
public health suggests that STPs may be falling short of
ambition. BMJ 2017; 357 doi:
https://doi.org/10.1136/bmj.j2552 (Published 25 May 2017)
Cite this as: BMJ 2017;357:j2552 Available at:
http://www.bmj.com/content/357/bmj.j2552?rss=1&utm_sou
rce=feedburner&utm_medium=feed&utm_campaign=Feed
%3A%20bmj/recent%20%28Latest%20from%20BMJ%29&v
ariant=short&sso= (accessed May 25th 2017)
• Middleton J. Public health and the general election 2017.
https://www.lgcplus.com/services/health-and-care/public-
health-and-the-general-election-2017/7017915.article
• Middleton J. Time to put health at the heart of all policies.
BMJ 2017; 357:
http://www.bmj.com/content/357/bmj.j2676?sso.

137. • Quantz D, Jenkin D, Stevenson E, Pencheon D,
Middleton J. Sustainable development in public
health consultant education. The Lancet Planetary
Health, DOI: http://dx.doi.org/10.1016/S2542-
5196(17)30114-6 Available at :
http://www.thelancet.com/journals/lanplh/article/PIIS
2542-5196(17)30114-6/fulltext (accessed October 6th
2017).
• Bellis M, Hardcastle K, Purkis-Garner A, MiddletonJ.
Interpersonal, collective, and extremist violence are
public health problems BMJ opinion, October 30th 2017.
Available at:
http://blogs.bmj.com/bmj/2017/10/30/interpersonal-
collective-and-extremist-violence-are-public-health-
problems/ accessed November 1st