a presentation to public health colleagues at the University of Warwick Medical School , 3rd May 2018. 180503 middletonj warwick 2final

1. Advocacy and the public’s health
Professor John Middleton
President of Faculty of Public Health

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
MiddletonJ Advocacy and the public's health 180503

3. ‘Don’t just fight for
the profession of
public health fight for
the public’s health’
Alwyn Smith, President of
the UK Faculty of Public
Health, 1981-1987
Public health
professionals are not
here to make
decisions easier, it is
to make things better

4. The public’s health

6. Salus populi suprema
lex esto
Cicero
‘The health of the
people is the highest
law’

9. Improving
outcomes

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

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

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

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

16. 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
MiddletonJ Advocacy and the public's health 180503

17. MiddletonJ Advocacy and the public's health 180503

18. These 10 Corporations Control Almost Everything We Eat
MiddletonJ Advocacy and the public's health 180503

19. http://www.bmj.com/content/358/bmj.j4443?sso=
MiddletonJ Advocacy and the public's health 180503

20. Strategic
alliances:
A ‘one
health’
approach
MiddletonJ Advocacy and the public's health 180503

21. A future without antibiotics?
A future with only public health ?
MiddletonJ Advocacy and the public's health 180503

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

23.  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

24. 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

26. A role for our climate change
special interest group

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

30. Interconnectness
:
Climate change
refugees

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

32. My presidency
Pursue 12 asks of the Manifesto
Planetary health
A Public health curriculum for
young people

33. Achieved 2015-2017
Plain packaging of
cigarettes
Sugar sweetened drink
tax
Personal health and
social education
reinstated in scholls

34. President gets cross on Childhood
obesity strategy- August 2016

35. Public
health
and the
EU post
Brexit

36. Racist attacks
reported in the
month following
2016referendum

37. https://www.sustainweb.org/news/oct16_city_food_symposium_2016/
Public health and the EU post Brexit
A country fit to live in:
 Can the UK feed itself ?
 A new Food Act to protect health and improve the
enviornment
 Would reward farmers better and be job creating
 Reduce £24B food imports deficit

38. Brexit policy programme: Three areas of
focus short-listed
• MiddletonJ Advocacy and the public's health 180503
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

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

42. ‘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.”

43. ‘Valuing public health’: Three areas of
focus short-listed
• MiddletonJ Advocacy and the public's health 180503
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)

44. MiddletonJ Advocacy and the public's health 180503

45. 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
MiddletonJ Advocacy and the public's health 180503

46. 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/Do
cs/one_million_climate_jobs_2014.pdf
MiddletonJ Advocacy and the public's health 180503

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

48. The public health function
‘the public health system’
The public health profession

49. 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

50. My presidency
Build local authority relationships
Build relationships in health and public
health services in four nations of the UK
All areas of the UK visited by April 2018
Strong participant in the English Public
Health System Group
United Kingdom Public Health
Network

51. My presidency
Do things jointly where possible - policy
statements, conferences
UK Public Health Network
Developing relationships with major
Public Health national partners
Joint policy development with RSPH on
Taking a new line on drugs
Major contributors to ‘Every breath we
take’ RCP/RCPCH report
Conference/meetings strategy

52. My presidency
Implement new curriculum: personal effectiveness
and values and ethics; rebuild health protection and
health care public health
Major workstream on ethics and values: ESRC grant for
course development , working with law depts in 6
universities; proposal for Legal training for English
Public health in local authorities
Funded Work on credentialing with PHE to develop the
public health in all specialities capacity
Funded development work with PHE on personal
effectiveness /leadership/ management

53. My presidency
Develop member involvement; Ensure solid member services; build
special interests
Workforce strategy agreed November 2017
Learn from recent member survey
New website
Developing content offer online and through social media
Develop member database and apply to member services
Staff development and customer care
Policy development and member involvement through
>30 special interest groups

54. My presidency
Develop faculty governance
Failed effort to incorporate - exploring
alternative models for faculty governance
Modernisation of Board and Executive
New Strategy for 2019-2024
Start new curriculum work for 2020-2025

55. 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 deliverimprovements to the public’s health

56. Future training modes ?
Asset-based community development, and public health
generally
Address anti-health forces
Inter-professional learning
Ecological public health
Public health in all clinical specialties
Management training, leadership, personal effectiveness
Using the law for the public’s health
Widen the base of public health recruitment
Strategic, global alliances
MiddletonJ Advocacy and the public's health 180503

57. MiddletonJ Advocacy and the public's
health 180503
And my take on 2040 training
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

58. Housing and health
From Black Country CLARHC,
to Grenfell Tower

59. A box plot of the
Baseline SAP
measures for the
Sandwell MBC
housing stock,
1st April 2001, by
housing type,
n=25,595 dwellings

60. A box plot of the
Baseline SAP
measures for the
Sandwell MBC
housing stock,
31st March 2011,
by housing type,
n=25,595
dwellings

61. MiddletonJ Advocacy and the public's health 180503

62. MiddletonJ Advocacy and the
public's health 180503

63. Thank you
JOHN MIDDLETON
president@fph.org.uk

65. • 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

66. • 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_sour
ce=feedburner&utm_medium=feed&utm_campaign=Feed%3A%
20bmj/recent%20%28Latest%20from%20BMJ%29&variant=shor
t&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.

67. • 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/PII
S2542-5196(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

68. Appendix
The Faculty of Public Health

69. 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

70. Who we are and what we do
• 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 and international
members in more than 80 different countries.
• We want everyone to have the best chance to live a healthy life, no
matter who they are or where they live

71. Our role is to improve the health and wellbeing of local communities and
national populations. We do this in six ways:
1. We support public health professionals through training and beyond
2. We enable members to meet up and share ideas and best practice
3. We give members the chance to discuss new policy ideas via our
growing network of Special Interest Groups (SIGs). Each one specialises
in a different issue, from mental health to housing
Who we are and what we do

72. 4. We seek to improve public health policy and practice at a local,
national and international level
5. We campaign for change and work in partnership with local and
national governments
6. We encourage and promote new research and understanding of
public health via our Journal of Public Health, Public Health Today
magazine, blog and events programme – and we’re always looking for
new stories!
Who we are and what we do

73. Our future
• We’re determined to do even more to improve people’s health and
wellbeing and give everyone the best chance to live a healthy life, no
matter who they or where they live.
• We want to continue to improve the training and development of
public health professionals so that our members are even better
equipped to tackle the many new health challenges facing our local
communities
• And we want to play an even bigger role in shaping public health
policy across the UK and around the world

74. • We can only realise our ambitions with the help and support of our
members
• If you’re already a member, get in touch to find out how you can join
a Special Interest Group. If you’re not a member, go to
www.fph.org.uk/fph_associates to find out more or Tweet us @FPH
• From Student Membership to Fellowship and Membership by
Distinction (which you can self-nominate for with two references!),
there are different membership grades available