The future's bright, the future is public health. Presentation to the MPH students introductory course Bielefeld University School of public Health, October 11th 2021. 211011 2 middleton j bielefeld main
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
Die Zukunft ist rosig, die Zukunft ist die öffentliche Gesundheit
1. Die Zukunft ist rosig, die Zukunft ist die
öffentliche Gesundheit
Professor John Middleton Hon FFPH, FRCP,
President, Association of Schools of Public Health in
the European Region
2. The future’s bright, the future’s public
health
Professor John Middleton Hon FFPH, FRCP,
President, Association of Schools of Public Health in
the European Region
3. What is ASPHER ?
The Association of Schools of Public Health in the European
Region (ASPHER) is the key independent European
organisation dedicated to strengthening the role of public
health by improving education and training of public health
professionals for both practice and research.
We have 120 member schools of public health in Europe and
associates globally.
We are developing our partnerships with sister public health
organisations in America, Africa, Asia, Australasia and the
Arab world
6. Public health is :
The science and art of promoting health, preventing disease and
prolonging life through the organised efforts of society
Acheson 1988, after Winslow 1927, WHO 1948
7. What is public health?
The public’s health
And
The public system, services and profession
8. What is public health?
The public health system,
services and profession
9. What is public health?
Public health practice is population-based
It emphasises collective responsibility for health, health protection and
disease prevention
It recognises the key role of the state, linked to a concern for the underlying
socio-economic and wider determinants of health, as well as disease
Public health practice also emphasises partnership working with all those
who contribute to the health of the population.
Good Public Health Practice UK Faculty of Public Health 2016
10. What is public health?
Three domains of public health :
Health protection
Health improvement
Health care related public health
UK Faculty of Public Health, 2016
11. Good public health practice
• A: Knowledge, Skills and Performance
• B: Safety and quality
• C: Communication, partnership & teamwork
• D: Maintaining public trust
13. A medical specialty…
but a multidisciplinary profession, service and system
UK Faculty of public
Health
Careers in public
health
14. Multidisciplinary public health
• 19th Century: early Ukpublic
health practitioners were
multi-disciplinary: John Snow
(Surgeon/Anaesthetist),
Florence Nightingale (Nurse);
Edwin Chadwick (Lawyer);
Joseph Bazalgette (Engineer);
Mary Seacole (nurse)
16. “ Medicine is a social
science and politics is
nothing else but
medicine on a large
scale.
“Medicine as a social science, as the
science of human beings, has the
obligation to point out problems and
to attempt their theoretical solution;
the politician, the practical
anthropologist, must find the means
for their actual solution”
Rudolf Virchow
17. it's not who your
doctor is, it's who
you vote for, that
most affects your
health
18. 06/11/2021 18
• ‘The interests of health, and
the interests of common
physical convenience and
comfort are in various cases,
identical’
• Sir John Simon, First Medical
Officer of Health for the City of
London 1848, and First Chief
Medical Officer for the British
government , 1856
• WHO ‘Prerequisites for health/
health determinants’ perhaps?
35. 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.
39. Domestic burglary Sandwell 2001-2005
Full implementation
drug intervention
project doubling
numbers of drug users
in treatment
1300 fewer
domestic
burglaries
33% fall
40.
41.
42.
43. This is a looming disaster and
priority is to limit damage
44. 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/
50. • Reducing social inequalities: UK Marmot review
• Create fair employment and good quality work for all and improve quality of
work across social gradients
63. 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, 2019
66. Burden of disease attributable to 20 leading risk factors in 2010
expressed as a percentage of global disability-adjusted life-years
Global Burden of Disease Group. www.thelancet.com 2012 380 2245
Diet ≈ 40%
70. 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
104. 06/11/2021 104
ASPHER COVID-19 task force
Members in 30 countries
Actions:
• Reports on testing
• Masks
• Inequalities
• Second wave and winter planning
• How to count illness
• Basic terms of inequalities in health
• Herd immunity
• Five vaccination statements including the latest
Vaccine internationalism, vaccine passports and
vaccine diplomacy
https://www.aspher.org
/covid-19-task-
force.html
105. 06/11/2021 105
ASPHER COVID-19 task force
Actions :
Public health service functions :
• Contracts with European Health surveillance centre
ECDC for reviewing competencies in infectious
diseases, and vaccinology.
• Young professionals training and project work
• A survey of the work of our member schools in the
pandemic
• Surveys of actions by our schools in delivering teaching,
in person or remotely
• Papers on the erosion of public health
• Support statements for the role of WHO
https://www.aspher.org
/covid-19-task-
force.html
106. John Middleton [lecture title]
[date]
https://www.aspher.org/d
ownload/413/aspher_stat
ement_on_the_strategic_
use_of_masks.pdf
107. John Middleton [lecture title]
[date]
https://www.aspher.or
g/download/421/asph
er_statement_on_the_
covid-19_testing.pdf
121. John Middleton:Planning for an outbreak of health
Renew the mandate of the UN and
WHO in global health governance
The new Treaty for pandemic
preparedness
Governance
Transparency and information
sharing
Resources and capacity
New continental/WHO regional
structures with response capacity
Ceded authority to supranational
structures
122.
123.
124. Revised mandate of
ECDC and EMA
Crisis preparedness
and response
New regulation for
pharmaceutical
industry
Europe’s Beating
Cancer plan
125.
126. John Middleton: Planning for an outbreak of health
Planning for an
outbreak of health:
The public’s health
129. ‘Build back’ ?
Working practices and relationships ?
Reducing inequalities? Minorities?
Vulnerable groups? Women? Older
people?
130. John Middleton:Planning for an outbreak of health
https://www.health.org.uk/sites/default/files/upl
oad/publications/2020/Build-back-fairer-the-
COVID-19-Marmot-review.pdf
Build back
Fairer?
131. John Middleton:Planning for an outbreak of health
Build back
Fairer?
The richest billionaires could
give $139,300,000,000 away
and still be as rich as they
were in 2020. These
billionaires could end global
hunger for about $300 billion.
A fraction of their overall
wealth.
137. ‘Build back’ ?
To what austerity, poverty and
unfairness? Environmental squalor and
health and wealth for some?
Plan for an outbreak of health….
138. 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.’
139. Science knows no country,
because knowledge belongs to
humanity, and is the torch which
illuminates the world.
Louis Pasteur