A review of roles and actions of politicians, and professionals to promote and protect health and deliver a health and care system 171002 middleton j zagreb Croatian Healthy Cities Conference October 2nd, 3rd 2017

1. Politics and profession in
promoting and protecting
health : who is doing what ?
Professor John Middleton
President, UK Faculty of Public Health

2. UK Faculty of Public Health
Advocacy
Standards
Knowledge
Workforce
For public health specialist workforce
Student members,
Trainee members
Associate members
International members
New category for practitioner members
www.fph.org.uk

4. The first refugees from Sarajevo, Split Harbour, Croatia, May
1992
Middleton J:
Refugee for a
day. BMJ
personal view
November
1992.

5. Sandwell
Express and
Star ,
November
1992

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

7. 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

8. “ 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

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

10. The role of politician in improving and protecting
the public’s health:
Creating the social and economic conditions
for health and fairness

11. 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.’

12. The future of public health: follow the money? John Middleton March 10th 2017

13. The future of public health: follow the money? John Middleton March 10th 2017

14. Economic and social case for reducing health
inequities
1. Reducing health inequalities is cost effective
• E.g. the total welfare loss across the 25 European
countries is estimated at 9.4per cent GDP or €980 billion
(Mackenbach et al, 2011).
2. Benefits for the whole of society (not just the poor)
• More equal societies have improved health, societal,
human capital and economic benefits.
3. Investing in health in general has been shown to give
economic returns to the health sector, other sectors and the
wider economy:
• with an estimated four fold return on every dollar invested,
described as the fiscal multiplier (Reeves, Basu et al. 2013).

15. The role of politician in improving and protecting
the public’s health:
Funding a health and care service

16. The future of public health: follow the money? John Middleton March 10th 2017

20. The role of politician in improving and protecting
the public’s health:
Setting healthy public policy
Measuring the health impact of all policies

22. 1001 critical days
Personal health and social
relationships education, PHSE in all
schools
2 hours physical activity per week
reinstated

23. Stop marketing of foods high in sugar, salt and fat,
before the 9pm watershed and tighten marketing
restrictions
Introduce 20% duty on sugar sweetened beverages
Tackle alcohol related harm by introducing a minimum
unit price for alcohol of at least 50p
Rapidly implement standardised tobacco packaging
20 Mph speed limits

24. A living wage
Reaffirm commitment to universal
health care system free at the point of
need funded through general taxation

25. Invest in active transport to promote good
health and reduce our impact on climate change
Implement a cross national approach to meet
climate change targets, including a rapid move to
a 100% renewables and a zero carbon energy
system

26. UK Faculty of Public Health General election
statement
Health in all policies
Address health inequalities
Create conditions for the health and wellbeing
of future generations
Brexit: defend our rights to health and ensure
trade deals aspire to better health not less
Public health funding – restore cuts and
increase investment
Redevelop and secure the public health
workforce
Support our members and partners to achieve
the outstanding policy asks of ‘Start well live
better’

27. http://www.bmj
.com/content/3
57/bmj.j2676

28. The role of politician in improving and protecting
the public’s health:
Regulating and controlling
the anti-health vested interests

29. Effectiveness Hierarchy
Effects of different policy options
(evident for tobacco control, alcohol control, dietary salt & transfats etc)
29
Downstream Upstream
Sizeofpopulationhealthbenefit
INTERVENTIONS

30. Downstream Upstream
0
5
10
15
20
25
30
35
Tobacco Control Scale (Joossens & Raw)
TCS points
Joosens & Raw 2008
Tobacco Control Score (TCS)
Estimated effects of different policy options

31. 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%

32. These 10 Corporations Control Almost Everything We Buy
Industrial Corporations prioritise PROFIT, not public health

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

34. The role of politician in improving and protecting
the public’s health:
Investing in prevention

36. The role of the professional :
Measuring the health needs,
Using the evidence for investment,
Advocating for what needs to be done

40. The role of the professional :
Managing and delivering local public health
services

41.  Social care
 Leisure
 Education
 Environmental
protection
Housing
Town planning
Transport
Environment and
sustainability
Economic
development
Culture and heritage
Council services should all be
involved in the health agenda

42.  Social care
 Leisure
 Education
 Environmental
protection
Housing
Town planning
Transport
Environment and
sustainability
Economic
development
Culture and heritage
Council services should all be
involved in the health agenda
Office of
Public
Health

43. Population health needs assessment
Joint strategic needs analysis
Health impact assessment
Health advocacy
Reducing health inequalities
Specialist public health commissioning and
provision in health protection, health
improvement and health care related action
Office of Public Health

44. The future of public health: follow the money? John Middleton March 10th 2017

45. The role of the professional :
Growing local resources and assets
‘ABCD’: asset based community development

46. 46
Sandwell Youth Cabinet

47. Agewell-Sandwell
Agewell -Sandwell

48. 48
Community health network

49. 49

50. 50

51. The role of the professional :
Working with local partners who can improve
health, not least health services

53. The new Midland Metropolitan hospital
Opening 2018 – corporate citizenship offers of construction employment, low carbon
footprint, local health service employment , key worker housing and relocation of
services to community

54. 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

56. Salus populi
suprema lex
esto
Cicero
Oxford Public Health Training conference

57. Thank you
Professor John Middleton
President@fph.org.uk

58. • 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/Euroh
ealth-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/ldw054/2871
226/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