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12 June 2018
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From disaster preparedness to digital disruption: A whistle-stop tour through public health

by Anand Bhopal and Graeme Hood

Away days are an opportunity for clinical fellows to visit organisations involved in the scheme, learn from one another and build new relationships. The days allow fellows to gain a better understanding of the role, function and inner workings of other healthcare organisations which in order to help navigate the complexities of the health and care systems. Today the fellows met at Wellington House, London, to visit Public Health England - here is a snapshot of the day!

Professor Virginia Murray, consultant in Global Disaster Risk Reduction, opened the day at Public Health England (PHE) with a snapshot of the vast organisation which has over 5,000 employees covering a wide range of work to protect and improve the nation’s health. She then discussed her field of disaster risk reduction, outlining the important international agreements and the relevance to leaders in health, including: Paris Climate Change Agreement, Sendai Framework for Disaster Risk Reduction and the Sustainable Development Goals. This year’s PHE clinical fellows also gave an insight into their year: Anand Bhopal described his work in travel vaccines, air pollution and supporting the medical director, Graeme Hood discussed the work he has done with inappropriate antibiotic prescribing in secondary care and assessing health inequalities within public facing campaigns.

Professor John Watson (Consultant, Public Health) thought he had left respiratory medicine behind when he left a consultant post and trained in public health, however, a few years later he was Deputy Chief Medical Officer at the Department of Health where his earlier experience proved invaluable. Professor Watson described the “thorny problems” of public health – where price, public interest and politics collide. The challenge of improving influenza vaccination, the threat of pandemic influenza and the antivirals debate were prominent features of his time in office.

Dr Charles Alessi (Senior Advisor to PHE) presented on the future (and the idea that the future is already here). Disruption is all around and to stick to the status quo will be futile. Robots can already outperform doctors, pharmaceutical companies need a new model, the public/private divide on data ownership needs a radical overhaul and more. There are lessons from overseas which the NHS can learn from – many of the solutions are out there if we know where to look.

Jamie Waterall (Lead CVD Prevention, NHS Health Checks) got the audience voting with their feet. What is the leading risk factor for health disease and stroke? (Blood pressure) What proportion of people with hypertension are detected and treated to NICE standards? (35%).  Perhaps unsurprisingly, he is the National lead on CVD prevention!  With everyone wide awake, he described the All our Health Programme, a call to action for health professionals to use their skills and influence to contribute to the prevention agenda from the frontline, supported by reams of purpose built, easy to use resources.

Diane Ashiru-Oredope (Lead Pharmacist, AMR Programme) described the trials and tribulations of setting up and sustaining the Antibiotic Guardian campaign to combat antimicrobial resistance. The importance of engaging a range of stakeholders and the satisfaction of seeing the programme move into unexpected domains (Scouts Badge) and overseas (translated into 4 languages and pledges from across the globe). Diane also talked about the CV of failures – a timely reminder that we don’t always get what we want at the first time of trying and the importance of reflection.

After a late lunch (apologies from the organisers…) the afternoon began with a discussion led by PHE medical director Prof Paul Cosford – ‘what do you want to talk about?’. The session covered everything from flu vaccination to screening ethics, how to influence at a high level, the TB programme in England and Ebola screening at airports. Balancing clinical understanding with public perception and political priorities is an art as well as a science.

Lee Bailey and Clare Cook, director and senior communications manager at PHE, next described the role of marketing and communications in public health. There are five main means to improve public health: legislation, regulation, taxation, investment and communication. In a time of tight public finances and minority government, communication is particularly important. Understanding the target group (‘audience insight’) and how to communicate to them is vital in the digital age.

To wrap up the day, PHE deputy medical director Dr Jenny Harries, shared some reflections on her journey in public health –both the successes and the challenges. From balancing children and public health training (with an M.B.A. on the side!) to her experience of running the Ebola airport screening programme. She described the 7 transformations of leadership and her aspirations to become an ‘alchemist’ yet!

At its core public health is concerned with social justice: fairness, equity, opportunity. As the diverse range of speakers attest, improving the public’s health requires multiple interventions and collaboration across fields. This includes addressing the upstream political, social and environmental determinants of health and health systems as well as communicating the compelling economic case for investing in public health. With prevention rising on the health agenda, leaders must familiarise themselves with these fundamental public health principles, including the evidence base of different interventions, in order to ensure the rhetoric of prevention matches the realities of improved health outcomes for all.

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