Save the planet or save the NHS?
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Professor John Middleton discusses the role of the Association of Schools of Public Health in Europe (ASPHER) in enhancing public health education and practice globally. He emphasizes the importance of addressing social determinants of health, the interconnectedness of public health with issues like violence and climate change, and the need for collective responsibility and action in improving public health outcomes. The document also critiques responses to the COVID-19 pandemic and calls for a renewed focus on equitable health systems post-crisis.
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Save the planet or save the NHS?
- 1. Save the planet, or save the NHS? Professor John Middleton Hon FFPH, FRCP, President, Association of Schools of Public Health in the European Region
- 2. 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
- 3. 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
- 4. What is public health? The public’s health And The public system, services and profession
- 5. 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
- 6. What is public health? Three domains of public health : Health protection Health improvement Health care related public health UK Faculty of Public Health, 2016
- 7. A medical specialty… but a multidisciplinary profession, service and system UK Faculty of public Health Careers in public health
- 8. 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)
- 10. “ 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
- 11. it's not who your doctor is, it's who you vote for, that most affects your health
- 13. 13 05/04/2022 The public’s health: global burden of disease, corporate anti-health interest,
- 14. 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
- 15. Global burden of disease 2019
- 16. Global burden of disease 2021
- 17. 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%
- 18. These 10 Corporations Control Almost Everything We Eat
- 20. 20 05/04/2022 Violence, conflict and public health
- 21. 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
- 22. Interconnectedness: conflict over natural resources: oil, water
- 23. Interconnectness: Loss of agricultural land through global warming, crop failure, food riots, Arab Spring, Syrian war
- 24. 24 05/04/2022 Planetary health: environment, loss of biodiversity, food and ecosystems balance, climate change
- 25. A role for our climate change special interest group
- 27. 27 05/04/2022
- 30. Coccolithophore (diatom): Produces 50% of the world’s oxygen Algal blooms photosynthesising off south west coast of Wales
- 31. Climate breakdown is here now!- 1 fire
- 32. • Climate breakdown is here now!- 2 floods Indonesia floods Climate breakdown is here now!- 2 floods
- 33. Climate breakdown is here now!- 3 marine life extinction
- 35. John Middleton:Planning for an outbreak of health
- 37. 05/04/2022 37
- 39. Infodemics: misappropriating personal information to sway opinion and behaviour – in this example in elections
- 40. Infodemics: misappropriating social media - to sway opinion and behaviour – in this example in vaccine hesitancy
- 45. Selected European countries , with Peru (hi) and New Zealand (low) for comparators
- 46. 05/04/2022 46
- 47. 05/04/2022 47
- 49. Public mask wearing mandated early on- Czechia, Slovakia, Slovenia, Poland
- 72. The pandemic is over? But….high levels of infection High levels of infection in children High levels of childrens admission High levels of hospital activity, preventing other treatments Still high levels of unvaccinated young adults High levels of sickness absence in key sectors Reduce isolation periods allowing second spike of omicron infections … Next variant due March ? Abandoned basic measures in plan B that are protective against Covid and other respiratory pathogens : ‘Protections’ – not ‘restrictions’
- 73. 05/04/2022 73
- 74. 05/04/2022 74 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
- 77. Vaccinations: saving lives in millions
- 78. Vaccinations: saving lives in millions
- 80. Vaccinations: saving lives in millions There is no place for intellectual property protection during a humanitarian crisis But there must be fair assessment of how industry should be properly paid for their work and their products and to protect and ensure investment for future new life-saving products
- 82. Planning for an outbreak of health
- 83. Planning for an outbreak of health: The public health system, services and profession
- 85. John Middleton:Planning for an outbreak of health
- 86. 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
- 89. John Middleton: Planning for an outbreak of health Planning for an outbreak of health: The public’s health
- 90. What personal behaviours might we usefully keep for a post pandemic future? • Wash our hands more ? • Where masks in closed spaces especially in winter • Work at home when we can, not because we must • Don’t go out when we have symptoms
- 95. Build back health care
- 96. 96 05/04/2022 The COVID-19 what went well UK ? Initial efforts on social welfare/furlough/ increased universal credit/ hotels for the homeless? Vaccine development, commitment global collaboration of science and Technology, commitments to shared intelligence, research and delivery ‘COVAX’ Vaccination policy and delivery ‘December 2020-April 2021’ Clinical research: rapid assessment of effective and ineffective treatments including the Recovery Trial Rapid set up of major prospective studies REACT, ONS community infection, ZOE Genetic sequencing of virus and development of Genomic Surveillance
- 97. 97 05/04/2022 The COVID-19 what went (well) UK ? Not ‘well’- but ‘heroic’, ‘admirable’, ‘selfless’, ‘professional’, ‘caring’, ‘compassionate’ NHS services response Social care unsupported and unprotected Local public health services – undervalued, unrecognized, snubbed Community responses: volunteering, ‘mutual aid’, in food delivery, in the vaccine delivery programme National public health professional organisations working together
- 98. John Middleton [lecture title] [date] Upsides of lockdown 1 : Decline in air pollution
- 99. Upsides in lockdown 2: interest in more active travel
- 100. ‘Build back’ ? Working practices and relationships ? Reducing inequalities? Minorities? Vulnerable groups? Women? Older people?
- 101. 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?
- 102. 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.
- 103. ‘Build back’?
- 104. ‘Build back’ ?
- 105. ‘Build back’ ?
- 106. ‘Build back’ ?
- 107. ‘Build back’ ? To what austerity, poverty and unfairness? Environmental squalor and health and wealth for some? Plan for an outbreak of health….
- 108. 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.’
- 109. Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world. Louis Pasteur
- 110. Thank you John Middleton, President Association of Schools of Public Health In the European Region John.middleton@aspher.org