Darrell Gale on being DPH for East Sussex

East Sussex is a unique place to be the Director of Public Health. I like to describe it as being “in the southeast but not of it”. For instance, Hastings, one of our coastal towns, is only 55 miles from London and yet has levels of deprivation akin to those of Blackpool, Gateshead, or Hartlepool – no real surprise as it is still very much cut off from the economics of the capital. Historically, this has been because the county is made up of the impenetrable Wealden Forest, a barrier to providing the safe direct roads and straight-line railways that brought with them trade and wealth from the first commuting professionals.

As well as working in a unique county, I have a unique background to the Director of Public Health role having originally trained in architecture. My passion for social justice took hold as a student, evidenced by my voluntary work with the student Niteline service and organisation of HIV prevention activities. While still at university I also founded the first Rape Crisis centre for men to receive statutory funding. So, with the depression in construction the deepest for 250 years, it was only natural to begin working in my voluntary endeavours, working in HIV prevention firstly in North Yorkshire and secondly in establishing the Healthy Gay Life (HGL) project in Birmingham. This project was far more than a sexual health service, as I designed it to tackle issues around education and skills, regeneration and homelessness, where mental health and physical health were seen as equals. Interestingly it was the move of public health to local government, something I was at the time in the minority to celebrate, that meant that the City Council could pursue different commissioning priorities and sadly HGL was no more.

A move to Sussex gave me my first taste of broad-brush public health and so I took on a joint health improvement post between the District Council and the then PCG. The huge range of experience gained in this post with a clear population focus gave me the experience to join the London training scheme. I took my first consultant post in Wiltshire where Maggie Rae, had already established her team within local government. After two years of living out of a suitcase, I joined the public health system in Berkshire where at the time, each of the unitary authorities had a single consultant who discharged most of the DPH responsibilities. This was a great grounding in the leadership and political context of becoming a Director and my final year in the system saw me as the Interim DPH across five unitary authorities. Then in July 2018, I came to East Sussex, a place I’d always wanted to work.

Aside from the challenges of coastal deprivation and the second most aged population in England, East Sussex is a county of enormous opportunities as well as challenges. Climate change is impacting our county enormously already. In February 2019, I was alerted to a major wildfire in the Ashdown Forest covering over 100 acres – a time when cold temperatures and rainfall would not normally allow for such a fire but after weeks of drought and abnormally high temperatures, we had the perfect conditions for wildfires. Flooding has also been a major problem for the county, exemplified by the Lewes floods in 2000, and more recently we’ve seen the whole of Hastings town centre flooded on no fewer than three occasions within the last two years due to rapid onset torrential rain and blocked culverts. Hastings has also suffered a major inland landslip caused by heavy rain in a steep wooded valley between two residential areas, sadly seeing several households made homeless. Sea level rise threatens a huge part of Eastbourne (home to over 50,000 people) and coastal erosion at our famous chalk cliffs accelerates ever faster. In fact, during last winter’s storm season, the Met Office warned the county on more than four occasions that a storm could be as devastating as the 1987 hurricane. Growing up near Sevenoaks in neighbouring Kent, I know exactly what that could mean.

For these reasons, we are undertaking a health impact assessment (HIA) on the impact of climate change on the health of our population. This is led by my Healthy Places Team which continues to innovate in its work on spatial planning and health. Following the recommendations of my Annual Report on health and housing a few years back, I have also appointed a strategic lead for housing and public health, jointly appointed between my department and the five district and borough housing authorities in the county. This post is creating and implementing a strategic approach to housing and health, especially focused on the growth in temporary accommodation placements and mitigating the impacts on those households affected.

These two areas take me back to my architectural training, recognising that the built environment and living standards do much to determine the occupants’ health. I was honoured therefore to be asked by ADPH to chair it’s new Healthy Places Project, funded by the Health Foundation, which aims to improve the collaboration between planning and public health professions.

Meanwhile, taking me back to my sexual health roots, just three weeks ago East Sussex County Council launched the UK’s first digital PREP programme, with the aim of eliminating HIV infections in the county. We don’t have the high prevalence of other areas, yet we have innovated to commission this service so that other areas may follow, and together we can contribute to the aim of zero new HIV infections by 2030.

I’m truly blessed in having a comprehensive and committed team, and I have been keen to lift the lid on their growth, imagination, and innovation. Meanwhile, we operate in a Council known for being well run and making sensible decisions – throughout COVID for example, I could not have wanted to have led the response in a better place as nothing was too hard for the leadership team and colleagues to support and pick up to face the pandemic head on. It is therefore both a privilege and a joy to fulfil my role, knowing that behind me I have the full force of a tremendous public service ethos and amazing staff working as one, to support East Sussex – and through my involvement with ADPH – the country as a whole, through the impact of climate change and other challenges to public health.