200 Days On – My Reflections as ADPH President

December 6, 2018 in ADPH Updates, President's Blog

 

(given as the introduction to the December 2018 ADPH annual conference)  

It’s 200 days today since I was inaugurated as President of the ADPH. Usually Presidents get asked what they’ve achieved in their first 100 days – but I’m proposing that, seeing as I’m a part-time President, my time gets doubled. So, time to see how we’re doing on the priorities I set out in May:

  • Challenging the norm and advocating for equality in all its forms
  • Developing a vibrant, member-led organisation
  • Promoting our unique local system leadership role
  • Ensuring we continue to be well-respected as an organisation – but with an ‘edge’ 

My first priority was to seek to highlight the insidious normalisation of injustice or structural inequalities related to some or other characteristic of who we are – our class, race, gender, disability. This normalisation of inequality in our society serves to protect the power of some groups over others, yet it is unjust and profoundly damaging to our health and wellbeing.  

When I spoke at my inauguration in May, the UN’s Special Rapporteur on racism had just published their report, which noted that racism in Britain was becoming ‘normal’ again. This week, analysis showed a record number of children are being excluded for racist bullying (The Guardian, 1 December 2018).  

And in November, we had the report of the UN’s Special Rapporteur on extreme poverty and human rights, which found that ‘for almost one in every two children to be poor in twenty-first century Britain is not just a disgrace, but a social calamity and an economic disaster, all rolled into one’. He noted that it was women and children and those most vulnerable who were being disproportionately impacted by recent tax and welfare reforms. The 49% real-term reduction in government funding from 2010/11 to 2017/18 was cited as a contributory factor, with people no longer having access to the vital services they needed. The UN’s Rapporteur’s view was that the UK government could end poverty if it wanted to. 

Many believe that austerity is now actually costing more to the UK government than it is saving, with the Rapporteur noting: ‘the many billions [taken from] the benefits system since 2010 have been offset by the additional resources required to fund emergency services by families and the community, by local government, by doctors and hospital accident and emergency centres, and even by the ever-shrinking and under-funded police force.’  

While the renewed focus on ‘prevention’ is welcome, the reality is that interventions to prevent poverty, poor outcomes and mental distress are being cut on a massive scale. And the money and focus continue to prioritise crisis management – rising A&E attendance, knife crime, suicide, homelessness.  

Increasingly, our members are shining a light on the negative impact that the changes in our public services are having on citizen’s health; this month the Guardian covered research commissioned by Alice Wiseman, DPH Gateshead, on the negative impact of the roll out of Universal Credit particularly on claimants with disabilities, mental illness and long-term health conditions, as well as homeless people, forces veterans and care leavers. The findings led Alice to make the damning comment that: ‘I consider universal credit, in the context of wider austerity, as a threat to the public’s health.’  

Our members have also been leading efforts to challenge the new cultural norms created in society by commercial interests, which perpetuate the concept that our major public health issues are down to a collective failure of individual willpower. In London, Danny Ruta, Steve Whiteman and Vicky Hobart have been key in the efforts to challenge what’s normal to impose on our children, with the ban on junk food ads across the Transport for London network; or Ruth Tennant’s work with ASH on reducing children’s exposure to smoking in their homes.   

Today, we are in the middle of the international 16 Days campaign to end violence against women and girls. The ability of those in power to maintain their positions through normalisation and victim-blaming is no better demonstrated than by this form of violence and control. We kick-started our ADPH policy work on violence (in all its forms) through a lively conversation at the ADPH Council in October – and hope many of you will be engaged as it evolves.  

And finally, I recently had a fantastically positive challenge to my own preconceptions of what’s normal, when Becky Rich, a Dance Leader and Ambassador for DanceSyndrome (http://dancesyndrome.co.uk/) – a dancer-led, disability-inspired organisation – spoke about her many years managing her heart condition, how she had lost 3 stone through dance and healthy eating, and how she wanted to support others to do the same. I celebrate Becky who inspires us all to challenge the norms that limit us from living our lives fully. 

  Becky Rich #dancer #activist 

My second priority was you, our membership. Today, our ADPH conference was over-subscribed for the first time, with a waiting list – that suggests to me a vibrant organisation, where people want to be a part of a body that learns, challenges and improves, together. I’m particularly thankful for the contributions that our members make through the Board, our strengthened Council and soon-to-be reinvigorated Policy Advisory Groups (PAGs); many have also been active through our peer mentoring, our immersive days (one on DsPH with expanded portfolios is coming up in March; do send ideas for further topics!) and the recent workshop for new DsPH – please join in and be part of our growth.  

I, with members of our brilliant ADPH team, have been visiting many of you across England – Cheshire and Merseyside, Yorkshire and the Humber, the east of England, the north east and the south east of England, and in Wales. I’ve enjoyed getting out to meet you and hear about your challenges and successes – you’re doing amazing work under increasingly difficult circumstances. What’s struck me is how committed you all are to improving the public’s health in our local places – but that we also have our heads raised to working to improve as a sector, respectively and collectively, in our regions and at a country level.  

I’m looking forward to connecting with those of you I haven’t yet met, when I complete this round of first visits early next year.   

I’ve also enjoyed hearing our members’ voices commenting on visions and plans and budget decisions, prevention, population health and public health interventions. For this contributes to what’s needed to deliver on my third and fourth priorities – promoting the unique leadership role of the DPH in local systems; and ensuring we continue to be a well-respected – and ‘edgy’ – voice for public health nationally.  

These priorities require a lot of relationship-building – with Public Health England and Public Health Wales, the LGA, ADASS, ADCS, the Faculty, Royal Society, and of course with the NHS. And the ADPH team and many of you, our members, have worked tirelessly to ensure that we get our voice into the many spaces and places shaping our context and our role as DsPH within this – from PHE’s and other agencies’ initiatives, to the NHS long term plan and the Secretary of State’s prevention vision, to the budget and forthcoming spending review. 

We need to – and are – raising our public voice and profile, developing our ‘edginess’ and trumpeting our successes – through tweeting and writing blogs and pieces for the LGC, HSJ, BMJ and elsewhere, and presenting our local work nationally, in the media, through social media, conferences or hosting visits. And we’ve also continued our presence in public hearings, parliamentary committees and other parliamentary bodies, and the many different summits and conferences.  

At November’s Health and Care Committee on the impact of the budget on health and care, the messages I gave were:  

  • Prevention – or health creation – needs investment in all the things that help make us happy, healthy and able to lead fulfilling lives – our childhoods, our friends and our play and learning, our houses and the places where we eat and live, and our occupation and income. Yet there has been a 40% cut to local government funding and a £700m cut to the Public Health Grant over the last 5 years (2014/15 – 2019/20)  
  • DsPH have been doing the best we can, and managed the cuts to the Grant through innovation and transformation of our teams and services (many provided by the NHS) and through a focus on integrating and strengthening local systems; but this is not sustainable   
  • We are local system leaders and ambitious for our population’s health, with proven positive impact – just think what more we could achieve if we were fully resourced. 

We need to continue to develop and strengthen our key messages and overarching narrative. We need you to help us do this with your examples of local successes – watch out for the requests for this, and please contribute yours.  

So, 200 days on: 

  • Priority 1: With Brexit on the horizon, there are many areas for concern in our society, and we need to keep calling these out and championing human rights and equity 
  • Priority 2: I’m loving the way we’re developing as a vibrant, member-led organisation 
  • Priority 3: We need to be much clearer on our impact and our successes 
  • Priority 4: As an organisation, we continue to be well-respected – but I definitely see our ‘edge’ developing. 

I look forward to working on these priorities over the next 200 days! 

Sector-led improvement in public health: Progress and potential

October 26, 2018 in ADPH Updates, Publications, Sector Led Improvement

Embedding SLI in public health has become a real collaboration between partners. The LGA, ADPH and PHE are working together to support its development at regional, national and local levels. You can view the most recent joint publication here.

Tackling alcohol, challenging the norm

September 28, 2018 in ADPH Updates, President's Blog, Publications

I remember arriving in the UK as a Junior Doctor to work in the NHS in the mid-90s. The nurses were my new friends, and I used to join them at 9pm post shift for a crawl down the Derby Mile.

The bigger the group, the more the rounds to be gotten through before the 11pm closing hour bell rang. Then curry and Cobra at the end. Not something I had known before, but seemingly commonplace and well, normal.

I jumped into my new social scene with gusto, before long exceeding any recommended unit count, and rapidly putting on weight. A trip back home allowed for a welcome detox and sensible reflection and resolve.

Drinking too much. So easily done when it’s so normal.

The normalisation of harmful heavy drinking

Around that time, there seemed to be an explosion of new product development, new marketing approaches, new ‘normal’ ways of drinking – I remember the bursting onto the stage of alcopops, the surge of stag and hen dos, the creative, free-flowing Happy Hour promotions …

Licensed premises have exploded in numbers since 2005/6 – in my borough, there was a 41% increase. Schools and even hairdressers joined the corner stores and 24 hour pubs.

Since 1970 the amount of alcohol consumed per person has risen by 50% in the UK. Over that period alcohol has become relatively cheaper and more readily available. Alcohol is aggressively and expertly marketed and drinking has become a normal feature of everyday life.

Alcohol can play a positive social and economic role – and the large majority of people enjoy alcohol without harm. However, excessive alcohol use can have a harmful effect on individuals, their families and our community. The number of alcohol-related admissions to hospitals in England has risen yet again, with middle-aged drinkers most likely to be admitted, according to new Public Health England figures. We know we need to do something.

Navigating new approaches to population health

We know that public health issues such as these are too complex for a business as usual approach. We do need to challenge our own thinking and innovate – while developing, and keeping an eye on, the evidence of what works.

Partnering with Drinkaware could be just such a shift. However major changes in approach need careful consideration – a precautionary approach. The Alcohol Leadership Board should have been a place to talk this through with experienced and knowledgeable people.  The ADPH was therefore disappointed at PHE’s independent decision to collaborate with Drinkaware which has led us to a place where we, as a public health system in the broadest sense, have been, in effect, arguing publicly. And sadly, it is likely that this will lead to further confusion for the public around the actual messages about alcohol harm.

The key point is that alcohol is produced for profit. The more that is sold, the greater the profit. The industry spends billions creating new markets, promoting its product and lobbying for favourable business conditions. It spends some on corporate social responsibility (CSR).

A critical review in the latest (Sept) edition of WHO’s Public Health Panorama: Alcohol industry actions to reduce harmful drinking in Europe: public health or public relations? concluded that CSR activities conducted by the alcohol industry in the WHO European Region ‘are unlikely to contribute to WHO targets but may have a public-relations advantage for the alcohol industry’.

And we can all now quote the evidence review produced by PHE (2016) which demonstrated that education campaigns on their own, and particularly those with industry involvement, will not reduce alcohol harm.

These are some of the reasons why the public health community has a healthy scepticism of all things alcohol industry. As we noted in last week’s BriePH (the regular briefing for Directors of Public Health), ADPH has a clear Ethical Collaboration and Sponsorship Policy which sets out that the ADPH ‘will not work with, or accept donations from, organisations whose activities, policies, aims or objectives contradict or are inconsistent with its own’ – this includes partnerships with organisations involved in tobacco or alcohol manufacture. We regard Drinkaware as being too close to the alcohol industry. ADPH remains a member of the Alcohol Leadership Board. But we believe partnering with Drinkaware as they currently stand is unethical.

Missing the value DsPH can bring

I’m sure many of us can tell our own stories of how ‘normalised’ high risk drinking is in our communities and boroughs.

Directors of Public Health recognise that nationally developed social marketing campaigns such as the ‘One You’ have their part to play – and many have adapted these locally. Linking the One You brand with the Drinkaware campaign – without DsPH having any input – may adversely affect these local efforts. And declaring the campaign is ‘where the people are’ forgets that DsPH work closely with elected members and local residents. To some of us, it’s unhelpful and galling.

There is much work to do to reduce the harm. Minimum Unit Pricing, Health as a 5th Licensing Objective, adequate funding of treatment and recovery services and a levy on alcohol driven business to support the cost to councils and police of keeping safe and clean town centres are all part of that. The ADPH is committed to working with, challenging and supporting partners in the public health system – including PHE – to make sure we unite behind efforts known to have impact.

Annual Review 2017-18

July 9, 2018 in Annual Reviews, Publications

Annual Review 2017-18.

174 KBAnnual Review 2017-18

ADPH Response to ‘Hiding in Plain Sight: Treating Tobacco Dependency in the NHS’ Report

June 26, 2018 in ADPH Updates, Policies, Tobacco

Please find attached the ADPH response to the publication today by the Royal College of Physicians of ‘Hiding in Plain Sight: Treating Tobacco Dependency in the NHS’. 561 KBADPH Statement – ‘Hiding in Plain Sight’ Report June 2018

ADPH Statement on Chapter 2 of Childhood Obesity Plan

June 24, 2018 in ADPH Updates, Obesity, nutrition and physical activity, Policies

Please find attached a statement from ADPH on the publication of Chapter 2 of the Childhood Obesity Plan. 569 KBADPH Statement on Chapter 2 of the Childhood Obesity Plan, June 2018

ADPH statement on extra £20 billion for the NHS

June 18, 2018 in ADPH Updates, PH Funding, PH System

Please find attached a statement from ADPH on the announcement of an extra £20 billion funding for the NHS. 473 KBThe Association of Directors of Public Health – Statement on £20 billion for the NHS

PHE / ADPH Summary Report: Development Needs of Recently Appointed Directors of Public Health

June 12, 2018 in Publications

Working in partnership with Public Health England, ADPH has produced the report below on the experience of newly appointed DsPH.

As strengthening the pipeline for Directors is one of our organisational priorities, this report gives some valuable insight into the aspirations and frustrations that new DsPH experience. There is a great deal of good work that the report identifies.

The report gives helpful insight into areas where DsPH can be supported:

• For a significant number, the route to becoming a Director was through an interim or acting capacity. Therefore, support in the early period after appointment is critical.

• DsPH are the ambassadors for Public Health in local government. Several reflected that they needed more help to step into working at multi-discipline board level.

• The role of networks to support DsPH was reported to be invaluable. Much good work goes on, but provision of formal and informal networks is geographically variable and offers an opportunity to develop further.

365 KBPHE ADPH – Development Needs of Recently Appointed DsPH

Presidential Inauguration Address

May 24, 2018 in President's Blog

I first arrived in the UK in the late 90s – in those days, flights from South Africa still allowed smoking. You could be in a non-smokers seat just where the smokers section started. Trapped in a closed environment of smoke for 14 hours. Annoying, but normal. You wouldn’t dream of that being normal or acceptable now. Same with smoking in pubs and restaurants – once so normal, now totally not normal, harmful to people, not acceptable.

So I came to the UK and there I was as a PH trainee in a PCT in Nottingham in the early 2000s, and I remember going along to a talk on the NHS Pension. By then, I had been working quite a few years in the NHS and had been paying into the scheme diligently. I sat in a room with others, and a perfectly nice man in a suit talked us through how it worked, you know the 1 over 80 times final salary times years of membership. Then he spoke about what happened if you died and how your widow or widower benefited. It then occurred to me to check. ‘Yes – he clarified – only those who were married could get the survivor’s pension.’ It was only for straight folks in state legitimised partnerships who diligently paid into the NHS pension that benefited. Not folks like me. ‘But – he explained – that was normal’, just the way it was – inequality hidden, banal… Now, thanks to a lot of people fighting for what is just and right… I just need to get married (and of course die) and the survivor’s pension is hers!

I’m sure you could think of your own stories – about class, about race or gender, about disability – of when things were supposedly just normal. But they were – or are – damaging to people, to groups of people and unjust, and they create and perpetuate inequalities in our health and wellbeing.

The #MeToo generation has woken us up belatedly to the fact that people have turned a blind eye to practices and behaviours that have entrenched power, have created a norm of sexual exploitation; the exposure (yet again) of the gender pay gap suggests a norm that carries on regardless. The stories from Rochdale, Rotherham, Oxford, where ideas of the norms of race, class, gender and age enabled the sexual exploitation of hundreds of girls.

Indeed some stories suggest a rolling back of positive change – the callous changes to the disability living allowance that had enabled so many people to get on with their lives in society is for me a particularly iniquitous one. Can you imagine it, people with disabilities being actively part of our society, no longer the norm.

Or Brexit Britain, this week the UN Special Rapporteur on racism spoke about the ‘extreme views’ on racism having gained ground in Britain. Racism becoming normal again.

‘The harsh reality is race, ethnicity, religion, gender, disability status and related categories all continue to determine the life chances and wellbeing of people in Britain in ways that are unacceptable and in many cases unlawful’ – Tendayi Achiume, UN special rapporteur on racism

So how good are we at recognising injustice and structural inequality? How much do we really understand what groups of people are experiencing because of who they are or are seen to be – and how is it impacting on their health and wellbeing?

Fundamentally this is about power – and power works to keep the norm, it’s hegemonic power, something that operates very effectively in the UK.

Hegemony: the dominance of one group over another, often supported by legitimating norms and ideas. The term hegemony is often used as shorthand to describe the relatively dominant position of a particular set of ideas and their associated tendency to become commonsensical and intuitive, thereby inhibiting the dissemination or even the articulation of alternative ideas.

How are we complicit in this, it’s just so easy to not recognise when we have power over others, to not see things as problematic, to not see the inequality. Being white, and a professional, I recognise how steeped we are in – indeed conflicted in – what is the ‘norm’.

So my personal focus as President over these 3 years is to help us make things visible, to make them problematic, to name them and for us to be comfortable with talking about them – because by challenging ourselves and upskilling ourselves, I believe we become more effective agents for social justice.

The other areas of focus for my time as President were set out in my manifesto:

Firstly, I’d like to prioritise you, our members:

  • It’s been fantastic to see the number of people standing for positions – it really does suggest a vibrant membership who’re keen to step up individually and be part of the collective – and well done to our new Vice President and Board members, very exciting, I’m really looking forward to working with you.
  • So I’d like to ensure we mobilise all our collective skills and dynamism, through the Council, the PAGs, and in other ways
  • I’d like us to continue to deepen ways to support and energise each other including continuing mentoring support for new DsPH
  • And I’d like to understand what your experience and your issues are, locally and respectively. So I will be coming out on regional visits – and as part of these, I’d like to not only meet you in a large room meeting setting, but see whether, alongside this, I can set up a meal or coffee with some of you, or visit to one of your boroughs at the same time.

Secondly, I pledged to promote the unique leadership role of the DPH in local government – I think our understanding of what exactly this is continues to evolve – and again I’m keen to hear your experience and views about this. What I will do to support this is work at a national level to develop strong relationships with other local government networks and associations – the LGA, ADASS, ADCS, other public health bodies – PHE, the Faculty, Royal Society – and I’m really going to try hard with the NHS…

What I do think we need to do though, is consolidate our approach to sector-led improvement – DPHs as Members need to step up to the challenge of sector-led improvement.. I’d like to see a step-change in this over the next 3 years and today is an important event in helping us to do so.

Lastly, the recent ADPH survey of external stakeholders showed that we are a well-respected voice for public health – and they want to hear more from us. The word ‘edgy’ was used, they’d like us to be more ‘edgy’. Now I did have a little look at the definition of edgy, and found this from Urban Dictionary:

Edgy: something or someone trying too hard to be cool, almost to the point where it’s cringeworthy

Interesting how words have different meaning to different people… However, we need to work out for ourselves what edgy means (and indeed whether we want to use that word, or perhaps another – suggestions welcome…).

The report also recommended being really focused and prioritise only a few issues for strong advocacy. The Board, with Council, will be working on what these areas should be over the next short while. Watch this space!

So those are my areas of focus:

  • Challenging the norm and advocating for equality in all its forms
  • Developing a vibrant, member-led organisation
  • Promoting our unique local system leadership role
  • Ensuring we continue to be well-respected as an organisation – but with an ‘edge’

Lastly, but most importantly, I want to acknowledge and thank Nicola and the team. They are an amazing group of individuals who work really hard to deliver the goods for us – so on behalf of members, a big thank you to the team, and here’s to 3 really great years. And you never know, we may also hear some wedding bells!

Jeanelle deGruchy

ADPH Policy Positions – A Life Course Approach to Public Health

May 18, 2018 in ADPH Updates, Children, Young People and Familes, Healthy Ageing, Policies, Policy Statements, Publications, Work & Health

In May 2018, ADPH launched a series of policy position statements setting out a life course approach to public health. The statements explore health and wellbeing at key life stages and cover best start in life, living and working well, healthy ageing, and health inequality.

Our policy position statements help to drive our policy work forward and push for our members’ recommendations in all the policy work that we do.

All ADPH policy position statements are briefly reviewed annually with a full review taking place every three years. The most recent review of this suite of statements was in May 2019.

304 KBADPH Position Statement – Best Start in Life (May 2019) 321 KBADPH Position Statement – Living and Working Well (May 2019) 308 KBADPH Position Statement – Healthy Ageing (2019) 267 KBADPH Position Statement – Health Inequalities (May 2019)

If you would like to discuss anything in these documents please do contact the ADPH Policy Team by emailing policy@adph.org.uk

All of our policy positions are hosted permanently here.