Sheffield DPH

A few months ago I had the privilege of delivering the  @ScHARRSheffield 2021 Pemberton lecture    During the q&a at the end someone asked me to explain my statement that the trade off between saving health and protecting the economy was a false choice I gave a pretty poor answer Here I'll try set it out more clearly  In "normal times" (remember them) I've been here quite a few times, most recently here    The onset of illness in working age is very common Multi morbidity (more than one thing wrong with you) more common in poorer populations & earlier onset, see Barnett 2012  also more common numerically speaking in those of working age than those beyond retirement age.   for England (chart below from the Health Foundation)  In Sheffield broadly the same holds true Those with lowest income spend more of their lives, often within working age, in less than good health. When considering Healthy Life Expectancy, in She...

Personal responsibility and public health   1             industry loves this narrative. You have got to wonder why Of note the harmful product industries are strongly in favour of personal responsibility. You can draw your own conclusions why this might be. Read 1) the history of tobacco control esp the write up of California and New York from Stanton Glantz in Tobacco Wars   2             It is a policy framing problem for public health that crosses political divides   This has been one of the deep running rifts in what different camps think about what would be most effective in public policy for many generations It is fair to say that the response to Wanless and Marmot 2010 (for eg Govt response to Wanless in 2004 (John Reid), The NHS Long Term Plan and Five year view, and many others) continued to focus on lifestyle, and within that individual li...

  Why does thinking about the commercial determinants of health matter within local government   1             Why does Non Communicable Disease matters to local government. Why should local government care Non Communicable Disease, or NCD (for example cancer, diabetes, heart disease and stroke, muscle and joint problems) is, by far, the biggest contributor to overall ill health. Of course that matters to NHS demand. Often these illnesses occur concurrently (this is called multi morbidity) and this is more common in working age than old age in sheer numbers. This also matters to social care (a huge amount of social care demand is secondary to and the downstream consequence of illness. It also matters to economic productivity. The health / wealth / economic productivity line is under appreciated. People who develop cancer aged 55 most likely wont go back to work. This this becomes impact on family income, benefit ...

  a repost and slight update of an old blog It’s back This particular policy zombi was one of the issues I first cut my public health teeth on as a shiny new SpR (thanks Sohail!) I quickly saw it was pretty futile then as a method of financial savings. I’ve played the game a good few times since, my view is unchanged. 4 key questions that I often ask 1. Inequality – I cant see enforcement of further rescrictions would improve equity, it would likely make it worse. Has the inequality impact assessment been robustly done. This is more than a EqIA (protected groups) 2. Clinical sign off – it IS a CLINICAL commissioning group. There’s nothing inherently wrong with NICE / SIGN etc, but remember its clincial guidance, designed to guide a clinical decision (terms used advisedly). Engagement with GPs and secondary care clinicians – in the spirit of CLINICAL commissioning – is there full clinical sign off. There may be an appreciable harm from rest...

  Who wants more power   One of those occasional questions that crops up for every DPH  - “what powers would you like please”   Thoughts   1            I would like the SAME powers as national govt  …. Or something akin to the powers available to us cities. For example in NYC if National Govt isn’t going to do anything local Govt can take power in responsibility for addressing a risk to health. In U.K. the opposite is in place. Maybe THIS is the key power we need to ask for devo wise.   2             Caveats and cautions in “power” I don’t think “more power” is right (well only at any rate) way to solve the problem of health inequality.   Local power doesn’t / shouldn’t replace national. For example local powers on air quality shouldn’t be seen as a reason for no progress on tax and fiscal on fuel, diesel scrappage, DfT i...

  Is screening different to case finding in high risk groups  This is a repost of an old blog   The NSC provides advice to the 4 UK Governments on screening policy Often “screening” is done under the premise of “ahhh but its not population screening, its case finding in populations at high risk”. I was asked to try to define the difference between “screening” and “case finding” I failed to find much of a difference. Here is why   1             Background All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost [i] . Even when there is good evidence of a favorable benefit of a programme there is no a priori guarantee this will be seen in practice. This underscores the importance of complete implementation and ongoing quality assurance. Currently the four UK Governments ask UK NSC to provide advice on a proposal to offer population scr...

  Screening School Lesson 1 This is a repost of an old blog   Screening school. Lesson 1 I’ve  written a lot on screening . Mainly for a technical audience. I often assume that’s there is a lot more background knowledge than people really have. I was asked by someone with little knowledge of screening to give a single key reference that summarises the field in a few sides. I found it quite difficult to find an article to summarise the whole lot simply and easily. 3 key references This  article by Muir Gray  is one of the simple standard references I often give people. Maximizing benefit and minimizing harm of screening WHO/Europe | European Observatory on Health Systems and Policies – Screening. When is it appropriate and how can we get it right? (2020) http://www.euro.who.int/en/about-us/partners/observatory/publications/policy-briefs-and-summaries/screening.-when-is-it-appropriate-and-how-can-we-get-it-right-2020 Health Knowledge pages on s...