The future's bright, the future is public health Keynote presentation to the 25th anniversary celebration of the Instituto De Saude Publica Da Universidade Do Porto (ISPUP) meeting, January 10th 2020. 200110 middletonj porto final

1. www.fph.org.uk
John Middleton Instituto De Saude Publica Da
Universidade Do Porto,
25 year celebration,
January 10th 2019
O futuro é brilhante - a saúde
pública do futuro

2. www.fph.org.uk
John Middleton
Instituto De Saude Publica Da Universidade Do
Porto 25 year celebration,
January 10th 2019
The future’s bright- the future’s
public health

3. 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
around the globe.
We are part of the WHO Coalition of Partners in European public health
And we are developing our partnerships with sister public health
organisations in America, Africa, Asia, Australasia and the Arab world

5. Public health is :
The science and art of promoting health and
wellbeing, preventing disease and prolonging life
through the organised efforts of society
UKFPH 2011, after Acheson 1988, after Winslow
1920, WHO 1948

6. Where there is no
vision the people suffer
Andrija Stampar,
Yugoslavian Public health
pioneer and WHO
founding father
After Proverbs/29-18.

7. 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.’

8. Human rights are everyone’s
business
“Where, after all, do universal
human rights begin? In small
places, close to home … they
are the world of the individual
person; the neighborhood he
lives in; the school or college he
attends; the factory, farm, or
office where he works”
Eleanor Rooseveldt

10. www.fph.org.uk
The public’s health-
A life in local public health
The future’s bright- the future’s
public health

11. www.fph.org.uk
A life in local public health
In Sandwell, in the West Midlands of England

12. it's not who your
doctor is, it's
who you vote
for, that most
affects your
health

20. Improving
outcomes

22. Sandwell Valley,
King George
Playing fields
2014

23. www.fph.org.uk

25. New leisure
centres
Tipton

26. A life course – 24th annual report for Sandwell

27. Teenage Conception 1998-2012
Sandwell's reduction since baseline (44%) is higher than England & Wales's
reduction of 40.8%. The West Midlands reduction has also been lower than
Sandwell at 42%. Figure 1, above, show that the gap between Sandwell and
England is reducing further.

29. Marsch Addiction 1997

31. Domestic burglary Sandwell 2001-2005
Full implementation
drug intervention
project doubling
numbers of drug users
in treatment
1300 fewer
domestic
burglaries
33% fall

35. 11/01/2020 34

36. 11/01/2020 35
• Asset based public health
• Community assets

37. 36
Community health network

38. 37
Sandwell Youth Cabinet

39. www.fph.org.uk
Agewell -Sandwell

40. • Reducing social inequalities: UK Marmot review
• Create fair employment and good quality work for all and improve
quality of work across social gradients

41. www.fph.org.uk

42. www.fph.org.uk
By 2003 the mixed use site was in production…

43. www.fph.org.uk

44. 43

46. Middleton J. The hospital of the future comes to the West Midlands. BMJ blogs October 1st 2014.
http://blogs.bmj.com/bmj/2014/10/01/john-middleton-the-hospital-of-the-future-comes-to-the-west-
midlands/

47. www.fph.org.uk

48. 11/01/2020 47
• Asset based public health
• ‘The health dividend’

49. 48
Birmingham
Sandwell /
Urban Living
Smart
housing
manifesto
2004

50. 49
i- House, demonstration
house West Bromwich
2008

52. www.fph.org.uk
Health Futures
University
Technical
College
West
Bromwich,UK
www.healthfutures.co.
uk

53. www.fph.org.uk
The public’s health- Wider global concerns
The future’s bright- the future’s
public health

54. The public’s health
There’s never been a
better, or more
necessary, time to be
in public health

55. 5411/01/2020
The public’s health: global burden
of disease, corporate anti-health
interest,

56. 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, 2017

57. Global burden of disease deaths- all countries

58. Global burden of disease deaths- Portugal

59. 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%

60. These 10 Corporations Control Almost Everything We Eat

61. http://www.bmj.com/content/358/bmj.j4443?sso=

62. 11/01/2020 61

63. 11/01/2020 62

64. 6311/01/2020
Violence, conflict and public
health at home and abroad

65. 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

66. 6511/01/2020

67. Interconnectedness:
conflict over natural
resources: oil, water

68. Interconnectness: Loss of agricultural land through global
warming, crop failure, food riots, Arab Spring, Syrian war

69. 6811/01/2020
Planetary health: environment, loss of
biodiversity, food and ecosystems balance,
climate change.

70. A role for our climate
change special
interest group

72. •
7111/01/2020

73. 7211/01/2020

78. Coccolithophore (diatom): Produces 50% of the
world’s oxygen
Algal blooms photosynthesising off
south west coast of Wales

79. Climate
breakdown
is here
now!- 1 fire

80. Bianca Nogrady BMJ 2019;367:bmj.l6914
Climate
breakdown
is here
now!- 1 fire

81. Climate
breakdown
is here
now!- 1 fire

82. Climate breakdown is here
now!- 1 fire

83. Climate breakdown is
here now!- 1 fire

84. Climate
breakdown
is here
now!- 1 fire
NB this is a
simulation of
fires In
Australia
from Nasa
images, for 1
month,
December-
January2019-
20: *not a
satellite
image*

85. Climate
breakdown
is here
now!- 1 fire
Climate breakdown is here now!- 1
fire
And now it is intercontinental-as the
bushfire plume hits south America

86. Climate
breakdown is here
now!- 2 floods

87. • Climate
breakdown is
here now!- 2
floods
Indonesia
floods
Climate
breakdown is here
now!- 2 floods

88. Climate
breakdown
is here
now!- 3
marine life
extinction

90. 11/01/2020 89

91. 11/01/2020 90

92. 11/01/2020 91

93. ‘Protecting resources
from one generation to
the next’
▲The Welsh Wellbeing
of Future Generations
Act, 2015
A
‘Green
New
Deal’►

94. www.fph.org.uk
After 2016…
The future’s bright- the future’s
public health

95. This is a looming disaster and
priority is to limit damage

96. BREXIT and the public’s health
Loss of health and care workers
Loss of research grants and networks
Loss of leadership role in areas such as tobacco control and
antimicrobial resistance
Loss of international agencies which protect health –European
Communicable Disease Centre; The European illegal drugs
monitoring centre; European Medicines Agency; Pulling out of
Euratom Access to Medical isotopes for cancer treatment and shared
safety procedures for nuclear power stations;
Loss of protections for health - in the workplace, the Social chapter;
environmental protections; soil, beaches and air quality; equality
provisions;
Shared Security?

97. Brexit policy programme: Three areas
of focus short-listed
1. Protecting the European Centre for Disease
Prevention and Control (ECDC) (and other key
institutions)
2. The Great Repeal Bill – FPH calls on the
Government to introduce a ‘do no harm to the
public’s health’ clause
3. Free Trade and Investment Agreements, a
transitional agreement and World Trade
Organization rules

98. ‘Do No Harm’ Lord Warner Public Health
amendment to the EU Withdrawal bill
64 Health organisations support, representing over 1 million health workers

99. ‘Do No Harm’ Lord Warner Public Health
amendment to the EU Withdrawal bill
At Report stage Lord Duncan made clear to the House that “the
effect of Article 168 in the domestic law of this country before exit
will continue after exit by virtue of Clause 4…Article 168…will be
available in the future to UK courts to draw upon, both its
elements and its interpretation, and those elements will be
available afterwards…we are now in a good position to offer
certainty.”

102. 11/01/2020 101

103. ‘Valuing public health’: Three areas of
focus short-listed
1. Making the case for prevention (return on
investment; affordability; value for money; a call
for the ‘radical upgrade to be made real)
2. Investing more in prevention through the NHS (
including secondary prevention; rebuilding health
care public health)
3. Investing for outcomes (Developing the public
health outcomes dashboard, assuring the future
of public health investment)

104. www.fph.org.uk

105. www.fph.org.uk
Mason R,
Capewell,S,
et al

106. Effectiveness Hierarchy
Effects of different policy options
(evident for tobacco control, alcohol control, dietary salt & transfats etc)
105
Downstream Upstream
Sizeofpopulationhealthbenefit
INTERVENTIONS

107. www.fph.org.uk
Commissioning Public Health
Services Conference - June 2017

108. www.fph.org.uk
Austerity kills
Climate breakdown
Service cuts
Brexiting health
A manifesto for health, J Middleton November 28th 2019

115. You can change
her environment
through public
health advocacy!
120 high rise
blocks in
Sandwell 1988-
less than 30 in
2014

116. www.fph.org.uk
Thank you
John Middleton,
President
Association of Schools of Public Health
In the European Region
John.middleton@aspher.org

117. www.fph.org.uk
Obrigado
John Middleton,
President
Association of Schools of Public Health
In the European Region
John.middleton@aspher.org

118. www.fph.org.uk
Appendix
References

119. • Middleton J, ISIS, crop failure and no anti-biotics: what training will we need for future public
health? European J Public Health 2016; https://eurpub.oxfordjournals.org/content/26/5/735
• Middleton J, Weiss M. Still holding on: public health in the UK after Brexit. Euroheathnet
journal 2016; 22:no 4: 33-35. (ISSN 1356–1030)
http://www.euro.who.int/__data/assets/pdf_file/0010/325945/Eurohealth-V22-N4-2016.pdf?ua=1
• Middleton J. Public health in England in 2016—the health of the public and the public health
system: a review Br Med Bull (2017) 1-16. DOI: https://doi.org/10.1093/bmb/ldw054 and
http://academic.oup.com//bmb/article/doi/10.1093/bmb/ldw054/2871226/Public-health-in-England-in-
2016the-health-of-the?guestAccessKey=8f7a33a1-bdbf-4db4-948c-fd6b6293a259
• Middleton J, Saunders P. 20 years of local ecological public health: the experience of Sandwell
in the English West Midlands http://www.sciencedirect.com/science/article/pii/S0033350615003303
• Middleton J, Rae M. Health, wellbeing, and care should be top of everyone’s political agenda.
BMJ 2019;367:l6503 available at: https://www.bmj.com/content/367/bmj.l6503#; (accessed
November 16th 2019).