PHT June 2011_Jan 10 - UK Faculty of Public Health

In this issue 

> Interview with Graham Allen MP 

> How to handle a hotter Europe 

> Michael White behind closed doors at Number 10 

The magazine of the 

UK Faculty of Public Health 

www.fph.org.uk 

June 2011 

Getting in at the start 

The case for early intervention

Public Health Today 

The magazine of the 

UK Faculty of Public Health 


FROM THE PRESIDENT 

JUNE 2011 

Contents 

Up Front 3 

Interview with Graham Allen MP 4 

Special Feature: Early intervention 6 

A better start 6 

Predicting need in the early years 7 

Family Nurse Partnerships or 

universal visits 7 

Debate: Will the Government’s welfare 

reforms help early-years development? 8 

Meet the parents 9 

Parenting programmes make 

long-term sense 10 

Scotland aims for the best 

possible start 10 

It really is good to talk 11 

On the safe side 12 

Weighing the evidence – what 

actually works 13 

Child health surveillance 13 

Let’s not forget interventions 

in the later years 14 

Every child’s beginning matters 14 

Books & Publications 15 

Endnotes 17 

Noticeboard 19 

The Final Word 20 

Welcome 

THIS edition of Public Health Today 

focuses on the importance of 

early intervention to support the 

health and development of children and 

their families. Graham Allen‘s lifetime 

commitment to the health and wellbeing 

of his constituency is inspirational – a 

great example of what can be achieved 

if you really understand the community 

and its needs and are prepared to 

patiently spend time and effort over the 

years bringing people together to deliver 

change. I know the area well – in fact it 

was my experience with the children, 

families and schools there as a 

paediatrician in the 1970s and 80s that 

helped me to really understand the 

practical, day-to-day importance of the 

wider determinants of health – 

especially, at that time, housing. My first 

real experience of ‘joint planning’ was an 

informal group of people working in the 

area who got together occasionally at 

lunchtimes – speech therapists, teachers, 

nurses, doctors, the local vicar and 

others, chatting about what was going 

on locally, sharing ideas and, above all, 

getting to know each other so that we 

could work together and develop 

coordinated interventions when we 

needed to. That group didn’t cost 

anyone any money, and it did make a 

real difference to local health and 

wellbeing. It certainly showed me the 

potential of work on a broader canvas to 

address physical and mental health 

needs. 

The Marmot Review has made a 

convincing case for early childhood 

interventions, and it’s clear from Amanda 

Killoran’s article here that there is already 

plenty of evidence to show that the 

most cost-effective mix will include 

intensive home support for young 

mothers, universal high quality earlyeducation 

programmes and intensive, 

multi-faceted support for families with 

complex needs. Easy to write but much 

less easy to put in place, as it requires 

inputs from many different organisations 

and sustained support from a range of 

budgets. Delivering this mix in any 

community will but be much easier to 

community will be much easier to 

achieve if systems and levers are in place 

which support – and reward – 

collaboration, rather than force 

competition. 

I am writing this at a time when the 

progress of the Health and Social Care 

Bill through Parliament has been 

‘paused’ to allow for a period of 

reflection on the way forward for the 

NHS and for public health in England. A 

widespread listening exercise was 

undertaken during April and May and 

the Government intends to respond by 

the middle of June. FPH has taken an 

active part in the exercise, including 

sending a letter (jointly with the 

Association of Directors of Public Health 

and the Royal Society for Public Health) 

to the Prime Minister setting out our 

suggestions for the way forward, as well 

as participating in listening events at the 

Department of Health and at 10 

Downing Street. We are optimistic that 

the exercise will bring some positive 

changes to the proposals, resulting in a 

clear vision for the future of public 

health which supports and encourages 

cooperation and which, together, we can 

make a reality. 

Lindsey Davies 

To read the letter to Prime Minister 

David Cameron go to www.fph.org.uk

UP FRONT 

Public Health in a Changing World 

The University of Birmingham where, for the first time, FPH will hold its annual conference 

Highlights of 

the FPH Annual 

Conference on 

4 July 2011 

KEYNOTE SPEAKERS: Andrew 

Lansley CBE MP, Secretary of State 

for Health, and Dame Sally Davies, 

Chief Medical Officer for England 

THIS year’s FPH Annual Conference, to be 

held in Birmingham, promises to be an 

exciting and stimulating event, sure to 

generate debate and discussion on the 

major questions currently facing public 

health. There are three major themes: 

public health reforms, public health issues 

and a new approach to public health. 

Opening the event will be Health 

Secretary Andrew Lansley, who will share 

his thoughts on the reforms to public 

health and the NHS, how he views 

progress so far, and the challenges that lie 

ahead in delivering his vision for public 

health in England. 

Dame Sally Davies, the newly appointed 

CMO for England, will share her views on 

the major public health challenges, 

including those posed by the reforms. 

The Big Public Health Debate 

This session will look at the proposed 

expansion of the ‘any willing provider’ 

model. It will include presentations from 

influential commentators and those at the 

frontier of this expansion. Confirmed 

speakers include Roy Lilley, NHS 

commentator and broadcaster, a senior 

representative from UNISON, Massoud 

Fouladi, Medical Director and co-founder 

of Circle, and Mark Britnell, Global Head of 

Health, KPMG. 

The New Players in Public Health 

Policy 

It’s widely acknowledged that industry and 

its practices have a major impact on our 

health and wellbeing. But is industry really 

the big bad wolf it’s made out to be? 

Doesn’t it also have a valuable role to play 

in improving health and wellbeing? This 

session will hear views from health-policy 

experts and industry. Confirmed speakers: 

Melanie Leech, Director General, Food and 

Drink Federation, Tim Lang, Professor of 

Food Policy, City University London, Ian 

Gilmore, Royal Liverpool University 

Hospital, Seymour Fortescue, Chairman, 

the Portman Group. The session will be 

chaired by The Guardian’s health 

correspondent Denis Campbell. 

The New Commissioners on the 

Block 

This parallel session will hear from those 

GPs who are making the leap to the new 

system as proposed in the white paper 

reforms. Speakers will share their 

experiences of how it is working in practice 

and the practicalities of linking the DPH 

report, joint strategic needs assessment 

and health and wellbeing board strategy. 

Other session highlights include: 

Local Government and Better Health – 

understanding the practicalities of working 

in a local authority. Confirmed speaker: 

Andrew Cozens CBE, Strategic Adviser for 

Children, Adults and Health Services, Local 

Government Improvement and 

Development. 

In Fiscally Challenged Times, What Should 

be our Priority – the reduction of health 

inequalities or increasing life expectancy? 

A highly interactive session. Confirmed 

chair: Kate Pickett, co-author of The 

Spirit Level. 

Behavioural Change, Behavioural Insight 

and Public Health. Delegates will hear from 

experts on how these approaches can be 

used in public health. Confirmed speakers 

include Mike Kelly NICE, Dominic King, 

co-author of the Mindspace report, 

Stephen Sutton, Professor of Behavioural 

Science, University of Cambridge, chair 

Frank Atherton, President, Association of 

Directors of Public Health (ADPH). 

Public Health Innovation and Ideas 

Public health faces major challenges 

including lifestyle choices, emerging 

infectious diseases, antibiotic resistance 

and climate change. Technological 

advances help but there is a need to 

encourage new and innovative ways of 

thinking to solve the most pressing 

problems. This highly interactive session 

lets participants pitch their ideas to a panel 

of public health experts including Lindsey 

Davies, FPH President, Sally Davies, CMO, 

and Frank Atherton, ADPH President. There 

will be a prize for the best innovative idea 

presented. 

Free access to the Journal of Public 

Health 

Delegates will also receive two months’ 

complimentary access to our highly 

respected Journal of Public Health. 

Produced by Oxford University Press on 

behalf of FPH, the journal publishes 

rigorously peer-reviewed papers on the 

theory and practice of public health across 

the domains of health improvement, health 

protection and service improvement, with a 

particular focus on the translation of 

science into action. See 

jpubhealth.oxfordjournals.org 

Registration 

There’s still time to secure your 

attendance at one of the most prominent 

events in the public health calendar. To 

book your place go to the FPH website, 

www.fph.org.uk, and complete the 

online registration form. If you have any 

queries, please contact Karen Tidy, Events 

Officer, at karentidy@fph.org.uk or on 

020 7935 3115. 

JUNE 2011 3

INTERVIEW 

Graham Allen, Labour MP for Nottingham North, delivered 

his review Early Intervention: the Next Steps in January, and 

his follow-up report on financing the approach is just out. 

Here he talks to Public Health Today about what he sees as 

the main opportunities and challenges 

‘Smoke alarms, 

Intervene early and save billions, says Allen 

What inspired you to take up the early intervention 

‘banner’ in the first place? 

My own history in my own constituency, which has the highest 

teenage pregnancy rate in Western Europe, the fewest kids going 

on to university in the UK, and myself being born and bred in that 

constituency. It’s a white, working-class area with a lot of problems 

– but there’s nothing inherent in the kids to stop them achieving 

great things. The fundamental problem is an intergenerational 

cycle of dysfunction. I knew we could break into that by having an 

effective programme to give every baby, child and young person 

the social and emotional bedrock that most of us take for granted 

but which so often is not there because the transmission of good 

parenting skills has, for whatever reason, broken down. 

So how did you go about doing something about it? 

In 2005 I was asked to chair the local strategic partnership in 

Nottingham – and my vision was to create an ‘early-intervention 

city.’ We came up with a cycle of policies for ages 0-18 – some 

available to every baby, child or young person, and some 

specifically targeted. The general ones were things like family nurse 

partnerships (our ambition is to apply this to every child born in 

Nottingham and we’re well on the way); a SEAL [social and 

emotional aspects of learning] programme for every primary school 

child; and a life-skills programme – SRE [sex and relationships 

education], PSHE [personal social and health education], civic and 

financial awareness, etc – for secondary schoolchildren. Our 

specific interventions included a mentoring programme for eightyear-olds 

and help for children of persistent and prolific offenders. 

And the review? 

On the strength of our experience in Nottingham I co-wrote a little 

book with Iain Duncan Smith, published in 2008, and in July 2010 

David Cameron asked me to lead a review on early intervention. 

What has your review identified as the main 

challenges? 

The big one is that it takes time. You need persistence, 

consistency, sustainability. You need political commitment 

nationally and locally, which means an all-party approach. I’m not 

going to let the current dispute about cuts stop me from doing all I 

can for early intervention. I see our initiative as a poppy in the 

battlefield – and to be fair we’re getting a lot of political mileage 

across the political spectrum. 

Where do you see the ‘Big Society’ fitting into this? 

I’ve always been a strong advocate of civic society, but it’s 

underdeveloped. We need to maximise the ability of local people 

to come up with their own answers. And we need to develop 

effective partnerships between civic society and a much more 

independent local government to achieve the sort of social 

consensus to make things happen. 

And do you think that the business world has a part 

to play? 

Yes, an important part locally and nationally. Locally, through 

partnerships engaging with businesses to invest in the future of 

the entire community. Nationally, we’ve floated the idea of an 

Early Intervention Foundation. Although government will always be 

the main funder of programmes, there’s room for a small but 

significant non-government arm which would pull together the Big 

Society Bank, the Big Lottery and various foundations to provide 

some start-up funding and act as a conduit for investment from 

the private sector. If the Government creates the right mood music 

we could get some solid private investment. More private sector 

organisations are seeing that social investment can be as profitable 

as investing in coffee futures or the gold market. Let’s face it, the 

City could do with a bit of positive PR right now. 

4 PUBLIC HEALTH TODAY

INTERVIEW 

not fire engines’ 

The big bogies are 

institutional anxiety and 

territorialism, at 

Whitehall and local level, 

both of which get worse 

‘when budgets are tight 

‘ 

What about the short-termism of public sector 

managers? Any quick wins? 

We need as a society to change that philosophy. Looking back 

over the past 30 years, can we say that short-termism (what I call 

late intervention) has been successful? Clearly the answer is no. I 

think our party leaders need to have the courage to say that this 

isn’t the way to run public services. We need to think prevention – 

more smoke alarms rather than fire engines – to show how 

children with social and emotional capability can save on all the 

things that are the cost of failure: drink and drug abuse, literacy 

problems, antisocial behaviour, magistrates courts, lifetimes on 

welfare – billions of pounds. And the trick is to monetise the 

savings and to use that to repay investors. 

Many of our readers will soon be moving into new 

public health structures with broader responsibilities 

for health and wellbeing. What would you say to them? 

The whole early-intervention strategy is in essence a public health 

strategy. We see it in Scandinavia and in Scotland. There’s no 

reason we can’t see it in England. While good people can make 

almost any structure work, they can do even better if backed up by 

the philosophy of early intervention. There’s tremendous potential 

in the proposed new structures providing we can theme them to 

take on the philosophy of investing in early years. This is not to 

neglect teenagers and older people, but to see ages 0-8 as 

absolutely key to the future, so that kids can be self-starters and 

we don’t wait until problems become deeply rooted. 

With all this in mind, what keeps you awake at night? 

The big bogies are institutional anxiety and territorialism, at 

Whitehall and local level, both of which get worse when budgets are 

tight, often at the expense of a longer-term approach. Changing 

from a culture of late intervention to early intervention takes real 

political will, and I think a public health view is a strong driver for this. 

Finally what gives you hope – what keeps you going? 

In Nottingham and around the country I’ve seen what can be done 

with the right drive. We can make a difference. The challenge now 

is to learn from best practice and take it to scale. We’ve got 27 

local authorities saying they want to become Early Intervention 

Places. If we can encourage and support this movement with an 

Early Intervention Foundation we can roll it out across the country. 

As ever it’s about partnership, investment and political will. A lot 

depends on whether the Government listens to my report and is 

able to drive it through Whitehall and the Treasury. But I’m 

confident that the case is so self-evident we will see real progress. 

Graham Allen was talking to Alan Maryon-Davis 

To download a copy of Early Intervention: the Next 

Steps, go to www.dwp.gov.uk. For a hard copy, email 

matthew.woolston@parliament.uk 


SPECIAL FEATURE: EARLY INTERVENTION 

A better start 

Despite a mountain of evidence, it is only relatively recently that there has been a 

clear consensus on the importance of early intervention, says Alan Maryon-Davis 

THE baby who won’t stop crying. The 

toddler covered with bruises. The child who 

never speaks. The teenage mother with noone 

to help her. The chaotic couple with a 

small child and a big heroin habit. These 

cases are familiar enough to all those health 

visitors, social workers, family doctors and 

child psychiatrists who have to deal with 

the immediate impacts. 

But what often gets forgotten or put in 

the ‘too-difficult’ tray is the longer-term 

damage, not just to the individual child or 

family, but also the community at large. We 

know only too well how slow learning, 

emotional difficulties, antisocial behaviour, 

youth crime, binge drinking, drugs misuse, 

low educational attainment, poor job 

prospects and a whole raft of bad 

outcomes can be directly linked to failings 

in those crucial early years of life. And we 

know how these outcomes are so often 

linked to the repeating patterns of social 

disadvantage – low income, poor housing, 

joblessness, teen parenthood – usually 

through a lack of parenting skills and an 

alienating home environment. We see it 

happening over and over again, generation 

upon generation. The human, social and 

economic costs of this perennially unfolding 

tragedy run into billions of pounds every 

year. 

And yet despite this huge long-term 

burden, a clear consensus on the 

importance of the early years and the need 

for more effective intervention among those 

at risk has come only relatively recently. Yes, 

we’ve had Health Action Zones and Sure 

Start centres, but a strong focus on early 

intervention has had to wait until the 

publication of such influential reports as 

that of Sir Michael Marmot, Graham Allen 

MP (interviewed in this issue of Public 

Health Today) and Frank Field MP, 

highlighting the issues and potential 

solutions. 

There are many challenges in the early 

intervention approach. How do we engage 

with families? How do we assess a child’s 

need or monitor progress? What types of 

intervention are most appropriate? What 

are the safeguarding issues? How do we 

link up the services? How do we involve the 

voluntary sector? How can we skill-up the 

workforce? What about resources and the 

impact of cuts? 

In this issue of PHT we’ve gathered 

together some excellent contributions 

looking at these issues. There’s clearly no 

‘one-size-fits-all’ approach, and there are 

many examples of good practice; some 

such as the Family Nurse Partnership 

model imported from North America and 

being piloted in various parts of the UK, 

others involving an expansion and refocusing 

of our existing health-visitor 

workforce. 

The new localism is both a blessing and a 

curse, leading to a patchwork quilt of 

provision. What seems to be needed is 

an overall cross-sector framework, based 

on the evidence of what works, providing 

clear aims, effective guidance and a set 

of tools to better identify need, engage 

with families, empower professionals 

and inform service planners and 

commissioners. 

As Graham Allen points out, the 

potential benefits are enormous. All it takes 

is vision, the will, the coordinated efforts 

and assets of society, and the courage to go 

for it. 

Alan Maryon-Davis 

Editor in Chief 


Predicting need in the 

early years – the art 

of active filtering 


Family Nurse 

Partnerships or 

universal visits? 

THERE is a large body of evidence that 

wise investment to improve outcomes for 

pre-school children can pay a rich social 

dividend. The evidence available supports 

the intuitive view that we get the biggest 

payback from investing more in supporting 

those children with the biggest needs. 

However, as Marmot makes clear, it is also 

important that these targeted services 

should be underpinned by universal 

services, the need for which is less intuitive. 

The scale and intensity of services needs to 

be proportionate to the level of need. 

A pilot project was recently conducted 

by our research group at the University of 

Glasgow in which families were offered 

two universal contacts with their health 

visitor when children reached 13 months 

and 30 months. The project used structured 

assessment tools because this is the 

best way to ensure social equity; otherwise 

there is a high risk that interventions are 

offered to those who least need them in 

line with the Inverse Care Law. The work 

was designed to assess need (including 

unmet need) for parenting support in the 

community and to offer appropriate levels 

of service to families. We assessed parental 

wellbeing and the parent-child relationship 

at 13 months; language delay through a 

two-question screen, behaviour problems 

and parental stress at 30 months; and 

family background and demographic 

factors at both ages. 

Further work has been carried out with 

the Scottish Government and Glasgow City 

Council to develop the assessment of 

children’s emotional and behavioural 

wellbeing at school entry using the 

Strengths and Difficulties Questionnaire 

(SDQ). These data have allowed us to 

describe the emotional and behavioural 

wellbeing of children entering school in 

Glasgow. We now have maps of the 

distribution of emotional problems, 

hyperactivity/inattention problems, conduct 

problems and peer relationship problems 

across Glasgow. The prevalence of conduct 

and hyperactivity problems is roughly 50% 

higher in the most deprived parts of the 

city compared to the most affluent, but 

some of the most deprived areas appear to 

have excellent childhood mental health. 

The data will allow us to identify local and 

individual factors predictive of problems 

likely to interfere with children’s school 

attainment and will provide a baseline for 

proposed comparisons in future years. 

We have the potential for an efficient 

and flexible use of resources through use 

of an ‘active filtering’ approach in which 

professionals and families together 

determine level of need with reference to 

standardised assessment tools. Resources 

can thus be directed to those most in 

need. In other words we need an 

intelligent system for ‘case-finding’, an 

assessment of the level of child/family need 

and appropriate resource allocation, often 

called ‘progressive universalism’. 

In the interests of social equity, there is a 

strong case for universal assessments using 

validated tools to assess need at several 

stages in the pre-school years, using, for 

example, the Strengths and Difficulties 

Questionnaire and standard language 

assessments. Such tools could offer a 

number of benefits beyond facilitating an 

equitable approach to support. They could 

allow efficient information sharing, 

currently beset with problems, between 

primary care professionals and provide a 

useful instrument for policymakers and 

managers wishing to evaluate how well 

our early years’ services are performing. 

Dr Phil Wilson 

GP and Senior Lecturer 

Infant Mental Health 

University of Glasgow 

This article is adapted from a chapter 

in Thinking Ahead: Why We Need to 

Improve Children’s Mental Health and 

Wellbeing (FPH £5.99) 

THE national shortage of health visitors has 

long been a matter of concern. The past 

10 years have seen many attempts to 

stretch the service to meet increasing 

demands. 

The Coalition Government has 

announced a new-style health visiting 

service with an extra 4,200 health visitors 

by 2015 and has also advocated the rollout 

of the Family Nurse Partnership (FNP) 

programme. The FNP is meant to be a key 

component of the universal service but 

instead many fear it will throw the existing 

service into crisis. In these hard times do 

you continue a universal health visiting 

service or opt for a more targeted 

approach, focusing on those with the 

greatest needs? 

The FNP is a preventive programme for 

young first-time mothers identified as 

being most at risk of poor health and 

social outcomes. A family nurse visits the 

mother and her partner at least every two 

weeks from the fifth month of pregnancy 

until the baby is two years old. The 

programme is based on a US version which 

has shown positive impacts on both 

mother and child. 

A problem with a targeted approach is 

that it only addresses the needs of a small 

select population, while issues such as child 

protection, child development and postnatal 

depression are universal. There is also 

increasing evidence that it is parental 

mental health not deprivation that makes 

the biggest difference. This would not be 

picked up in targeted approaches as they 

are typically used in socially disadvantaged 

areas. We would also lose the early 

intervention function that the universal 

health visiting service does so well. For 

example, the development check at 2½ 

years is an excellent screen for detecting 

children who will require future 

educational, health and social services. 

Moreover, unmet needs surface 

inappropriately elsewhere, such as in 

general practice or A&E. 

Clearly a progressive universal service, 

providing the full range from light to 

intensive support, is needed. But that 

means big numbers, and the real question 

then is how do we improve recruitment? 

Dr Catherine Heffernan 

Consultant in Children’s Public Health 

NHS Hounslow & London Borough of 

Hounslow 



DEBATE: Will the Government’s welfare reforms help early-years development? 

Iain Duncan Smith says they will, while Alison Garnham warns of pain ahead 

Work is key to 

lifting families 

out of poverty 

“OUR long-term strategy for the decade 

ahead is to protect the most vulnerable 

and reform welfare so work pays as a 

sustainable route out of poverty. 

“First, we must ensure that families can 

work themselves out of poverty – if they 

do the right thing we will make sure the 

system makes work pay. Around 55% of 

children who are currently in poverty are 

living in working families. By moving all 

working-age benefit claimants onto the 

Universal Credit from 2013-2017 we 

expect to move around 600,000 adults and 

350,000 children out of poverty. 

“The Universal Credit will support those 

who do the right thing, who take a full 

time job, to have an income which lifts 

them out of poverty. Our proposed design 

should enable most families with children 

who have a parent in full-time employment 

to have an income that lifts them out of 

poverty. The same should apply for lone 

parents who work at least 24 hours per 

week or more. What this means is that we 

are creating a system which helps people 

work themselves out of poverty, a fair 

system that rewards responsibility, not a 

hand-out culture. 

“Second, we are concerned for children 

growing up in households where their 

parents cannot work. We will ensure the 

YES 

most severely disabled people with 

children, those who we do not expect to 

take steps to return to work, are able to 

live with dignity. We will bring forward 

proposals to take the next steps towards 

this goal within the reforms to disability 

payments. This is the hallmark of a fair and 

compassionate society. 

“Third, we will ensure that those not in 

employment receive the support needed to 

access the working environment so they 

can work themselves out of poverty – first 

through Jobcentre Plus, and second, 

through the Work Programme. 

“If their barriers to work are short term 

they will find support at Jobcentre Plus. If 

their barriers are medium term and more 

complex they will find support through the 

Work Programme. By continuing to ensure 

Jobcentre Plus delivers effective support, 

matched by conditionality to help people 

back into work, we seek to mobilise as 

many of the five million people on out-ofwork 

benefits as possible – and for those 

who do not find their own way into work 

we will help them through our 

comprehensive Work Programme. 

“We recognise that some families face 

complex barriers to work, many of which 

cause intergenerational disadvantage. To 

address the root causes of poverty we will 

deliver early and effective interventions 

through the Work Programme targeted at 

vulnerable groups.” 

Rt Hon Iain Duncan Smith MP 

Secretary of State for Work and 

Pensions (in his foreword to A New 

Approach to Child Poverty, April 2011) 

Cuts have 

already made 

families poorer 

DESPITE all the political rhetoric on the 

early years, families with children, 

particularly those with very young 

children, will be the hardest hit by the 

Government’s plans. 

Much of the £18 billion cuts that will 

precede the introduction of the 

Universal Credit (UC) is being felt by 

families now, such as the end of the 

Health in Pregnancy Grant, the end of 

the Sure Start Maternity Grant for a 

second child and the loss from tax 

credits of the baby and (proposed) 

toddler premiums. But much more pain 

is on the way, particularly through the 

decision to peg benefits to the 

Consumer Prices Index, eroding their 

value over time. 

The UC proposals promise that noone 

will be a loser at the point of 

change, but this is only after benefit 

cuts have already taken effect. There is 

no guarantee that help with childcare 

costs post-UC will even match the 

newly reduced level provided by tax 

credits. The Social Fund, which helps 

with one-off items, is to be localised 

with no ring fence – so no guarantee of 

help there either. And cuts in housing 

allowances will hit young families 

particularly hard. 

Material deprivation and debt are a 

likely consequence of major benefit 

cuts, coming at a time of aboveinflation 

price rises for basics such as 

NO 

clothing, food and fuel, so we should 

expect greater levels of depression and 

worse mental health in parents of 

infants. 

Early years services are also under 

threat – according to the Daycare Trust, 

up to 7% of Sure Start centres are 

under threat of closure within a year, 

while over half may have to provide a 

reduced service. Frank Field, who 

advised the Government on child 

poverty, said: “It is inconceivable that 

we can make the foundation years 

effective if children’s centres all over the 

place are being slaughtered.” He 

recommended that Sure Start centres 

should provide advice to improve takeup 

of benefits. 

Cuts to benefits may push parents 

towards lower-quality or informal care 

to save money. Poor-quality childcare 

runs counter to the evidence that it is 

only high-quality professional provision 

that has clear developmental benefits 

for children, and the effects are the 

longest lasting for the most 

disadvantaged children. 

Despite the many positive 

recommendations coming out of Frank 

Field’s Foundation Years report and 

Graham Allen’s Early Intervention 

report, the proposals currently on the 

table on welfare reform seem likely to 

do far more harm than good for earlyyears 

development. 

Alison Garnham 

Chief Executive 

Child Poverty Action Group 



Meet the parents 

The effect of parenting on a child’s future health is now better appreciated, but there 

is still much work to do to break the poor-parenting cycle, says Sarah Stewart-Brown 

TEN years or so ago, when I first spoke 

about parenting at an FPH conference, 

many in the audience were not convinced 

that the subject had much to do with 

public health. 

Now parenting appears in the white 

paper Healthy Lives, Healthy People, in 

the Marmot review Fair Society, Healthy 

Lives, and in the new mental health 

strategy No Health Without Mental Health. 

Frank Field, chair of the recent 

Independent Review of Poverty and Life 

Chances, has put parenting at the centre 

of the health and social inequalities 

debate, arguing that the focus on financial 

aspects of poverty “has prevented a more 

comprehensive understanding of why life’s 

race is already determined for most poor 

children before they even begin their first 

day at school”. 

What has changed in the past 10 years? 

One thing is a greater appreciation of the 

life-course approach and the importance of 

‘a good start in life’. We now accept that 

fundamental changes to public health 

must include improvements in children’s 

health and wellbeing. We also know that 

emotional and social health in childhood 

underpins the adoption of healthy 

lifestyles, interpersonal relationships, 

educational achievement and employment 

prospects. And, building on this, we 

recognise that mental and physical health 

are closely interlinked and that mental 

wellbeing is a public health goal in its own 

right. 

Parenting is the key determinant of 

children’s emotional and social 

development and thus their future 

wellbeing. The quality of the relationship 

parents make with their children, the 

extent to which they can attune 

themselves to their children’s needs, 

contain their distress, establish ageappropriate 

boundaries and maintain 

positive disciplinary strategies dictates the 

way the infant’s emotional and social brain 

gets wired and thus the way children 

interact with others, manage their own 

behaviour and handle stress throughout 

their lives. 

The problem is that parents tend to 

make relationships with their children that 

echo those they had with their own 

parents, and changing these lifelong 

patterns is not easy. Parents’ own mental 

health is central both to parenting and to 

their capacity to change. But it is now 

possible to help parents change their 

parenting for the better, and if this support 

is available we can expect incremental 

improvements in parenting norms in each 

generation. 

There are many approaches to 

supporting parenting, from low-cost 

web-based programmes to intensive 

high-cost programmes such as the Family 

Nurse Partnership. There are strong 

grounds to suggest that it is important 

to have a universal underpinning to 

parenting support. The great majority of 

parents want help with their parenting, 

and targeted parenting support with 

no universal underpinning tends to 

get stigmatised. Evidence-based 

programmes such as Triple P and Incredible 

Years have an important role to play, but 

many other creative programmes are 

emerging. 

A key issue in these times of cut-backs is 

whether provision of parenting support will 

be sufficient to reap the potential rewards 

to the public’s health. Much of that 

provided by local authorities may now 

disappear and many third-sector 

organisations working in communities are 

facing closure. At the same time, the NHS 

is getting more health visitors who could 

be trained to provide this level of care. If 

government, local authorities, NHS and the 

third sector all agree that parenting 

support is important, we can hope that 

somehow the resources to preserve and 

develop what has been provided will be 

found. 

Sarah Stewart-Brown 

Chair of Public Health 

Warwick Medical School 



Scotland aims 

for the best 

possible start 

Parenting programmes 

make long-term sense 

EVERY pound spent on parenting 

programmes to prevent conduct disorder in 

young children saves the taxpayer £8 over 

a child's lifetime. And this economic 

impact of early intervention is over and 

above the positive effects on the child’s 

wellbeing. 

Mental ill health is the largest single 

cause of disability in the UK, accounting 

for almost 23% of the overall burden of 

disease compared to about 16% each for 

cancer and cardiovascular disease. Most 

mental health conditions first affect people 

early in life, with 50% of cases occurring 

by age 14. Most current public spending 

on mental health is focused on crisis 

intervention and expensive longer-term 

care and support rather than on prevention 

and early intervention. Yet there is 

compelling evidence that good quality 

public mental health interventions 

dramatically cut costs and significantly 

improve lives. 

Behavioural or conduct problems which 

emerge early in childhood are very likely to 

persist into later life. The one in 20 young 

children whose problems merit a clinical 

diagnosis of conduct disorder face a 

lifetime of disadvantage, including high 

levels of ill health, offending and poverty. 

Yet early onset conduct problems and 

their risk factors are easily identifiable and, 

in many cases, preventable. An increasingly 

strong body of evidence demonstrates the 

effectiveness of a range of family and 

school-based programmes to prevent or 

manage conduct problems. 

Despite the undoubted benefits, the 

availability of these programmes falls well 

short of what is needed and the quality of 

services is variable. A range of barriers 

hinders the provision of evidence-based 

interventions. Programmes are not always 

compliant with what we know works, and 

many fail to target those who need them 

most. Take-up rates are low and drop-out 

rates are high. 

In a recent report*, we found that good 

quality parenting programmes save the 

taxpayer some £8 for every £1 invested. 

Other evidence-based early interventions 

also generate substantial savings. They 

include health-visiting interventions to 

reduce postnatal depression and schoolbased 

social and emotional learning 

programmes. 

It is clear that early intervention in public 

mental health is outstandingly good value 

for taxpayers’ money. It represents a major 

opportunity for directors of public health 

and Public Health England to invest in 

highly cost-effective interventions and 

dramatically improve the life chances of 

thousands of vulnerable children. 

Michael Parsonage 

Senior Policy Adviser 

Centre for Mental Health 

*Mental Health Promotion and Mental 

Illness Prevention: the Economic Case 

is published by the Department of 

Health, the Personal Social Services 

Research Unit (PSSRU) at the LSE, 

the Centre for the Economics of 

Mental Health and Centre for Mental 

Health 

www.centreformentalhealth.org.uk 

IN SCOTLAND, the main government policy 

statement has been the Early Years 

Framework (2008), developed with local 

authorities, leading to a sustained focus on 

this key area of public health. 

Across Scotland a number of initiatives 

are being developed to test specific 

elements of national guidance. These 

include population-based parenting 

programmes, pilots of the Family Nurse 

Partnership model and evaluations of child 

development contacts focusing on early 

communication and behaviour. 

The guidance, Improving Maternal and 

Infant Nutrition: A Framework for Action 

(2011), focuses on activities across the 

preconceptual, antenatal, postnatal and 

infant phases in order to improve 

outcomes for mothers and children 

through improved nutrition. It is coherent 

with the Refreshed Framework for 

Maternity Care in Scotland (2011) and the 

accompanying guidance, Reducing 

Antenatal Health Inequalities (2011), and 

together these documents set out a broad 

multi-agency approach to tackling 

antenatal determinants through assetbased 

work which will foster stronger 

relationships with families. 

The Pathway of Care for Vulnerable 

Families (0-3) (2011) continues the 

strengths-based theme, emphasises multiagency 

working and creates a framework 

to support the systematic search for needs. 

The document supports multi-professional 

working in the antenatal period. 

A New Look at Hall 4 – the Early Years – 

Good Health for Every Child (2011) sets 

out a number of changes to child health 

surveillance across Scotland, including the 

introduction of a universal face-to-face 

contact between 24 and 30 months. This 

contact will assess social and behavioural 

outcomes, provide health improvement 

messages and create an opportunity for 

parental issues to be addressed. In addition 

to the new contact, there are planned 

changes to the Health Plan Indicator (HPI). 

The HPI is a measure of a child’s need. 

Early years remains a priority in Scotland. 

Time will tell how financial realities will 

challenge the public sector to deliver this 

agenda. 

Dr John O’Dowd 

Consultant in Public Health Medicine 

(Child Health) 

NHS Greater Glasgow & Clyde 

10 PUBLIC HEALTH TODAY


It really is good to talk 

All babies are born ready to communicate but social inequalities can prevent the 

very natural process of parent/child interaction from fully working, says Liz Kirk 

HEALTHY interaction between parent and 

baby is essential. A child’s language 

development is crucially dependent on the 

quality of the interaction they experience 

during infancy. 

Unfortunately, optimum 

language-learning environments are not 

equally available to children across 

socioeconomic strata. By the time a child 

starts school, social inequalities have 

already had a profound and lasting impact 

on their development and life chances. 

According to recent data published by the 

Marmot review team, more than half of 

children starting school have failed to reach 

an adequate level of development. Those 

most likely to be failing are from lowerincome 

families. 

Research tells us this is largely due to the 

fact that the quality and quantity of 

interactions that children from poorer 

families receive is significantly impoverished 

compared to children from more 

advantaged households. Researchers have 

found that lower-income mothers tend to 

talk less to their children, use fewer 

different words and respond less to their 

child’s speech. 

With Hertfordshire Speech and Language 

Therapy team I have developed an 

intervention to improve the quality and 

quantity of interaction between lowerincome 

parents and their babies. Small Talk 

is a series of sessions delivered by a 

therapist at Sure Start children’s centres. 

Parents with babies aged between six and 

12 months are invited to attend these 

sessions, which encourage them to focus 

on, respond to and build upon their child’s 

early non-verbal communication. The 

sessions are well received by parents, and 

evaluation points towards a positive impact 

on the children’s language development. 

Lower-income 

mothers tend to talk 

less to their children 

and use fewer 

‘different words 

‘ 

The charity Best Beginnings is drawing 

on this work to develop resources for 

parents and healthcare professionals to 

support and encourage positive 

interactions from birth. Best Beginnings is 

committed to giving every baby the 

healthiest possible start in life by focusing 

on the time period between preconception 

and two years of age. Recognising the 

inequalities that exist in early parent-child 

interaction, Best Beginnings has produced 

short films of parents spending time with 

their babies that demonstrate positive 

examples of interaction. These films on 

baby conversations, nursery rhymes and 

engaging play are available to watch on 

the Best Beginnings website alongside a 

video commentary of tips to encourage 

baby communication. Go to 

www.bestbeginnings.org.uk/babycommunication 

to view it. 

All babies are born ready to 

communicate and all parents, regardless of 

their income or education, have what it 

takes to support and nurture their child’s 

development through quality interaction. 

Best Beginnings aims to empower parents 

to make a real difference to their child’s 

development and ultimately close the gap 

in inequalities. 

Dr Liz Kirk 

Research Fellow 

School of Psychology 

University of Hertfordshire and 

Policy and Development Manager 

Best Beginnings 

Other organisations promoting 

communication for children and 

young people: 

The Hello campaign – 

www.hello.org.uk 

The Communications Trust – 

www.thecommunicationtrust.org.uk 



On the safe side 

Local Safeguarding Children Boards need to be both strategic and aware of 

what is happening on the multi-agency frontline, says Edwina Harrison 

6mm 

ALTHOUGH there were a few independent 

chairs of Local Safeguarding Children 

Boards (LSCBs) prior to the Baby Peter 

case, it was the subsequent report by Lord 

Laming, The Protection of Children in 

England: A Progress Report 

(www.education.gov.uk/publications), 

which led to around 135 of the 148 chairs 

being independent. I took up my first post 

in September 2009. 

LSCBs became statutory bodies in 2006, 

replacing the previous, non-statutory Area 

Child Protection Committees, and the roles 

and responsibilities of the LSCB are 

outlined in Working Together to Safeguard 

Children, 2010 

(www.education.gov.uk/publications). To 

be successful, LSCBs need to perform two 

different but equally important functions: 

to be strategic but also to understand 

what is actually happening at the multiagency 

frontline. 

While much progress has been made in 

embedding effective partnership work in 

safeguarding children, there are a number 

of significant challenges facing LSCBs. The 

unprecedented scale of organisational 

change among agencies creates the 

potential for a retreat back into silos and 

for partnership working to suffer a severe 

setback. In the absence of specific funding 

for LSCBs, budgets are a big issue, and 

memories can be short when it comes to 

the cost, in terms of morale as well as 

money, of a failure of multi-agency 

working. 

Significant progress has been made in 

addressing issues which impact on multiagency 

working. These include agreement 

on thresholds for intervention, on 

developing effective training and on audit 

and quality-assurance processes. The 

reports presented to LSCBs on the reality 

of front-line working can be a real 

The unprecedented 

scale of organisational 

change creates the 

potential for a 

‘retreat back into silos 

‘ 

eye-opener for senior managers who may 

be used to receiving information from 

their own agencies in isolation. These 

include information from the first three 

years of the Child Death Overview Panels 

as well as the various stages of the child 

protection processes outlined in Working 

Together. 

Many LSCBs have now appointed lay 

members to provide a much-needed link to 

local communities. Potentially even more 

powerful is the work which is taking place 

incorporating the voices of children and 

young people to better understand their 

experience of the systems that are 

designed to protect them. And while no 

area would choose to have a Serious Case 

Review, the combined experiences included 

in Ofsted’s Learning Lessons reports 

(www.ofsted.gov.uk) are relevant for all 

practitioners. 

The models referred to in the recent 

reports by Professor Eileen Munro offer a 

more practice-based method of learning 

from serious incidents. Some changes of 

direction have been signalled already, with 

a return to child protection as the main 

focus of LSCBs. The first two reports from 

Professor Munro, The Munro Review of 

Child Protection: Part One and the Interim 

Report, The Child’s Journey, have both 

indicated that she sees a clear and 

continuing future for LSCBs as statutory 

bodies with an enhanced responsibility for 

embedding multi-agency learning. The 

third and final report, A Child-Centred 

System, came out last month, but it 

remains to be seen whether a government 

committed to localism will understand that 

child protection is too important to be left 

to local choice. 

Edwina Harrison 

Independent Chair 

Newcastle Safeguarding Children Board 


Weighing the evidence 

– what actually works 


Child health 

surveillance – 

how does it 

measure up? 

THE scientific rationale for early 

intervention to improve the health and life 

chances of children, particularly vulnerable 

children, is now strong and well 

documented (most recently in the 

independent reviews of Frank Field and 

Graham Allen). A child’s early experiences 

and environment have a major influence 

on his or her social and emotional 

development and on adult mental health 

and wellbeing. Exposure to risks such as 

poor-quality parent-child relationships, 

maternal depression and poverty are 

predictive of a range of negative health 

and social outcomes. These include 

emotional and behavioural problems, poor 

educational attainment, substance misuse, 

conduct disorder and criminality. Early 

interventions are concerned with 

addressing risks and enhancing protective 

factors through direct support to the child 

and/or increasing the parents’ capacity to 

provide a nurturing home environment. 

New government policy has endorsed 

the principle of ‘proportionate universalism’ 

(as advocated by the Marmot Review 

2010) whereby “the scale and intensity of 

provision of universal services is 

proportionate to the level of disadvantage”. 

This requires a strategy that achieves the 

most appropriate balance between 

universal and targeted interventions based 

on the needs of children and families 

locally, and evidence on what works. 

While there is considerable evidence 

concerning the effectiveness of such 

interventions as home visiting, parenting, 

childcare and early education, there are 

challenges to translating this evidence into 

mainstream practice locally. Much of the 

evidence is US-based and does not 

necessarily easily translate into the UK 

context. There is a heterogeneity of 

interventions that have been designed to 

address specific risks, and a diverse range 

of child and maternal outcomes. While 

some programmes have been shown to be 

effective, others have not. 

Nevertheless in England we have the 

foundations of evidence-based practice for 

improving early child development and 

readiness for school. For example, since its 

establishment in1998 the improved 

effectiveness of the Sure Start Programme 

has been informed by the findings from 

the national evaluation (National Evaluation 

Sure Start 2006 and 2008). The evaluation 

has demonstrated variation in quality of 

management and implementation of local 

programmes. The more recent evaluation 

of child outcomes shows a range of 

positive effects across all population 

groups, including the most disadvantaged 

(teenaged parents, lone parents, workless 

households). This improved reach was 

explained in terms of the increased 

exposure of children and families to Sure 

Start Local Programmes that had become 

more effectively managed over time. The 

Family Nurse Partnership (FNP) programme 

is planned to be rolled out following its 

piloting. It is modelled on a programme 

developed in the US that has been tested 

in three randomised controlled trials with 

benefits shown for mothers and their 

children and, in particular, more benefits 

for the most vulnerable. There is important 

learning from the process evaluation of the 

FNP pilots (eg Barnes et al 2008, 2010). 

Although there are gaps in the evidence 

available to guide commissioning decisions 

on the most cost effective mix of early 

interventions, a number of points are clear 

(Shonkoff & Phillips 2000): 

Much of the 

evidence is US-based 

and does not 

necessarily translate 

‘into the UK context 

n Early and intensive support to young 

first-time mothers through home visits by 

health visitors can produce benefits for 

both the child and parents. 

n Children in low-income families can 

derive proportionately greater benefits 

(compared to their more well-off peers) 

from participation in universal high-quality, 

early-education programmes (3-4 years). 

n For children living in families with many 

difficulties, multi-component programmes 

are required that provide direct support to 

parents as well as address the needs of the 

child. For young children exposed to 

significant stress through neglect or abuse, 

maternal depression, parental substance 

misuse or family violence, intensive services 

matched to the problems can promote 

better development outcomes. 

Amanda Killoran 

Public Health Analyst 

NICE 

‘ 

IN THE UK a programme of child health 

surveillance has been in place since the 

early 20th Century. The current programme 

was defined in October 2009 when the 

Department of Health launched the 

Healthy Child Programme (HCP). The HCP 

emphasises the needs of at-risk families 

and includes health and development 

reviews where the core purpose is to assess 

family strengths, needs and risks, and also 

growth and development. 

Mitch Blair wrote in 2009: “How would 

we know that we have succeeded in 

optimising child health and development 

across the whole child population over 

time? Clyde Hertzman and colleagues in 

Canada developed the Early Development 

Instrument (EDI) as a community measure 

of young children’s development. It is 

based on the scores from a teachercompleted 

checklist of over 100 questions 

covering language and cognitive skills, 

emotional maturity, physical health and 

wellbeing, communication skills and 

general knowledge and social competence. 

“The EDI acts as a proxy measure of how 

well a community is performing in raising 

their children and has been shown to be a 

powerful catalyst for community mobilisation 

and inter-agency collaboration. Results from 

Canada indicate that where appropriate 

and accessible early child development and 

parenting programmes have been 

implemented, community efforts appear to 

ameliorate socio-economic risks.” 

The Child Public Health Interest Group 

would like to see a surveillance programme 

along the lines of the EDI being adopted in 

the UK as a broader, more effective and 

more efficient use of resources to help 

shape health and wellbeing policies and 

practices for the 21st Century. 

Prof John Harvey 

Co-chair (FPH) 

Child Public Health Interest Group 



Let’s not forget 

interventions in 

later years 

WE SHOULD resist being swept along by 

the political and professional tide of ‘early 

years’ interventions as this may divert 

much needed resources from vulnerable 

teenagers. 

Serious problems may arise in the lives of 

children at any age, not just during the 

early years. Research on the maltreatment 

of teenagers reveals that just over 9,000 

young people, aged 10-17, are the subject 

of a child protection plan – a greater 

number than those aged under one, and a 

similar number to those aged five to nine. 

And there are higher rates of neglected 

young people (aged 10-16 and over) 

subject to a child protection plan than 

those physically, sexually and emotionally 

abused in the younger age bands (aged 

one to four, five to nine). 

Behind these statistics lie a catalogue of 

problems, many arising for the first time 

during teenage years: the 14-year-old 

young man, rejected and abused by his 

mum’s new partner, who ran away from 

home and ended up on the streets, 

desperate and having to beg and steal to 

survive; the 13-year-old girl, spending most 

of her time looking after her recently 

disabled mum, missing school and leisure 

time – one of the many teenage carers, 

caring for, rather than being cared for; and 

the 15-year-old girl having being groomed 

for sex and now selling her body. There are 

other groups of young people who need a 

lot of help as they grow older including 

young disabled people becoming 

independent, teenagers struggling with 

It is naive to assume 

that early-years 

interventions can 

solve the depth of 

‘their misery 

‘ 

mental health problems and young people 

leaving children’s homes and foster care, 

embarking on the journey from care to 

adulthood. 

Although defying popular and media 

stereotypes – such as ‘hoodies’, ‘yobs’ and 

‘feral youth’ – teenagers often suffer 

greatly: self harming, developing eating 

disorders, becoming mentally ill, and, 

tragically, some taking their own lives or 

being murdered. 

A quarter of all Serious Case Reviews 

relate to teenagers as victims, and 10% 

of these young people are aged 16 or 

over. Research by the Prison Reform Trust 

shows that young people with leaning 

difficulties or mental health problems are 

over-represented in the youth justice 

system. 

However, prioritising early-years 

interventions may not only detract from 

the emergent problems of teenagers, it 

may also diminish their persistent and 

entrenched problems which are often a 

consequence of the chronic physical, sexual 

and emotional abuse experienced within 

their families. Every day, professionals are 

faced with the reality of helping seriously 

damaged young people – some who have 

been assisted since they were very young 

children. It is naive to assume that earlyyears 

interventions can solve the depth of 

their misery, and also morally flawed to 

deny these young people the help they 

need. At the present time teenagers are 

already suffering disproportionately in 

terms of unemployment. The abolition of 

the Educational Maintenance Allowance, 

the ending of ring-fencing of Supporting 

People funding, cuts in non-statutory 

youth services and projects will all further 

disadvantage the most vulnerable young 

people. 

The Coalition Government should 

challenge the populist political and 

professional consensus surrounding earlyyears 

interventions in favour of a far more 

comprehensive and wider needs-led 

approach to assisting children, young 

people and their families. This should 

include primary or universal interventions 

(such as preventative health, education, 

housing, income support), secondary or 

early interventions when problems arise at 

any age in the lives of young people, not 

just early years, and tertiary interventions, 

when problems persist. 

Prof Mike Stein 

Social Policy Research Unit 

University of York 

Every child’s 

beginning 

matters 

IT IS easy to be distracted by organisational 

change and budget challenges, and miss 

the important developments that are 

happening in children’s public health. From 

Marmot to the Graham Allen review there 

is an increasing recognition that what 

happens in pregnancy and the first years of 

life has a major influence on health and 

wellbeing in childhood and adult life. 

Some of this is familiar, but the more we 

find out from neuro-imaging, genetics and 

longitudinal studies, the greater the 

imperative to do more to give children the 

best start in life, whether with parents, 

communities or by addressing the wider 

social determinants. It also looks as if we 

have a better sense of what works and 

some cause for optimism that intensive 

preventive programmes such as the Family 

Nurse Partnership (FNP) have the potential 

to improve the outcomes for some of our 

most vulnerable children. 

It is, therefore, no political fancy or 

ideological fashion that lies behind the 

Government’s commitment to an 

additional 4,200 health visitors or doubling 

the capacity of the FNP. There is a 

recognition that babies really matter and 

that universal as well as targeted 

preventive programmes are needed right 

from the start. The Healthy Child 

Programme is the core universal public 

health service for children – but it needs 

local public health leadership by experts 

who are up-to-date in child public health. 

To help build capacity in child public 

health, FPH, in partnership with the 

Department of Health, will be holding a 

professional update in the autumn on 

children’s public health in the early years. 

Kate Billingham 

Project Director 

Family Nurse Partnership Programme 

Department of Health, England 


How work can 

meet our core 

human needs 

THIS book provides an important reference 

source on occupational and environmental 

health, as well as an accessible practical 

manual for workplace case management 

and tasks such as health surveillance, 

environmental impact assessment and 

disaster planning and management. 

It will be of interest to those working in 

occupational and environmental health and 

other related disciplines including public 

health, health protection and planning. It is 

also a very useful teaching text. 

The book is extremely detailed and 

comprehensive in scope. The 39 chapters 

are organised into five sections. Section 

one covers a number of cross-cutting 

themes on work, environment and health 

(for example equity and social justice). 

Sections two and three are practically 

orientated, covering hazardous exposures 

(including tobacco smoke, water, food, 

waste and chemical and physical hazards) 

and adverse health effects (such as injuries, 

musculoskeletal disorders, cancer and 

cardiovascular disorders). Although the 

primary concerns are physical hazards and 

physical health, some attention is given to 

occupational stress and psychiatric 

disorders. Section four covers topics 

relating to recognition, assessment and 

prevention such as occupational and 

environmental hygiene, work design, risk 

communication and government regulatory 

frameworks. Section five is about an 

integrated approach to prevention. 

This is primarily a US-centred text, 

providing the latest US data and 

application with the US legislative and 

policy context. Nevertheless it has 

relevance to practice in other countries. 

The very contemporary nature of the text 

is illustrated by the chapter on 

implementing policy for a healthy 

workforce. This encompasses programmes 

that aim to promote healthy lifestyles and 

prevent chronic diseases, but it also 

addresses how aspects of work can affect 

quality of life. This broader perspective is 

underpinned by a number of theories. For 

example the “sociobiological model” 

recognises that work represents a social 

environment providing opportunities to 

meet core human needs: wellbeing, 

productivity and positive sense of self. The 

chapter states that this focus on a healthy 

workforce and worker wellbeing requires a 

different perspective on employee and 

BOOKS & PUBLICATIONS 

health and safety. It requires “integrated” 

approaches, and how these differ from 

traditional measures are described. It’s 

about the integration of workplace health 

promotion with occupational health at 

strategic and operational levels. 


Occupational and Environmental 

Health (Sixth edition) 

edited by Barry S Levy et al 

Published by Oxford University Press 

ISBN 9780195397888 

RRP: £50 

Heavy-duty 

theory and 

useful practice 

ANOTHER offering from OUP’s excellent 

catalogue of public health books – this one 

with a distinctly Canadian flavour, but with 

a wealth of descriptions and analyses that 

translate usefully across the pond. 

Segall and Fries are sociologists at the 

University of Manitoba. The first part of 

their book unravels the key concepts and 

issues in health and wellness very much 

from a sociological perspective – health as 

a social construct. So we’re given a resume 

of the emergence of health sociology from 

medical sociology and a comprehensive 

discussion of various sociological models of 

health, illness, wellness and attitudes to 

the body. This gets us into some pretty 

heavy-duty theory, with such delights as 

the Structural Functionalist Paradigm, the 

Symbolic Interactionist Paradigm and the 

Sociology of the Body Paradigm. 

Then by way of light relief we move into 

more familiar territory – a simple primer in 

epidemiology and, in the second part, a 

very accessible and useful account of 

health inequalities and the wider 

determinants of health (with some 

prominence given to our very own Michael 

Marmot and the social gradient). 

The final section, on pursuing health and 

wellness, begins with an in-depth look at 

Western systems of healthcare and the 

biomedical model and how these have so 

powerfully shaped, and constrained, the 

concepts. This is followed by an analysis of 

the health constructs of other cultures and 

belief systems, most of which are far more 

holistic than our own, and the book 

finishes by exploring the vision of societal 

empowerment and collective action first 

expounded in the Lalonde report on the 

health of Canadians (1974) and developed 

further in the Ottawa Charter for Health 

Promotion in 1986. Yes, Canada was, and 

to some extent still is, at the cutting edge 

of all this stuff. 

Pursuing Health and Wellness is a 

textbook rather than a cosy bedtime read, 

with learning objectives and study 

questions. But it also contains some handy 

overviews and chunky nuggets of 

information, interspersed with occasional 

cartoons and mini-biographies of such 

seminal social thinkers as Talcott Parsons, 

Michel Foucault, Erving Goffman and 

Leonard Syme. For anyone involved in 

post-grad learning or teaching, it would 

certainly be a useful addition to the library. 


Pursuing Health and Wellness: 

Healthy Societies, Healthy 

People 

Alexander Segall and Christopher 

J Fries 

Published by Oxford University Press 

ISBN 9780195430677 

RRP: £37.50 

Correction: Our review of Public Health: 

Policy and Politics (March 2011) incorrectly 

gave the author as Roy Baggott. It should, 

of course, have said Rob Baggott. 

Apologies. 


Tackling climate 

change across Europe 

CLIMATE change is already affecting 

population health and wellbeing across the 

World Health Organization (WHO) 

European Region. The heatwave of 2003 

triggered over 70,000 excess deaths in 

western Europe alone. By 2004 the modest 

warming that has occurred since the1970s 

was contributing to over 140,000 excess 

deaths globally each year. 

A European Regional Framework for 

Action to protect health from climate 

change was agreed at the Fifth Ministerial 

Conference on Environment and Health in 

Palma in 2010. The framework has five 

strategic objectives: 

n to ensure that all current and future 

mitigation and adaptation climate change 

measures, policies and strategies integrate 

health issues at all levels 

n to strengthen health, social and 

environmental systems and services to 

improve their capacity to prevent, prepare 

for and cope with climate change 

n to raise awareness to encourage healthy 

mitigation and adaptation policies in all 

sectors 

n to increase the health and environment 

sectors’ contribution to reducing 

greenhouse-gas emissions 

n to share best practices, research, data, 

information, technology and tools at all 

levels on climate change, environment and 

health. 

The Climate, Environment and Health 

Action Plan and Information System 

(CEHAPIS) project, jointly funded by WHO 

Europe and the European Commission 

from 2008-10, has identified a number of 

priority actions which the public health 

community can use to translate the 

framework into action. 

First, leading by example on sustainable 

development (e.g. ‘greening’ the health 

FUELING THE DEBATE: Chimneys in Copenhagen, Denmark 

sector), showing leadership in 

implementing climate change adaptation 

(e.g. adapting healthcare facilities) and 

raising awareness of individuals within the 

health sector workforce on how they can 

mitigate and adapt to climate change in 

their everyday working lives. 

Another key role is in making the case 

for change by highlighting the economic 

benefits of investing now in safeguarding 

health from the uncertain effects of climate 

change (e.g. the greater workforce 

productivity of a healthy population) and 

influencing public sector budget-holders 

and private industry to invest in 

programmes and products that benefit 

health and contribute to carbon reduction 

(e.g. supporting the public to make 

climate-friendly healthy eating choices). 

A third role is to advocate for evidencebased 

policy by highlighting the immediate 

co-benefits for health by reducing 

greenhouse gas emissions (e.g. active 

travel) and developing evidence to show 

how sustainable environments can protect 

health and reduce healthcare costs. 

And finally, as with everything we do in 

public health, embracing cross-sector 

working to pursue shared objectives (e.g. 

reducing inequalities) and ensuring that 

partnership-working is underpinned with 

measurable and verifiable progress. 

Bettina Menne 

Programme Manager 

Lucinda Saunders 

Specialty Registrar 

Jo Nurse 

Technical Officer 

Climate change, green health services 

and sustainable development 

programme 

WHO Regional Office for Europe 

News in brief 

School-nursing programme being finalised 

THE Department of Health is finalising 

details of a development programme for 

school nurses, says the Nursing Times. 

Following a meeting of the All Party 

Parliamentary Group on Primary Care and 

Public Health, DoH team leader for children 

and young people’s public health Richard 

Sangster said: “There is a vision of service 

being developed for school nursing which 

will build on work already taking place in 

health visiting.” 

We are not ready for a global health 

emergency, say flu experts 

THE world is not ready to deal with a 

lengthy public health emergency, a panel 

of international experts has said. 

The panel’s report on the World Health 

Organization’s handling of the 2009 

outbreak of the H1N1 flu concludes that 

the world is “ill-prepared to respond to a 

severe influenza pandemic or to any 

similarly global, sustained and threatening 

public health emergency”. 

It found that health regulations adopted 

in 2005 by 194 nations were not being put 

into practice fast enough globally. 

Coffee ‘cuts prostate cancer risk’ 

A STUDY claims that coffee can help 

prevent prostate cancer. 

Researchers at the Harvard School of 

Public Health studied almost 48,000 men 

for 12 years, and found that drinking up to 

six cups of coffee a day lowered the risk of 

prostate cancer. They found no difference 

between regular and decaffeinated coffee. 

Elderly care costs could treble, says OECD 

THE cost of caring for the elderly could 

treble by 2050, according to a report by 

the Organisation for Economic 

Cooperation and Development. 

The body, which represents the most 

industrialised nations, estimates that 10% 

of people in OECD countries will be more 

than 80 years old by 2050. That is up from 

4% in 2010 and less than 1% in 1950. 

Schools ‘should teach how to save a life’ 

A HEART charity is calling on the 

Government to include the teaching of lifesaving 

skills in the national curriculum. 

In a survey carried out by the British 

Heart Foundation, 73% of schoolchildren 

wanted to learn how to resuscitate 

someone and give first aid. 

More than 75% of teachers and parents 

also agreed it should be taught in schools. 

The survey questioned 2,000 parents, 

1,000 children and 500 teachers. 


ENDNOTES 

From the CEO 

WE ARE at this time experiencing a 

period of unprecedented change for 

both FPH and public health as a whole. 

Lindsey Davies has already covered the 

developments surrounding the white 

paper earlier in this edition – from an 

FPH internal perspective this has meant 

that we have had to work within a 

reducing forecast income, both from 

membership subscriptions but also in 

the availability of grants that FPH has 

enjoyed in recent years. 

As you may know, we are currently in 

the process of an internal restructure, 

which for any organisation is a time of 

great stress and anxiety. The Trustees, 

staff and officers have worked over the 

past months to ensure that FPH (and 

the future Royal College) are fit for 

purpose, sustainable and meet the core 

functions while operating within our 

charitable objectives. 

We were fortunate to secure the 

services of PricewaterhouseCoopers on 

a pro-bono basis to externalise the 

initial parts of the process and provide a 

comprehensive report to the Trustees at 

their meeting in May. Development and 

consultation has taken place since then 

with the help of the union Unite and 

FPH staff. 

As I write this, we are currently in the 

review period before releasing the 

agreed future structure of FPH. This will 

be followed by a programme of internal 

interviewing until the new structure is 

populated. I hope by the end of the 

summer that we have the new 

framework in place and have fully 

recruited for all the vacancies. 

It is hoped that the new operational 

It is hoped that the 

new operational 

structure will 

reduce costs by 

‘around 20% 

structure will reduce costs by around 

20% – this of course will mean new 

ways of working, and changes to what 

the membership may expect from FPH. 

As if this isn’t enough, we are also 

going through extensive renovation at 

Number 4 – new carpets, curtains and 

decoration. 

We have strived to maintain the level 

of support to members and the team at 

Number 4 have worked extremely hard 

during a period of great uncertainty. I 

do hope that I can ask for your patience 

and understanding during this period of 

change – something that I know many 

of you will be going through yourselves. 

Paul Scourfield 

Chief Executive Officer 

‘ 

Food that’s too 

good to waste 

HARD evidence now shows that educating 

young people about the benefits of a 

healthy diet can change eating habits. 

The Food for Life Partnership aims to 

encourage pupils and their parents to eat 

healthy food and to learn how to cook it 

and grow it themselves. Some 3,600 

schools have joined the scheme. 

But cuts to school meal budgets and a 

U-turn on cooking in the curriculum could 

have a dramatic effect on childhood 

obesity. Director Libby Grundy said: “Just 

as the programme looks as if it has 

reached the tipping point in terms of 

making a cultural shift, our good work 

could be undone.” 

FPH and the Food for Life Partnership are 

hosting a free conference on the subject in 

London on June 22. Speakers include 

schools minister Sarah Teather and the 

chair is The Food Programme’s Sheila 

Dillon. Email nmoseley@soilassociation.org 

or call 0117 987 4582 to book a place. 

In memoriam 

Dr Annette Rawson OBE FFCM 

1930 – 2010 

ANNETTE Rawson trained at St Mary’s 

Hospital Medical School (one of the first 

women to do so) and had just been 

appointed as the first female consultant 

physician at Queen Elizabeth Hospital 

Birmingham when she was struck down by 

a neurological illness which left her totally 

deaf. Instead she became a civil servant at 

the Department of Health & Social 

Security, rising to Senior Medical Officer 

with lead responsibility for developing and 

coordinating services for people with 

disabilities. In 1973 she produced a seminal 

report, Deafness: Report of a Departmental 

Enquiry into the Promotion of Research, 

which helped to shape government policy 

for years to come. 

Dr Rawson was a founder member of 

the Faculty of Community Medicine (now 

FPH) and, as a keen champion of lipreading 

and lip-speaking, took an active 

part in the Faculty’s affairs. She was 

awarded the OBE in 1990. 

Deceased 

members 

The following members have also 

passed away: 

Dr JE Asvall 

Dr Derek Edward Cullington 

Dr Ian Hayes Fyfe Murray 

Dr Kenneth Michael Parry 


ENDNOTES 

Policy updates 

Public health and NHS reforms 

The agenda continues to move apace, with the establishment of 

the NHS Futures Forum, chaired by ex-RCGP chairman, Steve Field. 

Of major concern is the lack of public health representation on the 

forum. Following concerted lobbying by public health 

organisations, Frank Atherton, President of the Association of 

Directors of Public Health (ADPH), is now a member but, given the 

size of the forum and the agenda, there is disappointment that 

there aren’t more public health experts around the table. We are 

working to ensure that the public health voice is heard. 

FPH, along with RSPH and ADPH, have also written to Prime 

Minister David Cameron. Developed through our close 

collaboration on the PHMCC White Paper Task Group, the letter 

sets out our concerns that, while the debate around the NHS 

reforms are of vital importance, there is a real danger that the 

public health reforms – and the consequences for the public’s 

health if they go through as proposed – are being overshadowed. 

You can read the letter at www.fph.org.uk 

We’ve also produced a ‘key points’ paper, through the PHMCC 

task group, which we’ve fed into the NHS Futures Forum and are 

using to drum home the message that government needs to take 

notice of what the public health profession is saying about the 

reforms. You can read our key points at www.fph.org.uk 

Health Select Committee inquiry into public health 

FPH President Lindsey Davies gave evidence to the Health Select 

Committee as part of its inquiry into public health. Prompted by 

the Government’s proposed reforms to public health, the 

committee set out to scrutinise the plans “not least because of the 

importance of public health in ensuring that health services are 

commissioned effectively”. FPH also submitted evidence to the 

inquiry and you can find this on our website. 

House of Lords HIV and AIDS Select Committee 

FPH Vice-President John Middleton gave evidence to the 

committee on HIV and AIDS, which looked at a wide range of 

issues including monitoring, prevention, testing, treatment, cost 

and stigma. It also touched on the impact of the reforms. FPH also 

submitted evidence via its Health Protection Committee, and this 

can be read at www.fph.org.uk 

FPH Online Members’ Area 

The new FPH online members’ area is up and running. You can 

update your membership information, tell us about policy areas 

you’re interested in and find out about the work of FPH and 

opportunities to get involved in our work. 

The area is still in the early stages of development, but we’re 

working on it so that you’ll be able to pay your subscription fees, 

register for the conference and other FPH events, and get access 

to pre-published copies of FPH reports. 

To get started, just follow the members’ link from the FPH 

homepage (www.fph.org.uk) and where it says ‘Activate account’ 

simply enter your email address and click ‘submit’. If your email 

address matches the one we have logged on our register, then a 

notification will be emailed to that account with a password. If your 

email address doesn’t match then contact omasupport@fph.org.uk 

Smokefree Action Coalition 

FPH continues to work as a member of the Smokefree Action 

Coalition to push government for further action on reducing the 

health burden of tobacco. We are co-signatories to a letter to Lord 

Coe calling for the Olympics to be a smoke-free event. 


Welcome to new FPH 

members 

We would like to congratulate and welcome the following new 

members who were admitted to the FPH between February and 

May 2011 

New diplomate members 

Louise Aston 

Roberto DeBono 

Helen Elsey 

Nigel Field 

Anjan Ghosh 

Tara Harrop 

Merav Kliner 

Sarah Lock 

Rosemary Millar 

Rachael Musgrave 

George Obita 

Mary O’Brien 

Helen Raison 

Subhadra Rajanaidu 

Susanna Roughton 

Neil Wigglesworth 

New trainee members 

Jillian Johnston 

Bruce McKenzie 

Leonie Race 

Daniel Todkill 

Emily Youngman 

New members 

Craig Russell Blundred 

Sarah Bowman 

Wendy Burke 

Steven Casson 

Christopher Chiswell 

Philip Conaglen 

Rebecca Cooper 

Sophie Coronini-Cronberg 

Jonathan Cox 

Dhanika Dabrera 

Matthew Day 

Simon Fraser 

Tha Han 

Matthew Harris 

Robert Howard 

Marko Kerac 

Kate Mandeville 

Helen Raison 

Jonathan Roberts 

Mohit Sharma 

James Smith 

Rhianwen Stiff 

Dana Sumilo 

Sarah Theaker 

Michael Wade 

Conall Watson 

Rachel Weston 

Nicola Wright 

New fellowships 

Ravikumar Balakrishnan 

Alison Bell 

Bruce Bolam 

Huw Brunt 

Miriam Davidson 

Andrea Docherty 

Susan Elden 

Darrell Gale 

Sian Griffiths 

Christian Gunneberg 

Sharon Hillier 

Susan Hird 

Maidrag Mashbileg 

Alison Merry 

Babafemi Oshin 

Clare Perkins 

Sangeeta Richhariya-Leahy 

Rachel Robinson 

Tasmin Sommerfield 

Paula Tele 

Wei Wang 

William Welfare 

Valerie White 

Christopher Zishiri 

FPH publishes book on 

children’s mental health 

In Thinking Ahead: Why We 

Need To Improve Children’s 

Mental Health and Wellbeing, 

seven authors consider different 

aspects of society – from 

parenting, family culture, the 

pre-school years, to schools, 

housing and other buildings, 

the media and our natural 

environment. All these elements 

can make a better life. 

This book outlines what 

needs to be done to improve 

children's wellbeing in the UK, 

and how policies across 

government departments need 

to change to maximise that 

improvement. 

Edited by Rachael Jolley, 

Thinking Ahead is published by 

FPH, priced £5.99, and can also 

be read on the FPH website. 

UK Public 

Health Register 

Through Defined Specialist portfolio 

assessment 

Sian Price 

Louise Unsworth 

Through Generalist Specialist portfolio 

assessment 

Folashade Adenekan 

Sarah Andrews 

Angela Bartley 

Ian Wake 

Through the standard FPH Generalist 

Specialist training route 

Benjamin Barr 

Hazel Henderson 

Laura Maclehose 

Jennifer Taylor 

GMC Register 

Delphine Grynszpan 

Gillian Hawkins 

Kulsum Janmohamed 

Dulcie McBride 

Kathleen Skinner 

Quality, Public Health 

& Scotland: Improving 

Standards in a 

Changing Climate, 

Macdonald Aviemore 

Resort, 

10-11 November, 2011 

Scotland’s health is 

improving but the major 

challenges of obesity, 

tobacco, alcohol misuse and 

mental ill health or illness 

remain. The demands on 

health improvement and 

healthcare services and the 

climate in which we operate 

are changing not least due 

to demographic changes, 

new technologies and 

financial pressures. 

NOTICEBOARD 

FPH in Scotland 

Annual Conference 

How should the public 

health community continue 

to promote and secure 

changes to improve health 

in this increasingly 

challenging climate? What 

are the key elements of 

successful leadership in 

times of hardship and how 

can best practice be 

inspired? 

These are just some of the 

questions we will explore in 

this year’s programme which 

will feature keynote 

presentations from a range 

of influential speakers. 

For further information 

and to submit an abstract 

go to 

www.fphscotconf.co.uk

‘ 

THE FINAL WORD 

’ “Great idea, Prime Minister...” Michael White 

overhears a conversation that might (or might not) 

have taken place recently at Number 10 

“MORNING all. Anyone in this office seen 

Andrew Lansley lately? I’ve been trying to 

track him down for ages, but he seems to 

have switched off his mobile since we 

agreed on the NHS pause.” 

“I saw him the other day, Prime Minister. 

He was looking very confident, despite all 

the strain which the Health and Social Care 

Bill must be causing him. He’s got a nice 

tan too – not what you’d expect in the 

circumstances.” 

“Good-oh. I don’t want my coalition 

ministers wandering around looking 

miserable, certainly not the Tory ones. We 

can’t have them all looking like a bunch of 

Gordon Browns, can we? That would never 

do.” 

“No, Prime Minister, it wouldn’t. What 

exactly did you want to talk to the 

Secretary of State about?” 

“Why the Bill, of course. Andrew and I 

are old pals, we go a long way back to the 

days when I used to make his tea for him 

in the Conservative Research Department. 

So we’re going to have a heart-to-heart 

about how to save the situation by giving 

Nick Clegg a bit of leeway on this NHS 

reform stuff I keep talking about.” 

“But I thought you said in your latest 

speech that not pressing ahead with 

reform is not an option, that we have so 

many old people piling up outside every 

hospital gate that the NHS will be £20 

billion short before you can say Derek 

Wanless.” 

“Well, yes. I did. Quite right too. Sam is 

always badgering me about the NHS 

deflator over the breakfast table. But a 

chap has to keep his coalition afloat as 

well as press ahead with the reforms vital 

to creating a Britain that is vibrant, modern 

and fair. “ 

“But Oliver Letwin vetted Mr Lansley’s 

white paper after the initial uproar and 

Quite frankly, 

Andrew’s 

communication skills 

leave something to 

be desired. He 

couldn’t sell ice cream ‘in the desert 

‘ 

declared it ‘intellectually coherent’, Prime 

Minister. He’s frightfully clever; everyone 

says so.” 

“Indeed, a first-rate brain has Oliver. I 

used to make his toast at Eton, but he 

always let it go cold. That’s not the 

problem. Quite frankly, Andrew’s 

communications skills leave something to 

be desired. He couldn’t sell ice cream in 

the desert. So, every time we think we’ve 

lined up a few friendly medics to smile 

supportively for the TV cameras, up pops 

another bunch of medics waving their 

wretched shrouds.” 

“What have you in mind, sir?” 

“Well. I thought we might go a bit easy 

on getting rid of these alphabet soups: 

PCTs, SHAs – I’m blowed if I can remember 

what the letters stand for. Move the 

goalposts back a bit and open up these 

GP-led consortia. Put a few hospital 

cleaners on the board, that sort of thing. 

We mustn’t sound too elitist, eh?” 

“Very good, Prime Minister. I’ll have a 

word with my opposite number in the 

Secretary of State’s private office. Was 

there anything else Mr Clegg wants 

changed?” 

“Apparently, this new economic 

regulator – ‘Monica’ I think it’s called – is 

upsetting people. Andrew told me it would 

be fine, but I was having a bad day. Nick 

wants him to take away most of its 

powers, and I want Nick to be happy. “ 

“Very good, Prime Minister.” 

“And another thing: Monica. It’s a silly 

name. Can’t we call it ‘Samantha’?” 

Michael White 

Assistant Editor and former Political 

Editor 

The Guardian 

Information 

ISSN – 2043-6580 

Editor in chief 


Managing editor 

Lindsey Stewart 

Production editor 

Richard Allen 

Editorial board 

Matthew Day 

David Dickinson 

Andrew Furber 

Catherine Heffernan 


Ashish Paul 

Premila Webster 

Contact us: 

news@fph.org.uk 

Address: 

Faculty of Public Health 

4 St Andrews Place 

London 

NW1 4LB 

Switchboard: 0207 935 0243 

Education: 0207 224 0642 

Policy & Communications: 0207 935 3115 


Submissions 

If you have an idea or a suggestion for an 

article for the next issue, please submit a 

50-word proposal and suggested author 

to: news@fph.org.uk 

Advertising inquiries to Richard 

Allen at richardallen@fph.org.uk 

All articles are the opinion of the 

author and not those of the Faculty 

of Public Health as an organisation

PHT June 2011_Jan 10 - UK Faculty of Public Health

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