PHT June 2011_Jan 10 - UK Faculty of Public Health

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SPECIAL FEATURE: EARLY INTERVENTION 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 14 PUBLIC HEALTH TODAY
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. Amanda Killoran 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. Alan Maryon-Davis 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. JUNE 2011 15
Page 1 and 2: In this issue > Interview with Grah
Page 3 and 4: UP FRONT Public Health in a Changin
Page 5 and 6: INTERVIEW not fire engines’ The b
Page 7 and 8: Predicting need in the early years
Page 9 and 10: SPECIAL FEATURE: EARLY INTERVENTION
Page 11 and 12: SPECIAL FEATURE: EARLY INTERVENTION
Page 13: Weighing the evidence - what actual
Page 17 and 18: ENDNOTES From the CEO WE ARE at thi
Page 19 and 20: Welcome to new FPH members We would

PHT June 2011_Jan 10 - UK Faculty of Public Health

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