December Edition – Happiness - UK Faculty of Public Health

THE FINAL WORD‘ ’ Wellbeing is the new mantra in public health. Buthow many politicians and health experts are awareof its roots in the philosophy of ancient Greece?asks Jules EvansIn this issue> Interview with PHE chief Duncan Selbie> Full commitment in a cold economic climate> Your guide to revalidation> What Greek philosophy teaches us about wellbeingThe magazine of theUK Faculty of Public Healthwww.fph.org.ukDecember 2012I FIRST became interested in the concept ofwellbeing many years ago. After beinghelped by cognitive behavioural therapy(CBT) myself, I decided to interview its codevelopers,the American psychologistsAlbert Ellis and Aaron Beck.Both of them told me they’d beendirectly inspired by ancient Greekphilosophy, particularly the Stoics, whobelieved that emotional suffering is causedby our unexamined habits of thinking,feeling and acting. We can learn toexamine our beliefs and habits and, if wechoose, change them. Greek philosophywas designed to lead people toeudaimonia, which you can translate as‘flourishing’ or ‘wellbeing’.CBT took the techniques of Greekphilosophy and turned them into anevidence-based short-term therapydesigned to help people overcomeparticular emotional disorders. UnlikeGreek philosophy, CBT has no mention ofGod, the meaning of life, the good society,values or ethics. CBT is meant to be anobjective science, not a moral philosophy.So you end up with a set of techniques forthinking rather than a comprehensivephilosophy of the good life.In 1998, a colleague of Aaron Beck’scalled Martin Seligman had further thoughts.Why don’t we use CBT not just for theemotionally sick, but for everyone? Whynot use it to help people go from zero to10 on the flourishing index? Why not useCBT and the empirical method to create anobjective science of the good life?Seligman called his new field ‘positivepsychology’, which was very successful atattracting corporate and political supportas governments looked for a new goal topursue at the end of the millennium.There are stillmultiple definitionsof wellbeing,depending on yourethical definition of‘the good life‘The ‘politics of wellbeing’ is today amajor movement. Policies inspired by itinclude the launching of national wellbeingmeasurements in the UK, France andEuropean Union; the US Army launching a‘resilience training’ programme designedby Martin Seligman, which every soldiermust take; the UK government puttingroughly £500 million into training newtherapists, mainly in CBT; and attemptsaround the world to teach wellbeing andhappiness in schools.I welcome the fact that politicians arereturning to classical ideas of flourishingand the good life, and I think the fusion ofethical philosophy and empirical science isexciting. But it’s also dangerous: thedanger is that politicians and ‘wellbeingexperts’ say they have objectively provedwhat wellbeing is, and therefore there isno need for the masses to debate it. Theymerely have to follow the official happinessinstructions. This is illiberal anddisingenuous, as there are still multipledefinitions of wellbeing, depending onyour ethical definition of the good life(individual versus collective, presenthappiness versus the happiness of futuregenerations, self-control versus wildabandon, and so on).Instead of this top-down approach Iwould like to see more of a grassrootsdemocratic approach in which people areempowered to reflect Socratically on whatthe good life means for them, to be the“doctors to themselves”, as Cicero put it,and to help each other flourish throughnetworks of mutual aid.Jules EvansPolicy DirectorCentre for the History of EmotionsQueen Mary, University of LondonInformationISSN – 2043-6580Editor in chiefAlan Maryon-DavisManaging editorsLindsey Stewart and Mag ConnollyCommissioning editorLiz SkinnerProduction editorRichard AllenPublic Health Today is distributed toover 3,000 public health specialists. Toadvertise please contact Richard Allenat richardallen@fph.org.ukEditorial boardMatthew DayDavid DickinsonAndrew FurberCatherine HeffernanAmanda KilloranAshish PaulPremila WebsterContact us:news@fph.org.ukAddress:Faculty of Public Health4 St Andrews PlaceLondonNW1 4LBSwitchboard: 0207 935 0243Education: 0207 224 0642Policy & Media: 0207 935 3115www.fph.org.ukSubmissionsIf you have an idea for an article or specialfeature, please submit a 50-word proposaland suggested authors to:news@fph.org.ukThe proposed subject of the special featurein the March edition is the transition tolocal authoritiesAll articles are the opinion of theauthor and not those of the Facultyof Public Health as an organisationMore the merrierThe happiness issue

Public Health TodayThe magazine of theUK Faculty of Public Healthwww.fph.org.ukDECEMBER 2012ContentsUp Front 3,6Interview with Duncan Selbie 4Special Feature: Happiness 7The greatest happiness for thegreatest number is still our goal 7Feeling sad – could there be anapp for that? 7Debate: Should we measure happiness? 8The real Shangri-La? 9Eat your greens to beat the blues? 10Putting moods on the map 10Revalidation guide 11Mirth of a nation 15Money no object 16Watching, wanting and wellbeing 17Survival of the fittest – and happiest 17Taking the path of most resilience 18Life, liberty and the pursuitof Mappiness 18Books & Publications 19Endnotes 20Noticeboard 23The Final Word: Jules Evans 24Lindsey Davies image © JonathanPerugiaFROM THE PRESIDENTWelcomeIN EARLY November, I spent afascinating few days at the WestAfrican College of Physicians’ (WACP)annual conference, held this year inAccra, Ghana. This was an impressiveand inspiring meeting. I was struckparticularly by the opening ceremony inwhich the members and fellows of thecollege all processed into the auditoriumin college gowns, accompanied by livelymusic from a military band playing onthe balcony. It was impossible not to feelpart of something special: both in thesense of occasion embodied in theceremony itself and in the esprit de corpsof the college and its various faculties,including community (ie. public) health.One important outcome of my visit wasan agreement with colleagues fromWACP that we would refresh and putnew energy into our mutualmemorandum of understanding, as wehave so much to learn from each other.Later in the same week I found anequally strong sense of commitment andmutual support in a very differentsetting. I was in Crieff, amongst the 300or so delegates from all walks of publichealth life who met at the excellentannual conference of the FPH inScotland.Both meetings made me reflect on theimportance of supportive networks tohealth, wellbeing, ‘happiness’ (thetheme of this edition of Public HealthToday) and the capacity for work andcreative thought. This is, of course, asrelevant to public health professionals asit is to the populations we serve. As therange of career opportunities available topublic health professionals extends andwe become increasingly dispersed, wemust find ways of developing andsustaining our own communities ofsupport. The FPH Board has made thisone of its priorities for the coming year.As a start, we will be working tostrengthen our regional networks anddevelop FPH’s use of social media overthe coming months. Please let yourrepresentatives know how we can helpyou best.A number of themes from thediscussions in Crieff will stay with me forsome time. The call from Gerry Hassan,for example, this year’s DARE lecturer,for louder and more focused‘indignation’ on the part of professionalsand the public when real need is beingignored; the determination of youngresearchers to improve the evidence-basefor public health practice in subjectsranging from suicide prevention to trafficcalming and aneurysm screening; and amemorable symposium on the impact ofthe arts on health and wellbeing. Thisincluded presentations on someremarkable initiatives turning openspaces on NHS properties into publicgardens, orchards, arboreta and parks,and developing canals for healthimprovement. Perhaps most impressiveof all for me was a moving presentationfrom El Gruer, a performance poet, onher work with an artist to explore theimpact of anorexia on body, mind andsoul.New perspectives, although not alwayscomfortable, are the lifeblood of publichealth. As Oliver Wendell Holmes put it:“One’s mind, once stretched to a newidea, never regains its originaldimension.”With my very best wishes for manynew perspectives in 2013 andbeyond.Lindsey DaviesThe fully committedscenario in a coldeconomic climateIT IS a decade since the first Wanlessreport, written in a very different economicclimate, but did Derek Wanless get it right?Fundamentally, yes. Wanless rightlypointed out the cost-effectiveness evidencegaps in public health, and the critical roleof information enabling people to makehealthy choices. His call for “fullengagement” – with concerted action atindividual, community, societal andgovernment level – remains essential if weare to tackle major public health problems,such as binge drinking, with local actionand national fiscal policy working intandem. In addition, the commercial sectorhas a critical part to play.But engagement in itself is not sufficient.We need to move beyond the fullyengaged scenario to the fully committedscenario. Commitment to tackling ourmajor public health problems has to betested rigorously for all the playersconcerned, including local authorities,central government and the commercialsector. As Gerard Hastings noted in arecent British Medical Journal article:“Public health has to demand a place atthe macroeconomic table; it has tocontribute to the debate about wherecorporate capitalism is going and ensurethat the public health implications ofbusiness decision-making are fullyappreciated.” Relentless marketing toencourage excessive consumption has tobe challenged if we are serious abouttackling obesity and alcohol-relatedproblems.The macroeconomic case for investing inthe health of the population is welldocumented, with better health being seenas an important determinant of economicgrowth and competitiveness. The challengeis to produce effective business cases atlocal level to persuade local authorities toinvest in public health interventions,drawing upon the evidence-base from theNational Institute for Health and ClinicalExcellence which is gradually filling thegaps that Wanless highlighted. Programmebudgeting could be used to compare thecosts and outcomes of investing indifferent areas, if only to highlight thetrade-offs involved and to agree a commonlanguage across, for example, education,housing, transport and healthcare.A key difference between 2002 and nowis that Wanless was calling for year-on-yeargrowth in health expenditure as apercentage of Gross Domestic Product. Welive in a much colder economic climate,which makes it even more important tomake the economic case for investingscarce resources in prevention rather thantreatment. Wanless also highlighted theneed for major shifts in expenditure, firstlyfrom secondary to primary/communitycare, and secondly highlighting thegrowing importance of self-care. Theformer remains a challenge which we mustnot shirk, particularly with chronic‘Public healthprofessionals neednot only tostrengthen theirstrategic leadershipand influencing skills,but also to ensurethat they speak thelanguage ofinvestment decisionsconditions such as diabetes. The lattercould have considerable traction if wesystematically realised the benefits ofmodern information technology such ashealth apps.Public health is at a crossroads – a oncein-a-lifetimeopportunity to strengthen thefocus on using intelligence and theevidence-base to influence investmentpatterns towards proven preventiveactivities. Public health professionals neednot only to strengthen their strategicleadership and influencing skills, but alsoto ensure that they speak the language ofinvestment decisions, backed up by soundbusiness cases. Derek Wanless left us alasting legacy; but now more than ever weneed to use economic tools and commitfully to securing the health benefits forfuture generations.Brian FergusonDirectorYorkshire and Humber Public HealthObservatory‘UP FRONTNews in briefMMR vaccine uptake reaches 14-year highMMR vaccine coverage has reached itshighest level in 14 years in young children,according to the Health and Social CareInformation Centre. In England, 91% ofchildren under the age of two received thefirst dose of the jab between 2011 and2012, a rise of 2.1% on the previous year.This is still short of the 95% that isrequired to stop the spread of measles.Fifth UK drug user is infected with anthraxA drug user in Oxford contracted anthraxafter injecting heroin.The case came aftertwo people who injected drugs died fromanthrax infections in Blackpool in Augustand September. The Health ProtectionAgency said there was an ongoing outbreakof anthrax infections among drug users inEurope with 12 cases so far, five in the UK.Obesity surgery 'seen as quick fix'Obesity surgery is often seen as a quick fix,without proper consideration of the risks, areview says. The National ConfidentialEnquiry into Patient Outcome and Deathlooked at the care given to more than 300patients at NHS and private hospitals inEngland, Wales and Northern Ireland. Itfound that many were given insufficienttime or information to consent properly tothe operations.Many still not washing their handsFaecal matter can be found on just over aquarter of the population’s hands, researchsuggests. Faecal bacteria are present on26% of hands in the UK, 14% ofbanknotes and 10% of credit cards,according to research by Queen Mary,University of London and the LondonSchool of Hygiene & Tropical Medicine.Highest-ever HIV diagnoses in gay menThe number of gay and bisexual menbeing diagnosed with HIV in the UKreached an “all-time high” in 2011,according to the Health Protection Agency.It said there had been a “worrying” trendsince 2007, with more and more newcases each year. Nearly half of the 6,280people diagnosed last year were men whohad sex with other men.Indoor laundry drying ‘poses a health risk’Drying laundry in the home poses a healthrisk to those prone to asthma, hay feverand other allergies, a study by theMackintosh School of Architecture hasfound. Many homes had too muchmoisture indoors and up to a third of thismoisture was attributed to drying laundry.DECEMBER 2012 3

INTERVIEWINTERVIEWDuncan Selbie is Chief Executive Designate of Public HealthEngland. His previous job was as Chief Executive of Brightonand Sussex University Hospitals. From 2003 to 2007, he wasthe Director General of Programmes and Performance andthen Commissioning at the Department of Health. Here heexplains why he believes public health’s moment has comeReady, steady, go for EnglandWe must seize our moment, says SelbieHow will Public Health England protect and improveeveryone’s health at a time of such hugeorganisational change?The first thing to say is that Public Health England will be bringingtogether experience and professional expertise from many differentorganisations – for example, the National Treatment Agency,health observatories, cancer registries and the Health ProtectionAgency to name but a few. So while this is a new organisationwith a wide-ranging public health remit, the thousands of peoplewho are moving into it will not be starting from scratch.It means that Public Health England will from the outset be ableto work alongside local government and clinical commissioninggroups and provide whatever support they need to enable them tomeet their new legal responsibility for improving the health of theirlocal populations. In fact, our common purpose – to improve thehealth of the poorest and most poorly – has never been as clear,and it is not surprising that our partners in local government aretalking about public health “coming home”.Of course, it is taking time to ensure everything is in placegiven the extent of change across the system. I am in no wayunderestimating the challenges involved, but the importantthing is that we make the most of this great opportunity forpublic health and get it right. Public health’s moment has come,and we must seize it. We have made sure that the currentspend on public health in Primary Care Trusts is transferred overto local authorities. There will not be a reduction in the publichealth grant to local authorities during the next financial year[2013-14].Every local authority will either have their own director of publichealth or, in some cases, will share the post with another, and thiswill be a matter for local agreement. There is always a risk oflosing corporate memory at times of great change and we will bedoing all that we can to minimise this.Public Health England will be bringing togetherseveral new, as well as existing, organisations whichwill need to communicate well – and fast. Inquiriesinto high-profile cases, such as the Victoria Climbiecase, often point to lack of communication amongprofessionals as being a key factor in serious mistakesbeing made. How will the new structures prevent thishappening?I spent a decade working in mental health services. When thingswent wrong, the problem was always traced back to a lack oflistening and communication, so you are right to raise thequestion. As public health staff transfer to local government, therewill be a local integration programme to enable them to make asmooth transition to their new employer. I believe that publichealth will be at the heart of the family of local government.Public Health England itself will also be professionally led at everylevel. It will be a single organisation that will work through localand regional networks, and you can expect a step change inimproved communications.At the moment, and this will continue, I spend most of my timegetting out and meeting people, learning about the work they aremost proud of and where we could do better still.The Health Protection Agency is known worldwide andgenerates significant income for the UK. How will thatwork continue in the new system?Public Health England will generate just under 50% of its incomeexternally – approximately £180 million of the core operationalexpenditure budget of approximately £400 million. It is vital that itdelivers value for money and, as far as possible, places minimalburden on taxpayers. I expect Public Health England to maintainand build on the non-grant-in-aid income generated by thoseorganisations who are becoming part of it.It is not surprising thatour partners in localgovernment are talkingabout public health‘“coming home”‘The Health Protection Agency is known throughout the worldfor its science, its research and its people. We receive income fromthe US and Europe, as well as from UK public bodies, governments(both national and international), NHS organisations, privatehealthcare providers, research funding bodies, pharmaceutical andvaccine companies, charities, laboratories, universities, dentists,homeowners and landowners. [For example, dentists have X-raymachines that need testing, homeowners require radon testingkits, landowners periodically require various environmental tests.There are not great numbers in each category, but they illustratethe range of commercial services required – ed.]Many of our members are concerned about how thenew structures will work at a regional and local level.How do you see the links between local authoritypublic health and NHS commissioners developing?Our purpose is clearer than it ever was. We now have to make ithappen in practice – and that’s all about people and localrelationships. It takes time to develop these, and of course the NHSis also going through huge change. Locally and nationally PublicHealth England and the NHS Commissioning Board will work handin glove. We will not duplicate or replicate each other; we willcomplement each other.What has surprised or impressed you most about thepublic health workforce?I’ve been impressed by having met so many fabulous people whoare driven by a mission and a passion to protect and improvehealth. Of no surprise but a great pleasure has been witnessinghow well-received the new duty to improve the health andwellbeing of their communities has been by local government.If you could ask each of our members to do one thingto help make Public Health England a success, whatwould it be?To have ambition to be the best they can be and be intolerant ofthe status quo. It puts me in mind of a great line from SeanConnery’s character in the film The Untouchables, whose dyingwords are: “What are you prepared to do?” This is our moment,and we’ve been waiting decades for it. It’s too important amoment to be pessimistic.Interview by Liz SkinnerTell us your experience of how the transition is working in yourarea. FPH relies on members to keep it updated about how thetransition of public health to local authorities is progressing. Wehave been using your feedback and experience to inform ourpolicy and advocacy work. Please let us know if you agree withDuncan Selbie’s assessment of how Public Health England willwork, or if you have concerns about what is happening in yourarea. You can share your views and experience by emailingpolicy@fph.org.uk or calling 020 7935 3115 in confidence.4 PUBLIC HEALTH TODAYDECEMBER 2012 5

UP FRONTThe greatest happinessfor the greatestnumber is still our goalSPECIAL FEATURE: HAPPINESSFeeling sad –could there bean app for that?Coming of ageA new focus for the Whitehall Study is providing vital information about ourageing population, say Eric Brunner, Archana Singh-Manoux and Mika KivimakiWHITEHALL II is a cohort study of healthand ageing based at University CollegeLondon, now in its 27th year. The studyof 10,308 men and women was set upby Michael Marmot in 1985 to understandthe nature of social inequalities in health,and coronary heart disease (CHD) inparticular. The graded associationbetween socioeconomic position andmortality had already been demonstratedin the original Whitehall study of 17,500male civil servants begun by GeoffreyRose and Donald Reid in 1967, whenthe CHD epidemic was reaching itspeak.Whitehall II extended the findings towomen, who made up one third of thebaseline age cohort (35-55 years) of civilservants, and documented stepwise socialpatterning of incidence for many causes ofmorbidity, both physical and psychological.The study showed that widerdeterminants, such as low perceivedcontrol at work, and influences fromchildhood, as well as biological andbehavioural factors, contribute to healthinequalities. Evidence from Whitehall II andother studies helped to place the socialdeterminants of health firmly on the publichealth policy agenda.The participants are now aged 60 orover and the cohort is increasingly valuableas a platform for studying age-relatedaspects of health. Participants are highlyphenotyped by virtue of five-yearly clinicalexaminations and their loyalty to the study,with high response rates over more than aquarter of a century.Cognitive function was assessed in 1998,2003 and 2008; and during 2012/13 some6,000 participants are completing cognitivetests for the fourth time. We are able tocharacterise variation in the trajectories ofage-related decline in physical as well ascognitive function. Repeat objectivemeasures of physical function includewalking speed, handgrip strength andstanding balance. Mental health is thethird major domain of interest. These andother assessments permit us to constructcomposite measures of frailty, disability,and activity limitations at one end of theageing spectrum, and healthy or idealageing at the other.In the ageing population, decline inphysical, mental and cognitive function isof increasing concern. We have developeda detailed research programme fordiscovery science, centred on thelongitudinal effects of midlife biologicaland behavioural risk factors on old-agefunctional decline. An important driver inour thinking is that there is greatunexplained heterogeneity in rates ofdecline between individuals. Whitehall IIdata shows that individual healthybehaviours in midlife explain only a modestproportion of differences in old-agefunctioning and health, but their combinedimpact is more substantial. In 2008, weadded aortic pulse wave velocity, ameasure of aortic stiffness, to the clinicalprotocol. It predicts later functioning, and awider set of cardiovascular risk factors wasstrongly related to subsequent cognitivedecline, supporting the view that vascularhealth is a key determinant of bothphysical and cognitive ageing.Early Whitehall II results on socialinequalities have made a majorcontribution to public health policy. Withthe new focus on ageing, we plan totranslate the effects observed in theWhitehall II cohort into potential impactson the ageing British population. Theindirect linkage of Whitehall II withother population-scale data will producenovel estimates of the proportion offunctional loss and dependence that ispreventable.Eric Brunner, Archana Singh-Manoux and Mika KivimakiDepartment of Epidemiology andPublic HealthUniversity College LondonGOOGLE the word ‘sadness’ and you get11,600,000 results. That’s a whole lot ofsadness. But google ‘happiness’ and upcomes an amazing 312,000,000.Conclusion? Humanity is roughly 27 timeshappier than it is sad.Er... maybe not. Measuring happiness isnot quite that easy – as several articles inour special feature section point out.Distilling the essence of happiness, findingways to define and quantify it, anddeveloping validated scales and practicaltools for measuring it have spawned anarmy of academics and contributed to aswathe of disciplines from psychology toeconomics, and from neuroscience topublic health.It was the philosopher Jeremy Bentham,one of the greatest luminaries of theEnlightenment, who laid the foundationsof our thinking about the links betweenhappiness, wellbeing, wealth and health,and more specifically the part played bypublic policy in creating a harmonioussociety. He expounded the utilitarianprinciple of “the greatest happiness for thegreatest number,” which still forms acentral tenet of public health practicetoday.What makes us happy? Well you couldwrite a book about that (and we review acouple of them on p19). Successive surveyspoint to the importance of physical andmental health, the strength of family andcommunity ties, leisure time and a sense ofcontrol over one's life. Another factor isinner fortitude, often formed in one’s earlyyears. Economist Richard (Lord) Layard seesa person's happiness as more stronglyrelated to their emotional health as a childthan almost anything else.How important is money in all this? Arecent Office of National Statistics reportfound a surprising lack of correlationbetween levels of deprivation andhappiness, area by area, across the country– and yet we know from other studiesthat, as far as the individual is concerned,relative income is a key factor in wellbeing,raising the issues of fairness and socialjustice.So it’s all wonderfully complex. Moneycan’t buy you love – or happiness – but itcan buy comfort and choice. According toWoody Allen: “Money is better thanpoverty – if only for financial reasons.”And as Wilkinson and Pickett so ablydemonstrated in The Spirit Level, fairness inthe distribution of wealth, resources andservices makes for a happier, healthier andmore stable society. At no time can thissound utilitarian principle be moreimportant than as we enter yet anotheryear of cuts and austerity.Alan Maryon-DavisEditor in ChiefWOULDN’T it be great if there was a cheap,widely available happiness app that reallyworked? In the current economic climateany therapy that is commissioned needs tojustify the resources allocated to it. CognitiveBehavioural Therapy (CBT) has done well inthis area. There is ever-expanding evidencefor its effectiveness in most psychiatricdisorders in children and adults. We knowCBT does make mentally ill people happier.CBT is incredibly versatile. Many structuredmodels have been developed to addressspecific diagnoses, but one of its strengthsis its flexibility in providing a framework tounderstand human distress and worktowards the patient’s individual unique goals.But with access to accredited therapists stilllimited on the NHS, an important questionis: can an online therapy have a significantimpact on psychiatric symptomatology?There’s a growing number of online CBTresources for treating mental illness, somewith good evidence to support theirefficacy. Often they require a therapist’ssupport, although some are stand-alone.Yet it is not a panacea. For CBT to beeffective, a patient needs to:n be motivatedn collaborate with the therapistn be able to think about their inner worldn be able to act differentlyn reflect on the consequences of theseactions.The evidence for the impact of CBT inpeople without a mental illness is muchless well-established. As the old adagegoes: “Absence of evidence is not evidenceof absence.” Probably it’s just a matter oftime before more evidence to support thisemerges. A CBT model for an illness andtreatment can be manualised and hencecomputerised. But the problem is that thedifficulties of a dissatisfied person with awish for greater happiness are not yetspecific enough for an illness model and acomputerised approach. An experiencedtherapist, however, is able to work withthe individual to develop understandingand achieve their goals and so promotegreater happiness. It seems for the timebeing that a happiness app is still somewayoff. Unfortunately, there just don’t seem tobe any short cuts to human happiness.Stephen WestgarthConsultant child and adolescentpsychiatristCity Hospitals Sunderland6 PUBLIC HEALTH TODAYDECEMBER 2012 7

SPECIAL FEATURE: HAPPINESSSPECIAL FEATURE: HAPPINESSDEBATE: Should we measure happiness? Paul Dolan says it helps us focus on theultimate prize of better lives, while Steve Davies argues it is too unreliable to be usefulSubjectivehappiness is themain objectiveHOW are you doing? Well, I hope. Theonly way I can find out is to ask you. Sure,other things, such as your health, matter,but such information would only be usefulin allowing me to predict how you aredoing. And that prediction would be farfrom perfect; health and other things allmatter, but they matter to each of us todifferent degrees. But how we are all doingdoes depend on one important thing –how we feel.Life goes better when you feel better. Or,more accurately, life goes better when youfeel better for longer. So we need todirectly measure happiness. Yes, but it’s allsubjective, I hear some of you say. Tooright it is. Our feelings and experiences oflife are all subjective. Objectivecircumstances matter, but only becausethey affect how we feel, and, if not today,then tomorrow. And remember that pain isa subjective experience, and we trustpeople’s reports of how much it hurts.We have made enormous advances inthe last couple of decades in developingmeasures of happiness, and we now knowquite a lot about the causes andconsequences of happiness. We know thatmental health affects happiness muchmore than physical functioning and hasYESobvious implications for the relativepriorities afforded to different conditions.We also know that people adapt toobesity, and so there is little hedonicincentive to shed the pounds. If we wantto understand and change health-relatedbehaviours, we need a betterunderstanding of the feedback loopbetween what we do and how we feelabout it.Happiness measures are now beingtaken seriously by governments andpolicymakers around the world. The Officefor National Statistics in the UK ismonitoring national happiness and manyother countries are following our lead.Happiness measures are now part of theUK Treasury’s Green Book on economicappraisal and, as a consequence, they areincreasingly being used to evaluateinterventions in many areas of publicpolicy. This will allow us to compare theeffectiveness of healthcare relative to otheruses of public money.I have no doubt that policy shouldseek to help people feel as good as theycan for as long as they can. This overarchinggoal can easily get lost in a worldof national targets, performancebenchmarks and healthcare league tables.Happiness measures can now provideus with a robust metric that focuses oureyes firmly on the ultimate prize of betterlives.Paul DolanDepartment of Social PolicyLondon School of EconomicsThe real Shangri-La?Happiness is more important than GNP to the government of Bhutan. Peter Horbyassesses what the Himalayan kingdom can tell us about measuring the H-wordA fool’s gamethat leaves uswith truismsGOVERNMENTS around the world areincreasingly interested in measuringnational wellbeing, or happiness, as analternative to conventional measuressuch as gross domestic product (GDP).However, measuring subjectivewellbeing is so fraught with problemsthat it is probably not worth theeffort.Measurements of happiness aretypically on a scale of one-to-three orone-to-five and focus on two things:‘life satisfaction’ (evaluating life so far)and ‘immediate happiness’ (usually theprevious few days). This seems simple,but the results throw up problemswhen you try to draw conclusions fromthem.Every national survey comes up withan overall life satisfaction rating ofabout seven (where 10 is blissful andone is suicidal). This happens regardlessof factors such as economic conditionsand crime. In fact it is remarkablyconstant over time and has nocorrelation with any other significantfactor such as wealth, equality oreconomic performance.The reason seems to be twofold.Firstly, people are reluctant to say theyare very unsatisfied or totally content –so they cluster around ‘satisfied butwith room for improvement’. Secondly,trying to measure this on a scale withNOthree or five points is inherentlyproblematic. For the national level tochange, a huge number of peoplewould have to move by at least tworanks in a 1-5 scale, which is alwaysunlikely. So it’s not clear that this tellsus much.You can ask more personal questions,but then any patterns tend to disappearin individual variation. We are leftwith statements such as that peopleare less immediately happy whenthey are bereaved or ill. There aresome unexpected findings, such asthat women are on average happierbut more anxious than men, butit’s not clear what follows fromthis.Moreover you can affect happinesssurvey results in many ways. You getmuch higher reported happiness ifyou ask people questions on a Fridaythan on a Monday. People reportsignificantly lower happiness if askedfirst about politics and then afterwardshow they have felt over the previousfew days.Attempts to measure subjectivewellbeing tend to leave us with truisms,not real insights. People are likely to feelbetter when they are better off, have astable life and friends. You hardly needexpensive research to find this out, andit’s not clear how this gives any kind ofguidance to policy at the national(rather than a very local) level.Steve DaviesEducation DirectorInstitute of Economic AffairsTHE fourth Dragon King of Bhutan was 17years old when in 1972 he declared:“Gross National Happiness is moreimportant than Gross National Product.”Although slow to mature, the idea hasbeen tenacious, and the constitution ofBhutan now requires the state to “promotethose conditions that will enable thepursuit of Gross National Happiness.”Bhutan held its first survey of GrossNational Happiness (GNH) in 2007.While cynics might argue that a shiftfrom measuring wealth to measuringhappiness is a desperate attempt by thecaptain of a sinking ship to redefinefloating, it is hard to dismiss the philosophyof measuring GNH. Although health andwealth are desirable, happiness is notcontingent on them: the rich and healthyare not always happy, and the poor andunwell can be remarkably cheerful. Thepursuit of happiness rather than materialwealth as a national goal has thereforeproved appealing and 2011 saw a UNresolution inviting member states todevelop measures of happiness to guidedevelopment goals and public policies.The crux of many criticisms of GNH liesnot in the desirability of ‘happiness’ as anoutcome, but in measuring it. How canmetrics of happiness be defined that arecomparable across ages, genders, cultures,countries and time? Happiness is trulymercurial: it’s hard to predict, quick tochange, sensitive to environmentalconditions and difficult to capture.Happiness is also multi-dimensional. The2010 Bhutan survey of GNH defined ninedimensions of happiness, included over750 indicators and took an average ofthree hours to complete by a trainedinterviewer.Bhutann Population: 738,000n Size: 38,364 sq km (14,812 sq miles)n Life expectancy: 66 (men), 70 (women)n GNI per person: £1,300n Main exports: Electricity, timber,cement, agricultural products, handicraftsn Religion: Buddhism (official), Hinduismn National dress is compulsoryn Tourism is heavily restrictedn Limited television and internet servicesallowed in 1999 for the first timen Unrest amongst ethnic Nepali minorityIn 2010 David Cameron announced thatthe Office of National Statistics (ONS)would soon begin to measure nationalwellbeing. The concept of nationalwellbeing seeks to balance the ficklenature of happiness by combiningmeasures of subjective wellbeing (feelingsof happiness and self-worth) with objectivemeasures, such as healthy life expectancyat birth and crime rates. After a period ofconsultation on “what matters to you?” inJuly 2012, the ONS announced 10 domainsand 38 indicators that would be used toroutinely measure national wellbeing. Inrecent months ONS has released a numberof publications on wellbeing.Any attempt to measure the impact ofpublic policies in a holistic way and to setan alternative, non-cash, framework fordevelopment indicators has to beapplauded, but there is a long way to go.Like the fourth Dragon King when heannounced GNH, the methodology is stilljust a teenager. It is not clear thatindicators can be developed which arevalid over time and across socio-culturaland political systems, nor that we knowthe right policy levers to direct changes innational wellbeing.In short, the evidence that surveys ofwellbeing contribute to improvements inwellbeing is not yet there. The Bhutansurvey of GNH has a category of “not-yethappy”.I would put myself in this categoryif asked for my view on happiness andwellbeing surveys.Peter HorbyDirectorOxford University Clinical Research UnitHanoi, Vietnam8 PUBLIC HEALTH TODAYDECEMBER 2012 9

SPECIAL FEATURE: HAPPINESSEat your greens tobeat the blues?A RECENT analysis* has looked at therelationship between fruit and vegetableconsumption and mental health in threerobust, representative, cross-sectionalstudies of adults in England, Scotland andWales. Each survey gathered self-reportedintake data, measured in portions of up toeight or more a day, whereas most surveysstop at the recommended five or more.They also gathered data using differentmeasures of mental health – mentalwellbeing (WEMWBS), mental illness (GHQ-12), life satisfaction, happiness,nervousness and feeling downhearted.Together these surveys capturedinformation from more than 80,000 peopleand took account of factors such as age,sex, ethnic group, socioeconomic andeducational circumstances and otherlifestyle factors such as smoking. Theyshow a consistent dose-responserelationship between mental health andportions of fruit and vegetables consumed:the more fruit and vegetables consumedthe more mental wellbeing. In modelsbased on indicators of positive mentalhealth (WEMWBS, life satisfaction andhappiness) coefficients increased up toseven or more portions. In models basedon mental health problems (GHQ-12,nervousness, feeling downhearted) theyincreased up to five or more.While a strong and consistent doseresponserelationship, as shown in thesestudies, is pretty powerful evidence thatfruit and vegetable consumption isinfluencing mental health, the possibilityremains that the surveys could just bedocumenting the fact that people withThe more fruit andvegetables consumedthe more mental‘wellbeingbetter mental health tend to look afterthemselves better than those without.We already know that increasing fruitand vegetable consumption would meet awide range of public health goals includingreduced cardiovascular disease and cancer.If it could be shown that fruit andvegetable consumption make a differenceto wellbeing, public health messages toincrease consumption would be greatlyenhanced.If it could also be shown for certain thatfive portions a day is not optimal formental health, public health messageswould also need to change. With theevidence available from this study, it ispossible to claim that this is likely to be so,but we urgently need prospectivesupplementation studies to prove thingsone way or another.Sarah Stewart-BrownProfessor of Public HealthWarwick Medical School‘* Blanchflower DG, Oswald AJ, Stewart-Brown S. Is psychological wellbeing linkedto the consumption of fruit and vegetables?Social Indicators Research 2012 Epub 11October DOI10.1007s/11205-012-0173-yPutting moodson the mapTHE aim of ‘mood-mapping’ is to helppeople and groups understand, measure,compare and manage how they feel. Atpresent mood is measured withquestionnaires or on a scale using factorssuch as anxiety or wellbeing, depression orenergy. Mood-mapping is a visual, nonculturalassessment of mood that is easy tolearn and apply. It measures mood in themoment and can show how immediatecircumstances affect how a person feels.The technique separates mood intoenergy and positivity. The four quarters ofthe graph describe four basic moods: action,stress, tiredness and calm (see Fig). Theindividual plots their ‘mood point’ byestimating how much energy and howpositive they feel. The mood point can belabelled with the time and circumstances. Ifrequired, an intervention can be offeredand its effect on mood assessed.Numerous studies show the benefit ofinterventions and environment on health,wellbeing and energy levels. Moodmappingcan be used as a simple selfassessmenttool alongside five approachesto managing mood: the environment,physical health, relationships, cognitivestrategies and individually specific factorsto improve how people or groups feel(Miller L, Healthcare Counselling &Psychotherapy Journal 2011: 2; 17-19).Mood-mapping is a simple way ofvisualising how people feel andencouraging them to have greater controlof their emotions, better understand howtheir actions affect their health and stresslevels, and take more responsibility for theirwellbeing. This self-help approach isespecially useful in times of austerity. Fromthe perspective of public health, the toolcould perhaps be validated to allow thehealth and stress levels of a population tobe measured and compared.Liz MillerGP and occupational health physicianREVALIDATIONRevalidation guideYour pull-out-and-keep manual for the new systemThere are a number of aspects of revalidation about which the Faculty of Public Health frequently receives queries from members. We’vedeveloped this pull-out-and-keep guide to give you the essential facts about revalidation. Working with colleagues in the field, we’vedeveloped this guidance to help those working as public health professionals, as well as those appraising them. You can find this andfurther information on our website at: www.fph.org.uk/supporting_information_for_gmc_revalidationFROM THE VICE PRESIDENTIT HAS been a long time coming but, atlast, revalidation to the General MedicalCouncil (GMC) is about to commence.The regulations that bring revalidationinto our professional lives were enabledon 3 December 2012.For most of you, there will be littlechange in your annual appraisals,merely a strengthening of existing localprocesses. For those of you not used toannual appraisals, which are the basisof revalidation, you will need tofamiliarise yourself with the requirements.These pages will help all readers toprepare for revalidation to the GMC, toensure they are aware of therequirements, the types of supportinginformation they will be required toreflect on and present at their annualMain types ofsupportinginformationAN IMPORTANT part of revalidation isthe building, over a period of five years, ofa portfolio of supporting information thatdemonstrates your practice against the 12attributes of Good Medical Practice.The supporting information that you willneed to bring to your appraisal will fallunder four broad headings:n General information – providing contextabout what you do in all aspects of yourworkn Keeping up to date – maintaining andenhancing the quality of your professionalworkn Review of your practice – evaluating thequality of your professional workn Feedback on your practice – how othersperceive the quality of your professionalwork.There are six types of supportinginformation that you will be expected toprovide and discuss at your appraisal atleast once in each five-year cycle. They are:appraisal. More detail is available on therevalidation pages of our website atwww.fph.org.uk/revalidationBringing supporting information toappraisal may be new to many of you,and the GMC has specified six types ofsupporting information for you toprovide over the five-year revalidationcycle. This information, which you willreflect on and discuss at your annualappraisal, will demonstrate your practiceagainst the attributes outlined in GoodMedical Practice.In discussing your supportinginformation, your appraiser will beinterested in what you did with theinformation and your reflections on thatinformation, not simply that youcollected it and maintained it in aportfolio. Your appraiser will want toknow what you think the supporting1. Continuing professional development2. Quality-improvement activity3. Significant events4. Feedback from colleagues5. Feedback from patients (if you seepatients)6. Review of complaints and compliments.The nature of the supporting informationwill reflect your particular specialist practiceand your other professional roles. Yourportfolio will make it easier for yourappraiser to complete the appraisal and foryour Responsible Officer (RO) to make arecommendation to the GMC about yourrevalidation. If you feel that you are unableto collect all pieces of supportinginformation you should discuss the matterwith your appraiser. The requirements arethe same for all doctors.information says about your practiceand how you intend to develop ormodify your practice as a result of thatreflection. For example, how youresponded to a significant event andany changes to your work as a result,rather than the number of significantevents that occurred.The UK Public Health Register(UKPHR) will be introducing a system ofrevalidation based on annual appraisal.More details will follow in due course,so please do check the UKPHR and FPHrevalidation webpages.For trainees, your Annual Review ofCompetence Progression will cover thenecessary requirements.Edmund JessopVice President for Standards andResponsible Officer, FPHGuidance onauditEVIDENCE of quality-improvement activityis mandatory for revalidation; it providesevidence that you review your practice,learn from any mistakes and improve as aresult. Audit (which consists of audit, takeaction and re-audit) is a requirement onceevery five years, and two case reviewsshould be produced in the interim fouryears. FPH has provided some examples ofaudit and case review in the main areas ofpublic health as guidance for appraiseesand appraisers.10 PUBLIC HEALTH TODAYDECEMBER 2012 11

REVALIDATIONREVALIDATIONMulti-sourcefeedbackguidanceTimelinesTHE GMC will write to all doctors startingin December 2012 to confirm the date atwhich it expects to receive arecommendation about the doctor’s fitnessto practise. It is aiming to tell every licenseddoctor their recommendation date byspring 2013 at the latest. It will give aminimum of three months’ notice of whenthe doctor’s revalidation recommendationshould be submitted but will let them knowearlier if it can.The GMC’s schedule is as follows:n (Year 0) December 2012 to March 2013:All ROs and other senior medical leaders tobe revalidatedn (Year 1) April 2013 to March 2014: FirstRO recommendations (20% of doctors)submittedn (Year 2) April 2014 to March 2015:Second tranche of recommendations (60%of doctors) submittedn (Year 3) April 2015 to March 2016: ThirdReflective notesFEEDBACK from colleagues and patients ismandatory for revalidation. Feedback fromcolleagues will need to be gathered by alldoctors. Those of you who do not treatpatients will not need to provide this typeof feedback.Which multi-source feedback (MSF)questionnaire you should use is the decisionof your Responsible Officer (RO), and it isexpected that doctors will follow the localprocess as determined by the RO.The General Medical Council (GMC) haspublished guidance on the minimumrequirements for the first cycle whichincludes guidance on the MSF. Theguidance states that the MSF does not haveto be GMC-approved for the first cycle, butit must have been carried out within thefive years prior to the recommendation dateand relevant to the doctor’s current scopeof practice.tranche of recommendations (majority ofdoctors) submittedn End of March 2018: All remaininglicensed doctors. End of first cyclen April 2018: Second revalidation cyclebegins.While a revalidation recommendation ismade once every five years, you will beexpected to undergo an appraisal everyyear.REFLECTION is an important aspect ofrevalidation, as a driver by which you canimprove the quality of your professionalpractice. You will need to reflect on thesupporting information within your portfolioand document that reflection as a way ofproviding insight into your work and, inturn, informing the appraisal discussion.Good reflection goes beyond descriptiveobservation. It demonstrates evidence ofanalytical thinking, learning and actionplanning. The intention is that you provideinsight into your supporting informationand, in turn, your professional practice,approach to medicine and demonstratecompliance with Good Medical Practice.To help with this important aspect of CPDand revalidation, FPH has produced Tips onWriting Effective Reflective Notes.Minimumrequirements fora revalidationrecommendationTHE General Medical Council (GMC) hasset out guidance for doctors on theminimum requirements for the first cycle.In order to be ready to have a revalidationrecommendation made about them, doctorswill have to fulfil the following criteria:n The doctor must be participating in anannual appraisal process which has GoodMedical Practice as its focus and covers theentire scope of their medical practice.n The doctor must have completed at leastone appraisal, with Good Medical Practiceas its focus, which has been signed off bythe doctor and their appraiser.n The doctor must have demonstrated,through appraisal, that they have collectedand reflected on the following informationas outlined in the GMC’s guidanceSupporting Information for Appraisal andRevalidation:– continuing professional development– quality-improvement activity– significant events– feedback from colleagues– feedback from patients (if applicable)– review of complaints and compliments.n Evidence of continuing professionaldevelopment, review of significant eventsand review of complaints and complimentsmust relate to the 12-month period priorto the appraisal that precedes anyrevalidation recommendation.n Evidence of regular participation inquality-improvement activities thatdemonstrates the doctor reviews andevaluates the quality of their work must beconsidered at each appraisal. The activityshould be relevant to the doctor’s currentscope of practice.n Evidence of feedback from patients andcolleagues must have been undertaken noearlier than five years prior to the first revalidationrecommendation and be relevant tothe doctor’s current scope of practice.n Feedback from patients and colleaguesthat does not fully meet the criteria set bythe GMC may also be included but musthave been:– focused on the doctor, their practiceand the quality of care delivered to patients– gathered in a way that promotesobjectivity and maintains confidentiality.n Team-based information may also meetthe requirements where no individualisedinformation is available for qualityimprovementactivities, significant events orcomplaints and compliments – as long asthe doctor has reflected on what thisinformation means for their individualpractice.Specialty specific guidanceFPH has worked with the Academy of Medical Royal Colleges to produce specialty-specific guidance that will be used by appraisers,appraisees and Responsible Officers who require further guidance on the particularities of revalidation in public health. The guidanceincludes this helpful checklist for supporting information that should be used in conjunction with the remainder of the guidance.Remember: it is your responsibility to ensure the information you supply is correct and up to date.GENERAL INFORMATIONPersonal detailsScope of workRecord of annualappraisalsPDPsa General Medical Council (GMC) numbera demographic and relevant personal information and qualificationsa self-declaration of no change or an update identifying changesa description of whole practice covering the period since last appraisala current job plan (if required for reference)a any significant changes in professional practicea extended clinical and non-clinical activitiesa any other relevant information for field of practicea signed-off appraisal portfolio record and satisfactory outcomes of previous appraisala evidence of appraisals (if undertaken) from other organisationsa confirmation that previous actions/concerns have been addresseda current personal development plan (PDP) with agreed objectives from previousappraisala details of any new objectives added since last appraisal or to be addeda access to previous PDPsAnnualAnnualAnnualAnnualProbity a signed probity self-declaration AnnualHealth a signed health self-declaration AnnualKEEPING UP TO DATECPD a description of CPD undertaken each year as set out in requirements AnnualREVIEW OF PRACTICEQuality improvement activity – at least one of the following activities as appropriate for specialty (see full guidance)Clinical audit a evidence of demonstrating active engagement in complete audit cycle Minimum 1 in 5 yearsReview of clinicaloutcomesCase review ordiscussiona documented review of clinical outcomes, as where defined by specialtya documented case reviewsSignificant eventsClinical incidents, a summary of all SUIs or root-cause analyses that you have been involved inSignificant Untoward a summary of at least 2 clinical incidents per year ORIncidents (SUIs) ora self-declaration that you have not been involved in any events.other similar eventsIf availableAnnual in remainingyearsAnnualFEEDBACK ON PRACTICEColleague feedback a MSF colleague feedback exercise (normally by the end of year 2). Minimum 1 in 5 yearsFeedback frompatients and/or carersFeedback from clinicalsupervision, teachingand trainingFormal complaintsa patient-feedback survey or equivalent exercise, normally by the end of year 2(if applicable).a evidence of performance as a clinical supervisor and/or trainer (a)a feedback from formal teaching included annually (b)a documented formal complaints received ORa self-declaration that none have been received since last appraisalMinimum 1 in 5 years(a) Minimum 1 in 5years (b) annualAnnualCompliments a summary of unsolicited compliments received Annual12 PUBLIC HEALTH TODAYDECEMBER 2012 13

REVALIDATIONSPECIAL FEATURE: HAPPINESSFrequentlyasked questionsQ: Who will need to revalidate?All doctors with a licence to practise arelegally required to revalidate if they wish toretain their licence to practise. Specialistsregistered with the UK Public HealthRegister (UKPHR) will be required torevalidate in order to remain on thespecialist register. Please refer to theUKPHR website for further details.Those on the General Dentist Council(GDC) register are strongly encouraged tomaintain similar portfolios of evidence asthe GDC intends to introduce revalidationin due course. Visit the GDC website forfurther details.Doctors in training will be required toundergo revalidation. This will take placethrough their deanery and be based on theAnnual Review of Competence Progression(ARCP) process. For further informationvisit www.gmc-uk.org/reval4traineesQ: How will GMC revalidation work?Revalidation is based on a local evaluationof doctors’ performance through annualappraisal in the workplace. Doctors willneed to maintain a portfolio of supportinginformation to bring to their appraisals as abasis for discussion. Information from theappraisal will be provided to a ResponsibleOfficer (RO). Every five years the GMC willrequire confirmation from a doctor’s ROthat they are up to date and fit to practiseand that there are no significantunresolved concerns about their practice.Q: Who is my Responsible Officer?You cannot choose your RO; it is laid downin law. The GMC has developed a tool toaid doctors in identifying their RO. Visit theGMC website to find your RO.Q: How often must I revalidate?Revalidation will be a five-year cycle. Whilsta revalidation recommendation occurs onceevery five years, appraisal is an annualrequirement.Q: When should I start collectingsupporting information forrevalidation?You should start to collect your supportinginformation as soon as possible.Q: What multi-source feedback(MSF) should I use?The MSF for you to use is decided by yourRO. There is not a specialty-specificquestionnaire for colleague or patientfeedback. If you do not treat patients, youdo not need to gather this type offeedback. However, the GMC recommendsthat you consider other relevant sources ofinformation such as students or clients.Q: What will happen if I do notengage in appraisal andrevalidation?If you choose not to engage, you riskhaving your licence to practise withdrawn.Q: I work for a Primary Care Trust(PCT). Is FPH my designated body?No. If you work for a PCT, the PCT is yourdesignated body. PCTs are legal entitiesuntil 31 March 2013 and have a legalobligation to carry out revalidation andappraisals for all doctors under theirremit until this date. If you have troublesecuring an appraisal from your PCT, pleaseinform your human resources departmentor RO.Q: I will move to a local authoritysoon. Who will I revalidatethrough?We are expecting the Department ofHealth to publish its response to theconsultation proposal that local authoritiesand Public Health England becomedesignated bodies.Q: What happens if I don’t work inthe NHS?Regardless of employer, if you wish toretain your licence to practise, you will stillbe required to revalidate. Please refer tothe GMC website to find your designatedbody for revalidation.Q: I do not have a connection to adesignated body. What should Ido?You should make the GMC aware of yourcircumstances by updating your details onyour GMC online account and stating thatyou do not have a designated body.Q: Does revalidation affect myspecialist registration or GMCregistration?No. Revalidation is required to maintain alicence to practise. Revalidation is aboutdemonstrating that you are up to date andfit to practise in your current fields andacross your scope of practice.Q: What if I work overseas?The licence to practise gives doctors legalrights and privileges in the UK only. If youchoose to maintain your licence whilepractising abroad, you will have torevalidate in the same way as doctorspractising in the UK and link to a UKdesignated body.There is an option for doctors torelinquish their licence to practise, butremain registered with the GMC andmaintain entry in the specialist register.Visit the GMC website for furtherinformation.Q: I work for periods of timeoutside the UK. How will this affectmy ability to revalidate?It should be possible for you to revalidatethrough your practice in the UK. Youshould discuss management of yourappraisal and supporting information whilein the UK with your RO and appraiser.Q: I work across differentspecialties. Do I need to berevalidated twice?No. Your supporting information shouldreflect your entire scope of practice. Ideally,you will have one appraisal to cover all ofyour roles. You will only have one RO whowill make a recommendation to the GMCabout your entire practice.Q: I work exclusively in a nonclinicalrole. How do I revalidate?If you hold a licence to practise, you willrevalidate in the same way as doctors inclinical roles, and the supportinginformation you bring to appraisal willreflect your non-clinical role. However, youmay not need a licence to practise if youdo not carry out any clinical practice.Q: I only work part time. What arethe requirements for revalidation?You will be expected to revalidate in thesame way as full-time doctors, includingparticipating in annual appraisal andcollecting supporting information inrelation to the practice that you do.Q: I have retired from activemedical practice. If I continue tomaintain CPD will that besufficient for revalidation?No. If you choose to or are required tohold a licence to practise, you will need torevalidate in the same way as every otherdoctor.Q: I am retiring in less than fiveyears. Do I have to revalidate?Yes. You will need to revalidate up until thepoint that you relinquish your licence topractise.Q: How will a short career break(for example maternity leave)affect my ability to revalidate?Your ability to revalidate should not beaffected if you take a short career breakwithin a five-year revalidation cycle. If youdo plan a break you should manage yourappraisals around that break as far aspossible, so that you do not miss anappraisal prior to going on leave. Youshould speak to your appraiser and RO todevelop an agreed approach.Mirth of a nationStatistics about wellbeing in the UK can inform policy decisions andalso help individuals plan their own futures, says Rachel O’BrienTHE Office for National Statistics (ONS) setup the Measuring National Well-beingprogramme in November 2010 to deliveran accepted and trusted set of nationalstatistics to help people understand andmonitor national wellbeing. Theprogramme brings together information onthe economy, society, the environment andsustainability to provide a comprehensivepicture of life in the UK today.Two years on, ONS is making goodprogress towards achieving its aim and haspublished a wide range of work. We havedeveloped a set of 10 domains (includinghealth), containing 38 measures – someobjective (such as health, education, accessto services) and some subjective (such aslife satisfaction and happiness). Both typesare important to the measurement ofnational wellbeing.The development of measures drawsheavily on consultation and feedback fromusers including findings from a ‘nationaldebate.’ Health was the most frequentresponse when individuals were askedwhat affected their wellbeing. The headlinemeasures of health we currently includeare healthy life expectancy, physical health,self-reported health and a measure ofmental ill-health.ONS has also taken the lead on thedesign, development and testing, andreporting of subjective wellbeing questions.This has led to us having more detailedmeasures of life satisfaction, meaning andpurpose in life, as well as respondents’assessment of their happiness and anxiety‘yesterday.’Analysis of these measures shows thatboth physical and mental health havestrong associations with subjectivewellbeing measures. For example, almosttwo thirds (62%) of those reporting badhealth also reported low levels of lifeHealth was the mostfrequent responsewhen people wereasked what affected‘their wellbeing‘satisfaction, compared to almost one infive (18%) of those reporting good health.In addition, half of individuals reportingbeing long-term disabled reported lowoverall life satisfaction. This compares toonly 19% of those with no disability.Further details are available in the firstannual experimental results on subjectivewellbeing from the Annual PopulationSurvey (APS) and the Measuring NationalWell-being: Health article (July 2012).In November 2012 ONS published anarticle which provided a snapshot of “lifein the UK”, drawing on the full range ofmeasures along with the interactive ‘Wellbeingwheel of measures’ where the latestdata and trends can be explored.The programme has achieved a greatdeal in its first two years, but this is a longtermdevelopment programme. There willbe further testing and evaluation of thesubjective wellbeing questions, continuedevaluation of the domains and measures,and ongoing analysis, including drivers ofwellbeing. Continued engagement withusers will be critical. ONS wants to ensurethe measures we develop are relevant tothe public, government and otherstakeholders. As well as leading to moreinformed policy development andevaluation, they should be of value topeople making decisions in their own livesand also those seeking to understand howthe UK as a whole is doing.Rachel O’BrienProject LeaderSocial ProjectMeasuring National Well-beingProgrammeOffice for National Statisticswww.ons.gov.uk/ons/guide-method/userguidance/well-being/index.htmlEmail: nationalwell-being@ons.gov.uk14 PUBLIC HEALTH TODAYDECEMBER 2012 15

SPECIAL FEATURE: HAPPINESSWatching, wantingand wellbeingSPECIAL FEATURE: HAPPINESSSurvival of thefittest – andhappiestMoney no objectThe relationship between income and mental wellbeing appears to bemore complicated than many people expect, says Sarah Stewart-BrownHAPPINESS is central to mental wellbeingand, because we now recognise thatmental wellbeing underpins physicalhealth, it is also central to public health.The terms are not synonymous becausemental wellbeing includes the skills andattributes that lead to happiness as well ashappiness itself, but happiness is a veryimportant component of wellbeing.Analyses of country-level correlationsbetween happiness and Gross DomesticProduct led the Stiglitz-Sen-FitoussiCommission to confirm the age-old adagethat, above a bare minimum income, itisn’t money that makes nations happy. TheCommission report [2009] has been veryinfluential, alongside the UK ChiefScientist’s Foresight report Mental Capitaland Wellbeing [2008], in sparking interestin happiness among governments andcreating demand to measure wellbeing.Using the Warwick-Edinburgh MentalWellbeing Scale, we have looked at therelationship between income and mentalwellbeing at the individual level and foundthat it is not simple. Those with moreincome report greater wellbeing than thosewith less, but there is no simple doseresponserelationship. Interpretation iscomplicated by the fact that mentalwellbeing includes the personal attributesthat make people successful in theworkplace and conversely that mentalhealth problems can cause poverty. Whatis evident in all the statistics is that there isa great deal more variation in mentalhealth within income groups than betweenthem and that most people with mentalhealth problems are not poor.So it seems that the strongly held beliefthat mental health problems are caused byincome inequalities needs re-examining. Atthe same time any solutions need to takeinto account the fact that losing your jobThere is a great dealmore variation inmental health withinincome groups than‘between them‘or being on long-term sick leave are bothstrongly associated with poor mental healthand poverty, and that getting a job isassociated with improvement. Suddenchanges in available income are highlystressful. If they knock confidence and leavepeople feeling useless they may make it verydifficult for them to reverse their fortunes.But this is where mental wellbeingcomes in. Those who are resilient, whosesense of value does not depend on otherpeople’s assessment of them, who canembrace change as a challenge and remainadaptable in the face of crises come throughsuch life events sometimes in better shapethan before. So interventions which workat the individual level are a key componentof wellbeing/happiness programmes. Suchprogrammes may be dismissed as ‘pacifiersto make poor people feel happy with theirlot,’ yet those who have been helped findthem very empowering.Public health practitioners who adopt thisdismissive stance may be taking on the roleof ‘rescuer’ in the psychological triangle ofpersecutor/victim/rescuer. Rescuers makethemselves feel better by ‘helping’ victims.The problem is that they often make a badsituation worse by empowering persecutorsand disempowering victims. In thinkingabout happiness and money, we need to becareful not to get caught in this trap and tofind a balance between societal changeand individual change.Robust mental wellbeing enablescompassion and creates discomfort withsocial injustice. So if our policymakers andthose who voted them into power enjoyedbetter mental wellbeing we would have afairer society where events that knock theless resilient would be less common.Sarah Stewart-BrownProfessor of Public HealthWarwick Medical SchoolWITH Christmas almost upon us, childrenacross the country will have been madlyscribbling their wish lists for Santa Claus.Without a doubt the toys, games andgadgets most fervently desired will be theones most heavily advertised on TV, in thecinema and on the internet. Commerciallydriven pester power (which of courseoperates all-year-round) is hugely annoyingto parents. However, evidence now showsthat the effects of advertising are not justirritating but can be harmful to children’smental health and happiness. Is it time toput the commercialisation of childhood onthe public health agenda?Unsurprisingly, researchers find thatchildren who watch more advertisingpester their parents more and that naggingis linked to more family arguments. Allparents have been through the scenario:“Can I have one of those?”“No.”“Pleeeease!”“I said, ‘No!’”“I’ll be good for the next year.”“Really? I don’t think so.”“But everyone else in my class has gotone.”“Well, we’ll see.”However, what we may not realise is that,for children, these household negotiations,disagreements and tensions are stronglylinked to low life satisfaction, depression,anxiety, low self-esteem and a range ofpsychosomatic symptoms. And it may notbe common knowledge that childrenexposed to a lot of advertising are alsomore materialistic in that they focus theirlives around getting the latest stuff whichthey believe will make them happy andpopular with their peers. They may evenbelieve this protects them from bullying; abaseless hope, as it turns out, becausematerialism in childhood and adulthood isstrongly linked to a range of mental healthproblems.The dynamics of the links betweenadvertising, materialism, family disputesand unhappiness are of course extremelycomplex, and we need more research inthis area – particularly in relation tocausation. However, we can say with somecertainty that children who are depressed,Materialism inchildhood andadulthood is stronglylinked to a range ofmental health‘problemsleft out or disenfranchised (a group thatoften includes those from deprived socialcircumstances) are much more likely to buyinto the advertising promises that cool stuffwill make things better. However, insteadthis leads to negativity towards parents andfamily conflict which in turn actuallyexacerbates insecurity and low self-esteem– not to mention putting financial pressureon the very families least able to afford itall. It is a vicious circle.In the UK, where child wellbeing islowest in the developed world, it may beworth trying to learn lessons from Sweden,the Netherlands and Spain where childrenappear to be happier. Sweden bannedadvertising to children in the 1990s andcommercial TV in Spain and theNetherlands is still relatively in its infancy.As advertising continues to insinuate itsway into more areas of children’s livesbeyond TV and press, and into the moreloosely regulated environment of theinternet and mobile phones, I believe thatthe mental health implications ofcommercially induced nagging, bullyingand materialism is a public health issuethat merits closer scrutiny and moreresearch funding.Agnes NairnProfessor of MarketingEMLYON Business SchoolFranceCo-author of Consumer Kidswww.agnesnairn.co.uk‘WE HAVE known for some time thatpeople’s psychological status is linked totheir physical health – people who areunwell are less happy. We also know thatpeople with existing mental healthproblems, such as depression and anxiety,have poorer survival rates. Could happinessin itself have the power to improve orprotect physical health?The British Heart Foundation has beeninvestigating the links between happinessand survival. As part of this research, weasked more than 3,800 people aged 52 to79 to rate their feelings of happiness andanxiety using standard scales.Researchers then followed participantsfor five years and found that those whoreported feeling happiest at baseline had a35% lower risk of dying from any causewithin five years, compared with thosewho reported feeling the least happy.These associations remained statisticallysignificant after other factors likely toinfluence happiness or health were takeninto account. So the effect wasindependent of age, sex, wealth,education, pre-existing illness anddisability, and lifestyle factors such assmoking, physical activity and alcoholconsumption. There could, however, beother factors involved that were notmeasured, so we cannot be certain aboutthe cause-effect relationship.Of course, a positive state of mind is notmerely the absence of depression andanxiety. We know that there are manyfactors that promote positive wellbeing forpeople, such as good social relationships, asatisfying job, a comfortable home, as wellas lifestyle factors such as leisure-timerelaxation and physical activity.Some of these are easier to implementthan others – tackling loneliness is notalways easy for services to do. We know thatphysical activity is often the easiestintervention to put into place, and that ithas a positive impact not only on wellbeingbut also on survival. Public healthprofessionals can help maintain andimprove the wellbeing of older people inparticular by promoting physical activityand ensuring services are available to helpkeep them active.Professor Andrew SteptoeBritish Heart Foundation Chair ofPsychologyUniversity College London(Prof Steptoe was talking to Liz Skinner)16 PUBLIC HEALTH TODAYDECEMBER 2012 17

SPECIAL FEATURE: HAPPINESSBOOKS & PUBLICATIONSTaking the pathof mostresilienceWHAT helps children and young peoplebecome better at managing risk – andeven, perhaps, happier?Much of the current emphasis onimproving outcomes for children andyoung people has been on earlyintervention, particularly in the early years.But how do we improve the outcomes ofolder children? How can we better supporttheir development as they get older andexperience different risks?The evidence suggests that this can bedone by developing their resilience. Resilientchildren and young people learn tomanage the risks they encounter, bounceback from adversities and are happier.In Wakefield we were particularlyinterested in developing an approach toresilience that looked at such familiar risksas sex and relationships, alcohol, smoking,substance misuse, obesity and child safety.This was in part due to our local publichealth priorities, but also because researchsuggests that resilience is important inmanaging the risks associated with each ofthese.Edith Grotberg identifies three sources ofresilience: “What we have, what we areand what we can do.” Resilience is notsomething that people either have or donot have – it can be learned, and as welearn we increase the range of strategiesavailable to us when things get difficult.The starting point for the Wakefield Riskand Resilience Framework was to identify‘what we can do’ in the form of keycompetences children and young peopleResilient children andyoung people learnto bounce back fromadversities and are‘happier‘need to ‘learn’ in order to have a positiveimpact on their social, emotional andhealth outcomes.The framework is broken down intoeight main competence areas:n Loving myself (self-awareness)n Expressing myself (self-management)n Working it out (responsible decisionmaking)n Being heard (effective communication)n Living together (social awareness)n Keeping safe (risk awareness)n Getting informed (informationmanagement)n Knowing where I am going (self-efficacy)Each of the eight areas is broken downfurther to provide the core competencesthat practitioners may look for a child oryoung person to have achieved by the timethey reach a particular age. Thecompetences are incremental anddevelopmental.Working with a range of stakeholderswe sought ways to help children andyoung people identify their existingcompetencies and those they need tobuild. The results are an online assessment,various other tools for use by early years’practitioners and a paper-based assessmentfor use where an online tool is notpracticable.The final element included the mappingof the competencies across existinginterventions and the production ofbespoke session plans to support thedevelopment of competences and practicalstrategies transferable to differentsituations. This work is ongoing, withvoluntary and statutory organisationscreating and sharing session plans andactivities to build up this resource bank.The framework is now in use acrossWakefield in both universal and targetedsettings. The aim is that children andyoung people will receive the samemessage from all the practitioners workingwith them about what they can do, andhow they can develop to become moreresilient, emotionally well and happy. Asone young person said: “Feeling goodprotects other parts of your life.”Suzanne GahlingsHealth Improvement PrincipalNHS Wakefield DistrictSharon TabbererCo-DirectorArc Research and Consultancywww.riskandresilience.org.ukLife, liberty andthe pursuit ofMappinessTHERE is good evidence that where andhow we live has a bearing on ourwellbeing. The research tool and iPhoneapp Mappiness (www.mappiness.org.uk)gathers real-time information about theselinks to better understand how people'sfeelings are affected by features of theircurrent environment, such as air pollution,noise and green spaces.Participants in the research are beepedonce or more a day to ask how they arefeeling, and for a few basic things tocontrol for: whom they’re with, where theyare and what they are doing. The data issent back – anonymously and securely – toa data store, along with an approximatelocation from the iPhone’s GPS and anoise-level measure. People also haveaccess to their data after they submit it.The research team at the London Schoolof Economics has had more than 3.5million responses from more than 50,000people. Most of the results are intuitive.People feel happier by the coast or in arural environment. Very hot weather makespeople much happier. Following feedbackfrom participants, we added a newcategory covering intimacy and makinglove, which has had much higher ratingsthan any other category.The project has had unexpected benefits:we know that some psychiatrists andpsychologists have directed patients towardsthe app as a means of tracking their mood.We are open to collaborating with publichealth professionals who work on wellbeing.George MacKerronVisiting FellowLondon School of EconomicsStraight talkingfrom the archspin doctorALASTAIR Campbell: a man synonymouswith spin, New Labour, the Blair years andeverything that went with them. Butwhatever your personal views onCampbell, there is no doubting hiscredentials in this subject area: happiness.In this book, Campbell draws upon hisown experiences of depression to try toanswer the million-dollar question: what isit that makes us happy? He then uses hispolitical experience to consider another bigquestion: can politics deliver happiness,and should it try?In addressing the first question,Campbell talks candidly about the impactof his depression on those closest to him,and the insights into managing a conditionwhich affects one in 10 will strike a chordwith many.In addressing the second question,Campbell’s insights draw upon hisconsiderable knowledge of the governmentmachine, while at the same time weavingin research evidence and examples ofhappiness policies around the world.How music cansoothe thesavage breastAT THE risk of misquoting Noel Coward –we all know the extraordinary power musichas to move and soothe us. We know howuplifting it can be. We know the buzz wecan get from creating it, sharing it, beingimmersed in it. We also know that musiccan heal.Yet only recently have researchers begunto explore these effects across a range ofcultures and musical genres. With so muchdiversity and serendipity, how can weencapsulate, codify, quantify and make anykind of unifying theoretical sense of themusic/health/wellbeing relationship?Should we even try?For the first time, expert perspectivesfrom a wide range of academic disciplines,including music psychology, therapy,neurobiology and public health, have beenbrought together in a single book, buildingup a truly comprehensive overview of themany ways in which the power of musiccan be harnessed to help prevent and treatillness and promote health and wellbeing.There’s a chapter on the philosophicaland cultural foundations of music as socialOne of the highlights is a summary ofthe key literature on happiness, wealth andpublic health. The public health readershipwill no doubt enjoy the graphs, one ofwhich shows the work of the so-called‘happiness economist’ Richard Layardplotting relative happiness against GrossDomestic Product per capita. Campbellrecalls Layard presenting this graph inDowning Street alongside a paper entitledLife Satisfaction and Its Policy Implications.But as Campbell says, Blair “didn’t reallygo for it”. However, and to my surprise,Campbell is complimentary about ourcurrent PM for his leadership on thehappiness agenda, praising Cameron for“taking up the ideas presented to thepredecessor on whom he sometimesmodels himself”. He couldn’t after all resista little spin, but this book is at its bestwhen it avoids such political put-downs.One of the most powerful chaptersreturns to Campbell’s personal life and hisexperiences dealing with the loss of one ofhis closest friends, the Labour pollsterPhilip Gould. The articulation of theprocess of preparing and then grieving fora loved one and his reflections onhappiness at the end of life contrastdramatically with the ‘evidence’ presentedin the previous chapter. It is a pertinentreminder of the power of our personaltherapy – and another on the theories andmodels behind music as individual therapy.There’s a chapter looking at music and thehuman brain – neurotransmitters, thelimbic system and brain plasticity. Furtherchapters consider community music andpublic health, music as an adjunct topsychological therapies such as CognitiveBehavioural Therapy or guided imagery,music and pain management, music andchronic physical illness, and many otheraspects.A particularly intriguing chapter looks atthe role of music in the management ofautism and vividly describes a number ofcase studies with severely autistic children.Another, quite topical, chapter outlines thelinks between community choirs andwellbeing – from older people in nursinghomes to adults with learning difficulties,and from prisoners to asylum seekers andrefugees. No mention of military wives –but only because the academics haven’tyet got round to studying them.There’s even an in-depth discussion ofthe evidence for and against backgroundmusic in supermarkets (increased sales),workplaces (increased productivity), dentalsurgeries (calmer patients) and operatingtheatres (calmer staff).This book is not an easy read, anddoesn’t pretend to be. But it is probablythe most all-embracing collection of theoryexperiences, the eternal fabric of theevidence we sometimes cling so tightly to.Whatever your views on Campbell, it isfor this reason that this short book isworth a look. I can’t guarantee it will makeyou ‘happy’, but it will, at the very least,prove an interesting and reflective read.The Happy DepressiveAlastair CampbellPublished by ArrowISBN 9780099579823RRP: £4.99Matthew Dayand evidence linking music, health andwellbeing currently available. For studentsand researchers in social and psychologicalsciences, as well as those in musiceducation and therapy, it’s nothing lessthan a symphonic extravaganza.Alan Maryon-DavisMusic, Health & WellbeingEdited by Raymond Macdonald,Gunter Kreutz and Laura MitchellPublished by Oxford University PressISBN 9780199586974RRP: £5518 PUBLIC HEALTH TODAYDECEMBER 2012 19

ENDNOTESENDNOTESA spotlight on...Rob HowardI WAS reminded a couple of weeks agothat every public health intervention is abalance between benefits and risks. Ithappened when I fell off my bike,breaking my collarbone and a rib. No,I wasn’t trying to do a Bradley Wiggins– although our cycling careers haveoften been in strange parallel. When hewas winning the Tour de France, I waswatching it on TV.So, what are the benefits and risks ofchairing the Specialty RegistrarsCommittee (SRC)? Well, the benefits areeasy. The SRC is the FPH committee(strictly a sub-committee of theEducation Committee) that representsthe interests and views of all publichealth registrars across the UK. As chairof the committee I am also a co-optedmember of the FPH Board, and attendFPH Executive meetings. This presents afantastic opportunity to learn fromhugely experienced and committedpublic health specialists from a widevariety of backgrounds. It provides anopportunity to influence the direction ofpublic health training and to representthe interests of registrars across the UK.It also gives me great insight into someof the national discussions on the futureof public health – particularlyfascinating in times of such greatchange.The risks? Well, one of the roles ofthe SRC is to represent registrars on aplethora of committees (at least 18) andto respond to the numerousconsultation documents that require aregistrar perspective. Fortunately, theSRC has two Deputy Chairs – SiobhanFarmer from the North West Deaneryand Ben Leaman from Yorkshire andHumber – and we divide the workloadbetween us. Each member of the SRCcommits to representing the SRC on atleast one committee, and we also havenominated leads to develop actionplans for the three priority areas we willbe working on over the following 12months:n ensuring the future of a multidisciplinaryworkforcen ensuring better linkage between theFPH work programme and the work ofthe SRCn ensuring suitability of traininglocations – including the promotion ofregistrars to local authorities.More than enough to be going onwith. Handily, the work of the SRC alsocontributes to some of the moredifficult-to-achieve learning outcomes!So, like cycling, it’s clear to me thatthe benefits far outweigh the risks, evenif at times it can be a little painful.Rob HowardChairFPH Specialty Registrars CommitteeLettersI thought you made a good job of thePublic Health Today issue on men’s health.I can see a fair bit of effort went in topreparing it. I was intrigued to note howmany of the contributions were written bywomen. This I guess is in keeping with thefact that, in general, men do not takemuch interest in their own health.It was a relief to see that men’s healthissues were recognised as going wellbeyond the usual focus on testicular cancerand prostate cancer which, of course,make up only a small part of the picture.I was, however, concerned to read thecomment by Alan Maryon-Davis whoreferred to “the challenge of engagingmen in testicular self examination”. Thereis, in fact, not a shred of evidence thatritualistic testicular self examination isbeneficial, and it may well be harmful bycausing anxiety (the ‘worried well’syndrome) and by the identification ofminor abnormalities (or variations fromnormal) which waste health service timeand effort.The same issues have, of course, arisenin relation to ritualistic breast selfexamination which is not encouragedby the national screening programme.Rather, we have the concept of ‘breastawareness’ which was first put forwardand developed by the late Dr JoanAustoker. This concept encourages womento be aware of what is normal for theirbreasts when bathing, showering etc butwithout going through some regularritualistic anxiety-provoking procedure.By the same token, men should beencouraged to develop ‘testicularawareness’ rather than followingritualistic self examination.Martin VesseyEmeritus Professor of Public HealthOxford UniversityEvery year, people get hot under the collarabout the few per cent (6.4% this year)fewer boys who get A*-C GCSEs. DebbieWeekes-Bernard did so in the Sept 2012issue of Public Health Today. I’m notsurprised by journalists and politiciansdoing this, but I do find it surprising thatpublic health professionals (or peoplewriting for them) make this point and missthe far more important one.Thirty-nine per cent of girls and 45.4%of boys do not achieve this level ofeducational qualification. While it will neverbe 100% who are able to achieve this,should we not be focusing on the largeproportion of boys and girls whoshould/could but do not, rather than onthe relatively small difference between girlsand boys?Jennifer MindellClinical senior lecturerHealth and Social Surveys ResearchGroupResearch Department of Epidemiologyand Public HealthUniversity College LondonInternationalcommitteeupdateTHERE are many ‘international’ activities inwhich FPH could be involved and whichwould draw on the extensive public healthknowledge and skill that we have in theUK. But, because of limited resources, weneed to be clear about which activitiesrelate to the core work of FPH and onwhich it should lead, and which might bebetter led by others, supported by FPH.Over the past six months, the InternationalCommittee (IC) has considered the uniquerole of FPH and identified two key areas ofwork: supporting FPH overseas membersand contributing to standards through thedevelopment of competencies and training.Current initiatives include:n FPH International Network Group – theING is being reinvigorated to form avibrant community for discussion andinformation-sharing on international publichealth issues and for disseminatinginformation on job opportunities, trainingplacements, projects etc. The group is opento all FPH members and will provide avaluable forum for the development oflinks and for closer engagement with thework of the IC. If you are not already amember, you can sign up athttp://new.fph-groups.org.uk/.n Global health in the public healthcurriculum – the IC will be working withthe Education Committee on the curriculumreview. It is keen to see a small number ofcore learning outcomes in global healthincluded within the curriculum.n Sudan and South Sudan – FPH hasmemoranda of understanding (MOU) withSudan and the Ministry of Health in SouthSudan. It will be working with bothcountries on the development of trainingand standards.n West African College of Physicians –discussions are ongoing with WACP onpossible further work.n Development of standards – the IC is toundertake a review of other countries withwhich FPH might engage in the future onthe development of standards. There iscurrently widespread debate across Asia ontraining in public health, which mightprovide an opportunity for FPH engagementin the region. The IC has recently receiveddirect approaches from the Chapter ofPublic Health and Occupational MedicinePhysicians, Academy of Medicine,Singapore (with which an MOU isproposed), the Public Health Africa Groupand the Malawi Public Health Forum.Potential areas of collaboration are to beexplored. The IC will also be looking tosupport workforce initiatives in Europe.n Partnership working - the IC is keen toengage in partnership working. It is amember of the International Forum of theUK Academy of Medical Royal Collegesand the European Public Health Association.It also has close links with the UK HealthProtection Agency and the UK Departmentfor International Development, both ofwhich are represented on the committee.Finally, and most importantly, the IC iskeen to engage with FPH members and toharness the extensive experience andinterest that members have in global publichealth. We would welcome yourinvolvement through the InternationalNetwork Group or you can contact thecommittee directly via Lauren Ince(laureni@fph.org.uk), secretary to the IC.Pat TroopChairFPH International CommitteeIn memoriamDavid Morrell FFPH1929 – 2012PROFESSOR David Morrell, who died inMarch, was a pioneer of modern generalpractice training and the first academic GPto become President of the BMA.In 1962, after five years as a GP inHertfordshire, Morrell joined the world’sfirst university department of generalpractice, based in modest premises in WestRichmond Street, Edinburgh, combiningnormal clinical work on the ground floorwith teaching and research upstairs. Fiveyears later he transferred this model toKennington, south London, as adepartment of St Thomas’s HospitalMedical School, becoming WolfsonProfessor in 1974.He developed a close relationship withthe Department of Public Health Medicine,and his team were greatly aided by soundadvice on epidemiology, statistics andresearch methodology. His particularinterest was in factors influencing demandfor primary care and the ways in whichpatients responded to minor illnesses.David Morrell pioneered theundergraduate teaching of general practicewith experiential modules involving a livelymix of seminars, practice consultations andhome visits. He set up London’s firstvocational training scheme in generalpractice and co-founded the world’s firstMasters’ course in primary care. He wasawarded the OBE in 1982 and becameBMA President on his ‘retirement’ in 1994.Peter Ambrose1933 – 2012PROFESSOR Peter Ambrose, a radicalacademic who pioneered social housingand campaigned tirelessly against cuts inhousing benefits, died in August at the ageof 79.Born in south-east London, he leftschool at 16, working as a bank clerkbefore doing National Service in RAFCoastal Command. He then enteredacademia: at Kings College London, McGillUniversity Montreal and, in 1965, alectureship in geography at the Universityof Sussex. His great interest was urbanstudies, particularly the interplay of land,property, housing and finance on socialjustice and inequalities. In 1974 hisinspirational book The Quiet Revolutiongained him widespread recognition as aradical thinker and activist whose mainfocus was on real people in real places.Peter Ambrose retired from Sussex in1998, but was quickly appointed visitingprofessor of housing studies at BrightonUniversity and advisor to the Zacchaeus2000 Trust. His most recent researchlooked at the links between poor housingand poor health, and the impact of highhousing costs on poverty and debt. Suchwas his dedication and commitment that,despite being laid low with cancer, hefinished drafting the Pro-Housing Alliancesubmission to the ParliamentaryCommission on Banking Standards justdays before he died.DeceasedmembersThe following members havealso passed away:Dr William Lawrence FFPHDr Jeanette Morrison FFPHDr John Power FFPHProfessor William Ross FFPH20 PUBLIC HEALTH TODAYDECEMBER 2012 21

ENDNOTESNOTICEBOARDPublic healthtraining coursesTHE first FPH training course was run inBirmingham on 23 November 2012. This isa new stream of work for us, but in linewith our overall objective of promotinghigh standards of public health practice.The course, Influencing Skills for LocalAuthorities, attracted participants fromCroydon to Cumbria and everywhere inbetween. The evaluation was very positive,helped by powerful input from Stokecouncillor Gwen Hassall and SandwellDirector of Public Health and FPH VicePresident for Policy John Middleton. WePolicy updateConsultation responsesSince the last edition of Public Health Today,the FPH policy team, with the valuableinput of committee members, has maderesponses to a variety of consultations,including on the NHS CommissioningBoard Mandate, on Joint Strategic NeedsAssessment and Joint Health and WellbeingStrategy guidance, Local Authority HealthScrutiny, early access to new medicines,the future role of English local authoritiesin health issues, and the Health SelectCommittee Inquiry into the Role of NICE.FPH is in the process of producing itsresponse to the current NICE consultationon approaches to tobacco-harm reductionsmoking and is preparing to respond to theforthcoming Department of Health (DH)consultations on alcohol minimum unitpricing and licensing. You can read FPH’sconsultation responses on the FPH websiteat ‘Policy and publications/Consultations’.Update on front-of-pack nutritionlabellingFPH has welcomed DH’s announcement ofplan to repeat this course in 2013 at othervenues.We are also developing another suite ofcourses to help clinical commissioninggroups (CCGs) and commissioning supportunits do their jobs well. Commissioning –Traps and Tips is a series of four one-daycourses in February 2013. The day will besplit into two sections with the morningconcentrating on how to writecommissioning policies and the afternoonon how to run individual funding reviews.The course is aimed at new members ofCCGs, including GPs, but public healthstaff are welcome to send complete teams.The dates and venues of the courses are:n Wednesday 6 February – The Studio,Manchestern Tuesday 12 February – Armada HouseConference and Events, Bristoln Thursday 14 February – tbc, Londonn Thursday 21 February – The Studio,BirminghamEach course will be led by the FPH VicePresident for Standards, Ed Jessop, and runfrom 9.30am to 4.30pm.Numbers are limited, so registration willbe on a first-come-first-served basis.Further information, including a bookingform, can be found on the FPH website atwww.fph.org.uk or by contacting KarenGoodwin, FPH Events Officer, atkarengoodwin@fph.org.uka new, consistent front-of-pack nutritionlabelling system, which is excellent newsfor everyone’s health. It is the result of along campaign by FPH and otherorganisations to make it easier for peopleto make healthy choices about the foodthey buy. These personal decisions aboutwhat we eat contribute to the overallproblem of obesity, which costs the NHSaround £4 billon each year to treat.The detail of the scheme will be crucial,and the criteria for traffic-light labelling willneed to be robust. We await theimplementation of the scheme with greatinterest and hope that all foodmanufacturers see the benefits and take itup.FPH supports findings of Hospitalson the Edge reportFPH supports many of the conclusionsand recommendations of the Royal Collegeof Physician’s report, Hospitals on theEdge. We recognise the considerablepressures on acute services and very muchshare the RCP’s concerns about the currentstate of hospitals. The provision of hospitalcare is a whole-system problem whichneeds to fully address problems of socialcare and primary care to better meetpeople’s needs, particularly those of olderpatients.FPH AnnualConferenceTHE 2013 FPH Annual Conference will beheld at the University of Warwick, Coventryon Wednesday 3 July. Warwick hasexcellent facilities, affordableaccommodation, free parking and goodtransport links. We will host the FPH AnnualDinner and Awards Ceremony on theevening before the conference, Tuesday 2July, also at the University of Warwick.Contact detailsIF YOU have changed contact details –home or employer – and haven’t let FPHknow, please contact us atmembership@fph.org.uk to make sure youget your FPH communications and benefitsin good time. You can also update yourdetails via the online members’ area athttp://tinyurl.com/7c6wfxkChristmasopening timesThe FPH offices will close at 5pm on Friday21 December 2012 and will re-open at9am on Tuesday 2 January 2013.Clinical commissioning groups will needthe expertise of public health professionals,which is why it is essential to have enoughpublic health people with the right skills inthe right places. In other words, we mustensure that public health expertise remainsat the heart of service planning anddelivery, and not forget how prevention isfar better than cure.FPH to respond to news of foodandbeverage-industry funding ofthe Pan American HealthOrganizationWith news that the World HealthOrganization’s (WHO) regional office, thePan American Health Organisation, is forthe first time accepting funding from foodandbeverage-industry partners includingCoca Cola, Nestle and Unilever, FPH is tomake a strong response against thisdevelopment, which runs counter to theWHO’s worldwide policies and represents aclear conflict of interest.Get involvedWe are always keen to work with memberson policy issues. If you would like to workwith FPH, please get in touch. At present,we are particularly keen for mediaspokespeople. To find out more, pleasecontact policy@fph.co.ukWelcome to new FPH membersWe would like to congratulate and welcome the following new members who wereadmitted to FPH between August 2012 and November 2012FellowsRoxana AlexandrescuJohn DunbarSusan ForsterThomas HallBharathy KumaravelDavid McCoyBrendan O’BrienJulie ParkesEryl PowellThara RajLucinda SaundersIngrid WolfeMembersGabriel AgboadoLaura AsherRosalind BlackwoodAdam BriggsDuncan CooperCatherine CoyleRoberto DeBonoOrla DunnKirsty Anne HewittMarjorie JohnstonSuzanne MeredithMay MoonanJeremiah NgondiSarah PayneAmy PotterCharlotte SimpsonEva Van VelzenFPH elections2012-2013PresidentWe are delighted to announce the electionof Professor John Ashton as FPH President.He will take up office at the AGM in thesummer of 2013. The full election resultscan be found at http://tinyurl.com/7c6wfxkVice President for PolicyBallot papers for the election of a VicePresident for Policy were due to be sentout by post to all FPH voting members on12 December. The ballot closing date is 23January 2013. Please contact Lauren Ince(laureni@fph.org.uk/0207 935 0243) if youhave not received your ballot paper. Pleasenote that we are not allowed to count anyballots returned after the closing date.New diplomate membersShade AgboolaTazeem Bhatia TheussGillian BrennerHelen CruickshankLucy Douglas-PannettAbdel ElhassanJonathan HobdayShannon KatiyoSoili LarkinIain LittleJames Lopez BernalJohn Mair-JenkinsVictoria MatthewsBruce McKenzieIngrid SladeEmily StevensonSpecialty Registrar membersGillian ArmstrongAndrea ClementGavin CobbJoanne DarkeEmma FletcherJohn FordMichael FordeMary HallChristopher JohnsonStuart KeebleKelly MackenziePetra MatulkovaMartine UsdinEmily Van de VenterRegistrarNominations for the election of a Registraropen on 17 December 2012 and will closeon 24 January 2013. Details of the postcan be found athttp://tinyurl.com/7c6wfxk*Local Board MembersNominations open on 14 January and closeon 15 February 2013 for the election ofLocal Board Members for the EastMidlands and the North West.*General Board MembersNominations for the election of threeGeneral Board Members open on 4February and close on 7 March 2013.** Nomination papers for all posts will beavailable on the FPH online members’ area(http://tinyurl.com/7c6wfxk) from the dateon which nominations open. They are alsoavailable from carolinewren@fph.org.uk. Afull election timetable can be found on theonline members’ area.New publichealthspecialistsCongratulations to the following onachieving public health specialtyregistration:UK PUBLIC HEALTH REGISTERTraining and examination routeThomas HallJessica SheringhamGeneralist portfolio routeGlenda AugustineJane BeenstockAmy BirdAnna BrydenSian DaviesTim FieldingJulie O'BoyleLinda PrickettDefined specialist portfolio routeTeresa Salami-AdetiGENERAL MEDICAL COUNCIL REGISTERJennifer ChampionJohn DunbarKatharine HaireVanessa SalibaIngrid WolfeMinister’s visitFPH PRESIDENT Lindsey Davies met with DrAhmed Al Sa’eedi, the Health Minister forOman, in October and was delighted tohear of the efforts made in public health inthe region by our members.Professor Davies said: “Oman’s five-yearhealth plan is an important framework forthe development of the country's healthinfrastructure. We will continue to adviseand help where we can.”22 PUBLIC HEALTH TODAYDECEMBER 2012 23