December Edition â Happiness - UK Faculty of Public Health

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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
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December Edition â Happiness - UK Faculty of Public Health