547329 research-article2014

RSH0010.1177/1757913914547329Perspectives in Public Health

Guest Editorial

Public Health England 2013 Annual Conference: highlights and looking ahead Overview - Anthony Kessel and Emmeline Buckley The historian Dorothy Porter has described public health as collective action in relation to the health of populations. This definition de-emphasizes the contributions of professionals or particular interest groups, and instead stresses the essential collaborative nature of public health work. The sentiment of Porter’s definition was at the heart of the 2013 Public Health England (PHE) Annual Conference. Held on 10 - 11th September 2013, this was the inaugural conference for PHE, the new national public health organization. As such, the meeting was oriented towards bringing together a range of partners and stakeholders from the diverse public health landscape of this country, and providing a forum to galvanize the new public health system. Over 1300 delegates attended the conference, including representatives from PHE, local authorities, NHS, universities, the voluntary sector, government departments and the many other organizations and groups that work collectively in relation to population and community health. Around 30 delegates from over 15 countries overseas were warmly welcomed. Over the two days the programme included over 40 sessions covering areas such as sexual health, social determinants, population healthcare, global health, transport and local government, unemployment and health inequalities, emerging diseases, the national vaccination programme, mental health and antimicrobial resistance. There were also more than 300 posters on display. In this edition of Perspectives we have the opportunity to present a series of brief snapshots of the days’ events. The articles cover a wide range of issues including: the progress of an

intervention to reduce teenage pregnancy in Hull; developing capacity in the field epidemiology workforce; and assessing environmental chemical exposures. Also included is the write-up of an award-winning poster, describing a partnership approach to preventing excess winter deaths in Lancashire.3 These papers go some way towards showcasing the breadth of expertise on display at the conference. Further examples of the work presented at the PHE conference can be found in the Royal Society for Public Health’s sister journal, Public Health. Overall, the conference managed to display the strength of talent amongst those involved in public health in this country, and also exemplified the immense importance of collaboration with partners across sectors in the UK and internationally. The conference set a benchmark in terms of scientific quality as well as practical significance for public health delivery, and has provided a platform on which the second PHE conference in 2014 can build.

Improving the health and wellbeing of adolescents: what can we learn from Europe and apply locally? - Ann Hoskins and Fiona Brooks There are 7.4 million adolescents aged 10-19 living in the UK, representing 12% of the total UK population - the same proportion as the over-70s age group.1 Although considerable gains over the latter half the twentieth century have been made in terms of reductions in infant mortality and increased life expectancy for older people, adolescents have experienced relatively less improvement in their health and well-being than other age groups.2 The second decade of life marks an important phase in the life course; not only do young people have to traverse

important physical and developmental milestones, but they also gain greater autonomy and control over decisionmaking relating to health and health behaviours. Health-related behaviours established in adolescence, such as tobacco use, alcohol consumption and dietary habits and physical activity, may influence future health, with implications for long term conditions, health complaints and emotional wellbeing and mental health. The current generation of children entering adolescence and early adulthood also face considerable new challenges, including increasing academic expectations and uncertainties about future employment as well as changing social relationships (increasingly influenced by the presence of social media and the virtual world). In order to develop approaches that support young people to deal with the many challenges they face during this critical life stage, it is important that an improved evidence base is developed to address what makes young people thrive and in what context. This evidence base should be underpinned by the principles of positive youth development and assetbased approaches to understanding the factors that are protective of health and wellbeing. The session on adolescent health at the PHE 2013 Annual Conference brought together presentations on international, national and local work to provide a picture of the areas that need greater attention, and real world examples of local action currently being taken to tackle some of these challenges. The session commenced with a presentation by Fiona Brooks (University of Hertfordshire) reporting on the World Health Organization (WHO) Health Behaviour in School-Aged Children Study (HBSC). This study aims to provide new insights into adolescent health behaviours, health, and lifestyles

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Guest Editorial

in their social context, and has been undertaken every four years since 1983. The 2010 survey focused on the demographic and social influences on the health of people (aged 11, 13 and 15 years) in 43 countries. Statistical analysis identified meaningful differences in the prevalence of health and social indicators by gender, age and levels of family affluence. Comparisons across Europe and USA were interesting: smoking in England was in the third lowest ranking, but girls’ smoking needs to be reduced to reach the lowest rates. Some improvement was also identified in the levels of regular drunkenness, but England still ranks high compared with other countries. Overall, the presentation highlighted that prevalence rates have decreased across a number of key risk behaviours. However, less progress has been made over the last decade in terms of positive health behaviours, such as physical activity and healthy eating. Differences between countries also highlighted how adolescent health behaviours can be influenced through policy initiatives. Determinants of wellbeing and protective health factors were also addressed in the presentation by Cath Fenton (Hertfordshire University/Enfield Council). This presentation outlined work with young people exploring a health assets-based approach to health promotion. Qualitative analysis of data from focus groups and individual interviews with young people captured their views on the health assets considered most significant from their perspective. Coupled with further analysis of the results from the HBSC study, a model to guide public health policy and health promotion practice was outlined. Young people identified health assets related to three main domains: the first was concerned with the need to have access to safe environments and relationships (be that in the home, school or community). The second domain related to young people’s perceived need for constructive relationships and good support from the surrounding adults in

their lives. The third domain related to their need to have positive internal attributes, such as self-esteem. The session also examined approaches being adopted in local areas to address key health issues faced by young people. These ranged from the implementation of a national framework and evidence-based practice to tackle teenage pregnancy, to a project confronting communication problems in adolescents. The Hull experience, presented by Gill Teasdale (Hull City Council),4 outlined how sustained multi-sectoral leadership and attention can produce desired outcomes; in this instance, a reduction of over 50% in teenage pregnancy rates between 2001 and 2013. The whole-system approach ensured action was taken at every level, from workforce training, improved PHSE delivery in schools, enhanced sexual health services (including offering young people a choice of contraception) to specific work focused on boys. The importance of understanding local populations and taking a universal approach, as well taking action to target the most challenged areas/ schools, was highlighted. The paper by Geoff Lindsay (Warwick University), Emma Pagnamenta and Margaret Wiredu (Royal College of Speech and Language Therapists) highlighted the importance of speech, language and communication needs (SLCN) as a risk factor for poor outcomes among young people. The Walsall Pathfinder Project focused on SLCN, and had a measureable impact of the health and wellbeing of adolescents. The presentation outlined how the Walsall project worked with twelve schools, identifying and training teachers. Initial outcomes have shown a reduction in referral to specialist services, improved liaison with a virtual schools service and an overall improvement in understanding of the issue in the participating schools. The young people involved also reported improvements in making friends, joining

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in classroom activities and asking for help. The conference presentation highlighted the important message that it is never too late to improve speech and language in communication. (BCRP website CEDAR, University of Warwick http://www2.warwick.ac.uk/ bettercommunication. What works for SCLN? And communication observation tool http://www. thecommunicationtrust.org.uk/). Overall, the session provided an example of the value of bringing a multi-professional and multi-sectorial approach to addressing the public health needs of young people. The session provided examples of what can be achieved at the local and national levels through innovative thinking to impact positively on adolescent health and well-being. The value of learning from international data and policy analysis in order to guide future innovations and public health actions was also demonstrated. The focus on adolescents is important and PHE will continue to show leadership for this age group.

Developing the future field epidemiology workforce - Janet McCulloch, Isabel Oliver Epidemiology is the study of the distribution and determinants of healthrelated states or events. It is a science that underpins public health policy and practice and is a core competence for public health professionals. Field epidemiology applies epidemiological methods to unexpected health problems, such as outbreaks of infection that require rapid investigation, descriptive analysis and hypotheses generation that can be tested with analytical studies. A review of epidemiology by one of the PHE’s predecessor organizations, the Health Protection Agency, identified a need to develop epidemiology and epidemiological skills across the health protection workforce. This review resulted in the establishment of the PHE’s Field Epidemiology Service (FES), a service

Guest Editorial

that is nationally coordinated but geographically dispersed, and provides high quality, responsive and flexible field epidemiological investigations across PHE. The session at the PHE conference focussed on recent initiatives to develop the field epidemiology workforce in order to increase skills and capacity within PHE and the wider public health workforce. Iro Evlampidou described a review of field epidemiology capacity and skills undertaken within the FES with the aim of mapping and quantifying competence across the service and identifying development needs. Core competencies were derived from existing competency frameworks. The survey found extensive skills across the FES but some higher level skills were concentrated amongst consultants and there were opportunities to strengthen the skills of field epidemiology scientists. Mary Thompson described how the field epidemiology competence assessment tool was adapted to assess the knowledge and skills of Public Health Specialty Registrars (SpRs) in the third phase of their training. It is important that the programme equips registrars with the epidemiology skills needed for their future roles, including as consultant epidemiologists. SpRs scored well in the synthesis, analysis and interpretation of surveillance data, but less well in technical competencies and statistical analyses, including undertaking analytical studies from start to finish. Training needs arising from this survey have been identified and can inform discussions with the Faculty of Public Health (FPH) as part of the curriculum review. Janet McCulloch described how, in response to the review of capacity and skills, the FES plans to develop careers for field epidemiology scientists.5 This work is being taken forward as part of the wider FES workforce planning with the aim of outlining potential career pathways. It is important that developments in FES workforce planning are consistent with other plans, such as the Public Health Workforce Strategy, which identified

the need to develop careers for healthcare scientists and how these relate to the Modernising Scientific Careers (MSC) programme. MSC is led by Health Education England (HEE) and defines education and training programmes for non-medical healthcare scientists. HEE is engaging with PHE to explore the applicability of MSC to PHE scientists and is considering including epidemiology scientists as a specialist group. Sam Bracebridge gave an update on the UK Field Epidemiology Training Programme (FETP), which was launched in 2011. The first cohort of Fellows was awarded with diplomas at the conference and Sam presented lessons learnt through experience with this cohort. Five strands were identified: curriculum development involving a cross-divisional planning group to meet current and future needs; development of communities of practice; the development of supervisors; enhancing skills for supervision of Fellows; and programme evaluation, including qualitative methods for evaluation. Finally, as whole genome sequencing is playing an increasing role in public health epidemiology, epidemiologists and public health professionals need to understand the application of pathogen genomics to field investigations. Johanna Jefferies described how an e-learning package in pathogen genomics has been developed to support increased understanding in this field. The module comprises introductory tutorials and case studies related to outbreaks of meningococcal disease and tuberculosis. It will be freely available and it is hoped that further case studies will be added and the scope of the module will be widened to include human public health genomics. In conclusion, epidemiology is a science that underpins public health practice and is a core competence for all public health professionals. We need to take advantage of opportunities to strengthen epidemiology and the field epidemiology workforce. Current initiatives, such as the FETP, MSC and

the review of the FPH curriculum must be harnessed to meet our future service needs, including the application of new technologies such as whole genome sequencing.

Environmental hazards – outdoors - Naima Bradley The ‘environmental hazards – outdoors’ session focussed on the estimation of the burden of disease from key environmental chemicals, and the complex issues facing scientists assessing risks from environmental chemicals and radiation. Current levels of outdoor particulate air pollution have a considerable impact on public health. The Department of Health’s Committee on the Medical Aspects of Air Pollutants, COMEAP, estimated that the burden of anthropogenic particulate matter air pollution in the UK in 2008 had an effect on mortality equivalent to 29,000 deaths at typical ages, and an associated loss of population life of 340,000 life-years. Professor Frank Kelly, Chair of COMEAP, summarized the scientific evidence for this estimation and explains how the inclusion of the ‘fraction of mortality attributable to particulate air pollution’ indicator in the Public Health Outcomes Framework can help decision-makers to prioritize action on air quality. The second presentation addressed one of the major gaps in the UK for exposure assessment to chemical hazards: the need for national protocols and a national framework on human biomonitoring.6 For the first time in the European Union (EU), two projects have tested a common approach for human biomonitoring surveys, collecting biomonitoring data and questionnaire information about environment, health and lifestyle. The distribution of biomarker levels for selected chemicals was assessed in more than 1800 mother-child pairs in 17 European countries, including the UK. In general, the EU and UK exposures were found to be well below the current health-based guidance values and the biomarker levels

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Guest Editorial

in children were highly correlated with the levels in their mothers. The feasibility of an EU-harmonized approach has been demonstrated and using the lessons learned, policy-makers can now start to envisage a European survey programme. The third speaker demonstrated the multi-agency efforts required to assess the health risks from discrete radioactive objects found in several outdoor environments. The example focussed on the public health implications of radioactive objects found during beach monitoring in the vicinity of the Sellafield site in Cumbria. Finally, the potential risks of human exposure resulting from the radioactive release from the Tokyo Electric Power Company’s Fukushima Daiichi nuclear power plant after the earthquake and tsunami in Japan on 11th March 2011 were presented. PHE contributed to the

WHO’s risk assessment applied to the general population groups in Fukushima prefecture, neighbouring prefectures, the rest of Japan, neighbouring countries and the rest of the world. The results showed that the lifetime risks for some cancers may be somewhat elevated above baseline rates in certain age and sex groups in the areas most affected. For the less affected areas of Fukushima Prefecture, the rest of Japan and the rest of world, the excess cancer incidence risks for all the cancer sites under consideration are estimated to be much lower than the expected natural variation in background cancer rates. Professor Anthony Kessel Miss Emmeline Buckley Dr Ann Hoskins Dr Sam Bracebridge Dr Isabel Oliver

Dr Naima Bradley Public Health England Professor Fiona Brooks University of Hertfordshire

References 1. Hagell A, Coleman J, Brooks F. Key Data on Adolescence 2013: 8th Edition. 2013. London: Association for Young People’s Health (AYPH). 2. Viner R, Barker M. Young people’s health: the need for action. BMJ 2005: 330, 901-903. 3. MacDonald D. Affordable Warmth Interventions in North Lancashire. Perspectives in Public Health 2014: 134(5) 4. Teasdale G. Achieving Success in Reducing Teenage Pregnancy in Hull. Perspectives in Public Health 2014: 134(5) 5. McCulloch J, Bracebridge S, Thompson M, van de Venter E, Oliver I. Developing capacity in field epidemiology in England. Perspectives in Public Health 2014: 134(5) 6. Exley K, Aerts D, Biot P, Casteleyn L, KolossaGehring M, Schwedler G et al. Human biomonitoring to assess environmental chemical exposures: work towards a UK framework. Perspectives in Public Health 2014: 134(5)

Achieving success in reducing teenage pregnancy in Hull There are disproportionately poor outcomes for those who become teenage parents. Gail Teasdale, Integrated Services Manager for Children and Young People’s Health, Hull City Council, looks at the success of the local teenage pregnancy strategy in Hull, and how this success can be furthered in the future.

Teenage pregnancy is a complex issue with a range of contributing risk factors including poverty, low educational attainment, truancy, not being in education, employment or training (NEET), low self-esteem, early sexual activity and poor contraception use. There are disproportionately poor outcomes for those who do become teenage parents. At age 30, teenage mothers are 22% more likely to be living in poverty, 20% more likely to have no qualifications than mothers giving birth aged 24 or over and are much less likely

to be employed or living with a partner. Research and evidence-based practice has shown this issue cannot be addressed through a single intervention or service as the majority of teenage pregnancies are unplanned. Instead a consistent and co-ordinated partnership approach at a strategic and operational level across schools, health, youth services, social care and voluntary sector organisations is required to deliver improved outcomes. An early intervention and prevention approach which aims to reduce risks and build

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resilience, along with effective use of local data and performance management is vital to maximizse impact and ensure those areas/groups of young people most at risk are reached and supported. This paper aims to summarize the successful implementation of the National Teenage Pregnancy Strategy1 at a local level. It aims to inform future commissioning and policy and build on the evidence base to sustain the current downward trend, maximize impact and continue to deliver positive outcomes in a cost effective way for young people on this and other health issues.

National context The Labour Government’s Teenage Pregnancy Strategy for England1 had a national target to reduce under-18

Public Health England 2013 Annual Conference: highlights and looking ahead.

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