London Landlords – thought provoking poetry for environmental health

This is just a very quick blog to highlight a great piece of performance poetry that Rob sent me, which expresses the frustration of ‘generation rent’ in London. Deanna Rodger describes her situation, and that of many others, whilst questioning the system which has created it. We think it would make a great teaching tool as it provides a novel and engaging way of bringing the values which underpin environmental health into the classroom. We would love to get your thoughts on this, so do leave a comment if you feel drawn to.

London Landlords

Enjoy.

Caroline

Ebola: some further resources

With the UK media going into ‘yes/no’ Scottish referendum overdrive – plus a new Royal baby on the way,  of course – I’m constantly drawn deeper inside the newspapers towards articles documenting the appalling environmental health of so many on planet Earth. There are sadly so many examples to choose from, but the on-going Ebola epidemic in West Africa terrifyingly reminds us how easily disease can spread amongst populations with weak public health infrastructure and services. We mustn’t forget the millions who die each year from ‘less newsworthy’ preventable diseases like diarrhoea and malaria, but I’m glad that media attention is beginning to explore the complexities of the Ebola outbreak beyond the case of British nurse Will Pooley.

Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine (LSHTM), co-discovered the virus and has produced a fascinating podcast on his early work and reflections on the ‘perfect storm’ of the latest outbreak via the LSHTM blog: http://www.lshtm.ac.uk/newsevents/news/2014/ebola_response.html

Piot and LSHTM colleague Adam Kucharski have also written an excellent editorial on the challenges of containing the West Africa outbreak, many concerning the work of EHPs directly, in the latest edition of the journal Eurosurveillance which can currently be downloaded for free via:

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20899

The journal Waterlines remains an excellent resource for EHPs working in developing countries. In response to the recent outbreak Marco Visser’s Medecins sans Frontiers (MSF) guidance on Ebola response in the Republic of Congo in 2005 is currently available for free. The article includes guidance on setting up and managing isolation centres, the principles of which will be familiar to all EHPs, and is available via:

http://practicalaction.metapress.com/content/y188131344150206/fulltext.pdf

Lastly, the magnitude of the current outbreak is unprecedented and Piot, Kucharski and others are urgently calling for proportionate local, national and international responses. I’m therefore reminded of MSF’s July 2014 report: Where is everyone? Responding to emergencies in the most difficult places (free via: http://www.msf.org.uk/sites/uk/files/msf-whereiseveryone_-def-lr_-_july.pdf). This asks important and uncomfortable questions of all levels of the international humanitarian aid system, including shortfalls in environmental health responses.

I hope these resources are of interest and my thoughts are with the peoples of West Africa and all those working to help them.

With best wishes, Rob.

 

Contemplative practice in Environmental Health education

I have recently returned from a workshop in New York which explored the use of contemplative practice in higher education. Specifically how lecturers could use contemplative techniques such as meditation, yoga, lectio divina (a process of reading that incorporates deep reflection and contemplation) and deep listening in teaching. The main reason for incorporating contemplative practice is to bring students into a much deeper relationship with the knowledge that they are acquiring by turning their gaze inward, towards their own experience. Barbezat and Bush state “We want to create the opportunity for our students to engage with material so that they recognise and apply its relevance to their own lives, to feel deeply and experience themselves within their education” (2014 p. 3).

One of the words that came up frequently during the weekend was ‘meaning’ and how contemplative practice can support students in discovering and developing their own sense of meaning through exploration of their experience. A sense of meaning not only with regards to what they are learning, but also with regards to who they are and who they want to be. I was struck by how little attention I have paid to the meaning that students give to their learning and yet it is that, probably quite subconsciously, that is driving their commitment to the courses I teach.

I do not expect lecture theatres to be suddenly transformed into yoga studios or that every lecturer should incorporate meditation in their classes. In fact this could be unsafe if the teacher does not have a history of contemplative practice themselves. However, we can all attend to meaning. We can take more time to find out about what is motivating the students we teach, what values and ambitions drive their commitment to environmental health. Then we need to find ways to teach which pay attention to this meaning, allow it to develop, flourish and find a voice. As environmental health goes through something of an ‘identity crisis’ as a profession, giving students the opportunity to explore who they are and what their learning means to them, we provide the opportunity for the often highly altruistic motivations of students to come to the fore. By making students more conscious of what drives them we help them to live lives which express the values they hold and we prepare them for entry into a challenging profession that engages with some of society’s most pressing problems (see Jill’s blog on inequality below).

Best wishes
Caroline

References
Barbezat, D.P. and Bush, M. 2014. Contemplative Practices in Higher Education: Powerful Methods to Transform Teaching and Learning. San Francisco: John Wiley & Sons.

For more info
Association for Contemplative Mind in Society: http://www.contemplativemind.org/

Palmer, P.J. and Scribner, M. 2010. The Heart of Higher Education: A Call to Renewal. San Francisco: Jossey-Bass.

Daniel Barbezat and Mirabai Bush on youtube: https://www.youtube.com/watch?v=BAZWLtoi7gw

The Spirit Level

Many of you will already be familiar with the book The Spirit Level: Why Equality is Better for Everyone by Richard Wilkinson and Kate Pickett (2010). In a nutshell, the book argues that most things in society are not just a result of wealth, but of (in)equality and that new ways of thinking for positive solutions are necessary. You may have already read the book. Indeed, it may have informed your thinking and interventions in environmental health. If you haven’t read it, I would urge you to do so.

More recently, a documentary based on the book is being made to explore the true costs of inequality and its meaning in real lives. It features some names very familiar to us, including Richard Wilkinson and Sir Michael Marmot. The trailer is available here.

Environmental health can contribute hugely to tackling inequality and we need to ensure that we demonstrate why and how in effectively directed ways.

Best wishes, Jill

Sir Michael Marmot on Desert Island Discs

On Sunday 6th July Sir Michael Marmot was invited onto Desert Island discs to talk about his research and the impact of his work.  It provides a really useful summary of his areas of work to date from the Whitehall studies and the recognition of High Demand/Low Control job roles and their impact on stress and negative health outcomes.  Sir Michael has for years pointed to the evidence that it is not senior managers who have the worst health outcomes but those in roles where they have little control over their tasks or what is expected of them, with little reward or recognition of their role.  As public health practitioners with a role in work place well being could this be something that we should be offering leaderhip in? At a time where occupational health and safety is seen as a burden to business by the government and restrictions in place on proactive visits maybe operating under the banner of public health rather than regulatory services is a pathway to the same goal of worker protection (see Rory O’Neil’s Hazards magazine  Nos 122. 123 and 124….more in another blog for all the evidence that there is no evidence to support deregulation).

Sir Michael also talks about his work on the social gradient and the role of early childhood development in setting up your whole life development.  You can find all the reports at http://www.instituteofhealthequity.org/ and this can provide a wealth of evidence for the role of environmental health in reducing health inequalities particularly in relation to housing standards.    There is an array of evidence surrounding the negative impacts of high levels of inequality (see Wilkinson and Picketts range of work and also the Equality Trust http://www.equalitytrust.org.uk/resources/our-publications which again can provide evidence for environmental health to support interventions).  Kate Pickett is Professor of Epidemiology at York but focuses on social determinants and Richard Wilkinson is Emeritus Professor of Social Epidemiology at Nottingham.

To listen to the programme go to http://www.bbc.co.uk/radio/player/b048j630.   Listening to something close to my heart on what is a regular spot on radio 4 was a pleasant surprise

regards Alan

Out in the cold: HMOs and energy efficiency policy

Houses in Multiple Occupancy (HMOs) have long been overlooked in housing and environmental health research despite the challenges of managing this type of property. My own research has highlighted that in low income settings HMOs increasingly house vulnerable people who are unable to access other types of housing often due to affordability and inadequate provision of social housing (see Barratt et al. 2012). A new report has a highlighted how HMOs have been overlooked in policy terms too.

Lead by David Weatherall (Future Climate) and Dr Jenni Viitanen (Centre for Urban Research and Energy (CURE), Manchester University) this new research highlights that despite the vulnerability of people residing in HMOs and the poor condition of HMO stock, there is a significant gap with regard to HMOs and energy efficiency and fuel poverty policy making. Whilst other property types in the private rented sector (PRS) have to produce Energy Performance Certificates, HMOs that are let on a room-by-room basis are not required to do so. In the summary report it is noted: ‘without an EPC to act as a “trigger” at the point of rental, minimum energy efficiency standards to be applied to the rest of the private rented sector under the 2011 Energy Act will exclude HMOs that are let on a room-by-room basis’ (Future Climate and CURE 2014: 2). Furthermore, even if EPCs were made obligatory for this type of HMO it is currently unclear what process should be used to assess a property’s energy performance which is something that must also be addressed.

Additionally, the authors fear that the invisibility of HMOs within the current energy efficiency policy framework means that properties will also be overlooked with regards to possible for funding for energy efficiency improvements under ECO (Energy Company Obligation) regulations. In the full report the authors note that ‘HMOs with non-standard built forms and multiple tenants may not be prioritised for ECO funding as they are seen as too challenging – and therefore expensive – to address’ (Viitanen and Weatherall 2014: 44).

For environmental health professionals (EHP) the failure to fully incorporate HMOs into the energy efficiency and fuel poverty policy framework is a crucial oversight that constrains potential mechanisms which could potentially support EHPs to minimise risk in HMO properties, particularly those in relation to excess cold. The summary report does acknowledge that some local authorities already try and make up for this policy deficit through requiring an EPC as part of HMO license conditions however this is not widespread practice.

Overall this is an important piece of research which highlights a range of challenges that if addressed could result in improved living conditions and reduced fuel bills for HMO residents. The summary report is particularly accessible and should be read by everyone working to improve standards in HMOs. All the reports I’ve referred to can be accessed through the links in the reference list below.

I hope you find it interesting.

Best wishes

Caroline

Barratt, C., Green, G., Speed, E. and Price, P. Understanding the relationship between mental health and bedsits in a seaside town [Online]. Available at: http://www.essex.ac.uk/hhs/documents/research/clacton-bedsit-report.pdf[Accessed: 12 May 2014].

Future Climate and Centre for Urban Research. 2014. Housing in Multiple Occupancy: Energy Issues and Policy Summary Report. Available at: http://futureclimate.org.uk/wp-content/uploads/2014/07/HMO-Summary-FINAL.pdf [Accessed: 17 July 2014].

Viitanen, J. and Weatherall, D. 2014. Housing in Multiple Occupancy: Energy Issues and Policy. Available at: http://www.eagacharitabletrust.org/index.php/projects/item/houses-in-multiple-occupation-improving-policy-and-practice [Accessed: 17th July 2014].

Overcoming Environmental Health ‘invisibility’

I published a short piece in Environmental Health News yesterday, and have permission to reproduce it here for EHRNet followers. You can access the original article at http://www.ehn-online.com/news/article.aspx?id=12100

Eight lessons from the public health reforms

Over the past few years, I have found that in many areas environmental health is not well understood by our public health colleagues. Indeed, it is often ‘invisible’. Here are eight ideas from my research with EHPs and others for overcoming this ‘invisibility’.

1. Evaluate your work

Most importantly, evaluate your work as part of the day job (this does not have to be quantitatively, you can be creative with your methods) and ensure that you have the evidence to make the case for funding your service in public health terms, i.e. not by numbers of inspections, but on what your activities deliver as outcomes such as addressing fuel poverty or helping to tackle health inequalities. It seems a dangerous strategy to rely on statutory functions, and environmental health has such a lot to offer beyond these boundaries.

2. Share your findings

Share the findings of your evaluations, including interesting case studies and research projects. This will help to grow the evidence base for environmental health. Also, make use of the evidence produced by others – there is probably more than you think out there. See Dr Jill Stewart’s FREE edited ‘Effective Strategies and Interventions: environmental health and the private housing sector’ for example http://www.cieh.org/policy/default.aspx?id=46518 which is part of the Private Sector Housing Evidence Base available via MyCIEH. How about doing something similar in your area of expertise?

3. Use EHRNet

The Environmental Health Research Network (EHRNet), of which I am one of the founder members, has published an ebook ‘Evidence, research and publication: a guide for environmental health professionals’ to assist colleagues. It is available via this link to our website and currently costs 99p which goes towards our expenses. The website also has lots of other resources and a blog which will hopefully be of interest.

4. Marmot is your friend

The Marmot Review on public health is your friend – many of his objectives fit well with environmental health work and I found that almost all the Health and Wellbeing Boards I looked at had adopted them in one form or another as priorities. Linking with these priorities and promoting the role of environmental health in tackling health inequalities should help to make the case for funding your service.

5. Make friends with public health directors

Make friends with your local public health directors and consultants, especially now they are based within local authorities. They will be much more supportive if they understand what you do.

 6. Communicate with councillors

Don’t assume that the elected members representing you on Health and Wellbeing Boards know what you can offer either, especially if they are from a neighbouring authority and you have never met. Establish good two-way lines of communication with your representatives. This appears to be a particularly key issue in two-tier systems and in large unitary authorities, where functions can be ‘siloed’.

7. GPs don’t know your work

You can be fairly certain that most GPs won’t know what you do beyond food safety. There are opportunities here. When people do know and understand what you can offer, they will usually be amazed and very supportive and welcome the additional input.

8. Research is a priority

Finally, serious investment in high quality environmental health research is a priority. I know you’re thinking, she would say that, but it’s true!

Best wishes,
Surindar

 

With thanks to Dr Anna Coleman, Rob Couch and Dr Jill Stewart for their comments on this piece.

This research was carried out at the University of Manchester.