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 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 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   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


Barratt, C., Green, G., Speed, E. and Price, P. Understanding the relationship between mental health and bedsits in a seaside town [Online]. Available at:[Accessed: 12 May 2014].

Future Climate and Centre for Urban Research. 2014. Housing in Multiple Occupancy: Energy Issues and Policy Summary Report. Available at: [Accessed: 17 July 2014].

Viitanen, J. and Weatherall, D. 2014. Housing in Multiple Occupancy: Energy Issues and Policy. Available at: [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

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 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,


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.


Environmental Health: Wicked, I’n’it?

In 1973, Rittel and Witter told us that scientific bases to address social policy issues are bound to fail because some problems are “wicked” in that they are complex, multi-faceted in pluralist society, often contested as there is no right or wrong solution or answer, they are difficult to define and finding definitive and objective solutions is highly challenging.

Does this sound familiar in environmental health? I think so too! Rittel and Witter talk about modern professionals (whom we now refer to as front line practitioners, see also Rob’s blog below, Revisiting Lipsky’s street level bureaucracy, June 13th 2013 – also 1970s and US based) including social workers, housers, city planners and public health officials. We continue to have much to learn and take on board about how we respond to complex dilemmas presented and the difficult questions we need to address.

In a lengthier piece, Jordan (2011) calls for innovative and skillful change strategies to deal with these so-called wicked issues and develops a conceptual framework  to help us work through some of the challenges presented suggesting that knowledge gained can help further inform effective strategies. Both are well worth a read. It is also helpful to refer to the Australian Public Service Commission Archive which urges public services managers to reflect on wicked problems and consider new and innovative approaches to complex policy issues.

Stewart and Gritton (forthcoming 2014) grapple with some of these issues in a chapter in new book that may be of interest to those with a wider interest in the wellbeing agenda:  Knight, A., McNaught, A. and La Placa, V. (eds) (forthcoming 2014) Wellbeing: Policy and Practice, Lantern Publishing. We look at some of the complexities presented around families living in the private rented sector as well as housing for our ageing population – each complex for different reasons and with no easy solutions.

There seems huge potential here to think through and publish more about what we do with the wicked problems we tackle in environmental health. It doesn’t need a major research project or funding, just an investment of time and energy.

Any takers?

Have a good rest of Wednesday,


Jordan, T. (2011) Skilful Engagement with Wicked Issues: A Framework for Analysing the Meaning-making Structures of Societal Change Agents, Integral Review, 7 (2) 47-91.

Rittel, H. R. and Webber, M. W. (1973) Dilemmas in a General theory of Planning, Policy Sciences, 4, 155-169.

Stewart, J. and Gritton, J. (in press 2014) The Living Environment and Wellbeing: Wicked Problems, Wicked Solutions? (Chapter 6), in Knight, A., McNaught, A. and La Placa, V. (eds) Wellbeing: Policy and Practice, Lantern Publishing.


Welcome to Rio

Last Tuesday evening Ella and I were feeling quite down, in part a product of the usual hectic stuff of life (recent house move, raising baby daughter, blah, blah…) plus getting into what we call the ‘hospital zone’ ready for my yearly brain scan (a very long story, blah, blah…). By 2200 however we were feeling so much happier and stronger thanks to the BBC 2 documentary Welcome to Rio and its insights into favela life in the shadows of the stadia and luxury hotels of Rio de Janeiro.

I’m a fan of Keo Films’ Welcome to Lagos, and this first of three Rio episodes adopted a similar format by introducing the slums via three guides. The first was Rocky, a scrap trader and carrier of white goods up and down the steep steps of Cantagolo’s hills where he lives with his family. Second was Acme, an artist and creator of local Banksy like murals, but our third guide offered a very different perspective. Cue Commander Gripp, a senior police officer from a specialist unit responsible for the ‘pacification’ (sic) of the favelas. They had driven the drug dealers from Cantagolo, but the locals appeared equally wary of the heavily armed police patrols that replace them.

The narration was irritating and patronising at times, but the film provided a fascinating environmental health journey into informal settlement life including open sewers, illegal electricity connections and unplanned shack housing. Rocky and Acme were at constant risk of eviction, their homes and businesses classified as ‘illegal’ by the city authorities and rumours rife that the government sledgehammers were imminent. But both also demonstrated their expertise in responding to this turbulence. Acme joined a local action group (including University academics, hurrah!!) that organised successfully to protect his home, whilst Rocky converted the proceeds from his scrap metal store to refurbish his cargo bicycle and no doubt create new business opportunities.

Lastly, I don’t know how government environmental health works in Brazil and therefore my following opinions could be way out of line. However, I’ve worked in a few African informal settlements in the past and within the barbed wire fenced compounds of many hotels across the world. Therefore I fear that instead of working to support slum dwellers like Rocky and Acme to improve their public health, local EHPs are probably busy condemning their now ‘pacified’ homes and working hard to ensure the environmental health of all World Cup and Olympic venues will be ‘fit for purpose’! If our countries and cities can find the billions to stage one-off mega-events like this surely, as many Brazilian protesters argue, we can find similar sums to invest in our schools, hospitals and wider public health? Maybe I’m being naïve, but as I watch the next episode tonight I will be asking myself what kind of urban environmental health we want?

By Rob Couch

For UK residents, past episodes can be watched (for a limited period) via:

A few useful resources for further information:

Environment and Urbanization (an open access and peer-reviewed journal):

Shack/Slum Dwellers International:

The Centre for Housing Rights and Evictions:

Inside Housing

The latest edition of Inside Housing published a piece on the London Borough of Newham’s approach to Licencing private housing sector as part of its strategy to tackle poor housing conditions. The article demonstrates some of the difficulties and challenges faced not just by private sector tenants faced with high rents, insecure tenancies and poor conditions, but also the complexities presented to environmental health services in seeking to address housing standards and deliver effective services that positively affect health in some of our most vulnerable communities.

Paul Mishkin, Senior EHO featured in this article, is a great example of a busy practitioner who has also been able to factor research and publication into his work. For example, he contributed to Effective Housing Strategies and Interventions with colleague Russell Moffatt in relation to Newham’s initiatives.

We know much about the links between housing and health; what we need is more on what we are already – and also can – effectively achieve in promoting health outcomes. This is an area ripe for further research and publication in environmental health and much is already happening on a day to day basis.