This brief blog was prompted by yesterday’s request from Graham Jukes, Chief Exec of the UK Chartered Institute of Environmental Health, for EHPs to participate in the response to the Ebola outbreak. See:
Detail on the UK response to the outbreak is being updated constantly, but the UK Government’s website contains some useful resources including Public Health England’s guide for humanitarian aid workers considering travelling to the Ebola affected countries of West Africa. See:
The site also includes a link to the NGO Save the Children’s jobs page and the Ebola WASH (i.e. environmental health) related posts available:
The recent BBC article by Save the Children’s WASH advisor Mark Buttle provides a good summary of what this post would involve:
Lastly, I have very limited humanitarian aid experience (2 very traumatic weeks!!) but I’ve spent three years working in WASH and wider environmental health in three African countries and I would urge any potential UK EHP volunteers to think very, very carefully before putting their names forward.
I’m also a water & sanitation alumnus of WEDC, Loughborough University like Mark Buttle (http://wedc.lboro.ac.uk) and have completed three RedR EH humanitarian training courses (http://www.redr.org.uk/), but I can’t reinforce enough Graham Jukes’s comment that any UK EHP volunteer would need much training (and ideally lots of developing country EH experience) before embarking on this complex, important and potentially dangerous work. Mark Buttle’s article above summarises the roller coaster of humanitarian work in this outbreak very well, but I also recommend the 2006 book Emergency Sex (and other desperate measures) by Postlewait (et al) Ebury Press as compulsory reading for all those considering humanitarian work (please don’t be put off by the title)!
I hope these resources are of interest and my thoughts remain with all those affected by the outbreak.
With best wishes, Rob.
Yet another useful article from Environmental Health Perspectives, this time on the value of systematic reviews. The authors make a really strong case for the use of such reviews in pulling together existing research, evaluating it, rating the quality of the evidence provided and through this method being able to draw conclusions. The article provides a narrative and protocol on how to undertake a systematic review which practitioners and researchers alike can utilise for future research
I was looking today at one of my favourite resources EHP (sadly not environmental health practitioner) but the well regarded Environmental Health Perspectives http://ehp.niehs.nih.gov/ . There was a really interesting article on arthritis and proximity to road traffic. The correlation has been shown in a number of studies it is just that we do not seem to understand the mechanism between the proximity and the outcome. The article is interesting on 2 points. The first is the obvious public health relationship, however for me the real value to us as a group trying to advocate research activity is the fact that the researchers have reported that they could not prove that it had to do with air pollution or noise. I am sure that there have been many occasions when you have known something is going on but because you cannot show why you have thought that you could not report on it. Thus this article shows you a practical way of evidencing research even if your original hypotheses is not proven http://ehp.niehs.nih.gov/1307413/
Colleagues you might also be interested in the article on remote sensing http://ehp.niehs.nih.gov/122-A268/
Many of you will have read about John Middleton at Sandwell and his long public health career in The Guardian back in March 2014 – Public health is about making ordinary lives richer. We are delighted that he has written this blog for us:
My regional director of public health at the time, Rod Griffiths, asked the fairly fundamental question back in 1994, about how did we know all this partnership working was doing any good? It took nearly 20 years to start to answer any of this, especially on the housing front. The Health Action Zone gave us the first big chance to propose housing intervention for health and to test it prospectively. The repairs on prescription schemes gave health visitors and GPs the opportunity to refer children with asthma and later mental health clients for a range of housing improvements around affordable warmth, asthma prevention and minor repairs for slips trips and falls. A controlled study testing intervention with waiting list households gave positive results on asthma symptoms reducing medication, and improved school results. I am afraid we didn’t run the study through the one more year which might have given us the statistical power to get a publishable result. Being simple service folk our two year unpublished data was enough for us. It would be another ten years before we had the chance to publish something more academically rigorous on affordable warmth. Repairs on prescription has continued on a shoe string through the 2000s if housing or health had non recurrent under spends we would get in there opportunistically. It was the 2009 housing and health strategy that once again enabled us to get mainstream funding and more importantly formal GP commissioner sign up.
Our housing and health strategies from 2000 onwards have considered housing issues as quantity, quality and situation:
- Quantity going up
- Quality improving more in public sector
- Self build community centre
- Designing out crime
- Designing in food and green access
- Key workers near the new hospital
After nearly five years of work in the collaboration for leadership on applied health research and care we have a result on energy efficiency and health. We have a SAP rating for 2010 for 25,000 properties improved by the former arms length management organisation, (the ALMO – ‘‘Sandwell Homes” ). A ‘before improvement SAP rating’ was modeled for before 2005. This required the combined public health research and quantity surveying skills of our researcher Gavin Rudge. SAP improvements were in themselves an impressive achievement – most properties going from shiver range to thermally comfortable if not totally heat efficient. SAP improvements were correlated with excess winter deaths and cold – related hospital admissions.
The early results suggest a strong effect on reducing winter deaths and cold related hospital admissions – although these results will undergo peer scrutiny ahead of formal peer review on submission to a high ranking journal.
Much remains to be done to improve Sandwell health. The current threats of welfare reform, recession, food and energy insecurity, cuts in public services create new challenges – or old problems revisited.
In my last tour of Sandwell for Guardian Society editor David Brindle, I was struck by the revolution in housing across Sandwell massive private sector development is redrawing the social map of the borough – the idea of Sandwell as a dormitory for Birmingham was once a feed prophecy but is becoming a welcome reality – new people with money and demands for better public services schools and health are coming in and paying their council tax; prospering Asian families want their children to go to university and then settle in the area. They are forming a middle class. For the first time in Sandwell history the population has risen, and the death rates have gone down. The quality of housing is also improving mainly through innovative housing associations high energy efficient building and socially responsive building lifetime homes and mixed tenure. The Lyng estate which had been referenced in the Health action Zone is now prospering with new housing; concierge controlled high rise for older people, green and smart housing, combined heat and power developments and better served by the Lyng health centre, the new police station, metro station and bus stations and the newly overhauled West Brom town centre.
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.
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:
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:
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.