District councils’ contribution to public health

The King’s Fund say: “In partnership with District Councils’ Network, we have produced a set of slides that illustrate the key role played by district councils in keeping us healthy. We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.”

More on evidence!

The UK Health Prevention First Forum  have produced a report on the role of case studies as evidence in public health (January 2016).

Their research found case studies to help capture real experiences of public health work in specific times and places and reveal stories about interventions.  The Forum concludes that the uniqueness of case studies is that they capture local knowledge in ways that cannot be captured by other means in complex and varied contexts. They add that guidelines and templates that enhance the format, replicability and assessment would help improve status.

With a closer focus in environmental health, Stephen Battersby had produced a report on local authority use of enforcement powers in housing cases which can be accessed via EHN-online.

Each of these new reports are appended to our open access pages.

Jill

Disseminating research and new open access resources

Public Health England have just published their Annual Research Review for 2014-15. Its Executive Summary records achievements as securing funding, numerous peer reviewed publications and its “significant contributions to the evidence base for public health policy and practice.”

So, how can we strive to do things more effectively and at the same time add to the evidence base in environmental health?

Fuel poverty is a key area in environmental health for a host of reasons and where we could do far more to evaluate and disseminate heath impacts following interventions. Our open access housing resource page provides links to many useful sites, including for fuel poverty and affordable warmth to help inform local strategies. A new resources is available from Healthy Places (November 2015) Healthy Housing: Fuel Poverty & Health Toolkit Update. This updates online resources to help tackle cold homes and poor health locally.

Another way of sharing and disseminating information is via blogs. The Housing Learning and Improvement Network (Housing LIN) promotes housing, health and social care for older people. Creating better living environments in the first place and not just reacting to poor housing is fundamental in environmental health – see this recent blog. Housing LIN’s innovative website links other features of interest and tags subjects including environmental health (see for example CIEH Effective Strategies and Interventions).

More to follow soon on other approaches to living environments and health as well as new publishing opportunities. Meanwhile happy new year.

Jill

Our King’s Fund review & need for systematic reviews….

Dear colleagues,

Further to the post below on the King’s Fund’s report on the role of district councils in public health, a quick email from my PhD cave whilst I drink my coffee to publicise our review of this report which has just been published by EHN Online via:

http://tinyurl.com/htjkqf7

In summary we welcome the report and its recommendations and think that all EHPs (not just those in district councils) should read it. However, we are sceptical of it’s acceptance that there is no alternative to austerity policies for local government and (after Chadwick) we are not convinced that presenting only a ‘business case’ for our interventions will be enough to protect our work or, in the future, to encourage investment in what we do!

Further, the authors are concerned about the lack of evidence for the effectiveness of our interventions. We also recognise that more needs to be done, of course, but our own research suggests that we might already know enough to argue for the effectiveness of our interventions. The challenge is more to invest in systematically review this literature and ensure the findings are communicated and utilised by all EHPs, as per our arguments over the last four years for a more evidence based environmental health. We will write more about the need for systematic reviews in the New Year.

In the meantime many thanks, happy holidays and best wishes to all, 

Rob & Surindar

Hurrah for EHRNet & a King’s Fund urgent recommendation for EH research!

The Kings Fund has just published The District Council Contribution to Public Health: a time of challenge and opportunity.

The first “hurrrah” is the extent to which environmental health is mentioned.

The second “hurrah” is for the reference list. Check it out! Caroline’s work on HMOs features, as does EHRNet’s An introduction to evidence based environmental health. The latter is of particular interest because is shows that blogs present a creditable way of disseminating open access information.

The CIEH/BRE work is also there, plus work by David Ormandy and colleagues (Braubach and Jacobs) on the health effects of inadequate housing.

For environmental health to have a real influence, there is an ongoing need to publish widely, most particularly in peer reviewed journals where it can be more systematically accessed and reviewed.

I am now feeling more inspired today!

Jill

Rob adds:

Further to Jill’s post above I admit I haven’t yet read the whole of the King’s Fund’s report but senior EHPs including Graham Jukes and Ian Gray of the CIEH were involved in its development and it includes the following key messages and recommendations:

“…there is little published evidence on the effectiveness or cost-effectiveness of environmental health interventions. In a period when spending is being cut – particularly, it seems, in environmental health – this kind of evidence is urgently required to better inform difficult decisions about local priorities and to ensure value for money.” (page 7)

“Recommendation 8: The Chartered Institute of Environmental Health should, as a matter of urgency, work with the DCN (District Councils’ Network) and other relevant parties to better understand the cost-effectiveness and return on investment of environmental health services.” (page 9)

In response to the report, CIEH Chief Exec. Graham Jukes commented:

“Environmental health is also recognised within the report as a major factor in determining people’s health and wellbeing and rightly so. We agree that further evidence on the effectiveness of environmental health interventions need to be made and as the report recommends, we would welcome the opportunity to work with the DCN and other stakeholders to highlight the substantial positive return when you properly invest in environmental health services.” (see: http://www.cieh.org/media/CIEH-comments-public-health-and-district-councils-191115.html)

As a researcher I would argue that it’s up to us, as EHPs, to prove whether this ‘substantial positive return’ from our work can be demonstrated (or not). Further, I know from experience how difficult and complex this is and that it will require funding for research that is hard to come by at the best of times. Forecasts about next week’s UK Government Spending Review suggest this could be one of the worst times for expenditure on public health related services in recent history.

Lastly, ‘welcoming the opportunity to work with the DCN…’ doesn’t convey to me any great sense of urgency from the CIEH towards engaging with the considerable challenges set by Recommendation 8. Therefore I look forward to seeing what happens next and (hopefully) being proved wrong.

With best wishes, Rob

Towards ‘doing and thinking’: Surindar and Jill’s latest paper on evidence based EH

I was feeling quite deflated earlier this morning. My latest elective brain scan (a very long story – it’s still there, more a chronic plumbing problem!!!) recently scuppered my attendance at this Thursday’s CIEH workshop on bridging policy and practice with research (see blog below – though the rest of us will be there).

Further, I’ve just learned that my latest attempt to build a bridge with more established public health research colleagues has fallen at the first hurdle… then I received an email from Jill singing Surindar’s praises following publication of their new paper on the perceptions and experiences of EHPs about evidence based environmental health (EBEH).

This is available for free (hurrah) via:

http://sgo.sagepub.com/content/5/4/2158244015611711

I will ask Surindar and Jill to introduce it better soon, but from my first lunch time reading a number of issues spring to mind. First, I’m so relieved Surindar and Jill were able to publish this on Sage Open. Therefore all EHPs will be able to benefit, including those outside England where most of these arguments still apply. Further, by publishing in a non EH journal I hope that these arguments will reach a wider audience whose knowledge we could benefit from.

Second, the paper forms a solid foundation for a more informed debate about EBEH, not least by engaging with the complex and politically charged policy context in which it has emerged. Stuck in my PhD writing up cave I’m not the most policy-engaged EHP currently, but I know a few who are and I continue to be amazed by the apparent lack of EBEH debate amongst EHPs.

Third, Surindar’s PhD findings on the perceptions of EHPs and the practical challenges they face in moving towards a more EBEH provide such fertile ground for us EHRNetters, indeed in some ways they reinforce the need for our very existence. Indeed, the self-identification of EHPs in the paper as ‘doers’ – in contrast to their ‘thinking’ public health colleagues – suggests we still have a long way to go. When we started EHRNet in 2011 we speculated that it could take decades before EHPs were persuaded by EBEH, if they could be persuaded at all, though the challenges described by the pioneers of evidence based medicine continue to provide  comfort (see http://www.bmj.com/campaign/evidence-based-medicine).

We will therefore continue to publish and advocate for EBEH via workshops, meetings and our growing network of friends and colleagues. Further, I will escape the PhD cave soon and would love to develop and run some EBEH workshops…

Many thanks and best wishes,

Rob