A life in public health, influences and chunes

A life in public health, influences, and chunes
Professor John Middleton
Honorary Professor of Public Health, Wolverhampton University UK,
Immediate Past President, Association Schools of Public Health in the
European Region
Vice President, Global Network for Academic Public Health

A life in public health, influences and chunes. John Middleton ASSETS, Brussels July 2023
An Introduction
A bit of public health
A bit of music
And some of my influences

https://www.mindtools.com
/ah651dp/the-conscious-
competence-ladder

Public health is :
The science and art of promoting health and
wellbeing, preventing disease and prolonging life through
the organised efforts of society
Acheson 1988, after Winslow 1920, WHO 1948

What is public health?
Three domains of public health :
Health protection
Health improvement
Health care related public health
UK Faculty of Public Health, 2016

Good public health practice
• A: Knowledge, Skills and Performance
• B: Safety and quality
• C: Communication, partnership & teamwork
• D: Maintaining public trust

https://www.uems.eu/about-us/medical-specialties

A medical specialty…
but a multidisciplinary profession, service and system
UK Faculty of public
Health
Careers in public
health

Multidisciplinary public health
• 19th Century: early Ukpublic
health practitioners were
multi-disciplinary: John Snow
(Surgeon/Anaesthetist),
Florence Nightingale (Nurse);
Edwin Chadwick (Lawyer);
Joseph Bazalgette (Engineer);
Mary Seacole (nurse)

“ Medicine is a social
science and politics is
nothing else but
medicine on a large
scale.
“Medicine as a social science, as the
science of human beings, has the
obligation to point out problems and
to attempt their theoretical solution;
the politician, the practical
anthropologist, must find the means
for their actual solution”
Rudolf Virchow

PROFESSIONALISM AND
CAPACITY BUILDING

My 12 points that make for a profession of public health:
1.Is the need for a robust well-resourced public health system, service, function, and
profession, expressed in local, national, or international policy statements? The vision,
mission, policy, and strategy for protecting and improving the health of people and
planet.
2.Is there a statement of what knowledge and expertise professionals should
have? Competencies
3.And is it expressed in what Schools and Programmes should therefore teach? The
Curriculum
4.Do schools and programmes teach it to an acceptable standard? Accreditation
5.Do graduates achieve the standard they have been taught? Qualifications
6.Do graduates achieve a standard in relation to their practice and experience, as well as
knowledge and expertise? Credentials
7.Do professionals fit the requirements of their employers in the tasks they undertake? Job
task analysis; Skills and knowledge frameworks
8.Do professionals maintain their expertise? and practice to published
standards? Continuing professional development; Public health (clinical) audit; and
professional appraisal.
9.Do professionals behave appropriately? Codes of conduct
10.Are professionals supported in what they do? ‘Chambers’, ‘colleges’, ’associations’.

A life in music and public health John Middleton ASSETS, Brussels July 2023
Ewan Maccoll The Manchester Rambler
https://www.youtube.com/watch?v=V3H
60NgsAzw
Dr Harp’s Medicine Band:
The Derbyshire Rambler
https://music.apple.com/gb/album/the-
derbyshire-manchester-
rambler/574280936?i=574281154
Chune one: Ewan MacColl:
Lesson one: Rights, and
struggle

Influence 1 : John F Wands
Lesson 1 ’Lived experience’, ‘user focus’-’user involvement’ – insights into drug use
Chune 2: The blues : Good morning blues (after Leadbelly) https://www.youtube.com/watch?v=9N1efdwBB94

Music can be therapeutic, inducing well-being.
Only the Blues has, as its defining feature, catharsis: ‘a
release of repressed emotion by association with the cause
and elimination by abreaction: purgation; confessional’.
A cathartic drug is a purgative.
‘The basic attitude of the blues is that joyful music can
come out of real pain.’
Express your pain and you are not overpowered by it.

The Blues is both state of mind and
musical idiom-
‘a bout of depression; melancholic
music of black American folk origin,
often in the twelve bar sequence’.
Lesson 2: Public mental health promotion

Sonny Terry and
Brownie
MacGhee
Song 3
Cornbread, peas
and black
molasses
Lesson 2
a public health
detective story
and a
population
health
intervention

A prison
farm from
whence a
‘holler’
about
cornbread
peas and
black
molasses
came

Pellagra
dermatitis-
dementia
and
diarrrhoea
are other
symptoms

Dr Joseph
Goldberger,
discoverer of the
cause of
pellagra, in the
uniform of the
US Public Health
Service

The eventual
eradication of
pellagra came
about through
adding yeast
extract to
cornbread flour
Lesson 3 : Healthy public
policy : a population level
intervention helps more
people at lower cost than
asking individuals to do it
themselves

The Blues and public health
Champion Jack Dupree’s ‘Warehouseman Blues’
Sonny Terry and Brownie Mcghee’s ‘Cornbread, peas and black
molasses’ evoked a chaingang ‘holler’ alluding to Goldberger’s
experiments on prisoners, determining the dietary deficiency causing
pellagra
Leadbelly ‘Red Cross Store Blues’ :
poor blacks felt stigmatized by handouts and found themselves press
ganged into slave labour when they queued at Red Cross stations
Charley Patton/ Bessie Smith: Highwater Blues ) disasters always
Stevie RayVaughan: Texas flood ) hurt poor people more

28
12/07/2023
Our 2006 album Doctor Harp’s Medicine Band,
Doctor Write Me a Prescription for the Blues
Song 4 :
https://youtu.be/8dyvDwZaIwQ
www.drharp.co.uk

1981-1982 Joined the Medical Campaign Against
Nuclear Weapons, encouraged by my radicalized
Consultant Orthopaedic Surgeon, boss, Martin
Brett, when his farm appeared to become a
nuclear target near Greenham Common

Influence
2 George
pollock –
my first
boss

Coventry public health 1983-1987
Coventry Health Promotion Committee
Accident prevention
Heart disease
Measles
Maternal and child health
Cancer prevention
The Health of Coventry Annual public health report
1985
Health for Coventry by the Year 2000
https://journals.sagepub.com/doi/abs/10.1177/00178969880
4800215
Lesson 4 : Collect the local health data- create a local health
diagnosis, a local health profile

Lesson 5: health promotion
as civic pride
Lesson 5 :
Advocacy for
laws where
local action
doesn’t work

• https://www.sciencedirect.com/
sdfe/pdf/download/eid/1-s2.0-
S0140673685915648/first-page-
pdf
Influence 3
Victor Sidel
Lesson 6: a
global threat
to health- still
the biggest

‘The Peace
dividend’
Yevgeny Vuchetich
‘Let us beat swords
into ploughshares ‘
United Nations Art
Collection, 1959

Coventry
Alternative
Employment
Research ‘CARE’
project, first report
1987

A life in local public health

it's not who your
doctor is, it's
who you vote
for, that most
affects your
health

Influence 4
Selma
Sogoric
Lesson 7
community
development
and grass
roots to
health
improvement
- even in war

The first refugees from Sarajevo, Split Harbour, Croatia, May
1992
Middleton J:
Refugee for a
day. BMJ
personal view
November
1992.
on
4
February
2023
by
John
Duncan
Middleton.
Protected
by
copyright.
http://www.bmj.com/
BMJ:
first
published
as
10.1136/bmj.305.6862.1165
on
7
November
1992.
Downloaded
from

Sandwell
Express and
Star ,
November
1992

12/07/2023 46
Asset based public health
Community assets

Agewell-Sandwell
Agewell -Sandwell

• Reducing social inequalities: UK Marmot review
• Create fair employment and good quality work for all and improve quality of
work across social gradients

By 2003 the mixed use site was in production…

12/07/2023 53
Asset based public health
‘The health dividend’

Middleton J. The hospital of the future comes to the West Midlands. BMJ blogs October 1st 2014.
http://blogs.bmj.com/bmj/2014/10/01/john-middleton-the-hospital-of-the-future-comes-to-the-west-
midlands/
Lesson 8: The hospital as an asset for the local
community’ the health promoting hospital ; the low
carbon hospital

The new Midland Metropolitan Hospital
Due to Open 2018 - delayed by collapse of Carillion the builders….

‘Saving lives with Solar’ Royal
North Midlands Hospitals, Stoke.

Lesson 9 Thinking globally,
acting locally managing natural
capital : Coventry and
Warwickshire University
Hospitals Jubilee Nature
Reserve – managing water run
off from hospital car parks -
promoting biodiversity, saving
money

Health Futures
University
Technical College
West
Bromwich,UK
www.healthfutures.co.uk

FPH conference, Brighton Dome, June 2016
Came in as new President of the UK Faculty of Public Health
‘ Brexit blues’ David Stuckler’s keynote lecture expressed concerns
re the opinion polls a week before the Brexit referendum
Bruce Springsteen, Muddy Waters pictures on the walls…
I just had to play the Brighton Dome.
So I did my favourite harmonica solo Chune 5
Since my baby left me (I almost lost my mind) (Ivory Joe Hunter)/
‘Easy’ Shakey ‘Big’ Walter Horton
https://www.youtube.com/watch?v=
oSRluRfUZ2A&list=OLAK5uy_kLx2Pzlq
4NMiyNUlYkuI7kGpJ_8LHrhEA&index
=23

Achieved 2015-2017
Plain packaging of cigarettes
Sugar sweetened drink tax
Personal health and social
education reinstated in schools
MUP in Scotland and Wales
Lesson 10 National policy
lobbying does work

The epidemiology of violence
Evidence-based violence prevention: a life course
approach
Asset based community development
Primary, secondary &tertiary prevention role of the
public health community as primary preventers of violent conflict,
through healthy public policies and tackling major social inequalities in
health; and as early reactors, mitigaters and responders to violence.
New public mental health approaches
A role for public health in conflict resolution with
aid agencies, political scientists, theologians and international lawyers
A role for public health educational bodies
A leadership and partnership role for public
health
www.fph.org.uk/uploads/Violence%20report.pdf
Areas of action for the public health
community in preventing violence

‘Do No Harm’ Lord Warner Public Health amendment to
the EU Withdrawal bill
64 Health organisations support, representing over 1 million health workers

Scottish FPH conference sings ‘Freedom come all ye’
https://www.dropbox.com/s/kqi3b
62otfosh1i/1610%20freedom%20c
ome%20all%20ye%20.wav?dl=0

Song 6
Freedom come all ye
(Words appended )

Influence 5 Maggie Rae,
Head of Dept of Health Inequalities
Unit (mid 2000s) – a period when
inequalities declined in England …
President of the UK Faculty of Public
Health, 2019-2022

Austerity kills
Climate breakdown
Service cuts
Brexiting health
A manifesto for health, J Middleton November 28th 2019

President of Association of Schools of
Public Health in the European Region
2019-2022

Association of Schools of Public Health in the European Region(ASPHER)
Delegation to Gaza, June 5,6,7th 2015
•Prof. Vesna Bjegovic-Mikanovic, president of
ASPHER (chair)
•Prof. Anders Foldspang, past president and chair of
ASPHER's Honour's Committee
•Prof. Ulrich Laaser, past president, member of the
ASPHER Honour's Committee
•Dr. John Middleton, vice-president for policy, UK
Faculty of Public Health
•Mr. Robert Otok, Director, ASPHER
•Ms Marine Buissoniere, Open Society Foundations

https://epha.org/public-
health-must-be-
strengthened-for-a-
healthy-post-covid-world/
Global governance for health

https://blogs.bmj
.com/bmj/2021/0
4/26/what-
should-we-ask-
of-a-new-global-
treaty-for-
pandemic-
preparedness/
Henrique Lopes,
Catholic University of
Lisbon.
John Middleton,
President, Association
of Schools of Public
Health in the
European Region.

Global health problems : Interconnectness: Loss of agricultural land
through global warming, crop failure, food riots, Arab Spring, Syrian
war

Climate breakdown and health: The role of education
Health and educational communities as global corporate citizens
The European
health policy
Platform statement,
launched May 4th
2022. 88 signatories
across Europe,
including UKFPH

Public Health and militarism: Professor John Middleton November 30th 2022
http://www.campaigncc.org/sites/dat
a/files/Docs/one_million_climate_job
s_2014.pdf

This is a looming disaster and
priority is to limit damage
Chune 7
The European
National
Anthem
‘Ode to Joy’

‘Geopolitical health’: a challenge for
advocacy ?
Oligarchy, populism and political
corruption
Offshoring and inequalities
Industrial scale disinformation

https://s3.amazonaws.com/ASPPH_Media_Files/Docs/GNAP
H_Global+governance+for+health.pdf

Influence 6 Jose-Maria Martin-Moreno
Personal mentor for me during my ASPHER presidency
Outstanding contributor to the work of ASPHER COVID-19 task force
with over 100 papers published
Major contributor to WHO developmental work 2007-2017 on
Essential Public Health functions, (below centre) leading to WHO
global road map on Public Health workforce capacity (right)

Thank you
John Middleton
Immediate Past President, ASPHER
Vice President, Global Network For
Academic Public Health
johnmiddleton@phonecoop.coop

Roch the wind in the clear day’s
dawin
Blaws the cloods heelster-gowdie
ow’r the bay, But there’s mair nor a
roch wind blawin
Through the great glen o’ the warld
the day.
It’s a thocht that will gar oor
rottans –
A’ they rogues that gang gallus,
fresh and gay – Tak the road, and
seek ither loanins
For their ill ploys, tae sport and
play
Freedom, come all ye
Appendix 1 Freedom come all ye- the words

Nae mair will the bonnie callants
Mairch tae war when oor braggarts
crousely craw,
Nor wee weans frae pit-heid and
clachan
Mourn the ships sailin’ doon the
Broomielaw. Broken faimlies in lands
we’ve herriet,
Will curse Scotland the Brave nae
mair, nae mair;
Black and white, ane til ither mairriet,
Mak the vile barracks o’ their maisters
bare.

So come all ye at hame wi’ Freedom,
Never heed whit the hoodies croak for doom.
In your hoose a’ the bairns o’ Adam
Can find breid, barley-bree and painted room.
When MacLean meets wi’s freens in Springburn
A’ the roses and geans will turn tae bloom,
And a black boy frae yont Nyanga
Dings the fell gallows o’ the burghers doon.

Appendix two : organizing songs
https://music.apple.com/gb/playlist/organising-
songs/pl.u-oZyllE1FP4KAzb

What is ASPHER ?
The Association of Schools of Public Health in the European Region (ASPHER)
is the key independent European organisation dedicated to strengthening the
role of public health by improving education and training of public health
professionals for both practice and research.
We have 130 member schools of public health in Europe and associates
globally.
We are developing our partnerships with sister public health organisations in
America, Africa, Asia, Australasia and the Arab world in the newly
constituted, Global Network for Academic Public Health (GNAPH)

A life in public health, influences and chunes

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