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touch. Okay. Good morning. Thank you very much for having me. My name is Fiona Sim, uh, public health consultant and until recently, also a general practitioner, family, family medicine specialist. So I've stepped into this morning's, uh, slot, and I hope that this will work for all of us. Uh, normally, I would have spent a bit more time preparing, but, uh, hopefully we'll be fine. So let's see if I can move on. I think the screen in front of me at all at the moment is not helpful. It says screen sharing is paused. Are you seeing anything? No, I don't know where I've gone. Yeah, okay. Right. Can you see it as it is? Because last time I went on the slide show was when it crashed. So is it visible enough? Bordon Review. I'm going to leave it at that, if that's okay with everybody. Fine. Okay. So I'm gonna be talking about the science and art of public health. This is probably an introductory lecture about public health, and you may have had one or two other public health lectures in the meantime, and I know today was going to be about sexual health but my colleagues elite is going to come and talk about that another day. So the science and art and public health and I hope that this goes down well with you. It's probably a little bit different from some of the other stuff that you're doing. Hopefully, it's still relevant to you. Uh and I know that you're facing real difficult times at the moment. So, uh, thoughts of with you, but as a as a strategic and the longer term agenda, I'm really hoping that this will, uh, some of you will find this at least of interest in may. Be exciting. So what do we think public health is? If I could be more interactive, I'd be asking you that, but I'm not sure that's feasible. Please, moderator, Tell me otherwise I'll just talk. Yes, people can mute themselves since you've got small participant numbers and engage freely. Okay. If anybody wants to give me an idea of what I think public health is, I can't see any of your face is I'm sorry about that. Otherwise I'm going to just carry on. But I'd love to hear from you. I'm guessing it's looking at populations and a community sort of health of in a Yeah, in the community. Really, isn't it? And indeed it is. Thank you for that. Uh, yeah, What I didn't say is a prevention measure or two. I'm sorry. Say that again. I would say it's a prevention measure. T IV. Yeah, public health is about preventing disease as well as looking at communities, but it's very much about populations and communities. That's right. So let's give you a couple of, uh, agreed definitions. If I can get there not moving on, Let's do that one. Okay, here's some definitions that okay? I love to talk about art and science or science and art, public health so that we don't just get caught up with sitting and looking at numbers and not realizing that actually were talking about people and communities and people that have different behaving and thinking and conducting their lives and different options and choices that not everybody has. Uh, So this is the science and art, art and science of preventing disease. You said that prolonging life and promoting health through the organized efforts society I really like that. It was largely based on, uh, w h o definition. And then, uh, this Donald Acheson was the chief medical officer in England back in the 19 eighties, Um, and then a banker came along, called Derek Wanless, who was asked to look at public health in the UK And he added to that, You can see just a bit of a subtle addition to say it's not just about the organized efforts of society, but it's organized efforts and informed choices of society, of organizations, of public and private communities and individuals. They kind of extended that it says the same thing. But it just reminds us the society is made out of lots of different components. And what he was saying was, public health is everybody's responsibility, which is really easy to say, but difficult to make it happen. Um, and the and the World Health Organization Europe European region a couple of years ago updated their vision to promote greater health and well being, uh, in a sustainable way. So they picked up the state sustainable green agenda. Some people might call that, um and looking at the need for services to be there to support people in communities and the reduction of inequalities which we all know is incredibly important and a really big problem in most developed countries and between countries of different, uh, different, particularly different incomes. So I quite like that. W h o definition is brought in both sustainability and inequalities. Which back end of the last century, beginning of the century. People haven't really learned to take quite so seriously, as we now know is absolutely vital. So let's have a bit of go at the science, if I may. All right, This is where you either say Yes. I'm a scientist because I'm learning to be a doctor or goodness me. Couldn't you talked about the art? Okay, so we'll go with the science first because most of you probably think of yourself as scientists going into medicine, I would probably argue, and we'll continue to say you need to have an appreciation of both the science and the art of the whole of medicine, actually. But most of us view ourselves as scientists or we've relabeled as scientist doctors by and large, and medical students. So let's talk about science, Okay? Epidemiology, basic sciences, or public health. And most people in the general public hadn't a clue. They probably couldn't say the word epidemiology until 2 2020 when the pandemic came into view. And all of a sudden everybody understood what epidemiology was about. Just really interesting. So that's the people. Now I'm actually much more interested in, probably have an epidemiology than they were back at the beginning of 2020 or until we're getting 2020 hours. Really fascinating. So epidemiology is the incidents, distribution of possible control of diseases and other factors that relate to our health. So, traditionally, epidemiology was all about disease is increasingly, we're talking about other factors that that can impact on on the health of individuals and populations. Uh, like environmental factors that will influence our health. So it's another another bit of definition. It's about studying the distribution and determinant of health related states and events. Okay, so not just about disease, and it's very much a data driven sciences. So if you're interested in public health from this perspective or pretty much from any perspective, you have to be willing to look at numbers. Okay. What I think is important is that we're not overtaken by the numbers, but we have to be willing to look at and someone like me gets quite excited if somebody presents a bunch of epidemiological information to me, and I know that not everybody gets excited about that. But you can begin to appreciate what on earth is going on, whether it's in your out patient department, in the hospital or in the wards, or in people coming through the door of general practice by looking upstream a bit about the epidemiology to understand what is, uh, what's happening to the population as a home and the way that we start to recognize patterns in illnesses and disease and including obviously infectious diseases is by studying the epidemiology and getting a feel of what's going on in a whole community. And indeed that's how particularly I I often cite the pandemic just because it's difficult to get out of everybody's mind completely at any time. Obviously, you're you've got lots of other priorities in Ukraine currently, but most of us around the world, the pandemic certainly is still a big feature of our lives. So people beginning to see patterns of a disease or similar set of symptoms, walking through family doctors, doors walking through into hospital, being carried in on stretchers. There was the beginning of recognizing. Actually, there was an outbreak which became an epidemic, which became a pandemic. And that's a typical and very clear description of how epidemiology had paved the way to identifying an, uh, an acute situation. But it also is really helpful to look at patterns of disease in non acute situations. They're looking at long term conditions like heart disease and cancers and looking at their patterns. So epidemiology looks at patterns of diseases and helps us to understand how to prevent them how to manage them in groups of patient's as well as as in individuals. So my contentions would be the epidemiological information is as important as clinical and pathological findings. You might want to argue that, but try and think about it as you go through your course, um, as early as you go through today, but certainly as you as you go through your course to become a doctor, don't forget the numbers and the epidemiological epidemiological information the data behind what the patient's you were seeing. So just to have a quick look at this applying epidemiology during the during the pandemic, what was the population that you might be interested in and why, Okay, So initially it was made the population of people using a hospital where these people suddenly started to roll up in the hospital. Later on, it became a population of the whole city. Should they be locking down the whole city as they did in China, Beginning pandemic. As the virus spread around the world, it became, uh, each country started to look at their population as being the population interesting. And then it became the global population. So it might be quite different if you're looking at cancer or coronary heart disease or homelessness, addiction, inequalities, anything you can fit into. Looking at epidemiology, you have to decide the population you're looking at and just and then look at the prevalence and incidence and mortality if that's relevant to that particular disease or other factors that looking at, I'm assuming you're comfortable with yeah, words like prevalence and incidents. But if you're not, tell me now we can have a quick look at those before I move on. You're okay with those words? All right, So my you're not answering me, so I'm assuming that's okay. So when so this is my note of caution on this. Like, when is the known prevalence or incidents not the actual prevalence for incidents is not a trick question. It's really important because a lot of us find that we forget this. Anybody want to hazard a a view about that? Give me an answer. Sorry, I don't understand the question. Okay, So when is that? That? I guess that probably means that lots of other people do. Okay, so I'm making a distinction between the known prevalence or incidents. Isn't this necessarily the same as the actual prevalence or incidents? Okay, so the prevalence of disease, let's stick with disease for a moment, because that's the easiest thing for us to think about. The prevalence disease is the number of people in a given population have gotten that disease. And the incidence of disease is the number of new cases that are occurring in a particular time frame within that same population. Okay. And what we often talk about is the prevalence of your disease. Okay, So if you were a family doctor, for example, working in the in the National Health Service in England, you would be expected to be able to to know because you keep a register of the prevalence of diabetes type two diabetes, say both, actually, the Type two diabetes in your practice population. So you would say I've got a population size of 10,000 and out of those people, let's say 800 have got diabetes diagnosis, diabetes. So they're on our diabetic register and we're looking after them, and we're supporting them in providing lots of preventive interventions as well as care and treatment, to to stop their diabetes, getting getting progressing and to hopefully to to keep them well, healthy. Okay. But is that that known prevalence? Is it the same as the actual prevalence? And the answer is almost certainly not. Yeah, okay, all right, so that's the reason for for for putting that in there. It's just a caution, because most of us a lot of doctors will assume that the prevalence they know it's the actual prevalence. And in many, many situations, it isn't so that the probably the best known one is hypertension. BP, where probably somewhere between a half and two thirds of patients now are identified with BP. But many are not. And that's just in in the UK in a developed country, uh, with with a reasonably comprehensive health service, a lot of people walking around with a medical condition that I don't know about, So I kind of labor that a bit. I I won't anymore. It's enough for now, but it's something that somebody might just say. I know what the prevalence is because I know the number of patients that we've diagnosed with. That doesn't mean that you know the prevalence. Okay, where you've got a disease that is unmistakable. So something I mean, God forbid it comes back. But something like smallpox, where if you had a patient with smallpox, you would recognize it and you would know about it more or less likely then, that if those patients' can reach health care and be counted it that you know that the prevalence was the same as the the actual prevalence was the same as the name prevalence. But in many diseases, that is simply not the case. Uh, I just I'll leave it there. Uh, but But I didn't want to lose the opportunity to to mention some of the pitfalls that we all trip into. There's not a trick, but it's a it's a risk that we run, assuming that we know something that actually be doing okay. Next bit of science, demography or counting statistics, including birth, death, migration, which illustrate how a population is behaving. And again. You choose the population you want to look at, and you can understand lots about it by understanding it's age structure, the way it's moving, about the pace at which people are arriving through birth or migration and pace at which they are leaving through death or migration. Um, and it can be looked at at, at any level, from local through to global, Uh, and you can decide the boundaries won't look at that doesn't have anything to do with disease directly, but it is very often used together with epidemiology, to look at what is happening to the health and Robbie of the population and also to project going forward. What is likely to happen to that population? Incredibly valuable, uh, data democracy. It's used by lots of others as well, outside of health and medicine, to plan cities and, uh, and for insurance purposes and all sorts of other things. Demography is really valuable, so if you look up democracy and find all sorts of people from all sorts of backgrounds who have studied, you know, with with their own professional reasons and being. And it's being applied in all sorts of different ways. So from actuaries through to researchers through to, uh, to the doctors and town planners. So life expectancy birth is one example of demography you can see big increase in life expectancy. This is just in the UK up until, uh, up until now, uh, projections going forward still increasing, uh, from projections going forward from knowledge to date, Actually, that at the moment we'll concern that life expectancy might not continue to to increase and as a concern just because we will. We've all learned to expect it to continue to increase. But at the moment, live extensions. He seems to be flattening off quite a lot in developed countries. So, uh, although there's a bit of flattening, though, like it might flatten further uh, projections rather than no data, as you can see. So as time goes by, we might see that flattening off rather than continuing to increase. Um, what's, uh, relevant? That you can see there is that, uh, women live longer than men. Uh, and that is also the case in most developed countries. You probably know about that already. Um, so some people would define that as the ultimate in quality between sexes. Um, an interesting one. Largely, though. Do you know what? It's mostly due to the difference in life expectancy between men and women. The several factors give me anybody want to give me any one that they can think of Smoking? Possibly. Yep. Has made. It has made a difference. This is life expectancy and birth. That's a clue. But smoking is important. Yeah. Did you say something else? I was saying that genetics like mutations. And yes, probably, actually. I mean, it sort of bullet overall, genetics clearly is almost certainly got got to roll with pretty much everything that we that we that we know about and and and that we don't know about. Okay, so smoking just to pick that up. And you're absolutely right. Up until third, 30 years ago, smoking prevalence was much higher in men than in women. So the disease is associated with smoking, and the mortality associated with smoking was much did affect men much more than women less so now where women smoking is at about the same levels as as men around. Certainly the developed world around most of a lot of the world. But life expectancy in birth it's the infant mortality and particularly early infant mortality in male babies is higher than, uh, in female babies. So, uh, that very often if you look at post infant mortality, that gap is is significantly less is still there. Um and you're right that some of the disease and things like accidents and injuries in young men, uh, much more likely to cause death than in young women between the ages of 18 and 35. Uh, for example. And there are other causes of death that affect men disproportionately. But actually, it's, uh it's also very, very early mortality in, uh, in babies. Uh, although more boy babies are conceived in girl babies, the number of Children that survive infancy higher for females. Okay, this is just a picture of the UK. Forgive me, because my slides generally are rather UK orientated because they were made initially for her people who are going to be working in the UK and maybe some of you will one day totally will be the case. Um, so anybody want to tell me a little bit about what they see on there? Any patterns you can see about life expectancy in the U. K. Just just on the top of your head, the dark, the dark and people living longer. Say that again, please. I said it appears to be greater in the South, so there seems to be a possibly a correlation between wealth and life expectancy. Yeah, you put that beautifully. Thank you very much. There's a huge north south gradient, uh, in the UK with inequalities in the north compared with the South. And although there are a few very big pockets of deprivation in the south, there's a There is a gradient also in terms of, uh, income and affluence compared with deprivation. So going from south to north. So you're absolutely right. This is for males. I think I might have put the female one in as well. Yeah, less marked. And overall, as you've seen before, women living longer. Um, but still with a with a bit of a gradient. But the big cities of the big centers of the population in the north of England come out particularly badly for for women's health, which is, which is interesting. Uh, and and so the big pockets of deprivation in London don't really show up on that slide. London has got some of the biggest disparities in health experience over a very small geographical area within. It's very large population. And they did. Once you look up the countrywide, you don't see that nearly as clearly as when you look at the city on its own. Uh, but so when you look at, it's just something to think about when you hear about a country's life expectancy, it might be doing really well. But within that can be quite big variations inequalities, uh, of life expectancy experience between different parts of the country and different towns and even within towns and cities. I'm going to talk a little bit more about inequalities later on before we finished no longer life. So how life expectancy is how long we can expect to live a life expectancy of birth is the most common factor that's used, but you can or indicator, but you can look at life expectancy starting from any age, so this is life expectancy from from birth. Um, looking at, uh, at different times. Um, and we can see, Although life expectancy has increased, what's really increased is the number of years that people are spending in poor health. So actually, probably not a great win to most people. If you ask them how, if they want to live a long and healthy life, they will say yes. If you ask them if they want to live a long and unhealthy life. Most of us probably really wouldn't sign up for that very happily so. Although life is getting longer, not necessarily healthier, a lot of work being done now to try to improve health in those latter years and well being. It's quite stark. I think that that shift a little bit of healthier life expectancy, but not very much, and a huge, increasing, unhealthy life expectancy towards the end of life. Um, so this is just a quick look back again at the pandemic. This is the first wave of the pandemic, and, uh, just in England and Wales. I think it was quite similar in another place as well. But what? What we were looking at was people dying um of either of covid, which is the orangy red color or of any other reason for any other reason. And, uh, if you look at people dying in, uh, in care homes and home, uh, in their own homes in other places, which is fairly unusual, and in hospitals you can see a big, big bulge mainly about covid. You can see that, but also in hospital for other reasons. But the thing that surprised most people, including the guys that put out this slide, the winter Center for Risk communication is absolutely brilliant. They've got fantastic stuff on there on their website. If anybody's interested in looking at their work, thoroughly, recommend it. But when you get the slides afterwards, obviously will include that. That Web address. Um, so they said, Why are these extra people dying at home? Look at them, not that many with covid compared with hospital or care homes, where we were really very aware and very worried about the number of people dying of Covid. But lots of people dying not of covid in their own homes, and it's not never really been fully explained. Lots of research ongoing never been fully explained any any. Any suggestions? Because we've got lots of ideas as to why that might be happening. Anybody want to hazard a A supposition, I guess. Okay, I will if you don't want to. Okay, So two things have have come, come to the fore. Okay. One is that there were a lot of people who became unwell in their own homes, and they decided that the risk of going to hospital was too great because the media was full of people going to hospital with covid. And indeed, the media at the time was also focusing to a large extent on people catching covid in hospital. And a lot of people who are in their own homes quite frightened and saying that we're going to stay at home. We're going to put up with this. Okay? That's one side of the argument. I think both of these will turn up. Both of them are true. They're not mutually exclusive. The other is that people who might have been taken to hospital as an emergency made a conscious decision to say. Actually, no, I want to remain at home not because they were frightened to go into hospital, but because they had chosen place of death. And if you ask people in advance, if you ask people who are not at the end of life where they want to die, the vast majority of the same we want to try at home. And what seems to have happened in the pandemic was people exercising that choice in a way that they wouldn't usually do. They weren't calling an ambulance because they knew that they won't have to wait a long time. And they're also saying, You know what? I want to stay at home or to be in my own home. So we don't know about this at the moment. It's really interesting. Uh, but just as a piece of demography, uh, it's a It's a fascinating picture that we seem to have gone back to the previous story about people dying, uh, in other places in home. But for that 1st, 1st wave of the pandemic was quite a big change. All right, so this just simply tells you more about people uh, where they were dying. I'm not gonna to spend time on exam. I'm going to run out of time, Uh, a little bit by age, because there were a lot of people really frightened about who was dying of Covid. And you can see here, Uh, it was very largely people over the age of 75 thankfully, very few very young people. Um, and, uh, again, I said I said he said, uh, epidemiological information where people would I've got aged people dying. Very straightforward data. So that was only up to the first of May to first. That was that was only for the first wave. Yeah, but actually, the pattern hasn't vary tremendously. Um, because I've given this because I'm giving this lecture sadly, at about half an hour's notice today. I haven't had time to update the next time it will be updated, but that that was the picture in the best way. Indeed. But the picture for Children child mortality has remained, thankfully, exceedingly low. Uh, during the pandemic, and most of the people who have died of covid have been the very elderly, um, and increasingly recognized that that it's also affected people with underlying, uh, long term health conditions, which obviously you will be aware of by now that we didn't know too much about in that first way, let me move on quickly. If I may just talk a bit about avoidable mortality, which is really important issue for public health, we're talking about preventing ill health and and death. We need to look at what's avoidable and keep people healthy for longer, so that different terms of use once preventable mortality mainly avoidable through effective public health and primary prevention interventions. That's where public has come into its own preventable mortality but also treatable mortality, avoiding deaths through timely healthcare interventions, including secondary prevention. Okay, so things like screen, uh, would come in there, and treatment and avoidable mortality is a total of preventable and treatable, so hopefully find that quite useful. So in the UK, the estimate is that between 1/5 and a quarter of all deaths were considered to be avoidable in 2018. So we're talking about very, very high proportion of deaths that could have been avoided. And this is the breakdown here between preventable 64% and 36% treatable. So the potential for public health intervention is undeniable. Isn't it huge? And we've never been really good at making that happen. So we've we've we've done better and better, uh, with preventable mortality. But it's still a very big part of, uh, why people are dying. And again. Look at that. You I think you would make the same point again about that law cells divide. And, uh, what's happening there, which is very largely as you, as you quite rightly pointed out, is connected with with affluence and family income. Okay, that's very quickly. I don't want to miss the opportunity to talk to you about art. Okay, So human environment, environmental factors. Okay, I'm sorry to rush this. Normally, I'd say any more questions about the science, but I think I'd really quite like to to talk to this a little bit more. Hopefully, we'll have a couple of minutes. Just a question. Um, all right. So scientific evidence is essential by insufficient. I hope you agree, but I think I'm just going to approve it for you. So data analysis and intelligence are really important, but alone, they're not going to make a difference. Why aren't they going to make a difference? Because they don't change the way that people live their lives. They don't change the way that decision makers leaders politicians. People that hold government purse strings make their decisions. So what is what other ingredients are necessary? Good health and improved outcomes besides the sciences, What are they? Okay, all these things that influence the way that people's health at the individual level and community level, uh, pans out. So you probably know What about this Already? Has anybody not familiar with the diagram that looks a bit like that? If you're not, then please focus on it now, but this was developed by a dog and a white head back in 1991. I think it's beautiful. It's quite difficult to if you haven't seen it before. It's quite difficult to get hold of very quickly. But basically in the middle, you've got individuals and the way that they live their lives. I hate the world. Word lifestyle must have been because a lot of people don't have those choices. They can't just say, Oh, of course, I'm going to buy only the healthiest foods. I'm going to cook them very healthily, and my family is going to have plenty of exercise and physical activity, eat healthily, have a job that's meaningful, have higher education attainment and all the other things around them that you might think it's something to his life. So but actually other things that influence them through their lives. So how we produce our food, the conditions that people working, whether they've got safe neighborhoods, whether our roads are safe, whether our education system is comprehensive and reaches everybody and is accessible to everybody without impossible cost, whether they can access health and social care and all of the other things that make a difference to the socioeconomic, cultural environment and environmental conditions around those individuals. Really, all of those things affect their their health. Okay, so there's a little bit mention of science and there, but in the main, we're really talking about hugely important societal factors and environmental factors that influence our health and well being. So the chairman's of health, one of my colleagues produce this for me. Uh, I'm grateful to, uh, because we all think healthcare is terribly important for our health. Actually, looking at this really nice, uh, probable jobs and foundations, a big health provider in in the US, but and funds a lot of research. And they did this work with the University of Wisconsin so about 20% of health is determined through clinical care, and the rest comes from the way we behave as human beings, socioeconomic factors and the environment around us built environment as well as the the environment itself. That is really important that we all recognize that and remember it. So clinical care is important, but only represents 20% 1/5 of the contribution to our overall health of our individuals, and our population wouldn't want to be without clinical care. They don't get me wrong and not a weird purist that only thinks public population health is important, but it needs to be put into perspective. And the more people in a clinical clarify Arment that understand those wider determinants the better. Because then we can all appreciate when we see our patient's, the other factors that are influencing their health, why they got sick and how we can best help them to get better and to stay well afterwards and to prevent further ill health by taking all these other bigger and wider factors into account. They're very quickly, they kind of move on to inequalities. Briefly what we should do a completely separate talk on this but unfair and avoidable differences in health across the population and between different groups within society. And they arise because of the conditions that were born in grow. Live our lives, work and age. And they influence inequality in health influence our opportunities for good health. How we think feel an act and shape our mental health. Physical health number being Oh, you find that helpful. It's just a really quick snapshot of a definition that was produced in England by the NHS a couple of years ago, but I think it's quite useful. Um, but health inequalities used to be taken as one of those things. Oh, so people in the north of England, uh, live this lives the shorter lives People in Glasgow live shorter lives than people in Edinburgh. People in Zimbabwe live shorter lives than people in Spain. There's reasons for it, and mainly it's about inequalities. And these are things that can be tackled if there's a will to tackle them at the population of societal level. So difference in health status, different behavioral risks. Somebody's already mentioned smoking. Why do determinants We've just been talking about healthcare does come into an access to care, access to treatment and the quality of that care. So hopefully that's useful. Quick glance at inequalities, Michael Marmot. So like Mama, one of my, uh, favorite people on the planet who has worked tirelessly for the last 30 plus years to put inequalities on the agenda globally. And, uh, looking at that social gradient again that causes people to have worse health if they are in a lower social position. There are different in due to health care care just mentioned that before different in access to an ability to benefit from healthcare provision. And they're very often associated with the determinants of health and polishes. If you can't afford to see a doctor because it costs against the A doctor or if you can't get to the doctor because it's too, they're too far away, either because you can't afford the train fare or the bus fare or you simply can't get there because the journey is too horrendous. You're not going to be able to access healthcare, and that is unfair. So making sure that people can access healthcare. It's really important for that 20% benefit to our health that healthcare presents but important at a human level for all of us. Okay, So just to conclude, uh, we've talked about public health, needing to step up and look at avoidable and tackle avoidable deaths and avoidable ill health. We've had a quick glance at inequalities and inequity. We know that there's a major role for healthcare provision, but that it's only relatively small player in the health of the population as a whole, and that there's an enormous role for other sectors and other services that are not part of the healthcare sector, that we have huge inequalities, not just in England, across the whole world and between countries and within countries. Largely we tolerate them and mankind has got used to that and societies have got used to it. And a lot of people find it really difficult to take on board that they are really and that they are unjust. So to join a movement, please do that understands that inequalities between individuals between populations are simply just need to be tackled, really important part of what public health is about. From what I've said, I hope you might agree that we need both the science and the art to change this to change hearts and minds as well as just to present the data, which is really powerful. But you've got to be able to influence the hearts and minds in order for the data to be impactful. And to have a public health mindset and voice wherever you are in the system helps that movement change. So that's my little bit of passionate. I hope you don't mind that. But I think it's really important that all of us in healthcare system at any level, whether you're in an acute environment, working in community, working, primary care, working public health, the understanding of what it means to have a and Easter perspective about the whole populations healthy. Why has that patient got ill at that time? And how can we make them better and to put them in a position where they can be empowered to have their own health better than it has been previously? Um, and I like this from the first one doctor in Britain, so I'll leave you that just a bit of thought. I'm not reading out, but I think it's quite I think it's a nice, nice description of public health. Although she didn't describe it as such at the time, but thank you very much. And, uh, any questions, But have you just stop sharing my screen so that you can have questions? Last slide is probably Yeah, Any suggestions or anybody who wants to look later on, Uh, at any more reading, if you have somehow found public health of interest. So there you get any questions? Thank you, Doctor, for your lecture. If anybody has any questions, please feel free to a mute or put it in the chat and I will read it for you. As Lizzie has said in the chat, there's also the next lecture on healthy eating. So please stay in. Uh, but yes. If I don't have any questions, please feel free to add meat. And just to note, the feedback form and certificate are both in the chat. Please ensure you do the feedback form to continue our lectures and also know how you're finding it as well. Gosh, I'm worried that there are no questions. I hope there might be, uh, all right. Anyway, I hope it was useful, and it's lovely. Lovely to meet you, but I'll stay on so that if anybody wants to ask questions. Feel free. Anything you like about public health doesn't have to be about what I've just said. Have you found your role is like evolved since the pandemic? Obviously you spoke about the epidemiological consequences of, you know, covid. But do you think I mean, how have you evolved since then? I mean, obviously, I appreciate obviously you're you're not practicing as much as a G. P. Now was prior to that, but yeah, How How has it evolved? Really? Right. That's really interesting question. So I personally I haven't been practicing clinically. What I did do, which I really enjoyed doing, is I am I worked for NHS England. I didn't talk about what I do, but but part of my part of my portfolio now that I worked for NHS England, and back in March 2020 the General Medical Council gave back the license to practice to thousands of doctors who had retired within the last several years, and they sent us the list of doctors to say, Would you like to make use of them? Which was really fascinating because the beginning of the pandemic everybody was struggling hospitals and primary everybody was struggling. So all of a sudden we have these thousands and thousands of doctors, and that sort of became a chunk of my job to say, Well, what? You know, How can we make use of these doctors? So two things happened? Uh, lots of things happen, but to I'll just tell you very quickly because you asked me. And it's quite nice to share some of these things. Thanks for asking. So one was that a bunch of doctors who didn't have their licenses. We discovered who who were living in the country having qualified overseas, and they desperately wanted to help with the pandemic, and they really wanted to do something. But they didn't have the license, and the G M. C wouldn't extend giving the license to doctors who've never practiced in the UK before. So we couldn't argue with the GM. See the General Medical Council. But we could say to these doctors, Let's make use of you in some capacity. And what we've done since 2020 is not just me, but it's been a national endeavor, is brought in, uh, several thousands of these doctors to work in the National Health Service. Most mostly in secondary, mostly in hospitals, Uh, very few in general practice, but mostly in hospitals to support the front line. They have got a huge amount out of it because it's helped to prepare them for their career and the NHS. So this is amongst these are some refugee doctors, uh, doctors from pretty much every country in the world, some eu, some European doctors, but from all over the place who wanted to start their career here, Um, many of them were struggling to get into the NHS has given them a a great opportunity to work in a non doctor, but clinical way in the health service. With plenty of supporters in remission, we managed to do that for them and then the other the other group of doctors I I got to know quite well were those who had retired and they were saying, Well, you know what? We're pretty vulnerable. Particularly the first wave. It would be crazy to put us back on the front line. Uh, first of all, we're out of practice. We've not worked mostly and acute situation for a few years. Anyway, things would have changed, but also we're going to get, get sick. So do something else for us. We're getting frustrated. We really want to help. So a lot of them ended up working on on the covid, uh, vaccination delivery program, which was really helpful because that was considered to be quite low risk. And they could get, uh, they could get their vaccines themselves by then. But at the beginning of pandemic, many of them got quite frustrated. Um, and then what we did was one of the things I was very excited about was that, um I went to a lot of them and said, Would you be willing to volunteer to do something? And most of them said yes. We're not looking to have paid money, but we've been given our license back, and now we want to be able to do something useful. So what we set up was a mentoring scheme for those doctors from overseas who have never worked in the NHS. Um, and, uh so the retired doctors, all those doctors who left medicine have been acting as my mentor. Most of them have had a background in medical education, uh, which has been really helpful. Or they'd worked overseas themselves and they had a They have a very good understanding of of how it felt to come in. Some of them were international graduates themselves. So So what we've got is is doctors from two ends of the spectrum if you like those who are just embarking on their career in healthcare in Britain and those who wanting to give something back during the pandemic who have managed to come back as as mentors, so kind of been with win. Um, I've done lots of other stuff as well. I found myself doing lots of talking with, um community lay groups, non medics and and other people that I work with, uh, from a non healthcare background. Who, uh, who needed to understand better what was going on around them in 2020 much less so now everybody's much pressure in for anyway. That's that's one little anecdote about, uh, interest. That was very interesting. In fact, there was one thing that you said that a significant interests, and that was due to the what I said, Sorry. What you said was, you was able to get doctors who weren't, you know, fully licensed by the G. M. C. During the pandemic into help. I mean, I think that probably that possibly resonates too many people, um, currently out in Ukraine at the moment or sorry, least students who are studying that. Obviously, there's a big issue at the moment. May not know. You may know in regards to many a large cohort of students who have graduated from their studies, and now there's drug to get accepted onto the G. M. C. Due to certain reasons that probably all outside the scope of this conversation, we could pick it up elsewhere. But unfortunately, we haven't been able to persuade the G M. C to go beyond looking at people who had qualified another country and had had experience as a doctor before coming here. So people who were newly qualified we haven't managed to persuade the G M. C to allow them in. And I think that's the group that you're talking about. Is the music all of my doctors real struggle and they need. They need the opportunity to get clinical attachments, which is a different, a different way of getting through the barrier. Really problematic. Yeah, yeah,