6858229573_f0a0498bb7Welcome to Public Health @BCU

Welcome to the new blog from the Public Health team at Birmingham City University! For more information about us, please see the About page.

We’ll be using the blog as a thinking point on public health. As part of that we’ll be adding public health-informed perspectives to issues or events that you may not have thought of as ‘public health issues’.  We’ll also report on scholarly, research and engagement projects that we’re involved in.

70 Years of the NHS: A very British way of not queue-jumping.

save our NHS

Our team member Aldo Mussi argues that “Perhaps the most inconsistent thing about privatised healthcare is that it’s, well… not very British!”

I held the shiny new 50p in my hand. It was 1998, and this was a special commemorative coin minted for the 50th anniversary of the founding of the NHS – and given one each to (I’m not sure how many) staff for free! I was a team leader in the NHS, and proud to be part of the best healthcare system in the world.
Some might take that 50p to be symbolic of the waste that pervaded the NHS in the past – but the danger would be to overlook the bigger threats that have plagued it throughout its existence. In the early days it was noticeably the medical profession that resisted Aneurin Bevan’s setting up of a nationalised healthcare service – so much so that he complained of having to bribe them by ‘filling their mouths with gold’. Today it is the filling of the pockets of businesspeople and lawyers that we must be wary of.

These days I teach Health Promotion/Public Health, and my students get to see how most of the health of a population is actually determined by factors outside of healthcare (ie our environments and behaviours). That said, while healthcare’s contribution to health is limited, it is nonetheless an essential one, and especially with basic community & family care (Midwifery, immunisations, screening etc). Big, expensive hospitals are great for individuals who are acutely ill, but overall don’t make such a big impact on our average life expectancy, or happiness.

The NHS continues to be treasured by Britons – so, for a country where ‘socialism’ has been treated as a rude word by the establishment, my students are often surprised to consider how socialist an idea the NHS is (we pay via taxation according to our ability, receiving care according to our need). It seems that Britons are more socialist than they realise.

Of course, even at the outset there were capitalist strands to the new system (charges remained for dentists, opticians and prescriptions), but it took the Thatcherite introduction of a contract culture to really start undermining things: It could be claimed that a genuinely national health service ceased to exist when local ‘NHS Trusts’ were set up in 1992, with a ‘purchaser-provider split’.

My students can be puzzled by how many of their healthcare colleagues adhere to the idea that privatised healthcare is the best, for those who can afford it. But even setting aside the now-clear realisation that unequal societies make health worse for everyone at a population level, privatisation doesn’t deliver for us: the same staff could provide care for us in a better-supported NHS (which already has better facilities)… and of course when things go wrong in a private clinic, it is NHS emergency care which rescues people, at the public expense. Another example of ‘socialism for the rich, capitalism for the poor’?

Privateers in the USA point to the few areas where expensive insurance can open doors to fast & high-tech treatments for the few. People paying $100 to get a splinter removed, or selling their house to pay for cancer care, are less impressed. In fact the USA has the most expensive healthcare in the world, but with downright unimpressive outcomes (other than big profits for insurance companies and lawyers).

“We are renowned for waiting our turn in orderly queues, in the interests of fair play and order. Yet privatised healthcare is queue-jumping at best, and damaging to the public’s overall health. So it’s odd that people who wouldn’t dream of pushing in to a queue at something more trivial like the cinema, will in some cases be persuaded that it’s ok to pay for getting treated ahead of someone else.”

That might seem ok if healthcare was supposed to be in a ‘marketplace’, as a commodity to be bought and sold. But that would be forgetting that access to essential healthcare is a human right, and that (as with schooling) attempts to privatise it are a breach of that right.
But perhaps the most inconsistent thing about privatised healthcare is that it’s, well… not very British. We are renowned for waiting our turn in orderly queues, in the interests of fair play and order. Yet privatised healthcare is queue-jumping at best, and damaging to the public’s overall health. So it’s odd that people who wouldn’t dream of pushing in to a queue at something more trivial like the cinema, will in some cases be persuaded that it’s ok to pay for getting treated ahead of someone else. So far, paying for organs is illegal in Britain – but for how long will this be the case, in the event that we have another 40 years of uninterrupted Thatcherite healthcare policy?

Safeguarding the NHS, a collectivist system, will require us to maintain our collective commitment as a nation. As individual citizens, we could also take actions such as

– Decreasing our reliance on privatised healthcare. With the constraints currently being imposed on the NHS, an individual can’t necessarily be blamed for trying to get the quickest care for their loved ones… but we could opt out of, eg workplace healthcare schemes.

– Joining the political effort, such as the upcoming ‘Save Our NHS’ demonstrations led by organisations such as https://keepournhspublic.com/

– And of course, we must also look beyond treating illnesses when they arise, and get more serious about preventing those illnesses, and promoting wellness, in society as a whole.

A happy, healthy 70th anniversary!

Aldo NHS not Trident

Aldo Mussi
Tutor in Health Promotion / Public Health.

Universities divesting from fossil fuels – & how BCU has narrowly missed getting a ‘1st’!

Climate change is not only a pressing public health, ecological and justice concern – it’s increasingly a financial worry. With fossils fuels increasingly seen as a liability, the shift by investors away from this old technology is growing (1).

In keeping with that trend, in November 2015 I welcomed reports that BCU was in the top 16 of British universities which had started ‘divesting’ from fossil fuels. (The top 10 were divesting completely, while the fund managers for BCU and others were merely fleeing tar sands & coal (the dirtiest fuels) (2). Others have joined the trend since then, but BCU is still in the top 25% of universities who have made the move (3).

emmissions stacks
(photo: Getty Images)

People & Planet (a national network of student eco-societies) publish a ‘green league table’ of British universities, and in the 2016 results, it’s good to see BCU placed 31 out of 150 institutions (top of the list of those awarded a ‘2.1’, but frustratingly just missing out on a ‘First’) (4).

A quick look at BCU’s scorecard (below) raises an obvious question: If we are at the forefront of divestment, why did we score a zero for ‘Ethical Investment’? It turns out that People & Planet’s criteria depend largely on being able to audit an institution’s published policies, including an Ethical Investment policy. BCU had not yet published one, so that counted against us. Interestingly, had it been published, our partial divestment would have counted for a score of 5% – possibly enough to push us up into a ‘First’ next time?

It seems that BCU management may be addressing this in the near future, so I’m hoping I’ll be able to report even better news soon…

BCU 2.1 green league 2016
Birmingham City University People & Planet University League 2016 Scorecard :
1. Environmental Sustainability; Policy and Strategy 100
2. Human Resources for Sustainability 40
3. Environmental Auditing & Management Systems 100
4. Ethical Investment 0
5. Carbon Management 35
6. Workers Rights 15
7. Sustainable Food 60
8. Staff and Student Engagement 20
9. Education for Sustainable Development 35
10. Energy Sources 31
11. Waste and Recycling 76
12. Carbon Reduction 78
13. Water Reduction 50

1) http://www.huffingtonpost.com/entry/fossil-fuel-divestment_us_584ee51de4b0bd9c3dfdbce8
2) https://www.theguardian.com/environment/2015/nov/10/ten-uk-universities-divest-from-fossil-fuels
3) https://www.theguardian.com/environment/2016/nov/22/fossil-fuel-divestment-soars-in-uk-universities
4) https://peopleandplanet.org/university-league-2016-tables

Aldo Mussi is a Tutor & Activist in Health Promotion/Public Health at Birmingham City University
and Environment Rep for the Universities and Colleges Union branch at BCU.

Sustainability In Public Health: A response to PHE’s 2016 report.

We can’t maximise our health if our environments are unsustainable.

Public Health England accept this in their Sustainability In Public Health Report 2016.

I was asked to comment on the report, partly due to my role as Sustainability Rep for BCU’s branch of the Universities & Colleges Union – so here goes:

The first thing that must be said is that if all employers shared Public Health England’s apparent willingness to consider their impact on sustainability, the world would be a healthier place. Also, while I have concerns about PHE’s position, I was to some extent reassured by a conversation recently with PHE’s Paul Cosford, that at least individuals like him were right on the ball.

On the document itself : As so often happens, the focus is on immediate impacts on the physical environment. Important as that is, for true Sustainability/ Sustainable Development, attention must also be paid to the social and economic environment (see my comments at end).



PHE’s buildings use is rightly considered, and some care is being taken with their environmental impact. More information is needed on the impact PHE is having with any office moves, refurbishments and new constructions.

Greenhouse gas emissions

It’s good that there have been some reductions, and wise to have invested in photovoltaics – but any lead organisation like PHE must achieve more than 2.6% reduction per year, if it is to lead the way for Britain to achieve its climate change obligations.
Clearly, the government must reconsider the need for & operation of the facility at Porton, given its huge impact… & what is going on with refrigerant loss at Colindale?


It’s good that staff train use is up and car use is down (although we must hear why it is that the Chief Operating Officer’s department spends so much on car use). More data would also be welcome on how these cars are powered.
An increase in 73% on international flights is unacceptable (we need to hear how much of this is really due to crises like ebola) – and even worse, that domestic flights within a small country like Britain have also increased by 73%.
It’s welcome that more videoconferencing is being encouraged, but it is insufficient to say “It is hoped that this new technology, which is available for all staff, will help reduce our need to travel for face-to-face meetings,” or, “we will use public transport wherever possible, rather than our own cars”. Clearer intentions and actions are required. Further calculations would also be useful, such as whether the organisation is successfully increasing the proportion of commuting miles cycled/walked/run, compared with car use.

Sustainability training

The staff training on sustainability is welcome, and there are some good, if limited actions on biodiversity. Perhaps more could be said about, eg avoiding the use of pesticides such as glyphosate, and avoiding genetically-modified organisms.
I’m glad that the need for responsible procurement gets a mention – and more detail is needed on how successfully PHE manages to increase the proportion of its purchases which are organic, fairtrade, and locally- or co-operatively- produced, and how much of the electricity used is from renewable sources (not just ‘green tariffs’).


I’m glad that PHE has reduced its ‘waste’ materials, and especially that landfill has reduced (though we should hear more about what was actually done with its used materials). It’s good that there is a disposal plan for IT equipment – but more must be said about how the need for new IT equipment can be reduced. Indeed, it would be very instructive to have reporting of what goods/materials were acquired during the year, to see if the consumption could be reduced at the outset.

Cold homes

There is brief mention of cold homes (an essential consideration, given that colder countries such as Sweden do not tolerate the excess winter deaths of British citizens condemned to fuel poverty and inadequate housing). I doubt that “Providing local authorities with data on how to improve their housing stock” will have much effect – Councils already know what’s needed, but have had their funding cut. Stronger advice is needed to national government, which could do much more to reinstate the welfare safety net, as well as increasing housing standards (especially in the private rented sector).

Social & economic environment

More could be said on how well PHE is, for example, promoting equality, reflecting the population it serves, and avoiding use of ‘first class/business class’ travel.
On the ‘economic environment’, it would be good to see PHE’s pay ratios within the organisation (including externally-contracted staff), and whether PHE ensures its investments are free from arms, torture, tobacco, and fossil fuels.
So, overall, I would say this document shows a better picture than I would expect (unfortunately) from most employers – but given that PHE is a lead player on sustainable development, even more is needed, if Britain is to reach its sustainable development responsibilities.
I wish Paul Cosford and colleagues all the best for their future actions.

27 Jan 2017
Aldo Mussi
Tutor in Health Promotion/Public Health at Birmingham City University (BCU)
Sustainability Rep for University & Colleges Union at BCU.

Public Health Student Showcase

A happy new year to all our students and colleagues! We are pleased to introduce the Public Health Student Showcase; a semesterly update on the successes and achievements of our BSc and MSc Public Health students both on-campus and in the wider community.

The Christmas 2016 edition features our students’ involvement in regional and national conferences, contributions to local public health initiatives and community groups, and international travel. Students who wish to be involved in the writing of the new edition should contact jake.sallaway-Costello@bcu.ac.uk.

Click here to see this edition!

Air Pollution : 8 ways to stop killing people

by Aldo Mussi, Tutor in Health Promotion/Public Health.

The time has now arrived to take air pollution, as currently encountered in the UK, much more seriously. It should be considered a major public health problem”, according to a new report featured in The Lancet.chest xray

60 years on from the first Clean Air Act, this is the latest ‘inconvenient truth’ about our lethally sub-standard air quality, which the UK government will find ever harder to ignore. It’s been known for some time (but little discussed) that 29,000 per year die early due to inhaling particulates (invisibly-small specs of soot), mainly from diesel engines. The report now shows that the total increases to 40,000 when we add in the early deaths due to nitrogen oxide poisoning from exhausts. The effect of these toxins on the human body is mainly seen as heart and respiratory disease, stroke and lung cancer.



Motorists have some cause to feel confused: The ‘switch to diesel’ encouraged by governments over the last decade or so was based on the still-sound evidence that diesel engines produce less greenhouse gas pollution than petrol. That’s still important – but what wasn’t known then, is the level of disease caused by diesels, especially in towns. Both types of engine are harming us, in slightly different ways.

The report goes on to look at the additional early deaths from indoor air pollution. While second-hand smoke, faulty gas heaters and radon have long been recognised, the authors call for more attention to be given to the less-discussed threats from sources such as air ‘fresheners’ or other chemicals such as in deodorants and hairsprays, or from faulty log burners. It seems that more action is needed to enable people, and especially children, to enjoy clean air indoors.


So, some actions we could take as a country could include :

  1. For the government to stop acting illegally (costing us in fines as well as deaths), and comply with legally-safe levels of air quality.
  2. For ministers to stop costing our economy £20 billion per year from their failure to create a safe, accessible and interconnected transport system.
  3. Where private vehicles are seen as necessary, encourage diesel vehicles for long-haul journeys only, and in towns move to more low-emission options such as no cars, electric (renewable) cars or at the very least, high-efficiency petrol cars. Diesel buses, trains and taxis will become a thing of the past.
  4. For more councils to follow the example of Solihull, as the first authority in England to start restricting traffic volumes around schools – and on air quality grounds, not just to limit crashes.
  5. Make it easier for people to wean themselves off their car habits, and make our roads less hostile to non-drivers. As my students know, ‘making the healthy choice the easy choice’ has long been a mainstay of individual behaviour change.
  6. Do more research into the effects of household and ‘personal care’ chemicals, and fumes from heaters. A social marketing campaign to raise awareness of this may be necessary.
  7. For the Public Health community to give as much attention to ‘unfashionable’ hazards such as vehicle emission poisoning, as they do to comparable hazards such as tobacco and alcohol. Our BSc and MSc students here at BCU already do this, so it’s one reassurance that they’ll be part of the future workforce.
  8. For all of us to ensure the authorities are held accountable for protecting our health from avoidable hazards. (Who will you let in at the next election?)

Details of BCU’s BSc and MSc courses in Public Health can be found at : www.bcu.ac.uk



Conversation: A Public Health Perspective on Dementia

Image credit:  HarlequinQB at Deviant Art CC licence  BY-NC-ND
Image: HarlequinQB at Deviant Art. Creative Commons

This blog post is in the form of a dialogue (email exchange) between Aldo Mussi, one of our Public Health @BCU team, and Catharine Jenkins, a colleague who is a Senior Lecturer in Mental Health Nursing, with a special interest in dementia.

Aldo: Dear Catharine.  Media discussion of dementia often revolves around hopes for a cure, but a Public Health perspective on an illness would look more at how to prevent it occurring – and for this, we first need to identify the causes. What is known about the biological, psychological, social and environmental causes of dementia (or ‘dementias’, if they differ)?


Catharine: Good to hear from you. I agree, thinking about the broader factors that may be contributing to risk of dementia is very important. I think we get very mixed messages from the media, it’s as if a magic wand is just around the corner, about to bring us the ‘cure’ so we can bury our heads in the sand about anything we can do ourselves as individuals or as a society, that could reduce risk. But at the same time we are often told ‘use it or lose it’!

I suppose part of the problem is as you suggest, that understanding the cause is key. There are many different types of dementia and some different theories about causation. For example Lewy Body disease is very like Parkinson’s disease. As Alzheimer’s type is the most common I’ll stick to discussing that, although it seems increasingly likely that many people with Alzheimer’s have a mixed type of dementia where vascular factors are also involved.  Generally for health promotion advice the clearest message seems to be ‘what’s good for your heart is good for your head’.

What’s good for your heart is good for your head

But anyway, getting back to your question about causes, the most likely scenario is that there is an element of genetic risk the impact of which is then built upon or lessened over the years by other factors. Some peoples’ brains may be less well able to manage the amyloid protein which can build up in brain cells (and eventually kills them – the cells!) over time. We all have these proteins, but too much is not good. So given that amyloid is there, it’s a question of how can we reduce the amount, help our brains to deal with it, and help our brains to keep going when the number of neurones is reducing. Researching how to do this is quite difficult when brains are difficult to look at when people are alive and the brains of mice are only like ours to some extent. There have been a lot of drug trials that had great results on mice with dementia but then had harmful effects on humans.

Some of the research on causes has looked at the ‘amyloid cascade’ theory, which suggests that genetic and environmental factors tip the brain into a process where the amyloid and another protein ‘Tau’ trigger one response after another until the number of neurones is diminished to the extent that it is clear that the person is struggling with various abilities that we associate with dementia (memory, organising themselves, communicating and orientating themselves are some examples). But by the time the problem is obvious on the outside , it is late on in the process happening inside and too late really to do much about it. So we need to look at potential contributing factors way before – maybe 20-30 years before – anyone suspects there might be a problem.

One way of looking at factors is considering characteristics and history of people who go on to develop dementia and those that do not. Protective factors include having a healthy diet with lots of vegetables and fish, exercising regularly, minimising alcohol consumption, not smoking, having a good education and a challenging job (good news?) and being sociable. Being bi-lingual gives five years protection too apparently! Risk factors include not doing or having those things, but to add to that a history of depression in middle age is a risk factor. As is of course just getting older! Women are at more risk than men.  So there are some things we can’t do much about, but the main things seem to be protecting the brain’s circulation and resilience with health promoting behaviour, then working it so that there are neuronal connections that will step up (this is called ‘brain reserve’) if some are damaged.

These factors seem quite individual in orientation, but perhaps I’ve overlooked the context of individuals in society. Perhaps I should have thought about the role of stress in heart disease and circulatory disorders, or the expense of eating well, having a safe place to exercise? How would you see things more broadly? And what would you recommend from your professional perspective?

David Cameron becomes a dementia friend by The Prime Minister
Image: David Cameron becomes a Dementia Friend, by The Prime Minister’s Office (Flickr). Creative Commons

Aldo: Dear Catharine,  your comparison with heart health is useful, particularly in reminding us that dementias are complex and have multiple causes (many of them outside of the control of individuals) – but where individuals feel they can do something themselves, you may have a great campaign slogan there : “What’s good for your heart is good for your brain”!

As you also say, it’s important to recognise the limitations of a ‘lifestyle’ approach (especially if it over-emphasises dieting & sport, as heart health initiatives tend to).

Public Health England’s Annual Plan 2015/16 mentions ‘reducing dementia risk’ as a desired outcome, but it’s very disappointing that the only action cited is to ‘successfully transition the ‘Dementia Friends’ programme to the Alzheimer’s Society’.

Perhaps a more comprehensive and effective dementia prevention strategy would be one that stops creating a society/environment which encourages dementia, but adapts it so that it takes into account the identified causes you mention, and so promotes :

  •  A food culture based on mainly plants with some fish.
  • A drink culture based on far less alcohol and sweet drinks.
  • Greater restriction of the tobacco industry.
  • Daily routines where people are physically active (in work, travel & play).
  • Work which is stimulating and satisfying for all.
  • A culture where education for life, for all, is valued – & that it emphasises personal and social development.
  • Encouragement of ‘The 5 Ways To Wellbeing’ (which includes having more social connection, and fosters good mental health generally)
  • Much greater social & financial equality (so that, eg ‘a good education’ is for all, not just for an elite, and so that women are less disadvantaged)
  • Multi-lingualism !  (Perhaps if England stops isolating itself linguistically, there will be a number of other benefits too).

Looking at this list, it has echoes of broad health strategies such as ‘Health For All’, and even the UN Declaration of Human Rights! Once again, it’s likely that if we get the basics right, then apart from being healthy & desirable in its own right, this will be beneficial for brain health, heart health and the prevention of many illnesses.

Image licences: Creative Commons  Creative Commons Creative Commons Attribution-Noncommercial-No Derivative Works 2.0 Generic License




Summertime: If we can’t stand the heat, let’s stop heating the kitchen.

 Post by Aldo Mussi,  Snr Lecturer in Health Promotion/Public Health aldo.mussi@bcu.ac.uk

During the summer months in Britain, health concerns in the popular media often focus on familiar topics such as sunburn or food poisoning –which is fine, as far as it goes. But it tends to overlook a much bigger threat to the health of the whole population : climate change.

‘What?’ I hear you say, ‘How is that a health problem? And the summer’s aren’t always hot anyway!’.

The 2003 heatwave in Europe, thought to have caused 20000 deaths.
The 2003 heatwave in Europe. Image credit: BBC News

Actually, public health experts now recognise that “the potential health effects of climate change are immense” (1). This is partly due to problems from raised temperatures, such as heatwave deaths (mainly of vulnerable people who needn’t be vulnerable) and changes in infection patterns – and the NHS has already had to start preparing for such challenges.


Climate change is not just about ‘getting hotter & sunnier’, however: a big threat is the more unpredictable and extreme weather we are creating, whether it be storms or flooding patterns which are different to those of the past. That’s without looking at the early deaths we cause (as big a problem as heart disease) from air pollution, especially around busy roads during still, summer days.

Birmingham Smog. ITV News Central.
Smog in Birmingham, April 2014. Image credit: ITV News Central

And I say ‘created’ by us, because it is now 95% certain that climate change is real and being accelerated by humans changing the balance of greenhouse gases in the atmosphere – it’s official (though often neglected), and health experts show us what needs to be done in documents such as the NHS’s ‘Saving Carbon, Improving Health’ (2).

So what’s the solution? Relying on individuals to change their behaviour (like using a washing line instead of a tumble drier, or driving their car less) will only make a modest difference – though it’s a good start. The main things changing our climate are energy and transport from fossil fuels, a meat-heavy food system, and other big industry factors.

It’s encouraging that public health professionals are waking up to the threat, and our Public Health students here at Birmingham City University have become conversant with it as a health issue at least as important as things like diabetes – so there is hope for the future.

But the new government’s minister for Energy and Climate Change, Amber Rudd, has a lot of work to catch up on, given the failure in recent years to tackle the issue – and it’s worrying that she has already overseen a reduction in support for renewable energy generation, while continuing with backing for the fracking of damaging shale gas.

Time is short for Rudd, and for all of us – so what can we do as individuals, apart from encouraging her?

Well, it’s summertime, so enjoy it: maybe by walking in it more rather than driving.


  1. Costello, A et al (2009) Managing the Health Effects of Climate Change, The Lancet, Vol 373, No.9676, p1693-1733. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60935-1/fulltext
  2. NHS Sustainable Development Unit (2009) Saving Carbon, Improving Health’ http://www.sduhealth.org.uk/policy-strategy/engagement-resources/nhs-carbon-reduction-strategy-2009.aspx