Adam Briggs Profile picture
19 Apr, 25 tweets, 10 min read
Having now worked it's way through the @Telegraph system: with @louisemarsha11, our take on the plans for replacing Public Health England. 🧵

tl,dr: we need a more, not less, joined up system if we're serious about health & inequalities

No £-wall🔓…
PHE is being split into the UK Health Security Agency (UKHSA which also includes Test&Trace) - focusing on external threats like pandemics

and the Office for Health Promotion - focusing on health improvement and inequalities, such as obesity and tobacco.…
As we wrote at the time, it's a risky business reorganising public health in the middle of a pandemic.…
COVID loves inequalities.

The pandemic has exposed and exacerbated the deep rooted differences in health and opportunity across society.
Levelling up is an issue of social justice.

But it affects everyone *not* just the most vulnerable:
- it will help tackle the pandemic
- it will accelerate the economic recovery
- it will improve national resilience against the next major health or economic shock
People who are healthier feel better, they are more productive, they play a greater role in their communities.

Health is an asset.…
People living in deprived areas and from minority ethnic communities have not only been more likely to get COVID, but they have had worse outcomes once infected.…
These were often people who couldn’t work from home because they are carers/nurses, or keep supermarkets stacked, or deliver our packages.

The very people who kept the country going paid the biggest price.…
And when infected or identified as a close contact of someone with Covid, these same individuals were the least able to self isolate.…
Around 1 in 3 social care staff are on the national living minimum wage, 1 in 4 are on zero-hours contracts.

Insecure jobs and casual work can mean the appalling choice of staying at home to protect colleagues and limit spread, or going to work to be able to pay the rent.
Even at home, cramped housing often means people can't effectively isolate from family members/housemates, further increasing risk of transmission.
Until the underlying factors driving ongoing high case rates - like housing and employment - are addressed, we will keep experiencing outbreaks with the potential for new and more virulent viral variants to emerge.
And further local lockdowns will simply mean that those places most in need of economic recovery suffer yet further.

@chrischirp wrote this excellent summary of COVID and inequalities.…
Add to this, conditions like diabetes and heart disease are more common in deprived areas (and lead to worse Covid outcomes).

They are also largely preventable through health promotion measures like creating more green space, cleaner air, healthier food.…
And this is why separating health protection from the rest of public health is a false dichotomy.

The reforms have the potential to create a more, rather than less, fragmented public health system.
Some bits are welcome, like a new ministerial board to co-ordinate cross-government action on prevention, but there's still no independent scrutiny of gov actions on health and inequals.
There's also recognition of the importance of local gov & Directors of Public Health

But the public health grant – for local services on obesity, smoking, alcohol, sexual health etc – has had a real terms cut of 24% per head over the last five years…
Any organisational upheaval also leads to workforce attrition.

Over the past 12 months, public health professionals across the country have worked night and day to keep the nation safe.
They’ve tracked how the virus spreads & led research; managed cases/outbreaks in the most complex settings; they lead the ID of new potentially dangerous viral variants to limit their spread.

They have done this & more+++ with huge dedication & often little recognition.
They are physically and mentally exhausted, and there is a risk that many highly skilled professionals will leave during the transition unless staff wellbeing and workforce planning are taken seriously.…
As health secretary Matt Hancock said in his announcement, “levelling up health is the most important levelling up of all”.

To do this, the government needs a public health system that can work more closely across health security, health promotion, and inequalities.
The new structures may threaten this close working, but as with any new system bedding in, there is still the opportunity to shape things for the better.

Including respond to the current consultation, closing 26th April.…
The pandemic has highlighted the outstanding work of public health individuals, teams, & orgs.

But it's also exposed the scale of the task ahead.

I'm v optimistic our public health leaders will be making the case for a stronger system. I just hope someone's listening.

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Adam Briggs

Adam Briggs Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @ADMBriggs

8 Apr
This week's Test & Trace data - for 25th to 31st March (around the last week of school before holidays)

- LFD tests down
- big variations in LFD use across the country
- and increase contacts per case.…
The number of people tested week on week has fallen for the past two weeks, down to 4.8m from a high of 6.2m.
The fall is due to reductions in LFD use - down 23% to 5.5m.
Read 25 tweets
8 Apr
This week's @PHE_uk COVID surveillance report, 29th March to 4th April (incl. start of the school hols). 🧵

⬇️ case rates, partly from fewer 10-19y/o LFDs with no clear sign yet of schools leading to ⬆️cases in older ages

+ important variation by region…
Further drop in cases in the most recent week following a bit of a flattening off in previous weeks - with some of this due to school holidays and fewer LFD tests.

Worth noting that for March, both REACT and ONS surveys suggest that case rates are generally static.
Big drop in LFD use, which is mainly due to a drop in test use by secondary schools (see T&T data).

The drop off has accelerated with the school holidays, but the move from testing in school to at home may have contributed over the past few weeks.
Read 19 tweets
8 Apr
Latest update from REACT-1.

Looks 11-30 March (schools fully reopened on 8th March).

- Suggests infection rates fell by around 60% between Feb and March to 0.2%
- Big differences by age, region, and deprivation
- R now estimated at approx 1.…
Falls across all regions but highest rates still in NE, NW, and Yorkshire and Humber (round 9 is swabs from 4th-23rd Feb, round 10 is 11th-30th March)

Includes 12% probability R>1 for Y&H between two rounds. <1% in all other regions.

This is consistent with ONS survey data.
Highest infection rates among 5-12y/o (as does ONS), but REACT suggests lower infection rates among school age children than ONS does.
Read 4 tweets
1 Apr
PHE latest COVID surveillance report now out, as is ONS.

Covers 22nd-28th March 🧵

-cases down all ages except 10-19yrs.
-Significant geographical variation.
-Vax still motoring.
Fall in case rates in all age gps (incl 5-9y/o) *except* for 10-19y/o where they've increased by 7% to 110 cases/100,000.

Lowest cases rates are among 70-79y/o at just 11/100,000, and generally there's a step decrease in case rates for ages 60yrs+ compared to those <60yrs.
And among 10-19y/o, case rates seem to be rising mainly among 10-16y/os.
Read 27 tweets
27 Mar
If this is true, it is so disappointingly shortsighted.

I hope that @MattHancock and @Jochurchill4 will reconsider.

A quick walk through the evidence. 🧵
Nearly one in four reception age children and one in three children at year 6 are overweight or obese.

And there are stark inequalities - children in yr 6 are *more than twice* as likely to be obese if living in the most deprived areas compared to the least.
The government is aiming to halve childhood obesity by 2030 and reduce inequalities.

You can't do this with one or two policies here and there. Obesity is complex and multifaceted. To make any kind of dent, you need a multifaceted solution.…
Read 19 tweets
25 Mar
And most recent T&T data, 11/3 to 17/3. 🧵

- More testing
- Fewer cases
- And the numbers of non-household close contacts is rising again.

This week, just a short thread to pull out main points.… Image
Small increase in number of people tested but rise of 1.3m in number of LFDs used, driven by secondary schools. ImageImageImage
And case rates generally still falling, except among school age children

Read 10 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!