An independent Social Affairs magazine www.viewdigital.org Issue 36, 2016
THIS ISSUE IS SUPPORTED BY THE PUBLIC HEALTH AGENCY
VIEW, Issue 36, 2016
VIEW puts health on the agenda
y first face-to-face meeting with Joanne Morgan, director of the Community Development Health Network, took place over a coffee in a small cafe on the Antrim Road in Belfast. Joanne had agreed to be the guest editor for our health issue of VIEW. She didn’t hesitate when I outlined the time framework for the production of the magazine and has wholeheartedly thrown all her efforts into it. She and her organisation of community activists are often unsung heroes/heroines of action on the ground who are striving to deliver better health outcomes for their communities. I am also delighted that the Public Health Agency has given its support to the publication of this magazine. Health is such a major issue and impossible to do justice to in a 32-page magazine. Hopefully, our readers will enjoy and be provoked by the range of articles
By Brian Pelan co-founder,VIEWdigital in this issue. We are delighted to secure an interview (pages 10-11) with Dr Alan Stout – one of the members of the new health panel set up to look at the provision of the health service in Northern
Ireland in the years ahead. We welcome feedback on this story and are actively seeking other voices in the health sector who may wish to comment on what should be done to tackle our waiting times and cuts in budgets. If we want a decent health service that provides excellent service at the point of entry, we have to struggle and campaign for it. We do not believe that privatisation models are the answer, or endless rounds of austerity-led initiatives. The frontline staff – the doctors, the nurses, the hospital porters and cleaners – have tried their best to keep going in the face of pay freezes and job losses. They also deserve our full support and their voices should be listened to when the new health panel issues it recommendations. We either have a society where money and class determines your health care or a society where we all look after each other when we become ill.
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VIEW, Issue 36, 2016
VIEW, an independent social magazine in Northern Ireland
eing connected to my community has always been an important part of my life, even as a child. I have my mother to thank for that. As well as working full-time in the local high school, she ran a community choir, weekly Irish language classes and a three-week long Irish summer school for upwards of 100 children in a rundown community centre every summer. My mother knew the importance of connections. Learning a new language was a very small part of the plan; making new friends and having a sense of belonging – that’s what kept us all coming back. This early experience has helped me understand the importance of connections in my work with Community Development Health Network (CDHN). One of the first places I visited when I joined CDHN was a homeless shelter where we were supporting a partnership with a local pharmacist. We met at lunchtime, which gave us a chance to chat and what I heard made a lasting impression. The stories were heartbreaking – the majority of those I met had experienced serious mental health issues which led to relationship breakdowns, loss of jobs and homes. I walked away thinking that could be me, my husband, my friend. But it was their sense of connection that made the biggest impact on me; not just with the people from the shelter that were paid to or volunteered to support them, but with each other. The absolute need for human contact, friends, to be part of something. Why am I telling any of this? Because it’s fundamental to our understanding of how best to tackle health inequalities. Picture this. Two baby boys are born on the same day in the same maternity hospital but from different parts of the same city. Their mothers imagine the life they have ahead of them. In a modern world full of opportunity, anything is
By guest editor Joanne Morgan Director, Community Development and Health Network
It’s time to flex our muscles and get serious about ending inequality possible... is it not? What if we told them the truth? That when they grow up to be men one of them will die eight years earlier than the other. He probably won’t have a job and if he does, it won’t pay very well, because he didn’t get to stay on at school and get qualifications. He will live in an overpriced house in a rundown area because he can’t afford to live anywhere else. He will be lonely, anxious and isolated most of the time, angry and frustrated some of the time because nobody takes any notice of him, he feels invisible. The health system will view him as a burden because he has type 2 diabetes and COPD – long-term conditions that will require medication and treatment. He will be told these conditions were preventable because he developed them as a result of his ‘lifestyle choices’ and behaviours (eating too much fatty, sugary food and smoking). He will be treated for his depression, anxiety, diabetes and COPD and sent straight back to the conditions that created them. Is this fair, just or acceptable in modern society?
Sir Harry Burns, former Chief Medical Officer for Scotland and now Professor of Global Public Health at Strathclyde University, gives a clear message: “The ‘don’t do that, do this’ approach doesn’t work. To crack difficult lives, we need to discover what is really wrong in those lives and seek to transform them. You can tell people to eat less saturated fat but if someone is merely tolerating life on a day-to-day basis, they are not going to be motivated.” This becomes really critical when we look at current approaches to improving health for the most vulnerable in our society; approaches that focus on conventional health promotion methods of information sharing education for behaviour change. It’s not that they don’t have their place, but we can’t continue to treat symptoms and send people back to the conditions that made them ill. Increased disconnection across communities and generations damages health, wellbeing and social cohesiveness. Burns also says: “The answers lie in repairing a fragmented society where many people feel they do not have control of their lives. We must not concentrate on deficits but on assets, skills and capacities. We must build social capital so individuals can offer each other friendship and mutual support.” We in CDHN see the value of connections every day in the work we do with community groups across Northern Ireland. It’s complex, exhausting, exciting and hugely rewarding. It’s what helps address the power imbalance and build “civic muscle” with collective authority. It’s time to flex our muscles and get serious about ending inequality. Our communities and the people in them are the biggest assets we have in making that a reality.
VIEW, Issue 36, 2016
Positive: Lindsay Robinson at her home in east Belfast
VIEW, Issue 36, 2016
From darkness to light
Lindsay Robinson tells VIEW editor Brian Pelan of her battle with postnatal depression and how she now wants to help other mums who may be struggling with the illness
s the sunshine streaked into the living room of an east Belfast home, it was hard to believe that the radiant-looking young woman opposite me has been suffering from postnatal depression. Thirty-three old Lindsay Robinson, who is a mother of a two-year-old boy called Reuben and is married to Democratic Unionist Party MP Gavin Robinson, spoke softly as she described her harrowing experience. “I am five months into recovery and I am definitely seeing the light at the end of the tunnel. I think it’s only hitting me now, as I am getting better, just how physically, emotionally and mentally unwell I had become. Now that I am beginning to recover I am finding myself again. “I was very ill for a couple of years and wasn’t really sure what was wrong with me until last summer when I was finally diagnosed with postnatal depression. It was actually reading other mums’ stories online that helped me to speak up. Their stories made so much sense and helped me get my diagnosis of postnatal depression. I decided once I was feeling well enough, I wanted to try and use my experience to try and help other mums.” Lindsay tells how she decided to write a very personal blog (Have you seen that girl?) to put down in words what she was feeling. She grew up in Portstewart, Co Derry. About seven years ago she moved to east Belfast where she met Gavin. She said: “I’m five months into taking medication although I’ve only been on the highest dose for three months and I am not thinking about changing that or doing anything with it until the summer. “I hate to sound critical, but certainly in the first few months after I had Reuben the help provided to me by some people from the medical profession was very poor. I had asked for help on two occasions, three months after Reuben was born, and I was completely dismissed. I was
Extracts from Lindsay’s blog:
• I have postnatal depression. It’s over two years since Reuben was born and this is the first time that I am publicly admitting it. • I looked at Reuben and felt nothing except a desire to turn back the clock.
• My first night home, as I sat on the sofa chatting with Gavin, mum and dad, I had to resist the urge to hand Reuben to him and walk out the door and never come back. • I spent many days secretly crying, for sometimes no
told: ‘This is how mums feel, just get over it – it’s no big deal’. “Once I got a different GP it changed. He looked me in the eye and said: ‘You’ve got postnatal depression but you’re going to be okay.’ I could have kissed him. It was such a relief to know that this is what’s wrong with me and it doesn’t have to be this way forever.” Lindsay, who has recently become a health ambassador for the Northern Ireland Association for Mental Health (NIAMH), said: “I’m finding my voice again through my blog, but I’m also just finding day-to-day life is much easier. “I look forward to the day rather than dreading it. I enjoy being able to sit down and watch one of my favourite
reason at all. I would long for nap time, so that I could put Reuben down and weep privately, hoping the tears would help to ease the pain.
• Others days I have felt numb, as if nothing could touch me. As if I lived in a parallel universe to everyone else and was just watching life go by. • I felt completely detached from myself, from Gavin, from Reuben and from everything around me. Those days were equally as hard. It was like I was trapped in a black hole from which I should want to escape, but had no desire to leave.
programmes on TV – I couldn’t do that for two years. I am enjoying being out with friends. I just feel like life once again is to be lived and I’m able to do that.” I asked Lindsay did she think that her experience has changed her? “It’s definitely changed me. It’s changed how I see life. “It’s changed completely what my initial view of motherhood and even family was like from how I imagined what it would be like to be a mum and have a child. “I’m now starting to look and see what can I learn from these last two years and it doesn’t always have to be negative. “I’m a different person now because of this.”
VIEW, Issue 36, 2016
Residents and council officials enjoying a Community Spirit day in Toome, Co Antrim, and (below, right) a new logo designed for the Duneane project by Edel McNally and Geraldine McCoy Images Carrie Davenport
Community spirit strengthened in Toome
n innovative health project has boosted the spirit of residents in Toome, Co Antrim. Jenny Hanna, Pathways to Health Project Manager for the Community Development Health Network, based in Newry, Co Down, said: “We were delighted to be asked to be facilitators in a project between Antrim and Newtownabbey Borough Council and residents in Toome. “The council wanted us to work with a community project that used co-production as its basis. It’s public services and local community services working together. We do a programme called Community Health Champions and we train people in the local community.” The group in Toome have designed a logo for the Duneane Community Champions project that is based on an elk.
Facilitator: Jenny Hanna
Ms Hanna said: “We started the project last October and we have trained 30 people so far. “The people involved in the project are adults whose ages range from 30 years of age upwards. They have been recruited
through TIDAL – a community group based in Toome. “Our role was to facilitate the relationship between the council and the local community in Toome. “We believe that if people are better connected to each other, it will improve their health and wellbeing. “Initially, during the start of a Community Health Champions programme, people will say ‘we don't have enough space in our area for community activities’ or that ‘we have drug and alcohol problems’. It can be quite negative initially. But after a while they start to see the assets they have in their local community. And they start to see themselves as people who can make a contribution. “The group in Toome have just organised a Community Spirit day. It was held to let people be aware of all the positive things that exist in the area.”
VIEW, Issue 36, 2016
success story www.viewdigital.org
A young woman who has Asperger’s syndrome tells VIEW how a Action Mental Health project has helped to turn her life around
y name is Adrienne. I’m 27 years of age and I have Asperger’s syndrome. It’s a mild form of autism which affects my social interaction and communication skills as well as how I process and interpret information. I do not understand figures of speech unless I have learned their true meanings. I also have limited non-verbal communication and a poor short-term memory, so I cannot process a lot of information at once. My Asperger’s caused me difficulties at home (such as arguments with family members) and at university, such as taking longer to complete my coursework and other tasks in general. Not understanding my coursework, requiring clarification with things mentioned in lectures, and in particular group work, were all significant issues for me. I left university with a Bachelor of Science degree, depression, no self-esteem and no intention of applying for jobs because I felt as though all the hard work and stress I experienced trying to obtain my degree had come to nothing. I was unemployed for two years and in that time I completed a Prince’s Trust course that gave me my confidence back, so I started applying for jobs. I got many interviews and was capable of doing the work required, but because of my difficulties with processing and interpreting information due to my Asperger’s, the responses I gave at these interviews did not answer the questions being asked. I was constantly unsuccessful. The confidence I regained from the Prince’s Trust course was lost completely and I was on the verge of giving up until my occupational therapist got me into Action
Visionary project changes lives Patricia Kelly, Client Development Co-ordinator with Action Mental Health, said: “The Vision project is specific to Newry and Mourne, New Horizons. It’s a programme that supports people who are on the autistic spectrum. It’s intensive one-to-one support. “This project has enabled Adrienne to lead a normal life. “It has allowed her to hold down a job. She is also more independent. “The beauty of the Vision project is that there is no real end to it. “There is ongoing support for the person who needs it. “It is part-funded through the Northern Ireland European
Mental Health New Horizons. I took the term ‘New Horizons’ to mean me moving on to bigger and better things, a new start, the beginning of a better life for myself. At New Horizons, I completed many accredited training courses. With the help of the employment officer in New Horizons I secured a work experience placement in McKeown’s Solicitors. I was initially supported by the Vision support worker until I gained the confidence, knowledge and skills to do this on my own. I have been employed there on Supported Permitted Work Higher 15½ hours per week as an administration
Support: Patricia Kelly
Social Fund Programme 20142020 and the Department for Employment. “The Vision programme was started in May, 2003.” Ms Kelly added: “It would be good to see the project rolled out across Northern Ireland.”
assistant for two years. I get on very well with my colleagues, who are a wonderful support to me and always include me in any of their planned social events. I would highly recommend the Vision Service within Action Mental Health-New Horizons for people with Asperger’s because it has been a huge part of the journey to the success and fulfilment in my life which I never believed was possible. Now I live in a larger house with lots of nice things and I have my independence. I have come a long way since leaving university and my life has changed for the better.
VIEW, Issue 36, 2016
Children taking part in the SPACEWALK programme, which improves their health, confidence and wellbeing
SPACE created for wellbeing
family support organisation based in Newry has won praise from mothers whose children take part in its projects. Supporting People and Communities Everyday (SPACE) was started in a small terraced house in Thomas Street, Warrenpoint, in 2003 after local people identified the need for family support throughout rural South Down Jacinta Linden, Director of SPACE said: “We provide much-needed services and support to families struggling with life’s challenges.” SPACE co-ordinates the Newry Family Support Hub, which has a range of statutory and community sector partners – all of whom are focused on providing flexible services to support families. Referrals come from agencies such as
GPs, schools and health visitors. Ms Linden said: “Over a period of time individual referrals to the hub established an emerging need to support young boys in the eight to 13 age group. “Many of these boys had challenging behaviours and distrustful relationships with formal authority. “Others lacked a positive male role model in their lives and some struck out at parents, siblings and friends which, at times, led to anxiety and fear at home. A new nine-week SPACEWALK programme was developed with an emphasis on outdoor activities. It offers a chance for the boys and their families to come together and apply the learning from the one-one work. Paula, one of the boy’s mothers, said she had struggled to manage her son’s behaviour. “He was recently diagnosed with
moderate learning difficulties and was battling with school, home and routines.” Following the work with SPACE, Paula said she no longer required her mother to intervene for her, had joined a school organised parenting class, and along with her other children had begun attending community-based health and wellbeing classes. Ms Linden said: “Paula and her son have reported significant improvement in health and wellbeing since making that referral for help. “SPACE is privileged to work with these fabulous boys and their parents.”
• Contact SPACE at 028 3083 5764 for more information or go to their website at www.space-ni.com for further details
VIEW, Issue 36, 2016
Dispensing advice L
By Brian Pelan
ike the majority of us, I’ve been in a pharmacy, got my prescription and left. But recently, over a coffee in a Belfast hotel, I got to chat with a pharmacist for about an hour who not only preaches but practises the concept of community medicine. Gordon Pollock, who was born and raised in Bangor, and has lived there all his life, apart from a brief spell in London, is steeped in the world of pharmacies and medicine. He opened his shop, Pollock’s Pharmacy, on the Albertbridge Road in east Belfast in 1984. “Originally I had the idea of having one shop and then maybe two and then three. Then I discovered that l actually liked dealing with people and I have now been in the one shop for 32 years which is kind of scary. I’ve seen people grow up, I’ve seen families grow up and I’ve had the same staff with me most of those years. I wanted to be a pharmacist who is a businessman, not a businessman who is a pharmacist.” Gordon has obviously a very good relationship with his customers. “You open up and you find they trust you after a while because you’ve treated their mothers, you’ve treated their grandmothers, you’ve treated their children so you become part of their family. One or two of the older generation still call me Mr Pollock, but mostly it’s ‘Gordon’. “Because when they first came in they were children and I’ve seen them grow up. I’ve seen the mothers grow up, I’ve seen the daughters growing up and I’ve seen the granddaughters grow up. “If you’ve been in east Belfast since 1984 you’ve Pharmacist seen good and bad times Gordon Pollock around the place. There
have been relocations but most people tended to stay in the area if they could, and indeed the ones who moved away still ask me to go out to see them. “Every Wednesday I’d visit around 60 people of whom about 20 at any one stage would need help with their medications. I originally said I’d do it for one or two people, and then it grew.” Gordon laughs as he talks about the number of cups of tea he is offered during his weekly round. Some of them are are lonely, and want to talk because they have few visitors. He now delivers regular talks to community organisations. I was asked to give a series of talks about medicines, the use of medicines, safe use of medicines and side effects. I also talk about dietary issues. I have enjoyed engaging with the community outside the pharmacy.” He is also a strong advocate for the Building the CommunityPharmacy Partnership – a programme between the Community Development and Health Network (CDHN) and the Health and Social Care Board. “I get a tremendous buzz out of it and I hope that it is helpful to them.” I believe that we need more people among us with Gordon’s passionate community attitude – in fact, it should be prescribed on the NHS.
VIEW, Issue 36, 2016
the BIG interview T
As the new Expert Panel set up by Health Minister Simon Hamilton delivers its Working Principles for the Remodelling of Health and Social Care in Northern Ireland, panel member Dr Alan Stout tells Debbie Orme (left) how, when it comes to healthcare, the rest of Europe will be looking to us for the way forward
here's no doubt that things are certainly moving in Northern Ireland healthcare at the moment. Indeed, it seemed that the ink on Simon Hamilton's announcement of an Expert Panel to review the way forward for NI healthcare had hardly dried, than the said panel had published its Working Principles for the way forward. All of which, according to east Belfast GP and panel member Dr Alan Stout, bodes well for future progress. “It has been clear for some time,” Dr Stout told VIEWdigital, “that the current health and social care (HSC) system in Northern Ireland needed revamped. For a start, we’re facing new challenges, such as an ageing population with increasingly complex comorbidities (the presence of one or more disorders), but the simple fact is that the entire western world is facing the same healthcare challenges at the moment. “As healthcare professionals, these challenges may be local issues for us, but they're part of a much wider national and international issue. Although this is a time of challenges, it’s also a time of great excitement, since tackling these challenges will provide an opportunity for Northern Ireland to be a pioneer in designing and delivering health and social care services which are fit for the 21st century.” Sir Liam Donaldson's 2014 report on Northern Ireland's healthcare system – The Right Time, The Right Place – had recommended that “all political parties and the public accept in advance the recommendations of an impartial international panel of experts who should be commissioned to deliver to the Northern Ireland population the configuration of health and social care services commensurate with ensuring world-class standards of care”. In November of last year, however, Mr Hamilton opted instead to appoint a panel comprised of both local clinicians and national and international healthcare profes-
sionals. While he was initially criticised for not following Sir Liam’s recommendations to a ‘T’, Dr Stout believes that the panel mix was the optimum one to ensure the widest
One of the principles agreed at the political summit is that healthcare should remain free at the point of delivery perspective on the issue. “I think the Health Minister took a very bold – but ultimately clever – step in forming a panel with international expertise and experience while simultaneously retaining local appeal,” he says. “In particular, I think the appointment of Rafael Bengoa was an inspired choice given the similar demographics of Northern Ireland and the Basque region.” So, does that mean particular models such as the Basque initiative are being considered by the panel? “No, certainly no ‘copies’ of other models, but elements of other
programmes that have been shown to be successful will be considered. We don't need to completely discard what we have at present; we already have many elements of a successful healthcare system in Northern Ireland. We’ve clearly stated in the Principles, for example, that we're extremely lucky to have a HSC in NI which is already an integrated system – to the envy of many countries. “We're also fortunate that, due to the size of the province, we can have specialist services based anywhere in Northern Ireland and that any acute hospital here has the potential to become a regional centre. What we have to do is remodel our healthcare system so that different parts of the system are connected, interdependent, that they talk to each other and that they form an integrated whole.” Many involved in NI healthcare took the Health Minister’s formation of the Expert Panel, coupled with his axing of the Health and Social Care Board, as the death-knell for the Transforming Your Care (TYC) programme of work, which had been launched in 2011. With acronyms such as ‘Take Your Chances’ and ‘Transferring Your Care’ doing the rounds, and views on TYC varying widely across NI healthcare from a ‘total failure’ to ‘a work in progress’, it was felt that Mr Hamilton had decided that TYC was finished and that it was time to look for a new way forward. Dr Stout, however, doesn’t agree. “No, I certainly don't think that TYC is dead in the water,” he says measuredly. “Many of the key principles of TYC are still very valid and very important. The problem with TYC wasn’t the principles, more the implementation, and we now need to see a change in how services are delivered to realise the vision, and to ensure responsive and effective services into the future. “I can fully understand why, in light of some of the Health Minister's actions – such as the axing of the Health and Social
VIEW, Issue 36, 2016
Dr Alan Stout – one of the members of the health panel Care Board – there may have been a ‘psychological fallout’ factor which made many people sceptical, but Simon Hamilton has created an admirable element of positivity that, I believe, has been widely acknowledged. “At the political summit, which was held in February, for example, the overall feedback was one of broadly positive agreement, which, for Northern Ireland, was very encouraging. Not only was it well supported but, in light of the potential for disagreement, there was very broad agreement across the board. Indeed, Rafael Bengoa actually said that he couldn't have envisaged it happening in that manner in any other region. “I think that Northern Ireland has to understand that, if anybody can rise up to the challenges that healthcare is facing, it's us. After all, we have such a well-defined population of 1.8 million people that it's much easier to carry out forward planning in a relatively small population rather than in somewhere like England with a population of 70 million. “Our remodelling of our healthcare system will not only allow us to address these new healthcare challenges, but will allow us to provide others with workable solutions to their challenges.” And does this remodelling include a
Professor Rafael Bengoa, director of the health department at the Deusto Business School in Spain, is chair of the panel • Mairead McAlinden, chief executive of Torbay and South Devon NHS Foundation Trust • Mark Taylor, consultant in general and hepatobiliary surgery and the current lead clinician at Belfast's Mater Hospital • Alan Stout, east Belfast GP and deputy chairman of the Northern Ireland General Practitioners Committee • Bronagh Scott, deputy chief nurse for NHS England London region. She previously worked for the Northern Trust in Northern Ireland • Professor John Øvretveit, professor of healthcare innovation implementation and evaluation at the Karolinska Institute in Stockholm
Without change, the Northern Ireland HSC system is not sustainable in the medium to long-term
role for private medicine and private companies, I asked? “The key element is the best possible patient service and pathways to deliver the best care,” Dr Stout said. “This will more than likely involve joint working and partnership with a number of organisations and that will include the private sector which is, after
all, still a key stakeholder. It’s important that the patient experience is at the forefront of any new system, and that services are delivered in an efficient and cost-effective manner.” Might it include the introduction of some sort of fees structure into the NHS to address the financial shortfall? “No. One of the principles agreed at the political summit is that healthcare should remain free at the point of delivery. We want to ensure equity of access and quality of service to all.” Going forward, Dr Stout and his fellow panel members will be completing their meetings with all stakeholders by the end of April and will then write up their paper and recommendations by mid to late June. Working patterns and timeframes should be available by then too. “Without change, the Northern Ireland HSC system is not sustainable in the medium to long-term,” Dr Stout concludes, “and change is simply not an option”. “The eyes of the Western world are upon Northern Ireland now to see how we both identify and address the challenges that we are all facing in healthcare and I have to say that I have been very impressed by how we have risen to this task.”
COMMENT VIEW, Issue 36, 2016
Why co-operation is vital T
Dr Eddie Rooney, Chief Executive of the Public Health Agency, praises the role of the community and voluntary sector in making a real difference to people’s lives
he importance of co-operation was literally built into the foundations of the Public Health Agency. The legislation establishing the Agency in 2009 was explicit in requiring that, in the exercise of our functions, we must co-operate with other bodies which exercise functions relating to health improvement or health protection. That shouldn’t be a surprise. It recognised that the tasks of protecting and improving health and wellbeing and of reducing the persistent health inequalities within our community could only be achieved through collaboration and partnership with a range of bodies, including government departments, local councils, sporting organisations, business groups, and other arm’s-length bodies. However, one of the most important partners we have in making a real difference to people’s lives on the ground is the community and voluntary sector. The third sector has played a central role in bringing to life the areas of work identified by the agency for attention. With direct experience of the challenges many people face across a wide range of issues, voluntary and community groups have worked closely with the agency since we were founded in 2009 to tackle issues such as health inequalities, mental health promotion and suicide prevention, overweight and obesity, and drugs and alcohol. This collaborative working will continue to play a central role in our work. For example, the Northern Ireland Executive has acknowledged the importance of what we do in improving health and wellbeing and in supporting the Executive’s priority of tackling deprivation
The third sector has played a central role in bringing to life the areas of work identified by the agency for attention
and poverty. Important government support and focus in helping everyone to understand their important contribution to public health came last year in the form of the launch of the 10-year public health strategic framework – Making Life Better. As designated lead agency for the implementation of this new whole-system framework for public health, we convened a new Regional Project Board, welcoming representation from all relevant statutory agencies, local government, and the community, voluntary and private sectors. It is important to recognise that the health and social care sector alone cannot tackle the root causes of poor health and wellbeing or inequalities in health. The collaboration and partnership approach we take recognises that many factors can affect an individual’s health. Our collective aim and focus is to ensure the creation of the right conditions for people and communities to take control of their own lives, and ultimately achieve better health and wellbeing and reduce health inequalities. Working together, blending expertise and experience, is the key to success in improving people’s health and wellbeing. Our grass-roots level work with the community and voluntary sector is so important in achieving our goals of making people’s lives better, and we are extremely proud of all the individuals and groups involved as well as our own staff who are making such a difference. As we look to a new financial year, we are turning our thoughts to how we continue to bring about improvement in the health and wellbeing of the population.
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Séamus Mullen (left), the PHA’s Head of Health and Social Wellbeing Improvement in Belfast, with community gardener Mick McEvoy and PHA Chief Executive Dr Eddie Rooney, with organic community food being grown at a 'Meanwhile Garden' in east Belfast
Public Health Agency – Improving health at the heart of the community
he Public Health Agency (PHA) was established seven years ago to improve the health and wellbeing of the people of Northern Ireland, using a range of multi-disciplinary and partnership approaches and working both at a regional and local level to deliver change, in particular to reduce health inequalities. Inter-sectoral partnership working is a key component of the agency’s work to identify and address health inequalities across Northern Ireland, for example through partnerships such as the Western Making Life Better Partnership, Belfast Strategic Partnership or Southern Health Improvement Partnership. These partnerships include a range of inter-sectoral partners including government departments, councils, private sector and community and voluntary organisations. In addition, the agency adopts a community development approach to identifying and tackling issues which have a detrimental impact on people’s health and
wellbeing, recognising that communities are often best placed to identify and work with others to address their own needs. The agency promotes a community development approach through a range of measures, including supporting the employment of community development and health and wellbeing workers, supporting community networks, commissioning organisations to develop and deliver health and wellbeing improvement programmes using community development approaches, and through building the strengths and skills of people within communities. In recognition of the strong role that the community and voluntary sectors play in many areas across Northern Ireland, the agency commissions up to 75 per cent of programme delivery through the community and voluntary sectors. This practice reflects the strong commitment of the agency to community development as a principle and a process which ultimately builds healthier communities. Examples of some of the agency’s
investments are highlighted under the following categories.
Supporting the employment of community development and health and wellbeing development workers
The agency has a priority focus on tackling issues related to drugs and alcohol, which can have a significant impact not only on individuals, but also on those around them. Five Drug and Alcohol Coordination Teams (DACTs) are in existence across Northern Ireland – one per Health and Social Care Trust area. The DACTs are multi-agency partnerships comprising all of the key agencies (statutory, and community and voluntary) with an interest in, or remit for, addressing drug and alcohol-related issues and concerns in the local area. The work of the DACTs is supported by the PHA, whose local lead for drugs and alcohol helps to facilitate the work of each respective team. • Continued on page 14
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• From page 13 The aim of each DACT is to promote and support a more coordinated approach to addressing alcohol and drug-related issues across the trust area. The PHA funds a number of staff members to provide a ‘DACT Connections Service’ in each trust area which act as the operational arm of the local DACT. Using a community development approach, these members of staff assist the teams to take forward priority actions and build capacity of communities to develop and deliver drug and/or alcohol-related projects, events and initiatives. The Connections Service also works closely with local community groups and forums, service user representatives and/or networks and with drug and alcohol service providers to ensure that the DACT is made aware of any emerging trends, issues of concern and gaps or pressures in service delivery. Supporting community networks
Community networks provide important opportunities for the agency to engage with a wide range of organisations with similar focus and ethos, and also to work with networks that bring particular skill sets not available within the statutory sector. For example, the agency has a long-term working relationship with the Community Development and Health Network (CDHN). CDHN provides an important advisory role to the agency through participation in the Making Life Better Implementation group at regional level. This provides the opportunity for CDHN to represent the views of the community and voluntary sector in
CDHN also plays a lead role in the delivery of Building the Community Pharmacy Partnership grant programme
discussions regarding the ongoing implementation of the Executive’s new public health strategy, Making Life Better. CDHN also plays a lead role in the delivery of Building the Community Pharmacy Partnership grant programme and a key advisory role in development of the new Health + Pharmacy Programme. Both are important programmes which aim to stimulate enhanced partnership working between pharmacies and the community and voluntary sector organisations in their surrounding communities. Rural Support Networks provide an important platform for the agency to
Working in partnership with Bryson Energy and Belfast City Council, people in Belfast over 65 years are being offered free home safety checks
engage with rural communities throughout Northern Ireland. The agency works to address issues faced by rural communities, through programmes such as the Farm Families Health Checks programme and Maximising Access to Rural Grants (MARA). The MARA project aims to improve the health and wellbeing of people living in rural areas throughout Northern Ireland, where the hidden nature of poverty and isolation can make it difficult to connect with the most vulnerable members of our community. Under the project, people can benefit from a household visit whereby they will be given useful information on services, grants and benefits which may be of assistance to them. The project is funded by the Department of Agriculture and Rural Development (DARD) and led by the PHA, and aims to increase access to benefits, grants and services which are known to improve health and wellbeing. To reach out to the most vulnerable rural households, a personal, supportive and empathetic approach is required. That is where MARA makes a difference. By placing community networks at the heart of the MARA project and using local knowledge, it is easier to identify and connect with people who could benefit from a household visit. This support can make a real difference to people’s lives in rural areas. Other community networks provide important opportunities for the agency to engage with marginalised communities and communities of interest who face significant levels of health inequalities. For example, evidence suggests that lesbian, gay, bisexual and/ or transsexual (LGB&/T) people are at a statistically higher risk of
VIEW, Issue 36, 2016
experiencing mental health problems, including anxiety, depression, self-harm and suicidal behaviour. The PHA has commissioned a number of services focusing on addressing the specific mental and emotional wellbeing needs of the LGB&/T community. This has included funding for Rainbow Health Ltd to deliver support for the mental health and emotional wellbeing needs of lesbian and bisexual women and gay and bisexual men. New services have also been commissioned to support people who are transgender and their families, which will be delivered by Support Acceptance Information Learning (SAIL) Community Interest Company. The PHA has also used art as an important mechanism for engaging with other communities of need. For example, the agency has worked with Arts Care and the five health and social care trusts to develop the ‘Twilight’ arts programme with Looked After Children. In addition, the agency has worked with the Arts Council, Arts Care and a wide range of community and voluntary organisations to develop an Older people Arts Programme over the past four years. This innovative approach has successfully engaged many older people in arts activities, creating strong networks, building confidence, and reducing loneliness and isolation. Enabling capacity building
The agency works with a range of community-based organisations to help them build strength and skills to address health inequalities faced by their communities.
The Public Health Agency has also used art as an important mechanism for engaging with other communities of need
One such example is the Early Intervention Lisburn Project (led by the Resurgam Community Development Trust) which aims to improve outcomes for children, young people and families in deprived areas of Lisburn. As part of this project, school pupils in Lisburn have completed the 16-week ‘Incredible Years Programme’ which builds confidence to help parents understand and manage their child’s behaviour better and also to help teach children how to understand their emotions, with the aim of benefitting their long-term health and wellbeing. In the western area, the agency has
Siobhán O’Brien, PHA (left) with Liam Kinney from the Housing Executive’s Homelessness Unit; Ricky Rowledge, Chief Executive of the Council for the Homeless (NI) and Mary Black, PHA supported the Strabane Health Improvement Project for a number of years, which has enabled the group to provide community allotments and training on healthy alternatives in the heart of one of the most disadvantaged Neighbourhood Renewal Area’s in Northern Ireland. The group has successfully run the programme in a prominent location in the Ballycolman estate, linking in with the local Gaelscoil, GAA club and District Council leisure provision in the area to provide a prominent health and wellbeing hub in the area. The group is now launching a Men’s Shed and a ‘Handy Manny’ programme, which will further address social isolation, poverty and homes safety issues in the area. • The ‘Funding opportunities’ portal on the PHA website at www.publichealth.hscni.net/contracts provides information on procurement and grant funding opportunities as well as associated specifications and guidance. Anyone who is interested in procurement and grant funding opportunities with the PHA can keep this portal under regular review and note any timescales set for responses. • The PHA welcomes responses from all interested parties, large or small, whether community, voluntary or private as long as they can meet the requirements identified and demonstrate that they can deliver the benefits expected.
VIEW, Issue 36, 2016
VIEW, Issue 36, 2016
Members of the Traveller community; Gerry Joyce (23), left; 12-year-old Tony Reilly, right, and Edward Joyce (17), below, right. Dealgan boxing club coach Anthony Donnelly, below left IMAGES: Hannah Mitchell
A boxing club in Dundalk is tackling health and fitness issues among the Traveller community in a practical way
By Brian Pelan
walked into Dealgan club on a Wednesday night, and to use a boxing term, I was ‘knocked out’ by the sheer passion and fitness on display. To describe the atmosphere as buzzing would be a gross understatement. Former fighter Anthony Donnelly was 23 years of age when he started to coach the club. “I took over from Liam Moore in 1993,” said Anthony. “We gauge success by the number of names on the signing in book. People come here from all ethnic backgrounds, all dominations. The Mercedes is out there alongside the rusty bike. “It’s a boxing club for the community and what it brings healthwise far outweighs what most people would deem as success such as medals won. “Our success is the amount of children who come through our doors and keep out of bad stuff on the streets.
“We’ve had members of the Traveller community coming in since the club opened its doors. “My degree is in health and physical activity. As part of my course, I studied the health of Travellers, who would be seen as a vulnerable group. “There are some startling figures. They are at very high risk in terms of suicide, cancers and heart disease. Male Travellers live 15 years shorter than those in the settled community. “There are not too many sports that Travellers are involved in from an early age. “Boxing seems to be the only one that is holding onto them. “It’s male-dominated in terms of the Travellers coming in but we are now started to see some women coming in as well, which is great. “Their health improves when they start here because boxing is a weight-controlled sport. “They are working with other people who also believe in healthy eating and keeping weight down. We teach the importance of
healthy eating so the Travellers understand that from an early age. Their health improves because of exercise and eating healthy food. We hope that this has a knock-on effect on the other members of their family at home. There is never any hostility to Travellers coming in here. I have never witnessed it and boxing coaches would not tolerate it. “Boxing is a major health resource that the government have and they don’t realise it. Its clubs are based in areas of high social-economic deprivation. It’s there for everyone to use on a voluntary basis. “The best pill we have to decease obesity and improve the health of Travellers is exercise. If boxing is the only sport that they are involved it, then it is seriously underused as a health intervention strategy.” We need more ‘educators’ like Anthony if we ever are to seriously address health inequalities in the Traveller community.
VIEW, Issue 36, 2016
VIEW, Issue 36, 2016
undreds of runners recently gathered in Ormeau Park, Belfast, Runners (left and above) who took part in the Couch to 5k run in Ormeau Park, Belfast. on a Saturday morning. Many of them were about to embark Below: Liam McGarry (left) and Gerard Walls on their first ever Couch to 5k run. Music blared creating a disco-like atmosphere as the eager and Images: Hannah Mitchell not so eager enthusiasts went through there final preparation routine before setting off as the rain began to steadily fall. A high proportion of those taking part were women, aged from 40 upwards. Jog Belfast is a free 10-week 'Couch to 5k' programme run throughout Belfast. It encourages and supports people, especially beginners, to run 5km. Many of the participants will have never run before, but afterwards, go on to complete 10km and even marathons. Coach Liam McGarry, who helps train the runners, said: “People take this on for a lot of reasons. We are finding from the evaluations that those taking part are getting more sleep, energy and confidence.” Gerard Walls, who works in the Shaftesbury Recreation Centre, which manages the programme, added: “Today was a big success. We had more than 500 people taking part in the run. The Public Health Agency is supporting the initiative. “We are working with a lot of people, especially women aged 40 and upwards, who are taking part for underlying health reasons.” Nurse Margo Duffy, who took part the run, said. “I am in my mid-50s, I'm overweight and I have high-blood pressure. Last Christmas, I said to myself that I need to do something about this. It has been fun from the first class to actually completing the run.”
• For more details, visit http://www.belfastrunning.com/jogbelfast/
VIEW, Issue 36, 2016
Danny Dorling, Professor of Geography at Oxford University, argues in his new book, A Better Politics, that there are many policies that we could adopt if we really want to be happier and healthier. We could have a government that makes our lives happier
rofessor Danny Dorling in his new book, A Better Politics, How Government Can Make You Happier, poses a question that most of us rarely think about, but perhaps we should. In the preface to the book, Professor Dorling says: “The aim of this book is to inspire a better politics: one that will enable future generations to be happier. “While its publication coincides with the 500th anniversary of Thomas More’s Utopia, its proposals are not a utopian wish-list. They are, crucially, a set of policy suggestions that are already in place (or are being tested) elsewhere in Europe; proposals that address the issues that appear to matter most to people in the UK. “In the immediate aftermath of a
global financial crash, it is hard to imagine great progress, as it also was after the crash of 1929. “What I suggest here, is, in many ways, much less imaginative than setting up a National Health Service would have sounded in 1935, or the suggestion also made at that time that full employment was possible in the near future – but both of those things happened.” Later on in the book, Professor Dorling writes: “The UK has the highest level of economic inequality – the widest differences between rich and poor – in Europe. “The best-off 10 per cent in the UK take 28 per cent of national income, a larger share than in any other European
country. This gap is almost entirely due to the best-off one per cent in the UK taking such a large slice of the cake... “It is because of how we organise our society that, for every 100 children born, twice as many children die in childhood in the UK than in Sweden. There were no causes of death that were significantly more frequent in Sweden than in the UK. How society is organised affects all causes of death, from infection to congenital malformation to car crashes.” • A Better Politics: How Government Can Make Us Happier – Price: £8.99. London Publishing Partnership, http://londonpublishingpartnership.co.uk/a-better-politics/
VIEW, Issue 36, 2016
Dr Kayleigh Garthwaite, a researcher at the Centre for Health and Inequalities Research, Durham University, tells VIEW about her new book Hunger Pains – which is about the surge in foodbanks in the UK and how we need to listen to the people who are forced to use them www.viewdigital.org
Dangerously poor diets are leading to the shocking return of rickets and gout – diseases of the Victorian age
By Kayleigh Garthwaite
ritain is experiencing a food poverty explosion. Increasing food poverty and insecurity has led to foodbanks becoming an ever more prominent and politically controversial feature of the welfare landscape in the UK and beyond. Between 2014-15, for the first time over one million people received emergency food from a Trussell Trust foodbank, up 19 per cent on 2013-14. These figures are just the tip of the iceberg of UK food poverty. They do not include those helped by other emergency food providers, those living in towns where there is no foodbank, people who are too ashamed to seek help or the large number of people who are only coping by eating less and buying cheaper food. The use of foodbanks is unprecedented to this degree in the UK and is a shocking condemnation of current government policies, as rising demand for the basic need of food has coincided with an increase in those seeking help following benefit sanctions or benefit delays. Food poverty and insecurity has reached epidemic proportions with an estimated 4.7 million people in the UK now living in food poverty. Poverty leading to inadequate nutrition is one of the oldest and most serious global health problems. But in 2015 dangerously poor diets are leading to the shocking return of rickets and gout – diseases of the Victorian age that affect bones and joints – according to the UK Faculty of Public Health.
HUNGER PAINS Life inside foodbank Britain Kayleigh Garthwaite
Foreword by Jack Monroe Afterword by Linda Tirado
One in five family doctors has been asked to refer a patient to a foodbank in the past year, with GPs reporting that benefits delays are leaving people without money for food for lengthy periods of time. There are even rare reported cases of people visiting their GP with “sicknesses caused by not eating”. Evidence from GP surgeries is matched by hospital diagnoses of malnutrition, which have nearly doubled in the past five years. NHS statistics show that 7,366 people were admitted to hospital with a primary or secondary diagnosis of malnutrition between August 2014 and July 2015. These issues are central to my
forthcoming book, ‘Hunger Pains: life inside foodbank Britain’. Published on June 14 by Policy Press, the book presents rich descriptive data gathered through two years of field notes, observations, and in-depth interviews inside a Trussell Trust foodbank in Stockton-on-Tees, North East England. Food insecurity has serious adverse consequences for the mental, physical, and social health of adults and children alike. Many of the people I met at the foodbank were experts in budgeting, spending hours trawling the shops for the cheapest but most nutritious food. People told me how they wanted to eat healthy food that was good for them and their family, but often had to buy less nutritious food that would keep them feeling full for longer, sacrificing more expensive fruit, vegetables and meat. Regularly skipping meals, eating out-of-date foods, relying on friends and family for meals, and a worsening of existing health problems due to not having the right nutrients, were commonplace. This led to a worsening of pre-existing ill health, including mental health issues, for many people I met in the foodbank. We need to listen to the voices of people using the foodbank so that can we understand who uses them, why, and what it feels like. Maybe then we can start to do something about it. • Hunger Pains. Price: £14.99 Policy Press http://bit.ly/22s3yh6
COMMENT VIEW, Issue 36, 2016
Countryside matters R
Kate Clifford, Director of the Rural Community Network in Northern Ireland, says that policy makers should not ignore people living in rural areas when developing health policies
ural Community Network is a membership based organisation devoted to articulating the voice of Rural Communities and improving access to services for communities across Northern Ireland. Almost 35 per cent of NI’s population live in its rural towns, villages and open countryside and we believe that policy makers should not ignore this constituency when developing and delivering health services policies or programmes. As funding for public services comes under increasing pressure and as we continue a trend towards centralisation of specialist health care, government policies should be flexible enough to allow for tailored local delivery and configuration of services. We know of many examples of rurally based healthy living centres and community health hubs where health and social services ambitions are being delivered by combining the work of profession health service providers with the resources of the community and voluntary sector. But the caution in this tale is that while the community and voluntary sector is being well resourced and has the financial capability to complement and add value to those who provide key local services, this model will roll out well for local people. But the ongoing top slicing of budgets year on year, the erosion of central government funding streams and the move away from full cost recovery contracts means that the voluntary sector is being asked and depended upon to deliver more and more services with little or no assurance of funding or financial support. This is not sustainable for the service providers nor the clients and is frankly serving no one well. Access to health services is a basic expectation of any citizen and this should mean having access to a service which is reachable in a relatively short travel time. But we know from experience that many rural populations find it difficult to reach health services using public transport and
Access to health services is a basic expectation of any citizen and this should mean having access to a service which is reachable in a relatively short travel time
this is especially true for those needing to access hospital services. Indeed, in many smaller rural settlements, public transport is infrequent or, due to cuts in funding, it has been stopped altogether. The flexibility to configure services differently for rural areas can enable solutions to these issues to be found in rural locations where one-to-one service delivery is often not the best or most supportive model for the client. One example was a health visitor who provided home visits to new mums, their physical isolation issue and her long travel times were both addressed when she worked with her client group to reconfigure her services into a central location where the mums had a chance to socialise and she could deliver her support using a community facility. The result was a better outcome for the mums and longer contact time for her with her client group. A recent article in our Network News publication by a leading local GP suggested that urgent action needs to be taken to address a growing problem of recruitment of GPs across Northern Ireland and, in particular, to pay attention to the need to recruit and sustain more rural GPs and practice nurses as many reach retirement age. If centralisation of health services continues rural ageing populations will need easier access to non-specialist treatments. We believe that support should be provided to pilot models of care delivery that are shown to be cost effective and well suited to rural circumstances. Finally, in many rural areas the roads infrastructure is lagging far behind other regions, with no motorway provision in large swaths of the west of the province. This poses a huge challenge for ambulance response times. We welcome the introduction of the Rural Needs Bill in Stormont and we look forward to a future which will ensure the delivery of health services in a fair and equitable way across the region.
I felt as if I had a big sign hanging over me saying ‘broken’ VIEW, Issue 36, 2016
Michael McCarney tells Debbie Orme how Men’s Shed has helped him to deal with life again after a suicide attempt
decade ago, when Philadelphia-born Michael McCarney was enjoying the daily rough and tumble of his job as a building inspector in the US city, he could barely have imagined that a few years later he would be on a Co Antrim river bank being saved from a failed suicide attempt. Meeting this genial 45-year-old American, who manages the Men's Shed in Portglenone today, it's hard to believe that, only a few years ago, he was almost a recluse, who viewed buying a loaf as a major challenge. Michael's problems began when he and his wife moved from the US to his wife's home town of Portglenone in Co Antrim. “We moved here to give our young kids a better family life,” Michael says. “But almost immediately I felt isolated. I knew no one bar my family and no one knew me. On top of the physical isolation, I also began to work close to home and this increased the sense of emotional isolation. “Everybody I came into contact with was either related to someone else or knew everybody else. I was neither related nor home grown, so I felt totally alone. “People weren't being deliberately cruel, it was more a case of small-town mentality and they didn't understand my sense of isolation. I felt, quite simply, that I didn't fit in and, over the course of the next 18 months, I gradually sank into a deep depression.
“The depression eventually got so bad that I tried to end it all but was, thankfully, saved. After my suicide attempt, my wife was afraid to leave me alone. I felt as if I had a big sign hanging over me saying ‘broken’.” Following his suicide bid, it was to be a few months before Michael even felt able to leave the house. “It was very much a case of ‘baby steps’ in reintroducing myself to the outside world. I began by taking the dog for a 10-minute walk each morning. My wife would also pull up outside shops and I would make a mad dash into the shop to get a loaf. Neither of these actions sounds like a big deal, but at that time, they were both monumental tasks for me.” It was at this point that Martin McDaid from Action Mental Health entered his life. “Martin understood completely my need for the ‘baby steps’ approach to recovery. He suggested a men’s group which met once a week at the local leisure centre. He didn’t put any pressure on me, but simply took me for
coffee or suggested that I go to the men’s group to just kick a ball around. “I eventually took a computer course at Portglenone Enterprise Group (PEG), which gave me a sense of accomplishment but, during this period of time, I'd become aware of the fact that there was nowhere for men in the local area to go except for the pub or bookies – neither of which was going to promote health and wellbeing. “When PEG mentioned the Men’s Shed concept, I realised it wasn’t only what I needed as a focus into which I could pour my energy, but I realised that, by helping others, I could also continue to help myself.” Today, Michael is able to use his own experience to help others who are on a similar path. I’m still on anti-depressants,” he says. “From the beginning, they made me feel ‘flat’ and stopped me from feeling anything, so at one point I took myself off them and went cold turkey. “My mental state immediately plummeted back into the blackness so I began to take them again. The doctors told me that it was better to feel nothing than to feel bad so I’ve just had to accept that I need them for the time being.” In his role as facilitator of the Men's Shed, Michael is now – ironically – much more a part of the community from which he once felt totally isolated. “There’s an element of symbiosis in this whole process. By helping others I'm helping myself, and we're all benefiting from this experience.”
VIEW, Issue 36, 2016
VIEW, Issue 36, 2016
Professor Donna Fitzsimons tells VIEW editor Brian Pelan that choice and responsibility are key in terms of helping to prevent coronory disease.
eart disease remains the single biggest killer in the world today – even higher than cancer mortality figures. That stark statistic was given to me by Professor Donna Fitzsimons – Professor of Nursing at Ulster University. “I’ve been a nurse for almost 30 years now and my clinical background is in cardiology. “What brought me to nursing was that I realised that it was a really important job within society and I knew from my own father’s heart trouble that cardiology would be an area of interest for me because his first heart attack was when I was very young – I was about 11 years of age – I saw at first-hand what the nurses and the doctors did to turn that situation around and put him on the road to recovery. He died about 10 years ago but he didn’t die from heart trouble. “The backbone of a talk I recently delivered was all around prevention, it was all around making healthcare choices, taking more exercise, eating a healthier diet and being more food conscious and stopping smoking. “We do not have a tablet or any box that is more effective than stopping smoking. And yet patients find that is one of the most difficult things to do. And as for exercise, we all know that we should be taking more exercise. “It’s a choice. It’s their choice. It’s individual responsibility. The treatment will only be as good as the compliance of the individual taking it.” I asked Professor Fitzsimons are we investing enough in terms of preventing heart disease? “Investment in prevention is poor. Without investment in what we call primary prevention, people are likely to go on and have unhealthy lifestyles. “When ever individuals turn up at the hospital and have a heart attack – we’ve
Professor Donna Fitzsimons got 'Rolls Royce' treatments – they get taken straight to the operating theatre, they have a little stent put in, they can be home out of the hospital in a couple of days. And that’s really effective, world class treatment for the problem that they’re presented with. “But the difficulty is very often those people feel like they’ve almost had an appendicitis; they came out of the hospital, they had an operation and they’re good as gold. Because they haven’t had the time to absorb their diagnosis and to realise that heart disease isn’t an acute illness – it’s chronic. Once it manifests itself, it’s there for the rest of your life.” What is the role of communities in tackling heart disease? “It's absolutely key. I think it’s really important that all of us get more active. We’re so safety conscious we’d rather have our children sitting at home playing a game console rather than playing football on the street. “I think we need to engage
individuals and communities in healthier living initiatives. “People will say to me: 'Well, you know what. I will take the risk of my Ulster fry every morning because I don’t mind if I get a big bang heart attack and it takes me out in the night. “But the reality is you’re also likely to develop a stroke, you’re also likely to live a life disabled with peripheral artery disease, because the disease that happens in the arteries of the heart will also be going on in your brain and your legs and everywhere else. “The whole holistic approach, such as looking at individuals and their place in society, is hugely important.” I was interested to know her thoughts on effective community strategies for tackling heart problems and reducing them. “I’m not sure that I have the evidence to tell you which is the best strategy for community engagement and prevention. But you need to engage people, you need to empower them to take action on their own behalf. Heart disease is a condition that we manage ourselves. Doctors can give you good treatments in an operating theatre and they can give you tablets to take home and use. It all comes down to managing your own condition, making choices. “In Northern Ireland, we have one of the lowest uptakes of cardiac rehabilitation than anywhere in the UK. It’s a really big missed opportunity.” As our interview came to an end, I asked Professor Fitzsimons how does she relax when she is not working? “I love walking. I love cooking. I love investing time in my family. I’ve got teenagers. It was quite interesting for them to come and attend a recent talk I gave because they were able to see at first-hand in a scientific session what they probably have to hear across the dinner table all the time.”
VIEW, Issue 36, 2016
And now for another thing
In a world where ‘personal responsibility’ is becoming the mantra, can our columnist John Higgins shed the weight, get fitter and become a healthier, slimmed-down Adonis?
I’ve given up red meat, fat, sugar, bread, milk, cheese and happiness
obody knows I’m fat. I’m a stealth lard-arse, an undercover tubby. I walk, widely, amongst you, as one of you. You would never know. But beneath my pristine surface there’s an exo-skeleton of whale-bone, a tightly bound corset with more hooks and eyes than a buccaneer spider, swaddling my porridge-in-acondom body. I’m not a pervert: I do all this: the confinement, the rope-burn, the Matt Talbot self-mortification, out of a sense of civic responsibility. In these straitened times, food is expensive and I would rather it stayed in your stomach than have it make an unwelcome reappearance as soon as I put my head around the door. It’s not vanity, its selfless philanthropy. It makes me laugh when I see lolly-pop ladies getting MBEs for dicking around waving a stick in a hi-viz tabard for doing their jobs that they’re paid for, while I, trussed up like a cenobite for the benefit of mankind, go unrewarded,
unacknowledged.But no more: I’m going to lose weight. I’m doing the usual things, the obvious things. I’ve stopped drinking two bottles of wine a night and replaced them with no bottles. I’ve given up red meat, fat, sugar, bread, milk, cheese and happiness. On hearing about this reckless self-denial my mother asked “My God! What else is there?” A good question: it tends to be fruit, vegetables, turkey and herbal tea. On the first couple of days I assumed I would be craving delicious booze, but no, it was fat and French bread that gave me the pangs. I assumed abandoning my vices would instantly give me a feeling of serenity and wellbeing or the DTs. But no, what I got was skin-like styling putty and the first cold-sore I’d had in 20 years. These are dubious benefits at best. Of course, diet is only half the story: the other half is positive thinking. No, obviously not: that would be ridiculous. The very
idea. The other half is exercise. As you can tell I know nothing about dieting and I’m just guessing that not drinking the weight of your own head every night and eating less obviously filthy food, less often, is a good idea. It may not be, a lot of modern dieting is counterintuitive, but I’m going with my gut and hopefully my gut will be going. But exercise is problematic. I can’t afford to join a gym, I have an increasingly low attention span and I refuse to surrender my dignity, so wearing bosom cupping T-shirts, trackie-bottoms and (cough) trainers is out. So, like I say, it’s problematic. Instead, I go for walks. Big long walks. The plan is that the reverberations from each footstep, as well as powdering my arthritic knees, will eventually smooth out the marbled fat of my body as though shaking down a duvet inside a duvet-cover. Nice and smooth and linen-cupboard fresh, that’s the way I want it. I remain a work in progress. I hope you’ll be hearing less of me.
VIEW, Issue 36, 2016
By Ciara Lawn
eenage girls are demanding more than ‘the facts of life’ when it comes to their health and one north Belfast youth club in helping them do that. Six lively teenage girls are sitting around a table with youth workers Cathy Valente and Ciara Maskey. The teenagers have just started their second week on a Safe and Well programme at the Artillery Youth Centre in north Belfast. The scheme, funded by the Health and Social Care Trust, is designed to work with young women and men who are at risk of engaging in alcohol and drug misuse and risk-taking behaviours. Sexual health charity Brook and suicide prevention charity Lighthouse are also contributing to the programme. “In school we didn’t really learn about it properly, we just learned about girls’ stuff, such as periods,” said Katie aged 15. “I wanted to do a sexual health course to get us prepared for when we’re older. “I wanted to be in this programme because I knew it would help me outside
of the youth club,” said 15-year-old Eva. This week’s session deals with what constitutes a healthy relationship. The girls offer their opinions on healthy and unhealthy qualities in relationships. They challenge each other’s views and engage in debates over the semantics of the scenarios that youth worker Cathy Valente reads out during a physical activity which involves the girls running to either the ‘healthy relationship’ or ‘unhealthy relationship’ side of the room. Over the next few months the programme will deal with sexual health, mental health and alcohol and drug awareness. Katie talked about a potential solution for those suffering from mental health issues. “It would be good if there was a place open 24 hours daily in a community where people feeling down could walk in any time of the night.” Eva added: “You could just go in and ask for advice and try and get help and it might stop people taking their own lives.” Youth worked Ciara Maskey said: “We want the girls to be more aware of their
own health and what measures they can put in place to look after their health, whether it’s healthy eating, physical exercise, sexual health or the dangers of drink and drugs.” “It’s all about being safe,” Ciara added. “The healthy relationships and the alcohol awareness courses are Open College Network-accredited. “We are also aiming to work with the Red Cross because we found out that they do a great first aid programme around alcohol.” As well as educating the girls on major health and wellbeing topics, the programme also encourages them to adopt a healthier lifestyle. One night per week, the group participate in a healthy eating and cooking activity and they are hoping to make Sunday night visits to a Boxercise class – a fun form of exercise. The teenagers’ enthusiasm for learning about health and wellbeing in the Safe and Well programme, combined with the range of topics covered, will hopefully enable them to make informed decisions throughout their lives.
COMMENT VIEW, Issue 36, 2016
Taking control of our lives
Joan Devlin, Chief Executive of Belfast Healthy Cities, argues that the new incoming Assembly must adopt a unified approach to tackling health inequalites in Northern Ireland
orthern Ireland elects a new Assembly in May. The new Assembly has a great opportunity to build on existing policies and take strong action to promote health and reduce inequalities. Action now can significantly help deal with the rising costs of health care, and also enable people to take control over their own lives and health. Effective policy and action must, however, take a whole of government and whole of society approach. The health sector alone can only treat the symptoms, as health – and inequalities - are created outside the health sector. Health is determined above all by people’s social and physical living conditions, which set the framework for people’s lives and the choices they can make. Effective action requires collaboration across regional functions from housing, education (including further and higher education and essential skills) and transport to planning, economic and rural development, as well as local services including youth work, family support and culture and the arts. Inequalities arise as a result of differential access to money, facilities and services, and they are deepened by gaps in preventative and remedial services. Essential to effective action is an understanding of how poor health and inequalities arises, and how each sector can take an appropriate role. It also requires a reallocation of resources; fortunately, however, investment in the key determinants of health can create a triple benefit of more sustainable communities, improving health and public expenditure savings. Belfast Healthy Cities is a partnership organisation working to be a leader in creating a healthy, equitable and sustainable region. We act as the link between the
Effective policy and action must, however, take a whole of government and whole of society approach
World Health Organization (WHO) and Belfast as a WHO Healthy City and provide a platform for intersectoral collaboration to promote health and wellbeing. A key role for us is to share learning from the 100 cities in the WHO European Healthy Cities Network and introduce and test new concepts and ways of working. Reducing inequalities is a core principle of the movement, which has pioneered local level action and advocacy for tackling inequalities with political decision makers. Our recent work on inequalities has included developing a model for integrating health equity in all policies, building on a model from South Australia. Through this, we have identified a need to build understanding and capacity on inequalities and health across sectors, and we are piloting a programme designed to do this. We are also working to develop a programme to promote health literacy, which aims to reduce inequalities by strengthening clear communication of health messages. Inequalities exist across Europe, but sharing learning offers opportunities for innovation and targeting resources effectively. The EVIVA project in Turku in Finland sought to reduce inequalities by engaging local people in decision making through participation in culture and the arts, while cities including Stockholm, Ljubljana and Vienna are investing in public transport and walkable environments. Swansea is focusing on early years education and family support. Northern Ireland, in turn, has been hailed as a pioneer in developing policies to tackle inequalities, although implementation of these policies has varied in success. Health is a political choice. We have the capacity to make it, and it is time we took action.
VIEW, Issue 36, 2016
Positive Life praises lifting of ban on HIV self-testing By Jacquie Richardson, Chief Executive, Positive Life
n January 29 this year it became legal to purchase HIV self-testing kits in Northern Ireland. As Northern Ireland’s only dedicated HIV charity, Positive Life welcomed the move. Self-testing will enable people to test in the privacy of their own homes, empowering them to take a test but also likely revealing earlier diagnoses and earlier treatment, reducing the prevalence of HIV in the years to come. The removal of the ban will support increased HIV testing by providing an alternative testing choice. Previous to this announcement, people wishing to test for HIV in Northern Ireland could choose to be tested by visiting a GP, sexual health or Genitourinary Medicine (GUM) clinic, a number of voluntary and community organisations and some private clinics. Unfortunately, HIV is currently a stigmatised health issue which deters many people from accessing HIV testing through these traditional services. Allowing the sale of HIV self-testing kits will have an important role in reaching those who are not accessing services.
Impact: Jacquie Richardson
Compared with the rest of the UK, Northern Ireland had the largest proportional increase in new HIV diagnoses between 2000 and 2014. 94 new cases of HIV were diagnosed in Northern Ireland in 2014 and overall 809 people received HIV care. There are also approximately 200 people living in Northern Ireland who are unaware of their HIV+ status. A major issue or trend with HIV in Northern Ireland is late diagnosis. 51 per cent of new diagnoses in 2014 were made at a late stage – compared to 40 per cent in the UK as a whole. Testing for HIV is a difficult step that some cannot face with their GP or at their local GUM clinic, therefore self-testing provides another testing choice.
Positive Life welcomes this shift in the law as the impact it poses could be substantial, but we would warn those testing at home need to be fully aware of the potential impacts. Negative consequences may arise if testing at home including unexpected emotional distress. We would encourage those who test reactive for HIV to ensure they seek both medical and emotional support as soon as possible. There is also the unknown risk of a possible false result and a lack of understanding that there is a window period where infection is present but may not be detected by the test. If either of these outcomes occur, someone may be falsely reassured that they are not affected by HIV. Positive Life’s expert staff can confidentially help those worried or confused to further understand self-testing. Despite some reservations, Positive Life is supportive of any measures that increase testing and awareness of HIV infection, and the opportunity for early detection and intervention. • For more information on Positive Life visit www.positivelifeni.com or join in the conversation @PositiveLife_NI
VIEW, Issue 36, 2016
Unfair society, unhealthy lives
Economist Michael Roberts argues that both Labour and Conservative governments have failed to address the glaring health inequalities in the United Kingdom
n March the current UK government’s Health Secretary Jeremy Hunt issued a circular to relevant bodies aiming for a reduction in ‘health inequalities’ by 2020, the growing disparity between the life expectancy and health of the poorest and most deprived and the richest and most privileged. There are a multitude of studies from around the world that confirm the stark truth is that the poorer you are, you will1 probably live less longer than the average; you are more likely to get sick more often and get debilitating diseases and live in areas with more pollution and health risk. And the more unequal in wealth and incomes that a country is, the more are disparities in life expectancy and health. Back in 2010, Sir Michael Marmot, Professor of Public Health at University College London, delivered a report entitled, Fair Society, Healthy Lives. According to Marmot, British society is so unequal and unfair that it visibly damages the quality and length of life for millions2 of Britons. On average, life expectancy in the poorest neighbourhoods is seven years less than in the richest. People in the 3 poorest neighbourhoods will also spend a greater proportion of those shorter lives unwell. Northern Ireland repeats the story. In 2009-11, the differential in life expectancy between the Northern Ireland average and the 20 per cent most deprived areas was 4.1 years for males and 2.6 years for females. The poorest tend to commit suicide more often, from stress and worry, and are more prone to alcoholism and to smoke. They tend to eat cheaper and less healthy food and they are more vulnerable to pollution and disease. 4 In a report last month, the Royal College of Physicians attributed about 40,000 premature deaths in the UK to outdoor air pollution from road traffic and industry. And deprived areas “often have higher levels of air pollution”. And the cost to us all is immense. In England, treating illness and disease arising from health inequalities has been estimated to cost £5.5 billion per year.
It means ending the creeping privatisation of the NHS. It means stopping the food manufacturers adulterating our food with sugar, salt and other harmful chemicals. It means raising the minimum wage...
Health inequalities lead to productivity losses to industry of between £31-33 billion each year. Lost taxes and higher welfare payments resulting from health inequalities cost £28-32bn. Under successive governments, Labour and Tory, nothing has been done. In 2010, the Department of Health published a report, Tackling Health 5 Inequalities. The Labour government of 2003 had committed itself to reducing inequalities in health outcomes by 10 per cent. The report showed that it had failed miserably. Under the Conservatives over the last five years, nothing has changed. Hunt’s review places the burden of turning things round on local authorities and heath trusts. But what is really needed is more central government spending on health, infrastructure, research and education and a cleaner environment. It means ending the creeping privatisation of the NHS. It means stopping the food manufacturers adulterating our food with sugar, salt and other harmful chemicals. It means raising the minimum wage and protecting the incomes and services of the ill and disabled. Yet this government proposes to do exactly the opposite. • Michael Roberts is an economist working in the City of London, author of The Great Recession and who blogs at thenextrecession.wordpress.com • 1, Reducing Health Inequalities ...
https://www.gov.uk/government/publications/department-of-health-shared-deliveryplan-2015-to-2020/shared-delivery-plan-2015 -to-2020 2, Health, Income, and Inequality NBER Reporter: Research Summary Spring 2003 Angus Deaton* 3, FairSocietyHealthyLivesExecSummary 4, https://www.dhsspsni.gov.uk/sites/default/files/publications/dhssps/hscims-mlb2015.pdf 5, https://www.rcplondon.ac.uk/news/rcpcalls-eu-action-air-pollution
Tackling partner violence
INTERNATIONAL VIEW, Issue 36, 2016
Dr Ruari-Santiago McBride, who is based at the University of Witwatersrand, Johannesburg, South Africa, looks at an innovative attempt to try and reduce intimate partner violence
ntimate partner violence (IPV) is recognised as a major global public health issue. Ranging from verbal abuse to physical assault, stalking to rape, IPV is a complex issue that has a profound impact on the emotional and physical health of the survivor/victim. People of all genders, irrespective of their sexual orientation, experience violence at the hands of their current and former partners. However, research suggests that it is women and girls, who are the most likely to experience IPV at the hands of men and thus the most likely to suffer ill-health and premature death as a result. The World Health Organisation estimates that at least one third of women worldwide, which is over one billion women, have experienced physical and/or sexual violence from their intimate partners. Women who experience IPV may suffer from both short and long-term health problems, including physical ailments, reproductive complications and psychological distress. IPV also has effects beyond the individual. It impacts the emotional and psychological well-being of children who grow up in violent environments. It also has a profound social and economic cost by isolating women, preventing them from working and earning a wage, and inhibiting their ability to look after themselves and dependents. To date no intervention has been proven, using robust study designs, to be effective at preventing IPV. With this in mind the UK Department for International Development (DFID) has invested ÂŁ25 million, over a five year period (2014-19), in the What Works to Prevent Violence Against Women and Girls Programme. Funding research and evaluation projects across Africa, Asia and the Middle East, the What Works Programme is seeking to understand the underlying causes of IPV and how it can be prevented from occurring. One such programme is the CHANGE Trial, which will be conducted in Diepsloot, South Africa; a township on the
Project has the potential to dramatically improve the lives of women in Diepsloot, South Africa
outskirts of Johannesburg, which has attained notoriety due to high profile incidents of violence against women and girls. The CHANGE Trial has been developed in collaboration between Sonke Gender Justice, a local NGO that champions gender equality and human rights, and the School of Public Health at the University of Witwatersrand, based in Johannesburg. IPV is a significant issue in South Africa. Large regional studies have found that that 32 per cent of men report using violence against partners, and 28 per cent of men admit to having raped in their life time. The high level of IPV in this context has been connected to a number of interrelated factors, including extreme levels of poverty, high rates of alcohol use and men adhering to harmful gender norms (such as toughness, virility, and sexual entitlement). With many young men disempowered by their precarious socio-economic position and with few other means to assert their masculinity, violence against intimate partners becomes one way in which they can realise their identity as strong, dominant social actors and exercise control in their lives. Using this knowledge as its foundation, the CHANGE Trial aims to
tackle IPV in Diepsloot by challenging dominant gender norms and promoting gender equality through community mobilisation and advocacy work over a one-year period. Sonke Gender Justice will lead the intervention by training a team of community mobilisers who will in turn raise awareness about IPV through events such as door-to-door campaigning, drama performances, painting of murals, sport tournaments and workshops. These events will specifically target young men who are the most likely to engage in IPV, but who are also susceptible to embracing equitable masculinity norms. Academic partners, on the other hand, will lead the trial arm of the intervention in order to ascertain to what extent the intervention is effective in reducing IPV. The CHANGE Trial is an innovative attempt to tackle IPV in a context in which limited success has been achieved to date. It has the potential to dramatically improve the lives of women within Diepsloot by helping them have healthier and happier relationships. If found to be effective there is a possibility that this intervention model will be scaled up on a national level and have a similar positive effect for millions of women across South Africa, and perhaps beyond.
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