My name is Sandeepa Arora and I am a new PhD student in the Child Health Unit at PCPH. Before coming here to study I worked in research and data analyst capacity for over eight years at various health research organisations. I have come to the academic scene with enthusiasm, many questions and few answers, if any, so I would like to use this space to cultivate scientific precision and above all indulge in sheer ‘nerdiness’ on all things related to my PhD. My PhD is funded by NIHR Applied Research The current focus on integrated care reflects a Collaboration Northwest London (ARC NWL) – long-standing concern in the NHS with the Child Population Health. I am interested in organisation of care across three sectors of the child health because I believe that health and health service (primary, secondary and wellbeing of children are a matter of utmost tertiary). I would also like to reflect on the importance and the responsibility of the State. wider role of public services, such as schools In the UK, with public sector austerity and and social care. I will explore these questions widening inequality, there is growing concern first by conducting a literature review to that the health of children and young people establish a foundation of (my) knowledge on lags behind other groups more than it does in the topic of integrated care. A database over 2 most other developed countries. Undoubtedly, million residents of Northwest London has Covid-19 pandemic is expected to have a already been collected as part ARC NWL stronger impact on vulnerable children due to integrated care. I will assess the potential of social welfare and chronic health needs. I want this database and understand which outcomes to bring evidence from my research on child and measures contain information about health into the policy debate. processes and health of children in this area. What can we infer about child health through Children, and particularly those with chronic this dataset? How could we measure the area’s and other persistent conditions, often require collective ‘pulse rate’ and how it has changed more support from parents, health service over the recent years? providers, schools and related services to realise their potential and develop into adults I will also explore approaches to evaluation of who can fully participate in the society. integrated care programmes and address the Achieving integrated care requires a shared challenges faced in such evaluation. Which vision and coordination in planning, financing methods and approaches should be applied? and providing services, centred on the How can the impact of integrated care children’s and their carers’ perspectives. strategies be explained? There is an urgent need for more robust and high-quality evidence to inform decisions about I look forward to being part of a stimulating how to develop integrated care. What do we exchange and creation of ideas at the Child mean by integrated care? There is no single Health Unit’s various forums. To me this PhD is model of integrated care that is well suited to an apprenticeship in science. I hope to carry on all contexts, settings and circumstances. In my learning and seek to understand exactly what PhD, I will analyse fragmentation in children mechanisms bring about change, and I ensure services and search for methods, processes and that my research contributes to the benefit of models that resolve their weaknesses. children’s health.
Public Health Department - Your.md collaboration – SARS-COVID -19 When Covid-19 struck in the UK an opportunity had arisen in collaborating with Your.md. Your.md is a health start-up that stores Covid-19 symptom data from all over the world. The highest percentage of responses are coming from India, Mexico, Philippines, United Kingdom and Pakistan yet other countries from around the world have used this app. With Covid-19 symptom mapper app, the company managed to gather data from all over the world, where responders were able to fill in the Covid-19 symptoms which they experience. Up to date there are 184,000 responders. The Global Digital Health Unit had the opportunity to work with this data. From data visualization, to developing clustering models and even creating a library on SARS-Covid-19 symptoms and a symptom tracker which displays counts and percentages of symptoms worldwide. Other work has been done with the aim of checking whether different comorbidity groups report different symptoms. For this they have used clustering algorithms which gives different clusters of comorbidity groups based on symptom mapping. Additionally, a part of this work has been disseminated before the Global COVID observatory at Imperial’s Data Science Institute where academics, researchers and consultants have been part of giving expertise around the work done. We hope to publish the work which is currently still under development.
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Small nuggets of information that build up knowledge over time Microlearning, which is a person-centred learning intervention that delivers fragments of information that build up complex knowledge over time, is becoming increasingly well suited to help individuals learn about how to engage in self-care. Examples include public health awareness programmes, formal education, TV programming, and primary prevention and health screening campaigns. One of the main catalysts leading to the widespread use of microlearning is the evolution in individual learning style and behaviours, which have gradually become increasingly reliant on the use of digital technologies which allow individuals to learn at any place and at any time during their lifetime. Furthermore, as the human attention span has become shorter in the last two decades thought to be due to the ubiquitous use and pervasiveness
Image by AlexAntropov86 via Pixabay of bitesize content used in television, mobile smartphone, tablets, personal computers and other technologies, it is now increasingly more important to frame information in small, easy to digest bitesize nuggets of information that build up knowledge over time. Our recent systematic review showed that microlearning is only effective in improving self-care capabilities in the context of (i) promoting healthy eating, (ii) improving risk avoidance or mitigation skills, and (iii) promoting the adoption of good hygiene practices. However, microlearning was only partially effective in improving participant's mental well-being and self-awareness, knowledge and health literacy. Findings also suggested that microlearning had a relatively strong ability to trigger cognitive level changes among individuals, including changes in attitude, knowledge, awareness, mood or stress changes. Although microlearning did not always trigger self-care behaviour changes, it can under certain situations be used to raise awareness about the importance of adopting personalised health seeking self-care strategies. More studies are needed to explore which microlearning modalities are most suited to effectively promote the wide adoption of health seeking self-care capabilities and behaviours.
MAXIMISING THE Image by rawpixel.com IMPACT OF SOCIAL PRESCRIBING ON POPULATION HEALTH IN THE ERA OF COVID-19 Our new paper in the Journal of the Royal Society of Medicine discusses social prescribing, the process of referring people to non-clinical community services; such as exercise classes and welfare advice, with the aim of improving mental, physical and social wellbeing. Social prescribing has been increasingly adopted across high-income countries including the UK, United States of America, Canada and Finland. The UK’s Department of Health first introduced the term ‘social prescribing’ in 2006 to promote good health and independence, especially for people with long-term conditions. Over a decade later, in 2019, NHS England committed to funding social prescribing through link workers. Link workers receive referrals, mainly from general practitioners, and are attached to primary care networks with populations of 30–50,000 people. In the paper, we examine the impact of different social prescribing schemes in England, from a population health perspective, that focus on individuals, communities or a combination of both. We examine the opportunities to maximise social prescribing’s impact on population health, in the era of COVID- 19, by realigning social prescribing to a household model that reflects principles of universality, comprehensiveness and integration.
NEENA MODI “I am delighted and honoured to have been appointed president-elect of the British Medical Association. I will take over from Professor Harry Burns in 2021, who in turn picked up the baton from Imperial’s Professor Raanan Gillon. In my short acceptance speech, I noted there is probably no one in the UK who is not aware that the NHS is going through difficult times. The founding principles of the NHS - free at the point of need, funded through public taxation, available to all - remain however a magnificent beacon. Everyone working in healthcare also knows that strong teams, who put the best interests of the patient first and above all other considerations, provide the best care. Good care also requires good systems so healthcare professionals have a duty to advocate for a fair, efficient and high-quality NHS, not one weakened by the high transactional costs and divided loyalties of a marketised system. With a heed to the wider determinants of health, we also have responsibility to advocate for conditions conducive to population wellbeing, and a narrowing of health inequities. My focus during my presidency will therefore be Good Health and Good Healthcare for All”
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By David Skinner, President of International Self-Care Foundation Astrobiologist David Grinspoon said: “Humans are possessed, to some degree, with the power of foresight. Yet we so often learn things the hard way…” If 2020 is the start of a new decade for self-care, then there have been some hard lessons learned already.
The emergence of Covid-19 on the global worldwide. Awareness of self-caring is stage has had far reaching implications for likely at an all-time high. Whether it is healthcare, economics, social justice and hand washing, managing stress, a focus on more. No doubt people are besieged with nutrition or a myriad of other actions the enormous shifts in how they live their people are taking to maintain and lives and learning how to manage their improve their own health to cut their own health has been one of the critical Covid risks, it has made the importance of components of finding a path towards the ‘Seven Pillars of Self-Care’ that much reducing the impact of the coronavirus more remarkable. For example, Australians are taking greater responsibility for their health behaviour and outcomes, showing unprecedented eagerness to participate in preventative health and self- care including: • 84% Australians reported washing their hands or using sanitizer more than usual, • Four times as many Australians are trying to quit smoking, • More Australians are proactively seeking out reputable health information with health.gov.au experiencing a 760% increase in traffic, • More than 7.3 million flu vaccines have been administered in Australia this year, compared to 4.5 million and 3.5 million administered for the same period in 2019 and 2018, respectively. In a similar study from Canada, the self- Even though the evidence points toward care behavioral changes have been the emergence of self-care as a valuable significant. The report states that there tool, it has not been driven by a has been “a very significant increase in coordinated government policy approach Canadians looking for information on how (notwithstanding hand washing and social to take care of their own health. More distancing promotion). While it certainly than one-third say they are doing this could be that there are too many silos in more since COVID-19, compared to only health policy making bodies, it also could 3% who are doing this less. There has also be that the compelling evidence base has been an overall increase in the knowledge not been sufficiently developed. Perhaps and ability of Canadians to care for their this is a chicken and egg situation. own health at home. Self-rated Government has not taken it upon knowledge is up among 28% of the themselves to develop self-care population and down among only 3%. champions and programs, so they have Self-rated ability is up among 19% and not demanded or funded research in a down among 9%”. The effect on health robust way. Research gaps leave literacy is quite tangible if these numbers governments in waiting so they have no can stay strong. imperative to focus on self-care as a public health platform.
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In October 2020, the Mitchell Institute called upon government to address the need for a comprehensive approach to enabling self-care. The Blueprint identifies outcome measures that will indicate progress and proposes seven guiding principles, three strategic priorities and 12 ‘action areas’ for policy development related to self-care. The nine priority policy proposals for implementation are designed to: • Improve health literacy for all • Build self-care into health care practice • Enable consumers to be active partners in health care • Assure the quality and accessibility of digital health information and • Develop measures for individual self-care and self-care support by health services. The report goes on to develop structural policy approaches such as: • Implement funding and service models to support self-care • Drive investment in preventive health and self-care • Establish a national approach to enabling and supporting self-care and • Support individual and population health through all public policies While this Blueprint is the most recent tools to lower this barrier to better health and perhaps one of the most maintenance? comprehensive self-care initiatives, more evidence continues to be needed and the Keeping in mind that the Seven Pillars of share of mind for policy makers driven by Self-Care set a broad base for improving our painful Covid experiences should be health outcomes at both the individual leveraged to gain tangible support for carer level with societal health care ongoing research. Some public health resource implications, the importance of bodies have wondered if the increase in advocating for a comprehensive self-care sanitary behaviour has impacted strategy in Public Health has been antimicrobial resistance? Others note that understated or underappreciated at the increased emphasis and awareness about very least. The International Self-Care vaccination has been helpful but barriers Foundation and its network continue to to vaccine hesitancy still exist. What strive to make this point. A renewed focus research can be done to develop self-care on self-care research may be the key to unlocking the policy doors. If 2020 is any indication of what the new decade has in store for health policy and the opportunities for self-care, this could be the start of a very exciting era. Let’s take the multitude of lessons from the Covid pandemic and turn them into foresight and action.
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GOING ON GRID Identifying naturally occurring communities of NHS primary care providers Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that PCNs should represent ‘natural’ communities of general practices (GP practices) collaborating at scale and covering a geography that fits well with practices, other healthcare providers and local communities. Our study published in BMJ Open aims combined into communities reflecting to identify natural communities of GP their underlying populations in practices based on patient registration accordance with the specification of patterns using Markov Multiscale PCNs. Community Detection, an unsupervised network-based clustering At a time when integration of technique to create catchments for community, primary and secondary these communities. With PCNs care is being prioritised, concurrently, expected to take a role in population place-based primary care anchored in health management and with the local community is increasingly community providers expected to being challenged with the growth of reconfigure around them, it is vital to online GP consultation providers, such recognise how PCNs represent their as that provided by GP at Hand in communities. Our method may be London. Upscaling primary care into used by policymakers to understand larger networks has the potential to the populations and geography shared weaken further the ties between between networks. providers and their communities. There is a pressing need to better As health systems adapt towards understand how these networks will closer integration across services, represent their geographies and network analysis offers a data-driven patients, to identify who may gain and and unbiased means of understanding who may lose out and ensure a well- the connections between PCNs and intentioned policy does not widen their patients. Our findings inequalities in health. demonstrate that GP practices may be
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HOME & AWAY WHO GUIDELINE ON SELF-CARE (one year on) Self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions. Worldwide, an estimated shortage of 18 million health workers is anticipated by 2030, a record 130 million people are currently in need of humanitarian assistance, and disease outbreaks are a constant global threat. At least 400 million people worldwide lack access to the most essential health services, and every year 100 million people are plunged into poverty because they must pay for health care out of their own pockets. There is an urgent need to find innovative strategies that go beyond the conventional health sector response. The Consolidated Guideline on Self-Care was published on 24 June 2019, positing the WHO as the global champion for self-care. One year on, and there is great interest to determine the extent that countries are implementing the self-care guideline for sexual and reproductive health & rights. The SCARU team will be working with key stakeholders in Nigeria, Kenya & Uganda to determine the extent that the guidelines are being implemented in these countries. This policy mapping exercise will include an eSurvey and focus group discussions with key informants to identify extant drivers and barriers for the routine adoption of the guideline and the recommended self-care practices. The work will also result in an advocacy tool to help promote the guideline across Sub-Saharan African countries and will complement similar work being one in francophone countries. PUBLIC HEALTH ACADEMY FOR SAUDI ARABIA The Public Health Workforce has always included a variety of professionals. However, it is only recently that its core competencies have been put together, classified and described. Given the current circumstances, this particular field has evolved very quickly. This means that the need for recognition and further skills and knowledge development in the area of public health is well noted. WHO Collaborating Centre for Public Health Education and Training has been collaborating with Kingdom of Saudi Arabia Centre for Disease Control on the project whose main objective is the formation of the Academy of Public Health in Saudi Arabia. The project has been progressing well and is due to finish in September 2021. The reflections and lessons learnt will provide the foundation for evaluation and further improvements internationally.
COVID -19 WEBINAR SERIES This year has been like no other for the whole world. We all have had to adapt very promptly to an ever-changing reality. In response to this, as well as in an attempt to capture new experiences and disseminate knowledge, WHO Collaborating Centre for Public Health Education and Training in collaboration with the Arab Public Health Association has been offering a series of weekly webinars with experts in various fields in relation to the COVID-19 pandemic. The topics so far included: • Exit strategy: the new normal • Surveillance: testing, contract tracing and Intervention • Health systems: today and post-Covid • Self-care & Self- management during COVID-19 and beyond • Our mental health during and post-Covid • Primary care service during and post-COVID-19 pandemic • Treating COVID patients • Non-communicable Diseases during & beyond COVID-19 pandemic • The private Health sector during COVID-19 pandemic • The Media during COVID-19 pandemic • COVID-19 and Public Health Competencies • Physical Activities during COVID-19 and beyond • COVID-19 and cancer services • COVID-19 and return to schools • Six months in COVID-19 pandemic in Eastern Mediterranean Region: where are we now and future directions • COVID-19 and behaviour change • COVID-19 and reproductive health • COVID-19 and antimicrobial use The webinars have proven of interest to a large number of participants and are available to view on the WHO CC website. Image curtesy of rawpixel.com
Five minutes with… Kate Williams Personal Assistant & Administrative Officer
What does your role involve and what do you enjoy about it? I’m the Diary/Unit Manager to Prof Paul Aylin and ad-hoc support to Prof Alex Bottle and the Dr Foster Unit (DFU). My typical day involves comprehensive and complex diary & in-box management for Paul Aylin, just for starters…I also support Alex and help with general admin queries for the unit, recruitment, inductions, advertising, mortality alerts and general day to day things that might arise. I also keep tabs of the monthly budgets on 5 grants. It can be varied and chaotically busy some days, even before the Pandemic! I enjoy being part of a team which contributes to positive outcomes, even more so now given the nature of the work. Having worked in busy positions previously, in private and public sectors, has equipped me to deal with the ever-changing diary and commitments within the DFU. Given the challenging climate we find ourselves in, supporting and managing remits of Professors in Epidemiology and Statistics in PCPH at Imperial College, is a pretty useful role! (I’m currently doing a very good serene swan impression while paddling like mad in murky waters. What were you doing prior to this? 20 years in the private sector in varying EA/Marketing and Event roles, including 5 years as an Investor Relations Executive within Investment Banking, which being specialist, demanded incredibly long hours, lots of frequent travel but little time for anything else! I then had a switch in sectors to the legal world for an International Barristers’ Chambers where I organised their Events and Marketing as a freelance contractor. In 2008, I joined the public sector in Education as Public Relations/Executive Officer to the Vice Chancellor and Chair of the Board of Governors for another University for 6 years, then 3 years at King’s College as EA/Dept. Manager to the Head of Genetics & Molecular Medicine before joining Imperial last year. What are your outside interests and who are you outside of work? I am a keen swimmer, enjoy the water and immersing myself whenever I get the opportunity. I also enjoy cooking, and as an owner of an allotment, attempt to grow some seasonal stuff and my wonky veg can be impressive! This extra patch of turf came in as a very handy ‘go to’ place in early lockdown. I also dabbled in beekeeping for a bit, while I had the opportunity - but that had its moments. I am currently missing being able to go to concerts, properly socialising with family and friends and obviously travel. Luckily, I’ve always enjoyed walking, so this was a great escape early this year, while we were blessed with great weather! I did also get
away to a warmer climate for 2 weeks in January of this year where I managed to do lots of hiking before we knew what was around the corner. I did take a year out and backpacked around Europe ‘on a shoestring’, with my dearest pal in my early twenties, pitching up a two-man tent from destination to destination and staying at hostels and with friends in different countries, which was a great adventure. Trains, boats and mopeds were the mode of travel. What are your goals for the next few years? Hmmm, as always, I have too many! To possibly move out of the suburbs to the coast…maybe travel somewhere for a long period of time again (whenever that might be possible), learn some new skills. Own another dog. Swim the English Channel… What 3 tunes and luxury item would you choose to be marooned on a desert island with? White Rabbit (Go Ask Alice) – Jefferson Airplane Space Oddity – David Bowie Teardrop – Massive Attack There’s clearly more than 3… Why? Because any of those songs have the capacity to stop me in my tracks, transport me somewhere else, far, far away, in an instant - enchanting and mysterious, provoking whatever interpretation the lyrics may be to the listener. Always been a fan of ethereal Avant Garde vibes…and pretty much anything David Bowie! Oh yeah, he can be marooned with me also, please! Hmm, luxury items would have to be a waterproof mascara (I know, right, rolls eyes), a Moleskine notepad, a magic carpet, reliable Wi-Fi and if you could throw in a Cadbury’s twirl…that’ll do nicely while I figure things out. Like, how realistic does this have to get? I once read Life of Pi by Yaan Martel, someone lent it to me a long while back, so I think I might know some basic survival methods and how to navigate sharing a boat with a Tiger…but first I’d need to build a boat (if luxury item 3 is out of stock) and if Elvis and David don’t pull their weight, I can be very resourceful, so long as they sing while I row on out...and don’t dare eat my Twirl.
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Remember the Great Exhibition Road Festival? Well, it’s back! Explore an exciting programme of events and activities taking place throughout the year celebrating science and the arts. • Explore virtual fantasy re-imaginings of Exhibition Road in this unique project featuring artists Remi Rough and Turner Prize nominee Ian Davenport. • Discover this online exhibition, each artist has paired with a scientist to create art that will inspire you to reflect on the science of stem cells. • Take a glimpse into the future of literary translation in view of developments in Artificial Intelligence (AI) REGISTER NOW
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