Public Health Wales Conference 2017

Public Heath Wales Conference 26th – 27th October 2017, Celtic Manor, Newport

By Rebecca Broomfield

As a Paediatrician I think we play a vitally important role in Public Health, we have the ability to make a significant difference with every contact we have with children and young people, therefore I was excited to attend the Public Health Wales Conference in October. It provided an opportunity to keep up to date with all aspects of Public Health as well as focus in on paediatric specific topics, such as adverse childhood events, the venue was fantastic and with Michael Sheen making a keynote presentation what was not to love?!
 
The start to day 1 was nothing short of inspirational, a montage of pictures detailing the history of Public Health in Wales and significant events in history, such as devolving power over health, was accompanied by a harp and a flashmob choir popping up in the audience culminating in a local school choir taking to the stage, it was breath taking. After an impressive start the audience heard from Rebecca Evans, Minister for Social Services and Public health, who updated us on the progress which Wales had made within Public health. The next speaker Dr Christoph Hamelmann, Head of the World Health Organisation Europe office for Investment in Health and Development, spread the net wider and discussed more global issues and reiterated the importance in looking beyond your own borders in Public Health spheres. I was pleased to learn that the ‘Well being of future generations act” really is leading the way within the WHO.  We wrapped up before lunch with a keynote on Climate change, followed by a discussion panel exploring air pollution and how we can build a sustainable future. 

​​The afternoon sessions on day one were split into ‘Spotlight sessions’ there were many of these going on at the same time and the topics which you could choose from were diverse. I attended one entitled “Mindfulness for wellbeing: Evidence and Practise” The science behind mindfulness was discussed briefly, demonstrating the activation of the pre-frontal cortex when being mindful. Children who are naturally high in mindfulness react less strongly and have better emotional regulation. It was interesting to see demonstrated that by using mindfulness techniques with school aged children you can shift them into individuals with high mindfulness. After the training these children had a significant decrease in the intensity of their reactions to angry faces. Mindfulness has an enormous potential for development within education, as within other areas, but it important that the training is ongoing and children learn to use it within everyday life. Mindfulness, growth mindset and metacognition are surrounding feature of the new curriculum being developed in Wales and has the opportunity to vastly improve the outcomes in mental health for this generation of children.  My spotlight session was fantastic, but I had significant spotlight session envy as a college attended a Lego workshop based on driving improvement through the value chain and got to use LEGO to demonstrate visually resilience and improvements – she got to play with LEGO and call it work! (on a side note you can train to deliver LEGO sessions and this could be your job!)
 
Day 1 ended with a chaired Brexit Debate. The views from the panel were interesting and the uncertainty regarding the exit plans are already causing problems for Public Health initiatives within Wales. The panel presented reasoning that it doesn’t matter what side you were on when voting took place, we need to overcome this and work together to move forward. Wales have already done some of the ground work with how to respond. Brexit is currently overwhelming all of UK politics and other important issues are being neglected because of this focus. But on the other side of the coin, and attempting to be a glass half full type of person, Brexit is a huge opportunity to have ‘No more excuses’ and reduce inequalities. We need to change our mindset on Brexit, accept that it is currently happening and focus on the positives which we can derive from it.
 
Day 2 started by hearing from Dr Frank Atherton who is Chief Medical Officer for Wales and a person I will never get bored of hearing speak. He attended WPS last Autumn and delivered an engaging Keynote there, and as a Welsh Clinical Leadership Fellow we have been in the privileged position to meet him on several occasions. He presented that we should celebrate our Public Health successes (Hepatitis C, Future generations act, reduction in smoking rates) but also recognise that we still have a long way to go. Inequalities still exist and are widening. Moving forward we need to focus on prevention with improved outcomes and ensure sustainability. But because a long term view is not easy to fit into political cycles it is hard to engage managers with this viewpoint. Dr Atherton concluded that we are on the right track and need to continue to engage the public and sustain ongoing developments in Prudent Health Care.
 
Dr Chrissie Pickin followed on from Frank Atherton and presented an engaging talk entitled “Understanding people’s choices and how to influence them”. She started by noting that Health issues are complex and for every complex problem there is a straightforward, easy to implement, wrong solution. Providing education is an obvious solution because the assumption is that people would not deliberately harm themselves but a knowledge gap is rarely the reason behind the behaviour. She gave some top tips to influence people’s choices.

1. Understand the behaviour
2. Motivate not educate – on three levels: individual, peer and social.
3. Change social norms – legislation and policy are key factors in social change, for example drink driving laws, but these are not always the basis for change. Sometimes policy can be socially led and legislation needs to catch up.
4. Manage opportunity – make it easy, or capture people at a significant life event such as becoming a new parent.
5. Build capacity to initiate and sustain change

When looking at a problem find out where the problem lies. Is it a problem with Capacity? Motivation? Opportunity? Or all three? Once you have identified where the problem lies you can target the intervention.
Having learnt about how to influence people’s choices it was fitting that the next speaker, Richard Chataway delivered a talk on Social Marketing and Communication Science. Because we have a better understanding of what drives behaviour change as well as advances in technology social marketing has significantly changed. Richard Chataway presented, amongst other topics, a public health initiate undertaken in Australia, his team wanted to reduce smoking rates. When quitting smoking the motivation is there, the knowledge is there but people need support. He launched My Quit Buddy, an app which provided daily progress tracking, distraction techniques and motivational messages. This was an incredibly successful campaign and the app has had wide uptake. He also explored the use of technology within research into changing behaviours. With the introduction in artificial intelligence it is possible to pre-test communications such as an advertising campaign, to understand it people will find it motivating at a subconscious level this can remove the test and learn element of marketing which will make it more effective, quicker. He again reiterated that in order to find a solution it is important to understand the behaviour and design a solution around it. A panel discussion followed this.
 
After a short break, there were more ‘Spotlight sessions’ with lunch in the middle. There were again many topics to choose from. I attended “Tackling Adverse Childhood Experiences” It is known that if a young person experiences 4 events they are 15x more likely to commit violence, 14x more likely to experience violence and 20x more likely to be in prison than the general population. We need to break the generational cycle and make a social movement for change looking at the root causes and take a psychological approach to tackle these. The impact of breaking the generational cycle is huge, 47% of adults have experience 1 adverse event. The second of my ‘spotlight sessions’, after lunch was “The good, the bad and the social: Two sides of social media” Social media is more addictive than smoking or alcohol, 10 million photos are uploaded to Facebook every hour. It can be both positive and negative the challenge comes with harnessing the positives while mitigating the negatives. Instagram is cited as the most negative with associations to negative body image as well as anxiety and cyber bullying. There was a lot of discussion about where the responsibility lies for managing social media for children and young people. It was felt that this was not just the responsibility of parents, social media itself needs to take some responsibility.
 
The conference closed with Michael Sheen discussing “Building on our cultural strengths: Supporting communities.” As expected Michael Sheen was an engaging and well informed speaker. His message began with the understanding the if you want different outcomes you have to fundamentally change what you do. He outlines inequality as a significant problem, the less you have the more you have to pay for it. If we want families to drive themselves up socially then we need to look at the weight of debt which they have. We have a benefit within Wales as we have a strong community spirit and have held onto our identity and language. As a Public Health team we need to support our communities to be as healthy and sustainable as possible, we need to provide space where communities can come together and shift the power into the grass roots. His concluding statement is worth recognition and highlights a positive to finish a highly engaging conference. “One who has health has hope, and one who has hope, has everything” (Originally a proverb I think!)
 
Once again, I tweeted through the conference and these can be found on my twitter feed from these dates. Public Health is an important topic which is extremely relevant within Paediatrics and the selection of work presented during this conference leaves me in no doubt that Wales really is leading the way.