Public Health - RCEM Special Interest group
We all recognise how the Coronavirus pandemic has exposed health inequalities and how more so now than ever the relevance of public health and the role we play as emergency physicians in improving the nation’s health, as well as our response to infectious disease control in the emergency department and the wider urgent and emergency care system.
Public health underpins everything we do, even if you do not know it. For example, do you ever get frustrated by seeing the same sort of preventable injuries and illnesses coming through the front door of your Emergency Department (ED)? What about the injured child cyclist? The adult with recurrent alcohol, tobacco, or drug-related illness? Presentations due to failures in under-resourced community and social care systems? People struggling with mental health problems because they have nowhere else to turn? Social deprivation, alcohol, drugs and adverse mental health are inextricably linked and widen health inequalities with higher levels of preventable illness such as injury related to road traffic accidents, cardiovascular disease and infectious disease with lower socioeconomic status. The ED has annual patient-doctor interactions in the tens of millions, but how often do we take the opportunity to think about the "bigger picture", let alone have a positive impact on it?
The RCEM Public Health Special Interest Group was established in January 2017 with the vision to provide an integrated approach to strengthening the interface between public health and emergency care in order to improve health outcomes for communities. We are currently made up of 6 clinicians and 1 lay member (names below) who hope to achieve this vision through:
- sharing the vision with health care workers nationally and internationally
- working with partners in the development of policies, research, training, and clinical practice related to EM and PH
- fostering an environment that encourages health care workers to pursue their professional interests in this field.
As a Special Interest Group, we have developed partnerships with key stakeholders and been active in education and curriculum development, research and policy and media engagement. Our initial priority area was injury prevention. Our priority for the next three years is health inequalities and preventative approaches in emergency departments. For trainees this is a particularly exciting time as public health is incorporated into the 2021 emergency medicine curriculum and we plan to support you with resources.
Below is a summary of our work in these areas and future plans.
- We are currently developing a ‘how to guide,’ for implementing public health interventions in emergency departments.
- Because of the key role that public health has in the emergency department, RCEM has recognised the need for there to be a lead in public health within each emergency department. You don’t need to be an expert, just have an interest in improving people’s lives with a public health approach. The job description for this role is here (hyperlink). Please get in touch if you are interested so we can form a network of emergency department public health leads across the UK.
Education and curriculum
- We have provided expert advice on ‘health prevention and illness prevention,’ as part of the RCEM 2021 curriculum for trainees.
- We held a session at the Annual RCEM Scientific Conference in 2018 on the importance of public health in emergency care.
- In 2018, we also brought together a cross specialty group from public health and emergency medicine for a successful study day: ‘A case of opposites attract or more in common?’
- We are developing an RCEM learning module on public health.
- We are going to set up a buddying scheme for public health and emergency medicine trainees to work together on quality improvement projects.
Policy and partnership
The following resource has been released by NHS England highlighting 8 urgent points that need to be addressed in order to tackle health inequalities.
- We collaborated with injury prevention groups and contributed to the National Accident Strategy 'Safe and Active at all ages’
- We have worked with Doctors of the World, Faculty of Public Health (FPH), and Lancet Commission on migration, to advocate for the removal of healthcare charging for migrants.
- Member of the SIG revised RCEM guidance on homelessness and HIV in 2020.
- We have an agreement in principle to develop a joint RCEM and FPH public health group (delayed due to COVID-19 pandemic).
- The SIG have developed a set of recommendations for emergency departments on the need to consider public health.
Research and media engagement
- The media have been extremely engaged in the current pandemic and have produced extensive information through multi-source media. The following resources are a selection of media sources available.
- Podcasts available here.
- You can read about why we think public health is important in the emergency department in the July 2017 EMJ supplement (contact us for a PDF version).
- We work with the Emergency Care Data Set (ECDS) to improve better data collection to enable targeted interventions.
- Members of the SIG are working with colleagues within RCEM to write a legacy document on lessons learned by emergency medicine as a specialty during the COVID-19 pandemic.
- Harrison, HL (2020) NHS migrant healthcare charges are hampering the fight against COVID-19, The Guardian. https://www.theguardian.com/commentisfree/2020/oct/14/nhs-migrant-healthcare-charges-are-hampering-the-fight-against-covid-19
- Challen, K Emergency department use during COVID-19 as described by syndromic surveillance | Emergency Medicine Journal (bmj.com)
- Challen, K Potential added value of the new emergency care dataset to ED-based public health surveillance in England: an initial concept analysis | Emergency Medicine Journal (bmj.com)
- H L Harrison, G Daker-White. Beliefs and challenges held by medical staff about providing emergency care to migrants: an international systematic review and translation of findings to the UK context. BMJ Open 2019;9:e028748. doi:10.1136/bmjopen-2018-028748.
- E Fernandez, N Rahman, J Hayton, C Crichton, V DeWitt, G Cattermole, O Corn, S Gidwani, H L Harrison, R Lowsby, S Bruijns, Global Health and the Royal College of Emergency Medicine: A Cross sectional survey of fellows and members. Emergency Medicine Journal. 2020
- H L Harrison, Walker A, Boyle A. Learning from the first phase of the Coronavirus pandemic. Emergency Medicine Journal Supplement, 2020
- Natural experiment studies project - Helping to build capacity for high-quality evaluations of public health interventions - prevention and control of noncommunicable diseases. WHO/Europe. 2018.
- A framework for healthcare providers. Reducing health inequalities associated with covid-19. Priority actions: examples from practice. NHS Providers. November 2020. https://nhsproviders.org/reducing-health-inequalities-associated-with-covid-19/priority-actions-examples-from-practice
- Learning from lockdown: How can we build a healthier future post-COVID-19? The Health Foundation. July 2020. https://www.health.org.uk/publications/long-reads/learning-from-lockdown
The Kings Fund summarises what are health inequalities, inequalities in life expectancy, healthy life expectancy, avoidable mortality, long-term conditions, mental ill-health, access and experience of health services, plus pathways to health inequalities, interactions between the factors driving health inequalities.
The Kings Fund regularly update their health inequalities page with topical and interesting articles
Further health inequalities resources can be found on the Health Foundation Page
The NHS Long Term plan outlined aims and objectives for the NHS over a ten year period. Chapter 2 involved new funded action the NHS will take to strengthen its contribution to prevention and health inequalities.
The Health Foundation commissioned the Institute of Health Equity to examine progress in addressing health inequalities in the UK, 10 years on from the landmark study Fair Society, Healthy Lives (The Marmot Review). The following resource explores the changes since 2010 in 5 key objectives, outlining areas of progress and decline of each as well as recommendations for future actions.
Covid-19 and health inequalities
Research showing the association between the current pandemic and health inequalities has been definitive. The following links highlight just a small selection of key resources describing this association.
The following videos are a great resource for preventing vaccine hesitancy within ethnic minorities:
You can email the Public Health chair: PHChair@rcem.ac.uk, Public Health administrator Alison.Ives@rcem.ac.uk, or tweet us at @RCollEM and use#RCEMPH.
The group have set up a WhatsApp group to coordinate engagement with public health and emergency medicine colleagues.
Dr Ling Harrison (chair), Dr Kirsty Challen, Dr Najeeb Rahman, Mr Martin Rolph (Lay), Dr Thomas Shanahan, Dr Andy Snell and Dr Olivia Villegas