Analysis of the UK Government's 10-Year Drugs Strategy-a resource for practitioners and policymakers.

In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put 'people, health and human rights at the centre'. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childhood experiences and socioeconomic deprivation, and institute evidence-based measures to mitigate drug-related harm. This would likely be more effective, and just, than the continuation of policies rooted in enforcement. A more dramatic re-orientation of UK drug policy than that offered by the Strategy is overdue.

The interface of multisectoral and multilateral dimensions of public health policy: what's new in the 21st century?

The article examines key developments unfolding in the 21st century in the intersection of multisectoral and multilateral dimensions of public health policy. Several processes and mechanisms, relatively new or rapidly evolving, are fuelling this dynamic interface. They include, in particular, expansion of the spectrum of sectors involved in the health domain, the upsurge of trans-border and commercial determinants of health, growing presence of health issues in multilateral instruments and processes that are outside of the health sector, and strengthening the legal base of intersectoral relations and responsibilities for health. They also encompass and reflect important transformations in health diplomacy and governance for health, some of the fundamentals of contemporary public and global health. The article argues that overall, multisectoral and multilateral dimensions tend to interact, inform and reinforce each other, and that such interaction would be one of important drivers of 21st century intersectoral policy-and international cooperation-for health.

Education, training, and experience in public health ethics and law within the UK public health workforce.

BACKGROUND: Public health ethics and law (PHEL) is a core professional competency for the public health workforce. However, few data are available describing the extent to which UK public health workforce members experience ethical and legal issues or have sufficient educational and/or training background to adequately deal with such issues. METHODS: An anonymous online survey was developed for dissemination via member mailing lists of the: Faculty of Public Health, Royal Society of Public Health, and UK Public Health Register. Public Health England also included a link to the survey in their newsletter. The survey included questions about education, training, and experience in relation to PHEL. The survey was deployed from October 2017 to January 2018. RESULTS: The survey was completed by a diverse sample of five hundred and sixty-two individuals. The majority of respondents reported: (i) regularly encountering ethical issues, (ii) resolving ethical issues through personal reflection, (iii) having little or no education and training in PHEL, and (iv) questioning whether they have dealt with ethical issues encountered in practice in the best way. CONCLUSIONS: The results suggest that there is a need to develop and support wider PHEL capacity within the UK public health workforce through the provision of PHEL education, training, guidance, and mentoring.

Charging migrants for health care could compromise public health and increase costs for the NHS.

BACKGROUND: This study explores the implications of the UK Department of Health's intention to introduce charging for undocumented migrants for primary health care. METHODS: Following a background review of relevant recent literature, 12 in-depth qualitative interviews were conducted with experts on vulnerable populations in England and/or the English health care system, in collaboration with Doctors of the World UK. Data were analysed qualitatively using thematic coding and framework analysis. RESULTS: Stakeholders were concerned that implementing charging for migrants in England could deter medically necessary treatment, leading to threats to public health and increased health care costs. Interviewees identified potential challenges and opportunities provided by the Health and Social Care Act 2012 to improve health care for migrants. CONCLUSIONS: There are considerable concerns about adverse consequences of implementing charges for undocumented migrants. It will be essential to evaluate the effects of this policy once it is implemented.

A radical change in traffic law: effects on fatalities in the Czech Republic.

BACKGROUND: This study examines short- and long-run effects of a new-stricter-road traffic law on traffic accident-related fatalities in the Czech Republic. The law introduced tougher punishments through the introduction of a demerit point system and a manifold increase in fines, together with augmented authority of traffic police. METHODS: Identification is based on difference-in-differences methodology, with neighbouring countries serving as a control group. RESULTS: There was a sharp, 33.3%, decrease in accident-related fatalities during the first three post-reform months. This translates into 127 saved lives (95% confidence interval: 51, 204). The decline was, however, temporary; the estimates of the effects going beyond the first year are around zero. Unique data on traffic police activity reveal that police resources devoted to traffic law enforcement gradually declined. CONCLUSIONS: Tougher penalties have significant, but often short-lived effects. Weaker enforcement in the aftermath of such reforms may explain the absence of long-run effects.

Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government.

BACKGROUND: The power to influence many social determinants of health lies within local government sectors that are outside public health's traditional remit. We analyse the challenges of achieving health gains through local government alcohol control policies, where legal and professional practice frameworks appear to conflict with public health action. METHODS: Current legislation governing local alcohol control in England and Wales is reviewed and analysed for barriers and opportunities to implement effective population-level health interventions. Case studies of local government alcohol control practices are described. RESULTS: Addressing alcohol-related health harms is constrained by the absence of a specific legal health licensing objective and differences between public health and legal assessments of the relevance of health evidence to a specific place. Local governments can, however, implement health-relevant policies by developing local evidence for alcohol-related health harms; addressing cumulative impact in licensing policy statements and through other non-legislative approaches such as health and non-health sector partnerships. Innovative local initiatives-for example, minimum unit pricing licensing conditions-can serve as test cases for wider national implementation. CONCLUSIONS: By combining the powers available to the many local government sectors involved in alcohol control, alcohol-related health and social harms can be tackled through existing local mechanisms.

Public health and English local government: historical perspectives on the impact of 'returning home'.

This article uses history to stimulate reflection on the present opportunities and challenges for public health practice in English local government. Its motivation is the paradox that despite Department of Health policy-makers' allusions to 'a long and proud history' and 'returning public health home' there has been no serious discussion of that past local government experience and what we might learn from it. The article begins with a short resumé of the achievements of Victorian public health in its municipal location, and then considers the extensive responsibilities that it developed for environmental, preventive and health services by the mid-twentieth century. The main section discusses the early NHS, explaining why historians see the era as one of decline for the speciality of public health, leading to the reform of 1974, which saw the removal from local government and the abolition of the Medical Officer of Health role. Our discussion focuses on challenges faced before 1974 which raise organizational and political issues relevant to local councils today as they embed new public health teams. These include the themes of leadership, funding, integrated service delivery, communication and above all the need for a coherent vision and rationale for public health action in local authorities.

The Public Health Responsibility Deal: how should such a complex public health policy be evaluated?

BACKGROUND: The Public Health Responsibility Deal (RD) in England was launched in 2011 as a public-private partnership which aims to 'tap into the potential for businesses and other influential organisations to make a significant contribution to improving public health by helping us to create this environment'. It has come under criticism from public health advocates and others, who have suggested that it will be ineffective or perhaps even harmful. Like many public health policies, there have also been demands to know whether it 'works'. METHODS: We conducted a scoping review and used this, supplemented with interviews with stakeholders, to develop a detailed logic model of the RD (presented here) to help understand its likely outcomes and the pathways by which these may be achieved as a basis for planning an evaluation. CONCLUSIONS: Evaluations of complex interventions require not just assessment of effects (including outcomes), but also a clear conceptualization of the intervention and its processes. The way the RD and the pledges made by participant organizations has been presented makes it difficult at this stage to evaluate whether the RD 'works' in terms of improving health. Instead, any evaluation needs to put together a jigsaw of evidence about processes, mechanisms and potential future health and non-health impacts, in part using the current scientific evidence. This task is ongoing.