Money Power Health with Nason Maani Nason Maani

 

Hello everyone and welcome back to Money Power Health. 

 

As we have been discussing in previous episodes, health is to a large degree shaped by our social and physical environments. Public Health, as defined by Acheson, is “the science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society.” Some of that art and science, in fact a lot of it, plays out at the level of local, rather than national government. 

 

In the UK, local authorities have statutory public health responsibilities carried out by teams of local public health professionals, led by a Director of Public Health. Directors of public health are responsible for determining the overall vision and objectives for public health in a local area. 

What’s so fascinating to me about public health in local authority settings is that it is at the coalface. DPHs and their teams have to work alongside a range of other local stakeholders and elected councillors who change over time. For many of them, health might be a secondary concern, or not even something they consider themselves affecting. The skills they apply in doing this, are unique, but incredibly important for many of us who care about money, power and health.

 

This week we are talking about the practice of public health in local authorities, with Greg Fell. Greg Fell is the Director of Public Health in Sheffield, and Vice President of the Association of Directors of Public Health (ADPH). During the COVID-19 pandemic, DPHs like Greg and their teams faced enormous pressures in terms of their capacity, coordination, expertise and media presence. He is a leading voice in UK public health, and has an excellent blog where he pulls together a wide range of knowledge into bite-size, actionable chunks. 

 

In this podcast we cover Gregs journey into Public Health, what a Director of Public Health does, the state of health and health inequalities in Sheffield, what it was like working in a public health team during COVID-19, how to think pragmatically while mindful of the wider forces that shape health, what brings satisfaction in work of this type, what personal qualities one needs to be effective in that kind of local government setting, and what commercial determinants of health mean for public health at the local authority level. Huge thanks to Greg for sharing his candid reflections, he is a fountain of information.

 

Link to Gregs blog: https://gregfellpublichealth.wordpress.com

 

Link to ADPH website: https://www.adph.org.uk

 

Link to the article on the pollution of discourse he mentioned: https://www.bmj.com/content/377/bmj.o1128.long

 

Link to the Health Foundation’s excellent report on framing and health: https://www.health.org.uk/publications/a-matter-of-life-or-death

 

Link to the citizens advice bureau he mentioned: https://www.nhs.uk/services/service-directory/sheffield-citizens-advice-bureau/N10977109

 

Link to Daniel Maani’s music: https://youtalktoomuch.band

The firearm industry is, without question, a commercial determinant of health. It manufactures and markets harmful products, and companies actively compete with each other on features like round count, ease of reloading, and lethality. More civilian-owned firearms, of more types, with more accessories like scopes or red dot sights, more bullets and magazines, in more locations, is good for business, but as clearly born out by the evidence, is bad for health. In recent years gun sales in the US have increased dramatically, and the prospect of further gun control looks dimmer, as a result of the US supreme courts ruling on the right to concealed carry.

You might think of this as a uniquely American issue, but firearms are a global problem, and firearm harm certainly isn’t restricted to the US alone, but the US does loom large, both in terms of the harm to American citizens, but also as a source for guns that then end up in other countries, trafficked illegally, for example to Mexico, Jamaica, the Dominican Republic, and Canada.

However, even in public debates in the US, the main figures that dominate the debate are political ones, including the NRA. The industry itself has received somewhat less attention as a barrier to progress, or a facilitator of firearm-related harm, unlike for example the the tobacco industry. 

To talk through the role of the gun industry, the nature of firearm-related harm, and some of the challenges to reducing it, we are joined by Jonathan Lowy. He is the Founder and President of Global Action on Gun Violence, and before that was the chief council and vice president legal for the Brady Campaign. Jon has been an advocate and litigator on these issues for some 25 years.

If you want to find out more about Global Action on Gun Violence, their website is here.

You can read more about the lawsuit between the Mexican government and US gun manufacturers here.

If you want to find out more about the firearm industry as a commercial determinant of health, we wrote a commentary in the American Journal of Public Health here.

Led by Dr Zain Hussein, some empiric research on how the firearm industry frames firearm harms and their solutions can be found here. 

The music for this podcast was composed and recorded by Daniel Maani. You can find out more about his music here:

https://youtalktoomuch.band

Hi everyone, and welcome back to money power health, a podcast on how our health is influenced by wealth and power. As we discussed in our introductory episode with Sandro Galea, one of the main things that determines our health is the distribution of resources and opportunity, yet, when we think of data on health that might better inform decisions, we tend to focus on healthcare related data, on patients, disease prevalence, and risk factor epidemiology.

This week I want to speak with someone who is trying to help decision-makers think more broadly, and more upstream, when it comes to data on health.

As you will see my guest this week has already been at the heart of some very interesting work on inequalities and health, on who we think of, and whose voices we might include. Her own personal story is a testament to her tenacity, intelligence, and commitment to studying the causes and practical solutions to within and between country inequalities.

This week I am speaking to Dr Salma Abdalla about going upstream, when it comes to data and decision-making.

She is a Sudanese medical doctor, is an Assistant Professor in Global Health and Epidemiology at Boston University School of Public Health. She studies how data on the social, economic, and commercial determinants can be used to inform decision-making on health and health equity in different contexts. She also studies the effects of trauma on global population mental health. She has published over 50 scientific journal articles, co-authored 8 reports and policy briefs, and co-authored 9 book chapters. She was the Director of the 3-D Commission on Determinants, Data science and Decision making. She also served as a secretariat member for the WHO Independent Panel for Pandemic Preparedness and Response during the COVID-19 pandemic. Dr Abdalla was also engaged in advocacy efforts to incorporate the voices of young people in setting the global public health agenda for several years. She was elected the Secretary General of the International Federation of Medical Students Associations for the term 2013-2014. She was also named an emerging voice in global health in 2018 and a Moremi fellow for young women leadership in Africa in 2012.

You can find out more about the 3D commission here: https://3dcommission.health

The paper on global health scholarship we discussed is here: https://gh.bmj.com/content/5/10/e002884

The paper on CVD prevalence by wealth is here: https://pubmed.ncbi.nlm.nih.gov/32975572/

The paper that makes reference to "prisoners of the proximate" which I couldn't remember (!) is by AJ McMichael and is here: https://academic.oup.com/aje/article/149/10/887/172868

Thanks for listening as always.

Hello everyone, and welcome back to Money Power Health.

As you know, this podcast is about money, and power, and the role they play in shaping population health. I am particularly interested in the commercial determinants of health, the activities of the private sector, and the structures it operates in, that shape health directly and indirectly.

One of the values of taking a commercial determinants lens to these issues, is that it allows us to consider commonalities in commercial incentives, strategies and tactics. A key example of this, is considering commercial influence on science and the generation of knowledge.

That is what the topic of todays podcast is, and for this I am joined by Professor Lisa Bero. She is a Professor of Medicine and Public Health, and Chief Scientist at the Center for Bioethics and Humanities at the University of Colorado. She is Senior Editor, Research Integrity for the Cochrane Collaboration, and was co-chair of the Cochrane Governing Board from 2014-2019. She has pioneered the use of internal industry documents and transparency databases to understand corporate tactics and motives for research influence, and has developed a range of qualitative and quantitative methods for assessing bias in the design, conduct and dissemination of research. She also kindly contributed a chapter on industry influence on research for our book, the commercial determinants of health, published by Oxford University Press.

In the podcast we talk about how she got interested in this area of research, some of her findings on the cycle of commercial bias in research, the impact of this work, how to communicate it to scientists and to the public, and of course, some advice for early career researchers.

You can find more about her work here: https://www.cuanschutz.edu/centers/bioethicshumanities/facultystaff/lisa-bero-phd

And some of the work she mentions with Alice Fabbri is here:

https://pubmed.ncbi.nlm.nih.gov/30157979/

Here is an example of the use of meta knowledge research, in the context of research on the health effects of salt: https://academic.oup.com/ije/article/45/1/251/2363485

The music for this podcast was composed and recorded by Daniel Maani. You can find out more about his music here:

https://youtalktoomuch.band

Hello everyone, and welcome back to Money Power Health.

As I mentioned in the first episode, part of the goal of this podcast is to bear witness to some of the hidden forces that shape health, and the extent to which they relate to money and power. Sometimes it is hard to perceive, but everything from the quality of the air you are breathing, to the bacterial count in your tap water, or your proximity to a firearm, affects your health, and is in large part a consequence of the distribution of money and power.

And that isn’t just the case with the physical world. Many of us now also spend a large proportion of our lives and interact with others through social media. That digital world is shaped by commercial forces, just like the physical one is. The companies that produce these are sometimes incredibly large, and active political players, through funding political campaigns, co-designing and conducting research, and engaging in CSR efforts, including with UN organizations. Social media platforms are crucial conduits of information, and networks of influence, though often in highly selective and unequal ways.

These are not simply utility providers.  In the case of much of social media, while the platform itself is an environment we inhabit and interact with, it is designed by a company that relies to a large extent on maximising engagement, data collection, and ad revenue, through our presence on it.

There has been increasing interest in how social media algorithms may amplify or inadequately moderate harmful content, including hate speech and misinformation, or be used by harmful product manufacturers to promote their products, or shape public discourse.

Research is now beginning to consider the ways in which social media companies, and platforms, might be regarded as commercial determinants of health, and since you probably found the podcast via social media, I thought it would be good to devote an episode to understanding some of the health implications that arise as a result of the nature, incentives, platforms and activities of social media companies, since they are responsible for an increasing portion of our social worlds.

To do this, I have invited two guests. The first is Professor Nora Kenworthy. She is an associate professor in the school of nursing and health studies at the University of Washington, who has conducted a range of research projects on the health implications of crowd-funding platforms and social media more generally. Joining her is Marco Zenone, a researcher and doctoral candidate at LSHTM who’s studies focus on the intersection of public health, misinformation and marketing on social media.

You can find an example of the work Nora referred to on crowdfunding here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519036/

and an example of Marco's work here: https://onlinelibrary.wiley.com/doi/abs/10.1002/poi3.188

We wrote a short conceptual article on social media as a commercial determinant of health, which you can find here: https://www.ijhpm.com/article_4248_0357b3eafff74f9eec69cd6d310cd803.pdf

The music in this podcast was by Daniel Maani. You can check out more of his music here: https://open.spotify.com/artist/4GDF0XnCn78nce0gesJoC7

and here: https://youtalktoomuch.band 

Welcome back to Money Power Health. 

This week, we are speaking to Professor Martin McKee, on his research in public health, the responsibility to communicate public health to wider audiences, including the media, and some advice for early career researchers on specialisation and collaboration.

Martin is a Professor of European Public Health at the London School of Hygiene and Tropical Medicine, European Observatory on Health Systems and Policies. He is a past Chair of the UK Society for Social Medicine (2010), President of the European Public Health Association (2014-16), and chair of the Global Health Advisory Committee of the Open Society Foundations (2010-15). He is a member of the UK Academy of Medical Sciences and the US National Academy of Medicine. He is currently the President of the British Medical Association, the trade union and professional body for doctors and medical students in the UK.

The BMA has been very active in speaking up about the health impacts of the cost of living crisis for people in the UK. You can read more about their work here.

Martin just wrote a piece reflecting on the UK and health three years post Brexit, which you can read here. If you are interested in the work of the European Observatory on Health Systems and Policies, which he mentions in the podcast, you can find out more about their work here.

Thanks so much for listening.

Warmly, 

Nason