Given that PHE’s remit included tackling non-communicable diseases, many of which are caused by things like tobacco, alcohol, and unhealthy foods, it’s not that surprising that assorted lobbyists for those industries are pleased to see the back of the agency.

One such lobbyist, Christopher Snowdon, wrote an article for the Spectator celebrating the end of PHE. In it, Snowdon argues that health protection (protecting people from infectious diseases and other hazards) and health improvement (tackling non-communicable diseases and the things that cause them) are different things.

“For too long, these two different agenda have been bundled together under the umbrella…


A metaphor

Does poverty make it harder to make good choices, or does poverty change what counts as a ‘good’ choice?

Why do people on lower incomes die younger and get sick earlier than people who are better off?

Part of the reason is the fact that when you don’t have a lot of money, you are more likely to be exposed to hazards like damp, badly insulated housing; air pollution; crime; and poor quality, insecure work. These exposures lead directly to poor physical and mental health.

But an important part of the answer lies in the fact that behaviours like smoking, physical inactivity, harmful alcohol and drug use, and unhealthy diets are more common among people on low incomes. Here, unhealthy behaviours sit between poverty and illness. Because of this, the question of freedom comes up: are people…


A list of useful and free resources for learning to analyse data with R

There are lots of free resources that I’ve come across for learning to do various things in R. I keep seeing them and then forgetting about them. So I have made a list.

I’ll try to add things to it. Suggestions are very welcome.

It’s worth saying how great it is that there’s all this free stuff out there. Thanks to the authors and publishers for making that possible. If like me, you like physical books, I’m sure buying these books probably helps encourage people to put them out there for free.

Also, a caveat: I haven’t read all of…


The Guardian has reported that the government is planning an “English health index to paint detailed picture of nation’s wellbeing”, as part of the much-awaited prevention green paper. This isn’t a big surprise: Dame Sally Davies included the proposal in her final annual report as Chief Medical Officer for England. And it’s not just the Government and Dame Sally that think that more indicators are what’s missing in public health: last year the Faculty of Public Health successfully campaigned for a new public health dashboard.

Like most public health nerds, I do love data. So you might expect that, like…


I had an interesting exchange with Harry Aagaard Evans on Twitter about whether risk stratification is screening or not. Twitter is not always the best medium for these sorts of exchanges, so I thought I’d try to explain my argument better here.

What is screening?

For the purposes of my argument, I’m going to define screening as:

a process of using some test or tool to divide a population up into groups at higher or lower risk of some adverse outcome.

Do you see what I did there? By substituting ‘adverse outcome’ where ‘disease’ normally is I’ve dodged Harry’s excellent point that screening…


Why there probably isn’t a single ‘public health approach’

There has been a lot of talk of public health approaches to knife crime. London has set up a violence reduction unit and the commissioner of the Metropolitan Police has called for a public health approach. The Home Office may be about to adopt this approach.

But what do people mean when they talk about “a public health approach”? I think people mean different things, and I think this causes some confusion. Like when the Secretary of State for Health and Social Care said:

“If you try to say that it’s a public health issue that implies that it’s nobody’s…


Some initial thoughts about getting people outside public health to understand the importance of wider determinants in health

Erica Holt-White has blogged about some of the findings from the Health Foundation’s work on how the public understand what makes us healthy. The difference between what public health professionals think and what the public thinks is stark. This is a problem if we’re ever going to get serious about prevention.

Public health professionals tend to think that healthcare is one cause among many of good health, and probably not the most important. We’d point to evidence which suggests that healthcare accounts for only about a fifth of the improvements in life expectancy. We never miss an opportunity to talk…


Some thoughts on health needs assessments for ex-military populations

Local authorities in England have documents called Joint Strategic Needs Assessments, which describe the health of the local population. A review of these documents in 2015 for the Forces in Mind Trust found that most don’t specifically address the ex-military population, and of those that do, most only have a passing mention to former members of the Armed Forces. …


The supply of labour relative to capital matters. But policy and institutions also matter.

I came to this book ready for a thoroughly depressing read. I had heard about the effects of the Black Death on incomes for working people, and so I was very ready to believe that falls in inequality big enough to be seen in the historical record would only be associated with great loss of life. The book certainly delivers on that front, and the breadth of scholarship on display is impressive.

However Scheidel also argues, persuasively in my view, that policy and institutions also matter. For example, he argues that the reduction in inequality that happened after the two…


This is a lightly edited version of a blog that was first published on the Faculty of Public Health’s website.

The FPH asked me to write a blog about preparing for the Part A exam. The trouble is, I’m very aware of how much luck is involved in doing well at the Part A. I was lucky to have an unreasonably supportive family, a great bunch of people to study with, lots of support from the North West School of Public Health, and a great team in the office. And although my daughter was born in September (prime revision months…

Steven Senior

Public health registrar. Recovering government policy wonk. Lapsed neuroscientist. Opinions strictly my own.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store