people, communities, health, public health, listened, episode, guests, comedy, increased, ucl, hear, thinking, important, climate change, climate, individual, realise, disrupted, world, podcast
Rochelle Burgess, Xand Van Tulleken, Clo, Hazel Genn, Dominique Palmer, Helen Chatterjee, Keir Starmer, Matt Winning, Harold Offeh, Paul Ekins, Tinuke, Carol Rivas, Laura Lexx.
Xand Van Tulleken 00:03
Hello and welcome to episode 6 of Public Health Disrupted – the brand new podcast from UCL Health of the Public. I’m Xand Van Tulleken – a Doctor, writer and TV Presenter and I’m prepared to do pretty much anything to start a conversation on public health. And I do mean anything, whether it’s editing journals on humanitarian healthcare or experimenting on my body for children’s television.
Rochelle Burgess 00:28
And I’m Rochelle Burgess - a community health psychologist, specialising in community-based approaches to health. I’m a Lecturer at the UCL Institute for Global Health and a self-confessed hippy here to talk about the importance of community, solidarity and social change to pretty much anyone who will listen. This podcast is about public health… but more importantly, it’s about the systems that need disrupting to make public health better. Join us monthly as we challenge the status quo, and ask what needs to change and why. Each week we’ll be joined by activists, scholars, artists, comedians, industry professionals and anyone else we can think of. We want as many people, from inside UCL and out, to join in our public health conversation.
Xand Van Tulleken 01:20
We’re calling this podcast Public Health Disrupted because that’s exactly what we want to do. We’re going to be breaking down disciplinary, sectoral and geographic boundaries to really understand the diverse and complex issues impacting our health. This is the final episode of our first season and so we thought we’d spend it reflecting on what we’ve learned about public health over the past six months
Rochelle Burgess 01:45
And we've chosen some of our favourite bits of the episodes we've recorded so far, that really sort of highlights what things we think need disrupting in public health and what our wonderful guests have been doing to shake up the system to achieve that.
Xand Van Tulleken 02:00
I completely agree. And in fact, the first clip we're going to hear has one of my favourite conversations in it, because it's conversation about climate change, an incredibly important issue, but between people who have approached the issue from different generations, and in very different ways, UCLs Professor Paul Ekins and climate change activists, Dominique Palmer, and what was lovely was the way that they came together the amount they had in common and the amount that their work supported each other's work. So if we think about what needs disrupting in public health, I think the impact of climate change on public health is a great place to start.
Paul Ekins 02:45
I'm sure anyone listening to this, they will have seen on their television screens on numerous occasions during the course of this year, the floods, the hurricanes, the wildfires, all over the world, hottest ever in Siberia, killing 33 people in Australia and the West Coast of the United States. I mean, this is this is climate change… climate scientists have been saying for 20 years that we can expect those kinds of phenomena to get worse and to become more frequent. And that's exactly what's happening. And the one perhaps I should have mentioned first, but didn't is the heat stress… Europe was among the worst continents affected by heat stress in terms of people actually dying early because of excessive heat. And of course, in poorer countries where a large part of the labour force actually has to work outside, working outside in temperatures of between 30 and 40 degrees, we are expected to work for eight hours a day, you don't live long under those circumstances. And again, we can expect those temperatures to increase over the coming decades unless we get a handle on climate change and actually start reducing our greenhouse gas emissions.
Dominique Palmer 03:58
One issue that's not discussed as much as the impact on mental health as well, which is something that youth and especially have faced a lot in regards to the climate. Because you know, this existential threat, unsurprisingly has significant like psychological impacts. And one of those being eco anxiety, which a lot of young people face. Because a lot of young people don't know all of the education behind the severity of the crisis, which isn't being adequately taught in schools, they don't feel that they can be fully engaged in the process. And so all of that, like anxiety on action and feeling so separated from it can cause a lot of fear and have a lot of impact on people's mental health. And also, obviously, for those already suffering on the frontlines of the climate crisis will have mental health impacts. And, you know, trauma related to disasters, and relocation, and all of these things. And, you know, all of that is part of climate justice.
Rochelle Burgess 04:53
Yeah, I mean, I also agree that that was one of my favourite episodes. Definitely. For some of the reasons that you mentioned, Xand that you have this like sort of great meeting of the minds of people that you think are going to be opposed on something can activism and academia be together in the same process or same space. And it was really beautiful to see and show that example, actually, we have a lot more in common than we do not. But the other thing that I thought was really special about that first episode is it started to highlight the intersectionality of all these different specific health consequences that are linked to climate change. And Dominique in that exert talks beautifully about the ways in which mental health is affected by by climate change. And then we go through another episode on comedy which is about something entirely different and we hear the same issues coming up in Episode Two with Laura Lexx as she describes her, her own personal experience with this eco anxiety and what that meant to her.
Laura Lexx 06:03
For such a long time, I had to avoid all mentions of climate change and stuff. Like I remember, I remember things like listening to no such thing as a fish, which is a delightful podcast and full of little facts, and what and I remember one of the facts that they pulled out was that all hotels coming to a certain area, and I can't remember it was like the Canary Islands or somewhere in Southeast Asia. All hotels being built there now have to be five star so that they can afford the water because of climate change making access to fresh water so difficult. They need the investment. And that fact being presented on no such thing as a fish as a sort of delightful little sidetrack left me so cold and broken from hearing, it triggered me so badly. I haven't listened to that podcast since because I now just associate it with that. So I had to cut out all mentioned I had to mute all words, I couldn't bear it.
Xand Van Tulleken 07:00
So from the global to the local, this theme has come up again and again, climate change air pollution, and it was brought up by Keir Starmer in Episode Four. In that episode, we explored the way that public health and legal rights intersect. I think it's extraordinary to hear a modern professional politician talking in detail about their work and with expertise.
Keir Starmer 07:25
These days environmental and health impacts are taken into account and quite right to think if you look at what for example Camden council is doing, there's a wider piece of work, which you see on areas like air pollution, which is an obvious public health issue in and around Camden, Euston road we've got a real air pollution problem. And that has to be addressed and taken into account by the Council when they're designing not only new builds, planning concern, but also how we use our roads. And one of the things that Camden have been trying to do is to get as many cars off our roads as possible. That's why you see the various changes to the traffic systems, etc. So it is, I think, now much more central to the council's decisions, because if deaths from air pollution were recognised for what they are, they ought to be front page news in terms of the numbers of people that die from things like air pollution, but it isn't in the same way. So I think it is becoming increasingly important and central to what good local authorities like Camden do.
Rochelle Burgess 08:30
I think it's really important to think about that a lot of our guests pushed us to think about the environment, not just as sort of the natural environment, but also the built environment of everyday spaces where where we live our lives. And I think one guest in particular Professor Dame Hazel Genn really highlighted that for us when she starts to think about health and well being, and how that links to the different dimensions and spaces where we live our lives.
Hazel Genn 08:59
When we talk about public health, I think if we think about the things that affect health and well being not illness, but what affects health and well being things like having enough money to feed your children having a roof over your head, safe conditions, to live in safe working conditions, appropriate education, decent air to breathe security at home and elsewhere, if you think of all of those things that actually affect our health, the law is involved in every single major determinant of health.
Rochelle Burgess 09:30
Another thing that Hazel does a really great job of highlighting is the way in which people's attempts and desires to seek care get picked up by the system, isn't it? And so what happens when our desires for wellbeing meet systems that sometimes aren't either equipped or open to what we sort of bring to them?
Xand Van Tulleken 09:51
Right, so who is being listened to and who isn't? It's something we heard about in loads of different episodes, but most clearly in Episode Three When we spoke to the founders of the campaign five times more, who are raising awareness of the way that black women have higher rates of complications during pregnancy, and birth in the UK, here's Tinuke, sharing her own experience with us.
…I actually had a really terrible experience giving birth to my son, he's now three, I won't go into the details, but it was very traumatic. I had late diagnosed preeclampsia, which led me to be induced. And essentially, I just felt like I wasn't listened to by the midwife. And it led me to have an assisted birth, which in and of itself is not the end of the world. But my experience and the way I was treated, I just left feeling like nobody listened to me. And my pain was dismissed, and I wasn't taken seriously…
Rochelle Burgess 10:46
I mean, that's always just a really hard thing to listen to. But also not a surprising thing to hear. It seems to happen pervasively across every space of care and support that you can imagine, you know, just later in that same episode, Dr. Carol Rivas from the IOE told us about her experience, and some of her research in the space of diabetes and sort of looking at how the health system isn't really set up to listen to patients as as much as it should be.
Carol Rivas 11:15
so for example, if I take the diabetes study that I've just completed, we interviewed healthcare professionals. And a lot of them said that they were giving bad care even though they didn't want to. So their local communities, often very disadvantaged, had multiple jobs, work during the day worked in the evening, couldn't come to the clinic to get health care really couldn't focus on their diet. So as I said, it was diabetes, they couldn't focus on a good diet, because they were too busy just working, and the staff wanted to give them time to help them to self manage, but they were driven by incentivization. So it's quite a managerialist culture within healthcare. And so they wanted to get their QOF points - Quality Outcome points, I've forgotten what the F stands for, sorry. So they want to get their QOF points, so that they could give basic care. And so they're what they were doing was actually just forcing the local population to come in to have their blood pressure monitored, putting pressure on them to do that, so that they could get money from the government. And that was an opportunity cost loss, because they then didn't have the time to do what they really wanted to do, which is listen to their patients.
Xand Van Tulleken 12:26
So our guests have identified issues with the public health system from a structural perspective, all the way down to an individual level. But they didn't just bring us problems, we also got to talk to them about their work, and how they're helping to improve the health of the public. One of the things that most struck me was that everyone we interviewed had made a difference, perhaps, in some cases, to an individual person or a small group of people, and in some cases, to an entire set of policies, or the way that the state tackles a problem. But in every case, it was because they as an individual had taken an interest. And we're passionate and creative and imaginative about it. And that to me was genuinely inspiring.
Rochelle Burgess 13:12
Yeah, that's a that's exactly right. I think one of the things that really struck me across all of our presenters and speakers was that it made me think about some of the literature that I've been reading on social change over the years. And one of those really great pieces that has always stuck with me, is about this philosophy and psychology of small wins. And it talks about how oftentimes with social change, we assume that it must always be big and loud, and the combination of mass movement and pressure that hits a tipping point, and then everything changes. And those are the big examples that we can think of. But what this paper and this paradigm asks us to remember is that actually, all of those big moments are built up with small moments of change that happened individually or in small groups that build and culminate. And so we have to celebrate those small wins that sometimes are focusing just on on an individual patient or a specific group of people at a community level, in addition to the long term work of getting those big changes to happen. And the beauty of small wins, really, is that if you put enough of them together, each of us working either with communities, small communities or within our households, our families, these building of small wins come together to have big wins that result in societal change. They're just as important along the way.
Xand Van Tulleken 14:40
I think you've really nicely clarified an idea that was present in all of our conversations on the podcast that clearly we were speaking to a group of individuals who were every single one of them in some way involved in changing the world and improving the health of the public. And yet individual action is not enough on its own people have to work together, tackling these issues with small wins building towards institutional change and societal change.
Paul Ekins 15:12
There's an enormous danger in thinking that individuals can do this by themselves. And I'd like to say absolutely, categorically that they cannot, because so much of the solution to climate change and the reducing of the emissions, that cause it has to come through large scale investment… And obviously, individuals can help by consuming differently and giving market encouragement to those sorts of changes, but they can't bring about those changes by themselves. That has to be done by governments working with businesses in a certain way. And that can only happen through political pressure and political change. And the climate Youth Movement has been a very important part of that.
So we approached a RCOG, to ask them if they wanted to create steps with us. Because five times more and the disparities is everybody's problem is just not a black woman problems. The best thing to do is to join forces with RCOG and come up with five steps. So we joined forces them and came up with the five health professional steps, which is got a lot of attention. A lot of people are happy with it, a lot of midwives are happy that the steps are there in steps that they're already aware of. But it's nice to get a little reminder. And it also puts mums at ease, because they know that you know something is getting down for them to have better health health outcomes.
Helen Chatterjee 16:47
And I think if we really want to, I guess, harness the sort of collective power of arts and have included that nature and other sorts of community assets, we've got to build these sort of creative health partnerships and operationalize them in that sort of systems way. And that create requires big change, you know, at policy level at funding level, management level and strategic levels in price cost across government working, cross funding working and I think there are opportunities to do that. But really, it's only going to work if again, communities and particularly the most vulnerable members of society, put at the heart of that.
Rochelle Burgess 17:22
This idea of working together this idea of communities, obviously, is music to my ears, and my heart and my soul. And this was so nice to see it and hear it across all these different spaces and different disciplines, talking about the importance of that, and the importance of integration. And rather, rather than seeing things and particularly seeing public health as separate to things like the natural or built environmental, the legal system, or all arts and culture, a lot of our guests hated the idea that we were working in these silos and just kept begging for ways in which systems and people could be brought together, and how important it was to change that so that the different parts of our experiences could be brought to the fore and as part of improving health and well being. And I think one of my favourite guests who's captured this really eloquently was Dr. Harold Offeh the amazing artists who spoke about his work at the intersection of art and healthcare, these different social dimensions.
Harold Offeh 18:31
I work quite a lot in social contexts, where I'm working with people who don't often think about themselves as kind of creative beings or creative individuals. I think in that context, I really begin to see some of the problems that I think we have within the culture, which is this kind of siloing, where we, there's a kind of separation between people's experience everyday experience, and what they view as art, culture, in inverted commas, and creativity. And often people see those things as being very much outside of their everyday experience, or they, you know, and I think for me, that is the problem is that sense in which already, there's a sense of things being outside of their everyday experience. And I think, for me, something that I'm really invested in is that sense in which there isn't that separation is that you know, as, as, as humans, we explore, and use all, you know, all the tools that are available to us, including creativity, including, you know, thinking through our potential to make things to explore materials to engage in the world. I think when you begin to have more of a kind of holistic, I think, perspective, I think it begins to kind of counteract some of the damage that comes from people, their lack of access to certain areas of art and creativity
Rochelle Burgess 19:48
And I think Tinuke also did a really amazing job of highlighting this and sort of talking about silos, between medical professionals and the public and the ways in which service users interact with those spaces and what feels like to be on that side of the equation.
I believe it's really, really important to allow, forgive me for lack of a better term, but allow the service users if you like, The people who are on the receiving end of the treatment to actually have a voice. Because ultimately, I feel like things before anyways used to happen in silos and the doctors and the nurses, and everyone else. I know they have everybody's best interests at heart. But it was all done up there and us as patients, we didn't have a clue. We were just on the receiving end of it.
Rochelle Burgess 20:37
And Dame, Professor Hazel Genn, who also argued that our services needed to be integrated rather than spread out and, and both her and Harold spoke about taking more holistic approaches when delivering health services.
Hazel Genn 20:52
We're gonna keep coming back to this question kind of integrated services. Because I do it's the point that came before and I'm absolutely This is kind of my mission at the moment is to get things better integrated having much more of a holistic approach to the needs of people, getting help to the people who have the most complex needs.
Xand Van Tulleken 21:16
Changing the system as a society is important, but so is keeping it personal. And this is something we heard from comedians, Dr. Matt Winning and Laura Lex when talking about the power of comedy to discuss healthcare,
Matt Winning 21:28
is finding ways to talk about it that people understand. And I think comedy is a good way of sort of breaking down, you have to simplify everything, you have to make it simple for the job to work. And you also have to make it a shared experience, so has to be about something you all know about.
Laura Lexx 21:47
I don't want comedy to tell me what I should and shouldn't be doing about something I want comedy to tell me about stuff. And then I'll make my own mind up, it was something I've really tried quite hard to do with trying was not to lay any conclusions down. But just to go, this is my experience, and whatever that brings up for you is fine. But I made that show so personally about my mental health, because I didn't want to go. And here's how you should treat people with mental health. Actually, this is how we want to be treated. Because I know everybody's different… what I wanted to do was, and what I think comedy can do brilliantly is you're allowed to be utterly personal, you're allowed to tell anecdotes, it's the opposite of academia… It's the opposite of a thesis or an essay, you're not looking at the detail. And then extrapolating out to a big theory, comedy is involved in the detail. Work on the detail... That is what makes comedy very different to everything else. And what makes it engaging and why you don't feel like you're having stuff rammed down your throat when comedy is done well.
Xand Van Tulleken 23:03
So perhaps this is why so many of our guests are changing the world through community and grassroots organising, they're combining the personal with the power of the collective. In fact, a lot of our guests were very passionate about ensuring that any changes we make are community lead and empowering people who are normally disenfranchised from the system.
Dominique Palmer 23:29
so in the UK student climate network, we are a student led environmental organisation and taking to the streets to protest the government's lack of action on the climate crisis. And so we have been mobilising unprecedented numbers of students across the UK to create a strong grassroots and national movement in order to pressure the government to act and to push our aims… And in 2019, we organised over 850 climate actions, including the September global strike, which had over 300,000 people who are taking to the streets for climate action. (12:37) And there's so much untapped potential there as well, due to young people being made to feel as if they don't have a voice and they cannot enact change. But once youth realise the power they have to do that it's such an incredible thing mobilisation and I cannot put into words the absolute incredible energy that I see from such young people, a variety of ages in this movement, people coming from all different walks of life engaged in this and it's honestly just an incredible thing to see.
Rochelle Burgess 24:35
Yeah, this is this is love hugs and revolution, isn't it? That's it at its core that actually, we create communities and we build communities around a shared project of making our bit of the world a better place. And what's been really exciting for me as an academic has been to interact with so many other academics in different disciplines who share that idea and who from within UCL are also thinking about how we must work with communities in order to make that change happen.
Carol Rivas 25:08
In doing some work on diabetes education programme for black communities in London, where we've used coke production or participatory techniques all the way through from the very start to the very end. So they produced the tools that they would use in education sessions as well, helping us to design the research and education programmes. I think, the moment I just like to say one more thing in relation to what Tinuke and Clo are doing, they're talking about empowerment as well. And I think it's very important to draw that out that it's not just about hearing people, but making sure that marginalised groups are empowered to be able to push up against being marginalised. And so in my research, we also develop some of the tools to do that.
Hazel Genn 25:57
I can give you an example. That was a case that we dealt with in the health justice partnership that we set up in Newham. And the partnership was basically free legal advice provided by students and qualified staff to patients in the practice, and we train the doctors to kind of recognise cases that might benefit from having some legal advice. And one of the cases which we I call Alicia and her baby was a mother with a baby with breathing problems and skin infections. And she was repeatedly going back one day over and over again to the doctor, she had a sense that her living conditions might be making her child ill or worse, because she was living in social housing that had terrible damp, insects and rodents. And she'd been to the doctor several times. But when we were there, on one occasion, he just thought, hang on. And he said to her, do you know what, you know, I can give you more medications for the baby. But I really think you should go and see these people downstairs. And of course, we were downstairs, and she came down and saw us. And we talked to her. And then we got in touch with her local authority. And we asked for a review, and they reviewed her housing. And they said, Yes, she was living in inappropriate housing. And she was, and she was rehoused. And I have numerous examples like that.
Helen Chatterjee 27:08
And research has shown that arts and creative engagement elicits a range of different health as well as social and behavioural outcomes. We see increases in positive social experiences leading to reduce social isolation, increased opportunities for learning and acquiring new skills. And we know that that's important for good cognitive health, we see increased positive emotions, optimism, hope, enjoyment, and a sense of belonging, increased self esteem, a confidence, self identity and sense of identity, increased inspiration and opportunities for meaning making an overall healthier lifestyle changes, for example, increased visits to museums and green spaces once you've been encouraged to come.
Xand Van Tulleken 27:53
So there we have it, a short summary of all the great conversations we've had in the first season of public health disrupted.
Rochelle Burgess 28:01
But at the end of every episode, we also asked each of our guests to describe an artefact like a poem or an object or a song or an experience that has really disrupted their their thinking and they definitely didn't disappoint. So Xand did you have a favourite?
Xand Van Tulleken 28:18
I love that a lot of the artefacts were things that I may be new, but had not paid very much attention to Kier, Starmer, chose a sculpture that I must have walked past 100 times over the last few years. But I think I think my favourite thing was Harold offeh. I may be just assumed that he would choose a painting because he's an artist, or at least a piece of art. And he chose a book called The history of collective joy by Barbara Ehrenreich dancing in the streets is that is the title. And I love. I don't know why I loved it so much. I've ordered it, it's sitting on my bedside table, even the title of it cheers me up. And I'm super excited to get stuck into it. And I, the thing that it reminded me is that there are so many topics that as soon as they're brought up, they seem like obvious fascinating things to look into. And yet I had never thought about framing a question about joy in this way. I've never thought about collecting the ideas in this way. And I'm super excited to get stuck into it. And it just reminded me to keep reading and keep asking questions and of how much I didn't know.
Rochelle Burgess 29:24
Yeah, I mean, I also bought that book, and I hope many of the people who listened to that episode bought that book to the thing that struck me about some of the artefacts I mean, I really didn't have a favourite. I loved the fact that everybody totally got into it and could think about something that had changed them in some way. And to me, there's something that feels really special about that process of, I suppose, thinking about the ways in which we go through the world and we interact with it. People or places or objects, and you don't realise the effect they have on you until somebody forces you to. And so I guess maybe that's a cop out stopping me from having to choose just one but, but I really felt that what fascinated me most about it was everybody's willingness to really do that. And you got this whole range of artefacts that not just told us about who people were but told us a bit about our capacity for change and inspiration. And as you say, continual learning. I guess the coolest thing I heard was Helen, when she said that she does figure skating.
Xand Van Tulleken 30:40
Have you got an artefact to close this final episode, Rochelle?
Rochelle Burgess 30:44
I guess my current artefact at the moment that I will talk about is actually a phrase, this is gonna sound really weird and sort of embarrassing. But hey, wouldn't be me if I didn't embarrass myself in an episode. So there you go. The actor Jesse Williams, who plays a very handsome doctor in Grey's Anatomy, won an award recently. And for this award, you had to do sort of rapid five word speeches. And his speech, his five word speech, he says, scared, okay, do it anyway. And those five words literally, like, broke through a wall in my head that I didn't even realise was there, in the sense that, believe it or not, I'm actually a bit of an anxious person. And there are lots of things in my life and in my work that take me a really long time to do because I'm scared of how they're going to be received in the world. And so I put them off, I don't do them, I sort of delay them or whatever. And that phrase, like I love it so much, it would probably going to become my sixth tattoo. But for me, that's like my current artefact because that those five words just did something to my head totally, like, disrupted the way I've been thinking about myself and my own work. So yeah, scared. Okay. Do it anyway.
Xand Van Tulleken 32:19
Oh, I love that. That's great. Well, I have one that's much more mundane, the less Hollywood and closer to home that I will not be able to turn into a tattoo. But in my my fridge, I have a fish pie that my mother made me. And she throughout the pandemic has dropped off food for me. I'm perfectly I'm not a bad cook, I'm perfectly capable of feeding myself. And my mother also still works in her late 70s still has a job. Nevertheless, she cooks for her children. And whenever I hope this won't sound too morbid, but whenever she leaves me a meal, my meeting on my own, I think one day there will be a final meal that my mother cooks for me. And I'd that makes all of them. I think, especially as she's got older, that makes all of them taste a bit different. And I think about them very differently. And people talk about love as being an ingredient an important ingredient. But that that to me, I don't know. It's it's very nice to have still have a mum who can get from me and it's it makes me appreciate her even more.
Rochelle Burgess 33:16
I think that is so beautiful. I'm going to cry. So now I feel nice. And let's say it's so beautiful. Like, I mean, God, I miss my mother desperately. And that's it, isn't it? That's nothing tastes like your mother's your mother's food. And I think it's so special that you're cognitively aware of the importance of that. And I think a lot of times we don't like to think about the impermanence of life. But when you do, you're able to really hold the beauty of things a bit more. So I don't think it's morbid I think it's maybe the most beautiful thing.
Xand Van Tulleken 33:58
I'll get you the recipe!
Rochelle Burgess 34:05
You've been listening to Public Health Disrupted. This episode was presented by me, Rochelle Burgess and Xand Van Tulleken, produced by UCL Health of the Public, and edited by Cerys Bradley. It featured clips from interviews with Paul Ekins, Dominique Palmer, Laura Lexx, Matt Winning, Tinuke Awe and Clo Abe, Carol Rivas, Kier Starmer, Hazel Genn, Harold Offeh and Helen Chatterjee.
Xand Van Tulleken 34:30
If you would like to hear more of these podcasts from UCL Health of the Public, subscribe wherever you download your podcasts or visit This podcast is brought to you by UCL Minds - bringing together UCL knowledge, insights, and expertise through events, digital content, and activities that are open to everyone.
Rochelle Burgess 35:00
See you for season two!
Xand Van Tulleken 35:02
We'll see you for season two!