I provide public health advice and support on health and health inequalities. I am the public health lead and Chair of Trustees for the Zero2 Expo initiative in the UK.
My main work, though, is in Global Health, particularly in India, where I have co-led a programme to make make maternal health care more woman-centred, kind and respectful, and evidence-based, instead of mechanised and over-medicalised.
I have worked with Ministries of Health in Africa, to draft national public health legislation, and to engage health profession leaders in national collaborative working.
When offered opportunities, I work at national, State, facility and community levels, on strategic health improvement and policy, but also on curriculum, analysis, assessment, clinical outcome improvement, epidemiological needs assessment, and to engage multi-disciplinary and multi-sector partnerships to improve health.
While I have, over many years, worked on a range of health-transforming initiatives, the achievement I’m most proud of is to have co-designed the curriculum and training for a new maternal health profession in India – the Professional Midwives at Fernandez Hospital. They have since established their own woman-centred profession, and working with medical and other colleagues, have achieved some fantastic outcomes for thousands of women in Telangana, including really low intervention rates in labour and extremely high rates of breastfeeding within the first hour of birth. Thanks to Dr Evita Fernandez and colleagues, I am currently working with them, in a partnership with UNICEF and the Telangana Government to help roll out this maternal health-transforming initiative to wider Indian populations. We plan this to become a model for evidence-based, woman-centred care more widely in India and then in other low- and medium-income countries.
Response to Photographer Richard Ansett’s Mother & Child
- This piece of art is a response to the separation of the birth mother from the child, expressing the lived experience of preventable trauma. The mother is in the room but the child’s experience is of isolation, longing, loneliness. The picture was created just prior to the invasion of Crimea and the original piece remains there, now unreachable.
- Richard (artist) and Andy (Public Health scientist) collaborated without meeting, talking about the photograph, which speaks for itself of the infant’s experience of enforced separation from the mother and the powerful experience of neglect, isolation.
- Substantial evidence has accumulated from research on the impact of infantile neglect on brain development and its powerful effect on children’s development, influencing their ability to cope with later adversity, their adult health and life expectancy. (Anda, et. al., 2005)
- Increasingly the evidence from research shows lifelong health impacts. Infants have an intrinsic need for comfort, touch, reassurance, intimacy and acknowledgement through parental mirroring, and our senses and physiological systems are set up to receive this. When the child is cared for, the brain rapidly develops to enable the infant to interact positively and creatively with the world. Neuro-imaging shows how the infant brain develops increasingly sophisticated responses, enabling the infant to survive emotionally when feelings are overwhelmingly strong but before intellectual understanding has developed. Loving, emotionally-competent parenting enables the infant to meet disappointment and adversity and learn to interact positively with others. (Mackay, 2003}
- Conversely, neglect and isolation inhibit neuro-development, and tend to shape a child to be focused on coping, surviving, manoeuvring, avoiding. This neglect thrives in poverty and disadvantage. ‘Research has shown that adverse childhood events are linked to multiple adverse health outcomes… substance abuse, depression, cardiovascular disease, cancer, diabetes, risky sexual behaviour, smoking, suicidality and premature mortality in adulthood…’ (Prock, 2016). Childhood neglect affects brain growth before puberty, limiting emotional and behavioural capacities, impairing ability to deal with stress and adversity and increasing risk of later chronic physical, behavioural and psychiatric problems.
- We now have huge opportunities to invest in promoting good infant development across the UK. The economic and social deprivation that maintain them could be eliminated. We have an abundance of money and skills, and the sophisticated technology to aid us in targeting resources according to needs, if we choose to invest them there (The Marmot Report, 2010). We have good evidence about which groups of children have the worst health and would benefit most from support (Rao and Beckingham, 2015). There is overwhelming evidence that intervention in the early years can be far more cost- effective than treating behavioural disorders and established mental and physical illness in adolescence and adulthood (Campion and Fitch, 2013). National policy on chronic disease still needs a massive shift towards intervention in the earliest years, and to address the massive inequalities in child health and well-being that influence our adult lives too.
References
- Anda, R.F., Felitti, V.J., Bremner, J.D., Walker, J.D., Whitfield, C., Perry, B.D., Dube, S.R., and Giles, W.D. 2005. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci; (3): 174-186. Epub 2005 Nov 29.
- Campion, J., Fitch, C. (2013) Guidance for commissioning public mental health services. London: Joint Commissioning Panel for Mental Health.
- Mackay, R. Family Resilience and good child outcomes: an overview of the research literature. 2003. Social Policy Journal of New Zealand 20. NZ Ministry of Social Development.
- Prock, L.A. (editor). (2016) Holistic perspectives on trauma: Implications for social workers and health care professionals. London. Apple Academic Press.
- Rao, M., & Beckingham, A. (2015) Review of child health in North West London for Imperial College Health Partners – phase one: A rapid review of unmet needs. London. Imperial College.
- The Marmot Review. (2010) Fair society, healthy lives: Strategic review of health inequalities in England post-2010.
