Episode 11: GPs at the Deep End with David Blane

Hi everyone and welcome back to Money Power Health. We often tend to think of our health as the product of our own energies, something we alone are accountable for. But in reality, our health is to a large degree shaped by the conditions we find ourselves in, the quality of our air, the wealth of our parents, the food we have access to, our opportunities for work, our time for exercise. Schools and education are a key part of this. Schools shape how we see the world and interact with each other at a critical stage in development. Most people might assume that schools are a place in which commercial influence is largely absent. That however is far from the case. Children are a key market, and brand loyalties formed in childhood can persist into adulthood, and standards of behaviour, of consumption, taste, and definitions of coolness, risk, fun are all being formed during this time.  In part due to this, there is now a long history of the manufacturers of unhealthy products funding the development of lesson plans, initiatives and activities in primary and high schools that involve issues like fossil fuels, firearms, alcohol, gambling or smoking. This has significant strategic value, and in order to understand more about why this happens, and what it means for children and young people, I am very pleased to be joined by someone who has led on several studies examining the nature and purpose of such funded materials in schools.  May van Schalkwyk is a research fellow in commercial determinant of health in the Global Health Policy Unit and Centre for Pesticide Suicide Prevention at the University of Edinburgh. She also has an honorary public health consultant role with Public Health Scotland and is an honorary research fellow at the London School of Hygiene and Tropical Medicine where she completed her PhD in 2023 and is a member of the commercial determinants research group.  May originally trained as a clinical doctor and then specialised in public health medicine. Her research aims to explain how commercial actors influence ideas, knowledge, science and policymaking. She publishes research on the tobacco, alcohol, gambling, fossil fuels, opioid, pesticide and firearm industries, including on the influence of youth education and safety programmes as a form of corporate political activity. Full disclosure: May and I are good friends and go back some time, having met at the London School of Hygiene and Tropical Medicine, and worked together for over seven years researching the commercial determinants of health, including some of the articles we will be discussing. You can find out more about the topics we have discussed, including some of May's recent research articles, in the links below: Alcohol industry funded school programmes: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0259560https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00341-3/fulltextGambling industry funded school programmes: https://academic.oup.com/heapro/article/39/1/daad196/7565070https://www.sciencedirect.com/science/article/pii/S235282732200101XLink to public-facing videos May has made about research on the commercial determinants of health: https://www.youtube.com/channel/UCfnKnt8BHlSgTIdK7jfGwfg 

The alcohol industry is a significant commercial determinant of health, shaping global consumption patterns through aggressive marketing, lobbying against regulation, and expanding into new markets, particularly in low- and middle-income countries. With its substantial influence on policymaking and public perceptions, the industry has contributed to a global burden of alcohol-related harm, including chronic diseases, injuries, and social issues. In this episode, we are joined by Dr. Emeka Dumbili, a sociologist with a central interest in the shaping of social norms regarding substance use, to discuss the ways in which the alcohol industry is seeking to shape social norms around drinking in West Africa.Emeka is an Assistant Professor and Ad Astra Fellow at University College Dublin. He completed his PhD in the Department of Sociology and Communications, Brunel University London, exploring the interplay between media consumption, the gendering of alcohol, and aspirational drinking amongst young people. He held a lectureship position at the Department of Sociology and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria. He was a Georg Forster Research Fellow of the Alexander von Humboldt Foundation, Germany. Between 2016 and 2017, he was a Mildred Blaxter Postdoctoral Fellow at Brunel University London. In 2019, he was awarded the ACU (Association of Commonwealth Universities) Blue Charter Fellowship to explore plastic pollution in Nigeria. Some recent articles by Dr Dumbili and colleagues: "Alcohol industry-sponsored music festivals, alcohol marketing and drinking practices among young Nigerians: Implications for policy" https://www.sciencedirect.com/science/article/pii/S0955395924000690?via%3Dihub"Perspectives of community leaders/members on factors hindering alcohol regulation in Nigeria" https://www.tandfonline.com/doi/abs/10.1080/09687637.2023.2247540"Making sense of ''drink responsibly'' messages: Explorations of the understanding and interpretations of young Nigerians who use alcohol" https://pubmed.ncbi.nlm.nih.gov/35290927/

Hello everyone, and welcome back to Money, Power, Health with me, Nason Maani. This week we are speaking to Dr David Blane, a GP in Pollokshaws and Clinical Research Fellow at the University of Glasgow, and the academic coordinator of the Deep End GP network. As you know, in this podcast we have spoken about the ways in which the wider physical and social environments people find themselves in can profoundly shape their health, and how these environments are shaped by inequality and powerful commercial forces. In some ways, we have been talking about mich of what shapes health occurs outside of healthcare, and I have been contacted by clinicians who know only too well how frustrating it can be to attempt to treat patients, only to send them back into the conditions that made them sick, and to try to devote themselves to making their communities healthier, when those wider conditions are worsening, particularly for the most vulnerable.   Yet, healthcare can, and should engage with these forces, and one example of an initiative that has sought to do so in inspirational and innovative ways, is the Deep end GP here in Scotland. Today I have the great privilege of speaking to Dr David Blane, senior clinical lecturer in General Practice and Primary care, and academic coordinator of the Deep End GP group in Scotland. Glasgow in particular suffers from extremely high levels of health inequality and deprivation, and it is there that The Deep End GP network, while pools the experience and ideas of GPs in the most deprived areas, was established with the goal of increasing advocacy, mitigating burnout, and providing practical, grassroots interventions to improve patient care in areas with the highest patient need. Together, we explore the origins of the project, how these relate to cost of living challenges, and how one keeps going in spite of sometimes challenging circumstances. I hope you enjoy the conversation. More information on the Deep End GP Network can be found below:The Scottish Deep End Project:https://www.gla.ac.uk/schools/healthwellbeing/research/generalpractice/deepend/Link to latest Deep End reports, manifesto and newsletters:https://www.gla.ac.uk/schools/healthwellbeing/research/generalpractice/deepend/reports/Davids profile:https://www.gla.ac.uk/schools/healthwellbeing/staff/davidblane/Julian Tudor Harts 1971 article on the inverse care law:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(71)92410-X/fulltext

Hello everyone, and welcome back to Money Power Health.  Today I have the great privilege of speaking to Rebecca Cassidy, professor of social anthropology at Goldsmiths, on the gambling industry and her experience of working on gambling industry research.  The gambling industry has experienced tremendous growth in recent years, particularly through online and mobile gaming, and is increasingly consolidating globally. Gambling has significant health and social implications for both users and their families, particularly as the industry relies on a small proportion of players for the majority of gambling revenue. Notably, a significant proportion of gambling-related public health research is industry-funded, as are most academic conferences, despite a clear conflict of interest. Professor Cassidy and her colleagues were among the first to step into these spaces, and critically examine how the industry had coopted gambling research, terminology, and outcomes, and so besides being something of a hero of mine, her experience and example is relevant to anyone who has to stand up and say the unwelcome, but important truth about the root causes of health problems. I hope you enjoy this conversation as much as I did.  You can find out more about the work she refers to below. The report Fair Game on gambling research: https://research.gold.ac.uk/id/eprint/11731/1/Fair-Game-Web-Final.pdf  Her book, Vicious Games: https://blackwells.co.uk/bookshop/product/9780745340395?gC=5a105e8b&gad_source=1&gclid=CjwKCAjwkY2qBhBDEiwAoQXK5e8ilKkXnT5UqoYDR8RressAYaK72CcDuitgLkPtZEdBB_WAFBKFFBoCFm4QAvD_BwE A recent paper she co-authored on a public health approach to gambling regulation: https://linkinghub.elsevier.com/retrieve/pii/S2468-2667(21)00098-0 Music in this podcast was composed and performed by Daniel Maani. You can find out more about his music here:  https://open.spotify.com/artist/4GDF0XnCn78nce0gesJoC7 And here: https://open.spotify.com/artist/0Gs6V1gnUYEkZLfU2kjBdK See you in the next episode. 

Hello and welcome back to Money Power Health.    “Think global, act local!” “Be the change you want to see in the world!” “Every little bit counts!” We can all get on board with such sentiments, right? Well, todays guest Grant Ennis, would question that. He is the author of the book "Dark PR: How corporate disinformation undermines our health and the environment". In this new book, drawing on his experience working in the environmental, philanthropy, and public health sectors, he lays out the costs of commercial efforts to influence citizen action and discourse, individually and cumulatively. The book offers a wide-ranging appraisal of the narratives that he feels hold us back, the costs of our approaches to issues such as subsidies and tax breaks ,and, argues for the need to think more structurally, to organise, and to unite in broader coalitions if we wish to improve health in foundational, structural ways. I hope you enjoy the conversation. The book is available from Dajara Press in print or ePub: https://darajapress.com/publication/dark-pr-how-corporate-disinformation-harms-our-health-and-the-environment and from Audible as an audiobook: https://www.audible.co.uk/pd/Dark-PR-Audiobook/B0CCT1WMQ2 The publication he mentions led by Mark Petticrew is available here: https://jech.bmj.com/content/71/11/1078 and our related paper on the pollution of discourse and the need for effective counterframing is here: https://www.bmj.com/content/377/bmj.o1128 Dr. Terry Lynn Karl is the researcher he mentioned from Stanford in relation to electorialism: https://cddrl.fsi.stanford.edu/people/Terry_L_Karl The asian disease experiment was published here: Tversky, Amos, and Daniel Kahneman. "The framing of decisions and the psychology of choice." science 211, no. 4481 (1981): 453-458. The full quote from Arundhati Roy that he refers to is here: [the] whole idea of 'you have to be a saint first and then be political' is [a] way of making sure that a whole lot of people are not political.” (Roy, Arundhati. “Interview and Q&A with Arundhati Roy.” In Earth at Risk: Building a Resistance Movement to Save the Planet. Oakland, CA: PM Press, 2013) Music in the podcast was composed and performed by Daniel Maani. You can find out more about his music here: https://www.danielmaani.com

Hello everyone, and welcome to Money, Power, Health.    All three themes very much play into the health and wellbeing of the people of Lebanon, which has been assailed by a multi-pronged crisis for the past few years. Lebanon hosts an estimated 1.5 million Syrian refugees, the largest number of refugees per capita of any country, and has experienced a profound combination of socioeconomic turndown and COVID-19 pandemic since 2019, in addition to the devastating port of Beirut explosion in 2020.    This week, I will be speaking to Judy Makhoul. Judy is professor of Department of Health Promotion and Community Health at the American University of Beirut (AUB), and has a had a rich and varied career spanning academic work on disaster relief, displaced population and commercial determinants of heallth, but also work with Save the Children in Lebanon.   In this conversation we cover how she became interested in these areas, her work and life in Beirut, and her reflections on conducting research and teaching in the complex, challenging circumstances of Beirut in the light of the civil war, the Syrian war, and the 2020 explosion. Her research and publications have focused on war affected populations such as internally displaced families of the Lebanese civil war, border crossing refugee populations, (Palestinian and Iraqi refugees) qualitative research and community based research and research ethics in the Arab region.    You can find more about her research here: https://tinyurl.com/ycyvzsvc   And the work of the GECI-PH network here, coordinated by Rima Nakkash and Melissa Mialon: https://www.aub.edu.lb/fhs/Pages/GECI.aspx   Link to Daniel Maani’s music: https://open.spotify.com/artist/4GDF0XnCn78nce0gesJoC7  

  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