RCEM Study Day 29th April 2022: The Highlights

Authors: Ines Corcuera, Michelle Ryan / Editor: Lynn Stevenson / Codes: SLO9 / Published: 20/12/2022

“Agents of Change”, a Public Health (PH) study day, was held at the Royal College of Emergency Medicine (RCEM) to cover Domain 4 of the RCEM Curriculum: doctors in training must be aware of and demonstrate capabilities in health promotion and illness prevention.

Pivotal to understanding the topic is the fact that healthcare only contributes 15-20% to the overall health of the population. Figure 1. Dahlgren and Whitehead’s Health Policy “rainbow”  illustrates the wide range of different determinants of health, many of which are becoming increasingly significant in the evolving cost of living and climate crises.

Figure 1. Dahlgren and Whitehead’s health rainbow1

The Medical Director for Public Health England described how she became a national PH expert and leader.  Feeling compelled to tackle the number of farm related accidents in rural areas, as a trainee surgeon in Ireland, her PH improvements began simply by being concerned and curious about what was coming in through the door.

She encouraged people to think about “what kind of person has the disease rather than what kind of disease a person has”.

The Deputy Director for Inclusion Health at the Office for Health Improvement and Disparities provided insight into the complexities surrounding inclusion health. For vulnerable groups, including those experiencing homelessness, migrants, victims of modern slavery, sex workers and those in contact with the criminal justice system, the Emergency Department (ED) may be their only contact with a healthcare system and access to social support. As ED physicians we must therefore maximise this contact by optimising a person’s health and social support by signposting them to appropriate community services. If you want to learn more check out this RCEM e-learning module.

A junior doctor presented her Quality Improvement Project showing what a Migrant Friendly ED can look like. She highlighted simple measures from the availability of translation services, accessible information leaflets in multiple languages, simple referral and follow up processes, as well as ensuring that patients are registered with a local GP on discharge.

The Head of the North West London High Intensity Users Steering group discussed Mental Health Services in the ED and how this has been impacted by the Covid-19 Pandemic. She specifically highlighted the healthcare inequalities disproportionately affecting BAME communities. She introduced the concept of “Parity of Esteem” which is the need to value mental health as equal to physical health. This included the innovative idea of using a 2222 emergency call for a section 136  presentation, to ensure the same urgency is applied to a mental health crisis.

A case manager from St Giles provided practical suggestions on how to communicate with vulnerable young individuals affected by gang violence and  gang culture. She emphasized the need to listen to young people and rather than telling them what they should do, help them to come to their own conclusions and make their own decisions by rationalising their situation and options.

During the afternoon we discussed the new London wide systematic screening for blood borne viruses in ED supporting London’s ambition of getting to zero. This was highlighted as one of the most cost-effective public health screening programs to date and should be rolled out nationwide.

We also had a talk from a senior alcohol liaison nurse who urged us to refer early in a patient’s life course and use the teachable moment in ED to help patients realise their harmful drinking habits and its effects on their health. Tackling alcohol consumption and harm must be an essential part of the UK government’s COVID-19 recovery plan, given that tackling geographic health disparities are part of the government’s Build Back Better plans. Alcohol harm being a major driver of these differences.

The lead of the CoSTED Trial: a Smoking Cessation Trial in ED discussed the potential benefit of a 5-minute brief intervention (see Figure 2).

Figure 2 A brief intervention framework for smoking cessation advice via University of East Anglia

We wrapped the day up by discussing an emerging framework to tackle health inequalities. This is three-tiered approach implemented at Barnsley Integrated Care Partnership (Figure 3.)

  1. The first-tier approach looks at how we can support individuals to make better choices (e.g. tobacco advisors and alcohol care team services).
  2. In the second tier, they examined how socioeconomic deprivation and disability can impact the ability to access services.
  3. In the third tier, they focused on building a more inclusive society and economy by focusing on the hospital as an “anchor institution”. Read more on this topic on this RCEM blog.
Figure 3 Health inequalities, three tiers for action developed by Barnsley Integrated Care Partnership2

The key messages of the day included:

  • Public Health and ED have a joint agenda that is mature and remains of key importance to both.
  • The NHS has increasingly moved into the space of prevention, health improvement and place-based approaches to population health and care.
  • Early work will focus on tobacco control, violence reduction, leadership in integrated care systems, and data linkages to population outcomes, with an emphasis on inequalities.
  • We have a potentially exciting joint relationship on professional functions and training.

Huge thanks to all those who participated, we hope this post sparks new interest in PH in the ED and motivates people to attend the next Public Health study day in May 2023!


  1. Economic and Social Research Council, The Dahlgren-Whitehead rainbow. [Online] [Accessed 1 December 2022]. 
  2. Barnsley Health and Care Plan Refresh 22/23. Barnsley Place Partnership.