What is health protection?

aims to protect public from exposure to hazards which damage health & to limit impact on health when exposures cannot be avoided

Health protection services - surveillance

monitoring population health & hazards/exposures from communicable disease and environmental threats

How is health surveilled in scotland?

Scottish Environmental Incident Surveillance System (SEISS)

Health protection services - investigation

why & how people fall ill due to exposure to hazards & what can be done to prevent this

Health protection services - risk assessment

estimating probability of a population being exposed to a hazard which will damage their health &/or extent of that exposure or damage &/or impact of an intervention

Health protection services - risk protection

putting in place measures which reduce risk of exposure to hazards & impact it can have on health through prevention and control

Health protection services - risk communication

informing public about risks to their health & what they individually or collectively can do to reduce these

Health protection services - emergency response and maangement

responding to incidents/outbreaks to reduce number of cases of illness & other consequences to a minimum

Ten steps of outbreak management

Surveillance • Exclude artefact • Confirm diagnosis • Describe outbreak • Call OCT • Generate hypothesis • Test hypothesis • Control • Communicate • Document

Step 1 - Surveillance

Identify unusual event through • statutory notifications • clinical diagnoses • laboratory reports • ad-hoc tip offs

Step 2 - Exclude artefact

liaise with - Microbiologists - Clinicians - Environmental health officers or food safety officers

Step 3 - Confirm diagnosis

define case - Microbiological, Clinical, any other

Step 4 - Describe outbreak

Time, place, persons

Step 5 - Call Outbreak Control Team

Public health • Environmental health • Microbiology • Administrative support • Others – PHS/UKHSA, clinician, communications, technical experts • Government

Step 6 - Generate hypothesis

Using available information to make an educated guess on cause & source of outbreak • in depth wide-ranging interviews with cases and non-cases • biological plausibility

Step 7 - Test hypothesis

Microbiologically - from cases, vehicles or components • Environmentally - from history or inspection • Epidemiologically - descriptive or analytical Use case and control

Step 8 - Control

Exclusion orders - food-handlers • Closure of premises • Recall of food • Boil water/bottled water notices • Hazard warnings • Lockdowns!

Step 9 - Communicate

keep informed • colleagues • superiors • interested parties • press

Step 10 - Document and reflect

minimum dataset - for local and national use • outbreak control team report - essential to good practice • consider implications for advice and policy • publication in peer reviewed journal

Who has statutory responsibilities for health protection services in Scotland?

Public Health Scotland (government, NHS boards (14), local authorities)

Which organisations work to protect public health is scotland?

Government, health protection network, UK health security agency, NHS, local authorities, reference laboratories, SEPA, scottish water, food standards scotland

Across the UK and internationally, which organisations are involved?

Uk gov, health and safety executive, ECDC, WHO