Category: School of Public Health

How reconstructing the past hepatitis B epidemic can help prevent liver cancer in the future

Nora Schmit was shortlisted for the MRC Max Perutz Science Writing Award 2019 for the following article on her PhD research on predicting the impact of treatment for hepatitis B infection on preventing liver cancer in The Gambia.

What’s the first thing that comes to your mind when you think of cancer prevention? Maybe you’re thinking of not smoking or maintaining a healthy weight – great strategies to reduce your chance of getting cancer.

But did you know that the hepatitis B vaccine, introduced in the 1980s, has long protected children in many parts of the world from developing one of the most common and deadliest cancers later in life?

Although most people have no symptoms when they first become infected, the hepatitis B virus is the leading cause of liver cancer worldwide. Large-scale efforts to tackle the virus using vaccination have been hugely successful in preventing infections in children. Despite this remarkable achievement, hepatitis B infections are still very common and nearly a million people die from its consequences every year. With around 6% of all people living in Africa currently infected, the death toll there is expected to rise even further.

But while a liver cancer diagnosis is nearly always fatal, treating the infection is possible with the same drugs that work against HIV. So why do so few people receive these drugs, when over half of all liver cancer deaths globally are preventable? (more…)

What is environmental inequality and why should we care?

Charlotte Roscoe highlights the problem of environmental inequality and explores how potential solutions such as urban green spaces may help to close the gap.

Whether it’s standing on picket lines with Mind the Pay Gap signs, whether it’s the rallying cry of Black Lives Matter, or surging child poverty across the UK: one thing inequality probably doesn’t mean to you, is city planning. Yet over 80% of the UK population live in urban areas, and the built environment is unequally impacting our health and wellbeing.

Not all urban neighbourhoods were built equal

Urban neighbourhoods designed in the past few decades of vehicle priority tend to be the most damaging to health. Car parks and roads have swallowed up our public spaces, and despite government strategies to reduce vehicle emissions via charging schemes, vehicles continue to dominate our streets.

Perhaps you’ve read headlines such as: “Traffic noise revealed as new urban killer”, or, “Each car in London costs NHS and society £8,000 due to air pollution”. These shocking news stories feature robust scientific evidence from the MRC Centre for Environment and Health, that both traffic noise and air pollution are linked to ill health, and even death.

Newsflash – traffic is bad for us! (more…)

An open letter to the participants of my Hepatitis C study

© Kotryna Zukauskaite

For World Hepatitis Day (28 July), Dr Philippa Pristerà shares an open letter to the people that she met and interviewed early last year as part of her research study exploring the experiences of people living with and accessing care for Hepatitis C, and their perspectives on cure.

Dear all,

I am writing to you because you took part in my interview-based study ‘Viewpoints from hepatitis C: accessing and experiencing cure’*. Some of you I met about a month before I gave birth to my daughter, others would have met my colleague Jane Bruton who kindly took over while I was on maternity leave. Since my return to work, I have spent my time reading over the interviews to see what key themes came through and would like to take this opportunity to update you.

I want to say thank you

Thank you for sharing your story; for sitting down with a complete stranger, a heavily pregnant one, to be interviewed about your life. To help me build the context around your experiences and better understand your story, you revealed a great deal about your expectations and your beliefs, your current and past behaviour and their consequences. I was struck by your openness, and so grateful for your trust. (more…)

Stop blaming PrEP for the rise in STIs – the picture is more complex than that


Rising rates of STIs has fuelled a debate about whether growing PrEP use might be propelling the STI epidemic. Oli Stevens and Charles Witzel argue why this narrative is misleading and damaging. 

The UK recently celebrated two landmark achievements in the ongoing fight against HIV. It is now the seventh country to reach the United Nations target of 90-90-90: that 90% of people living with HIV know their status, of whom 90% are on antiretroviral treatment, and of whom 90% are unable to transmit the virus to others.

Also, London became the first city in the world to achieve 95-95-95. These are remarkable achievements and are a testament to the tireless, collective work of doctors, activists, policymakers and civil society organisations.

Zeroing in on the progress made in reducing new HIV infections between men who have sex with men (MSM), particularly the nearly one-third decrease between 2015-2017, two likely contributors stand out: a scale-up in HIV testing, rapid progress to treatment and pre-exposure prophylaxis (PrEP).

PrEP, sometimes discussed in hushed terms as a potential means of ending HIV transmissions, is a pill taken once daily or around higher-risk sex that markedly reduces the risk of contracting HIV.

This recent success also invites us to take stock and reflect on our failures, the perhaps unexpected costs of progress and the emerging roadblocks on the horizon.

The decrease in HIV transmissions has not been matched with a decrease in sexually transmitted infections (STIs). Instead, new diagnoses have risen year-on-year. The causal factors fuelling this increase are complex, driven by social and political changes. (more…)

The economics of universal health coverage

Universal Health Coverage

Dr Katharina Hauck, a Health Economist, explains how economics can help to implement universal health coverage in the real world.

Millions of people still have no access at all to health care. Millions more are forced to choose between health care and other daily expenses such as food, clothing and even a home. Globally, over 800 million people incur catastrophic out-of-pocket spending every year, with health care costs consuming at least 10% of their household budgets.

Therefore, this year’s World Health Day focuses on universal health coverage (UHC). The World Health Organization defines UHC as “ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”  Many countries have declared their commitment to UHC. But after the political declarations are made, policymakers are left to grapple with a central issue: what services should be made available? (more…)

A teaspoon of salt away from high blood pressure

This Salt Awareness Week, Dr Queenie Chan puts the salt intake guidelines to the test and looks at the reality of curbing salt intake for better heart health. 

Salt and sodium are often used interchangeably, but they’re not exactly the same thing. Sodium is a mineral that occurs naturally in foods or is added during manufacturing or both. Table salt is a combination of sodium and chloride, which was one of the most valuable modes of currency in ancient times. It has been used to preserve food for thousands of years and it is most commonly associated as a form of food seasoning. Salt also plays a role in food processing, providing texture and enhancing colour. (more…)

Strength in numbers: monitoring of fungicide drug resistance with the help of 500 citizen scientists

In this post, Jennifer Shelton provides an insight into her PhD project which involves over 500 citizen scientists from across the world, in the hope of better understanding a species of fungus that is linked to disease.

It started by a poolside in Gran Canaria.

I was reading my book but thinking about the sticky films we use in the lab to cover plates of DNA that a former postdoc in my group had used to collect Penicillium spores for his study on the population genetics of ‘Alexander Fleming’s lucky fungus’. I’d already decided as part of my PhD to conduct a country-wide survey to determine background levels of Aspergillus fumigatus – a species of fungus – spores in the UK. I had put aside several weeks for driving around the country to collect air and soil samples, yet thoughts of a citizen science project kept buzzing. What if I asked individuals across the UK to collect samples of their local air on a single day, say summer solstice, and post them back to me?

Citizen science projects are increasing in popularity and rely on members of the public to voluntarily collect samples, process data or record observations as part of a research project. Some well-known examples include SETI@Home, which uses internet-connected computers to analyse telescope data in the search for extra-terrestrial life; Foldit, an online video game about protein folding and Swab & Send, a widespread swabbing exercise to identify novel antibiotics in the environment. (more…)

Noël hypothesis: my life as a medical statistician

This festive period Three Wise Women from the Faculty of Medicine will be giving us the gift of their wisdom.

Our final wise woman, director of the School of Public Health Professor Deborah Ashby, shares her joy of medical statistics, from working in neonatal research to taking on the Royal Statistical Society presidency. 

“We Three Queens of Orient are…” came the dulcet sounds in the lead-up to Christmas. I looked up across the old Liverpool maternity ward, to see three colleagues singing and, channelling Morecambe and Wise, dancing towards me and my newborn daughter. The three women who had come to visit were all, like me, lecturers in medical statistics at the University of Liverpool, and that memory still brings a smile.

Although it was less glamorous than the alternatives, I’d chosen to give birth there, reasoning that if it went well, it didn’t matter where I was, but if not, I’d rather be somewhere with wide experience, actively engaged with and informed by research. In Liverpool, I had worked with the academic doctors from that maternity hospital, so knew I would get both. You might wonder why they had sought my advice, but research on babies involves analysing complex data on them, or designing studies to test competing treatments or strategies – all of which needs statistical skills along with clinical input. (more…)

NHS England’s plans to cut prescribing for low-value items: well-intentioned but poorly implemented

Professor Azeem Majeed shares his take on the realities of NHS England’s proposed ‘do not prescribe list' for primary care.
Professor Azeem Majeed shares his take on the realities of NHS England’s proposed ‘do not prescribe’ list for primary care.

This week NHS England (the organisation responsible for managing the NHS in England) announced plans to curb the prescribing of ‘low-value’ items. This includes items such as silk garments, and bath and shower emollient for eczema and dermatitis. The plans follow on from earlier guidance issued by NHS England that aimed to limit the prescribing medications that are available over the counter, such as paracetamol and ibuprofen.

At a time when the NHS faces unprecedented workload and funding pressures, health professionals and the public all recognise the need to make the most efficient use of the resources available to the NHS; and prioritising key clinical areas such as cancer care. Prescribing costs in primary care, currently around £10bn annually, are a key component of the NHS budget in England. It is therefore entirely appropriate to look at this area to see where savings can be made without compromising patient care. (more…)

What diversity and inclusion at Imperial means to me

Dr Rahma Elmahdi is a clinical academic who joined Imperial College London as a medical student. Here she reflects on the significance of diversity and inclusion at the College for Black History Month.

I loved my time at Imperial both as an undergraduate and postgraduate student. Being a student here I was exposed to a host of incredible opportunities that only an institution like Imperial can offer. Despite this, there were many moments when I felt both isolated and lonely as a young black woman studying here. As well as the very many good times, I recall living with a chronic sense of being ‘other’ and feeling that to pass as a true Imperial student, I should endeavour to look and sound like my white, affluent peers as much as possible. (more…)