Since the establishment of PRUComm in 2011 our research has focused on examining how the changes to the English NHS and public health system have developed. We continue to examine the development of CCGs and the new commissioning structures. We have also been exploring the mechanisms by which commissioning is undertaken, such as contracting and the use of competition and cooperation within the new system.
While most media attention has focused on changes to the commissioning and delivery of healthcare, the shift of public health to local authorities was a major part of the reforms introduced in April 2013. We have examined the progress and developments in the public health system with a particular emphasis on how governance and organisational structures develop and whether being embedded within local councils changes the way that public health services are provided. We have also been focusing on primary and community health care with recent projects examining general practice – including methods of funding primary care; research on recruitment and retention; QOF, scaling up primary care and running and analysing two rounds of the GP WorkLife survey (eight and nine).
Our research on CCGs has most recently focused on primary care co-commissioning and new forms of contracting, such as outcomes-based and alliancing. Given the increasing policy emphasis on this area of healthcare we anticipate that we will be increasingly involved in further research on primary and community healthcare. All these topics will be explored in today’s seminar with presentations by researchers from PRUComm.
Today we celebrate John Snow’s birthday (March 15th 1813 – June 16th 1858), a physician who made enormous strides in the fields of medial hygiene, anaesthesia, epidemiology and public health.
He is perhaps most widely known fo r his observations and discoveries during a cholera outbreak in Soho, London in 1854.
Snow’s cholera map
Snow disagreed with the contemporary thinking which held the belief of ‘miasma’ or ‘bad air’ was the cause of disease. After speaking to residents in the area of Broad Street, Soho he identified that the source of the cholera outbreak was the public water pump. After demonstrating patterns in the disease using maps, Snow was able to convince the local council to disable the pump by removing the handle.
John Snow, however, felt that while the removal of the handle was helpful, it was probably likely that the outbreak was already in rapid decline.
Even after the outbreak, however, there was disagreement regarding the means of transmission of disease. It took another 12 years for William Farr in 1866 to validate Snow’s findings during another cholera outbreak.
Snow’s text, ‘On the Mode of Communication of Cholera’, outlines the history of cholera with accompanying data which confirmed his theories. The text was revised, expanded, and published as a second edition in 1855.
Here at the London School of Hygiene & Tropical Medicine, the John Snow Lecture Theatre; opened by HRH The Princess Royal, is a lasting tribute to the man who helped promote a better understanding of medicine in a range of fields.
The archives of the London School of Hygiene & Tropical Medicine unfortunately do not contain a collection of John Snow. However, there are many resources available for more information on cholera or the history of public health, some examples below.
On the Mode of Communication of Cholera – John Snow, 1855: Available through the library
Rogers Collection – which contains papers relating to cholera: Available through the archives
Budd Collection – which contains publications on cholera, typhoid and cattle-plague: Available through the archives
Recently the library has been back-cataloguing its extensive collection of historical pamphlets dating from the early 20th Century to the late 1960s. The collection is comprised of information relating widely to all aspects of international Public Health and is particularly strong on concerns relating to the Anglosphere and the former British colonies. As such, the pamphlets provide a fascinating insight not only into developments in physiological understanding but also into changing cultural attitudes, scientific methods and technology.
There are many curious documents in the collection as well as a number of items unique to the school. A particularly interesting find is a 1961 report produced by the British War Office on developments in protection from sunstroke. A historical study, it offers an account of theories and preventative measures, mainly headgear, used against the affliction from antiquity up to the present day contemporaneous to its publication. From Persian headgear to 18th Century ‘Sugar Loaf’ hats and pith helmets the pamphlet charts the various hat designs and materials used throughout the ages with particular attention to local environment and influences taken from native customs. Detached in tone, the report’s description presents the near and far eastern regions discussed as barely hospitable sun beaten environments against which outsiders must forge protection or perish.
Another of the pamphlet collection’s gems deals not with altering oneself to suit the environment but altering the environment to suit oneself. “Report on Trial of Artificial Climate Chamber at General Hospital Shanghai” details an American physician’s attempts to create an air-conditioned operating theatre using imported fans and ice in 1913. The pamphlet contains a detailed analysis of the benefit of reduced temperature against increases in air humidity in the form of a hand annotated graph. A brief but evocative commentary on the problems faced by the physician and his “subscribing” colleagues in acquiring the necessary equipment and persuading the hospital authorities is also included.
Cataloguing the pamphlets should improve awareness and increase access to this fascination collection. Hopefully it will aid the research of medical historians, social scientists and other curious parties at LSHTM and beyond. The two pamphlets mentioned, as well as many others, can be found in the gallery above the reading room.
The two pamphlets discussed.
An illustration from “Life and Death of the Solar Topi” showing use of 13th Century French and Spanish straw hats.
An illustration from “Life and Death of the Solar Topi” show a diagram of an 1860 Jeffreys Helmet.
An illustration from “Life and Death of the Solar Topi” depicting a hunting scene in which the British settlers are wearing sugar loaf hats.
To commemorate International Women’s Day (March 8th) here are a few books from the LSHTM Library collection focussing on women’s health and women’s rights.
Women and healthby Marlene B. Goldman and Maureen C. Hatch(Academic Press, 2000).
Library classmark: SOE.W 2000
A comprehensive work with an international perspective. Includes physical issues and conditions along with some of the social and behavioural factors that affect health.
Aimed at academics, public health workers and physicians.
Handbook of women’s health : an evidence-based approachedited by Jo Ann Rosenfeld (Cambridge University Press, 2001).
Library classmark: SOE.W 2001
Emphasises collaborative care between the person and their healthcare provider. Sections include preventive care, psychosocial health, sexuality, genitourinary medicine, breast disorders, psychological disorders, and common medical problems.
Well women : the gendered nature of health care provisionedited by Anne Morris and Susan Nott (Ashgate, 2002)
Library classmark: ZVB.W 2002
A collection of 8 essays looking at women as recipients and providers of health care.
Essay titles include:
– “Care, control or coercion? Women in the mental health system in Ireland, England and Wales”;
– “Body beautiful? Feminist perspectives on the World Health Organization”;
– “Psychologizing abortion: women’s ‘mental health’ and the regulation of abortion in Britain”;
–“Infertility treatment and the HIV positive woman: old moral prejudices disguised as new ethical dilemmas”.
Women and gender equity in development theory and practice edited by Jane S. Jaquetteand Gale Summerfield (Duke University Press, 2006)
Library classmark: ZVB.W 2006
This book draws on the experience and research of academics, policymakers and development workers in Latin America, Asia and Africa to analyse international development themes in the context of women’s well-being.
Organised into three parts dealing with institutional opportunities and barriers, control of resources and livelihood, and mobilization.
Feminist theory from margin to center (2nd ed.) by bell hooks (Pluto Press, 2000)
Library classmark: ZVB.W 2000 (Reference only)
In this classic piece of feminist writing, author bell hooks argues for the end of gender oppression and a fundamental transformation of society.
First published in the 1980s, the book challenged mainstream feminism to acknowledge the involvement and leadership of poor and non-white women in the liberation movement.
Why do some men use violence against women and how can we prevent it? by Emma Fulu, Xian Warner, Stephanie Miedema, Rachel Jewkes, Tim Roselli and James Lang(UNDP, UNFPA, UN Women and UNV, 2013)
Library classmark: TJH.W.21
Report of a UN study conducted with over 10,000 men in Bangladesh, Cambodia, China, Indonesia, Sri Lanka and Papua New Guinea exploring the prevalence of men’s use of violence against women and the complex interplay of factors that makes it more or less likely to occur.
Girls and sex : navigating the complicated new landscape by Peggy Orenstein (Harper, 2016)
Library classmark: UTL.W.6 2016
American journalist and author Peggy Orenstein reflects on interviews with psychologists, academics, experts and over 70 young women to offer insights into current sexuality and sexual practice.
“Did today’s young women have more freedom than their mothers to shape their sexual encounters, more influence and more control within them?”, Orenstein asks. “Were they better able to resist stigma, better equipped to explore joy? And if not, why not?”
Hilary Bower is interviewed by BBC World Service Radio’s Newsday programme on the current outbreak of Lassa fever in Nigeria. Hilary is a member of the UK Public Health Rapid Support Team (UKPHRST) and said: “The cases are falling at this stage, which we would expect as this is a seasonal disease and they do usually fall off at this time. Our key effort now is that they [cases] do continue to fall.”
Daniel Bausch, Director of the UKPHRST, speaks to Vox on the possible reasons why Lassa fever has been so widespread: “I think it’s interesting that you have monkeypox and Lassa. Two rodent-borne diseases that have seen peaks of transmission this year. I would suspect the underlying determinants are ecological determinants that have favoured populations of small mammals.”
Heidi Stöckl is quoted by the Daily Telegraph on the prevalence of violence against women across the world, recently described by the WHO as ‘a global health problem of epidemic proportions.’ Heidi said: “We know that violence is associated with all these health effects like depression, anxiety, alcohol abuse and a lot of maternal health problems such as low birthweight and miscarriage. Governments have the data and they must now be held accountable.”
Heidi Hopkins provides comment to Science in an article on the challenge of diagnosing and treating non-malarial fevers: “People are moving from malaria to fever diagnosis and management [as a primary challenge for public health in malaria risk areas].”
Oliver Brady speaks to The Guardian on his work for the Brazilian government studying the impact of the Zika virus.
Andrew Bastawrous from PEEK and CEHC will give the keynote speech at the Commonwealth Service at Westminster Abbey on 12 March in the presence of Her Majesty The Queen, Head of the Commonwealth.
The service will be attended by Members of The British Royal Family, the Prime Ministers of the United Kingdom and Malta, senior politicians, dignitaries and diplomatic representatives from across the UK and Commonwealth, faith leaders and other public figures. Previous speakers at the service have included Nobel-Laureates Kofi Annan, Malala Yousafzai and Kailash Satyarthi.
The Service will be broadcast live in the UK on BBC One from 14:45-16:15 GMT. It will also be relayed live on the BBC World Service radio and streamed live on www.bbc.co.uk and www.bbc.com/news.
Congratulations to everyone who graduated this week and welcome to the alumni community!
We enjoyed celebrating with your achievements this week; you can view the photos from the graduation day on our Flickr page and check out our short highlights video.
As an alumnus of the School, you not only join a global network of more than 20,000 graduates in over 180 countries and we want to keep in touch with all of you. Our diverse alumni community provides a lifelong link to the School and each other. There are a number of ways that you can get involved and stay in touch.
Attend Alumni events
We hold alumni events all over the world, which alumni, students, staff and friends of the School are welcome to attend. These events range from Chapter meetings to gala dinners. Find out about upcoming events and past events near you on the Alumni Events page. View photos from past events on our Flickr page.
Blog for us
The Alumni Blog is where you find out the latest news from the alumni and School community. You can contribute to the blog by sharing your profile, writing a project report, or updating us on your career achievements. See the Alumni Blog for examples of news and articles.
Start an Alumni Chapter
Our worldwide network of alumni chapters are made up of volunteers from our alumni and distance learning community. Being involved with your local chapter is a great way to meet old classmates and make new contacts. Learn more about how to start a chapter in your city.
Donate to the Alumni Fund
Donations to the Alumni Fund enable the School to continue to improve health worldwide. This year donations to the Alumni Fund will be used to fund scholarships. For information on giving to the Alumni Fund including making tax-deductible gifts visit our Support Us section.
Come for a tour of the School
We enjoy having alumni come to visit us at the School. If you are planning to be in London and would like to organise a tour of the Keppel Street building, please send us an email at to let us know you are coming.
Give a career talk to current students
Alumni career talks are a great way to get involved in the School community. If you are planning to be in London, and would like to give a career talk to current students, please send us an email at so that we can make the arrangements.
Run a marathon or get involved in a number of other sponsored activities to raise funds for the Alumni Fund or a School memorial fund. If you would like to get involved in a sponsored activity, please contact us at for further information on how we can support you.
Advise current and prospective students
From time to time we contact alumni on behalf of current and prospective students who are looking for informal career advice, or would like to learn from alumni about studying at the School. Update your contact details via our online community, so that we can get touch.
Help at conferences
Alumni can provide support at health conferences. This assistance can range from helping to coordinate an alumni reception to supporting student recruitment activities. If you are interested helping at conferences, then please email us at .
If you are planning to be in London and would like to visit the Alumni Office, please drop us an email. We would love to see you!
Congratulations once again! We look forward to keeping in touch.
The School has approved a new policy for the RCUK open access block grant, managed by the Library & Archives Service. In order to make best use of the remaining funds during the rest of the block grant period (which runs to the end of March 2020), we have made the decision to only fund articles published in fully open access journals from 1 April 2018.
By Priyanka Rajendram (MSc Public Health Candidate)
The International Women’s Day, currently celebrated in many countries around the world on the 8th March, first emerged at the end of the nineteenth century in North America and Europe. Currently there is a strong global momentum striving for gender parity, with global activism for women’s equality, fuelled by movements like #MeToo and #TimesUp.
To celebrate the date, we spoke to Mitzy Gafos, Associate Professor at LSHTM, about HIV amongst women, the STRIVE study and challenges that women face in adhering to PrEP. Mitzy is Co-Research Director of STRIVE, an international research consortium dedicated to studying the structural drivers of HIV, including gender inequalities, stigma and criminalization, lack of livelihood options and alcohol use and harmful drinking norms.
Could you explain what STRIVE is?
STRIVE is a research consortium funded by the UK government to tackle the structural drivers of HIV. STRIVE is led by LSHTM in the UK and works with partners in South Africa, Tanzania, India, and USA. The consortium aims to describe the ways in which structural drivers increase vulnerability to HIV and evaluate interventions to address structural drivers of HIV. A core part of our research is to evaluate the ways in which structural factors, including gender inequality, stigma and gender based violence (GBV), impact on the uptake and sustained use of biomedical HIV prevention and treatment. As such, STRIVE partners in South Africa and Tanzania are conducting the EMPOWER trial to assess whether it is feasible, acceptable and safe to offer oral pre-exposure prophylaxis (PrEP) as part of a combination HIV prevention package that addresses GBV, stigma and HIV in adolescent girls and young women aged 16-24 years. Results of the study will be released later this year.
What PrEP is and how does it work?
PrEP stands for pre-exposure prophylaxis. The currently available form of PrEP is a combination of two anti-retroviral drugs (tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC)) which have been used in HIV treatment for many years. When taken regularly by HIV negative individuals, PrEP prevents the virus from being able to replicate in the cells and prevents HIV infection.
PrEP is as effective for both cis and trans women as it is for men. However, we know that more drug is needed to ensure sufficient protection in vaginal tissue than is needed in rectal tissue. As such, the prescribing of PrEP is different for women and men.
Women (cis and trans): need to take PrEP for 7 days before they are protected from HIV. They then need to take it daily to maintain sufficient levels of protection. This is true for both cis and trans women having vaginal sex.
Men who have sex with women (cis and trans): need to take PrEP for 7 days before they are protected from HIV. They then need to take it daily to maintain sufficient levels of protection.
Men who have sex with men (cis and trans): need to take a double dose of PrEP between 2 to 24 hours before sex, followed by a third dose 24 hours later and a fourth 48 hours later. This is called ‘event-based dosing’. However, some MSM at regular risk of HIV choose to take PrEP daily. This dosing option is also considered to be effective for trans women whose main route of exposure is through receptive anal sex.
An important advantage of PrEP for both women and men, is that people can take PrEP only during times in their lives when they think they may be at increased risk of HIV – there is no need to take it forever.
How effective is PrEP?
When taken as prescribed, PrEP reduces the risk of getting HIV from sex by between 92% to 99%. While PrEP is as effective as condoms at preventing HIV, it does not reduce the risk of other STIs or pregnancy. Among people who inject drugs, PrEP reduces the risk by more than 70%. However, we already know that clean needles are the best way to prevent HIV among injecting drug users and should be available to people who need them.
Have all the PrEP trial results been consistent?
There have been seven randomised placebo controlled trials of oral PrEP and one deferred start randomised controlled trial – obviously the RCT design is considered the gold standard for evaluating the benefit of a new drug. Three of the trials enrolled men who have sex with men and trans women having anal sex with men. Another three trials enrolled heterosexual women and men. All six of these trials reported high levels of effectiveness.
However, two other trials which only enrolled heterosexual women did not show any effect of offering PrEP. The results were explained by the very low levels of adherence with less than a third of women taking PrEP regularly. These trials highlighted the structural and social challenges that women face in adhering to PrEP. A number of trials and demonstration studies are ongoing, such as EMPOWER, to find ways to support women overcome these challenges and be able to adhere to PrEP during periods when they are at risk of HIV.
What were the main reasons for low adherence of women?
The reasons for low adherence were often complex but they included women not being motivated to use an unproven or placebo product, low levels of perceived risk among women joining trials primarily for the additional health care benefits available, or lack of trust in researchers. Other reasons have implications for PrEP use beyond clinical trial settings as some women found adherence challenging in shared households or in the context of insecure living arrangements, or because of lack of partner support or even knowledge of their PrEP use, or even a lack of parental support especially for young women, or due to stigma associated to ARV products and the use of prevention products thereby inferring sexual risk taking. We also know that gender norms, the dynamics of transaction sex, alcohol use, and the risk of intimate partner violence can all serve as barriers to the uptake and adherence to a range of sexual and reproductive health products and services. There is no doubt that any PrEP delivery programme has to attend to the structural barriers that women face in their every day lives.
Before joining STRIVE, I led the social science component of the PROUD study which evaluated the offer of PrEP to MSM and trans women in England. Now, Public Health England and the St Stephens AIDS trust are running the IMPACT PrEP trial which has expanded the offer of PrEP to all people at risk regardless of gender or sexuality. The trial will enrol 10,000 people over the next three years in GUM clinics across England.
The community advisory board advocated for at least 1,000 places to be reserved for heterosexual women and men (cis and trans) as awareness about PrEP is still limited in these groups. As such, community organisations are working hard to raise awareness about PrEP especially among women who are at risk of HIV in England. So far, very few cis and trans women have joined the trial but we think this is because they just don’t know enough about PrEP.
PrEP is licensed and available on the NHS in Scotland and there is a separate trial ongoing in Wales.
Is PrEP available in other countries?
Yes, PrEP is available is almost 30 countries globally. PrEP was first licenced in the USA in 2012 and the latest data suggests that over 120,000 people are using PrEP, although less than 15% are women. In many countries, such as South Africa and Kenya, there are concerted efforts to offer PrEP to women most at risk of HIV.
Are there health promotion activities to raise awareness among women in England?
United4PrEP is a collaboration of community based organisations, clinicians, researchers and other interested individuals, who work together to raise awareness about PrEP. A number of organisations have developed specific information for cis and trans women – these include the Sophia Forum, cliniQ (a trans health service), prepster and iwantprepnow. I have listed their websites below.
In addition, a number of community based organisations are offering training on PrEP to health and social care providers who deliver services to women who may be at risk of HIV. While the IMPACT trial is only enrolling participants in GUM clinics, it is important that staff in other sexual and reproductive health, mental health, addiction and social care services, are aware of PrEP and can sign post women who may benefit from PrEP to the IMPACT trial. We are looking for any opportunities to raise awareness about PrEP among women.
Mitzy Gafos and myself are currently collaborating to raise awareness about PrEP among women and the existence of the trial, through an online entertainment-education drama. If you would like to learn more about our collaborative work please e-mail me at: .
You can find out more about PrEP in the below websites:
We are seeking to appoint a Project Administrator for the International Centre for Eye Health’s Commonwealth Eye Health Consortium project and associated work streams.
The Project Administrator will be a member of the Disability and Eye Health Group’s (DEHG) Professional Support Team and will be responsible for providing financial, logistical and administrative support in collaboration with managers, researchers and educators based in London with activities at a number of overseas locations.
The Commonwealth Eye Health Consortium is a group of eye health organisations from several Commonwealth countries working together to deliver a five-year programme of fellowships, research and technology, which aims, over the long-term, to strengthen eye health systems and quality of eye care throughout the Commonwealth.
The post-holder will have Higher education to degree level or equivalent, or substantial relevant experience; experience in the administration of multi-partner projects, experience with establishing/maintaining project management tools such as guidelines, procedure manuals, reporting templates; experience in monitoring large and complex budgets and preparing financial reports; proven administrative and organisational experience including coordinating logistics for events and committee meetings both in the UK and overseas. Further particulars are included in the job description.
The post is funded by the Queen Elizabeth Diamond Jubilee Trust until 31st May 2019 and is available immediately. Salary is on the Professional Support Grade 4 scale in the range £28,751 – £32,705 per annum (inclusive of London Weighting). The post will be subject to the LSHTM terms and conditions of service. Annual leave entitlement is 30 working days per year, pro rata for part time staff. In addition to this there are discretionary “Director’s Days”. Membership of the Pension Scheme is available.
Applications should be made online via our website at jobs.lshtm.ac.uk. The reference for this post is ITD-CRD-2018-08. Online applications will be accepted by the automated system until 10pm on the closing date. Any queries regarding the application process may be addressed to .
The supporting statement section should set out how your qualifications, experience and training meet each of the selection criteria. Please provide one or more paragraphs addressing each criterion.The supporting statement is an essential part of the selection process and thus a failure to provide this information will mean that the application will not be considered. An answer to any of the criteria such as “Please see attached CV” will not be considered acceptable.
The London School of Hygiene & Tropical Medicine is committed to being an equal opportunities employer.
Please note that if you are shortlisted and are unable to attend on the interview date it may not be possible to offer you an alternative date.