'Everyone has a role to play'

Christen Pears meets Derwentside Primary Care Trust's new director of public health.

POVERTY, political unrest and ill health on a massive scale - the problems of Africa seem enormous in comparison to those facing the people of Derwentside but Dr Anne Low thinks differently. For over 20 years, she has worked in Swaziland, Zimbabwe and Namibia but has just taken up the post of director of public health at Derwentside Primary Care Trust.

"When I came back, people said the issues here must seem minor in comparison, but they're not," she says. "There are inequalities in health here and critical chronic diseases everywhere. I have found it just as interesting and just as much of a challenge from a public health perspective."

As director of public health, Anne's remit is huge, aimed at improving health and well-being and reducing inequalities in health across the district. A significant part of her time will be spent working with her PCT colleagues and in partnership with local government and other agencies, the voluntary sector and community groups to create a joint approach to addressing the major health problems, as well as the voluntary sector and community groups.

"There is a big public health agenda and we need to make the best use of the resources we have. We shouldn't think of it as being the work of the public health specialists sector alone. We're talking about health visitors, school nurses district nurses and GPs. Local authorities influence health through their education, employment and housing initiatives involved with environmental health, even teachers. Everyone has a role to play," she explains.

Anne trained as a general practitioner in her native Leeds but has spent much of her time in Africa, where her husband, Allan, worked as an agricultural economist.

Her first experience was in Swaziland, where she spent six years as a medical officer to a mission hospital. It's a far cry from Shotley Bridge Hospital, where she's currently based, and where the wind rattles the windows of her top floor office.

"I came across huge inequalities in health. I was treating members of the royal family and the cabinet Government but I also had patients who were living in shacks," she recalls.

"It's a completely different culture and often we found ourselves in competition with the witch doctors. Sometimes people would go to them him first. If that didn't work, they would come to us and vice versa."

Between 1986 and 1989, she worked in Zimbabwe for in a clinic in Harare City Council, and it was there she first became interested in public health.

"These people were living in very deprived circumstances and there is a connection between poverty and ill health. I began to realise that there was a role working on a population basis rather than just with individuals to develop policies and programmes to address chronic and infectious diseases.

"I saw how important it was to work with others outside the health service to address the wider determinants of health such as poverty, unemployment, housing, education and transport."

In 1989, she returned to England specifically to train as a public health consultant but between 1995 and 1999, she returned to Africa, where she worked as an advisor on an EC-funded health programme in the Ministry of Health and Social Services in Namibia.

She's now settled back in England and, after a period as a public health consultant with Sunderland Teaching Primary Care Trust, she took up her post at Derwentside just before Christmas.

"I absolutely loved Africa but I'm excited to be working here too. I've only been in the job a few weeks but already, I can see it's going to be an enormous challenge but one that I'm sure I'm going to enjoy."

Since the decline of the steel and coal industries, Derwentside has been left with a series of socio-economic circumstances that have a direct effect on the health of its population. Out of the district's 23 wards, seven are among the ten per cent most deprived in the country and another 12 are in the top 30 per cent. These areas experience higher levels of ill health.

Derwentside has high levels of mental health problems and an accident rate 19 per cent higher than the national average. Figures for coronary heart disease are 40 per cent higher than the national average. Life expectancy is 74 for men and 79 for women. This is just a year below the average for England and Wales but those who live in prosperous areas, such as Chelsea, Kensington and Westminster, can expect to live for another five years.

Dr Low's responsibilities are wide-ranging, covering everything from communicable diseases and accident prevention to breast screening to smoking cessation, but her post is only part-time. In April March, she plans to start work as a GP for one day a week.

"I haven't practised as a GP since 1989 but I thought it would be a good way to get know about the issues facing people working on the front line. I do enjoy clinical medicine and although I love working in public health, one of the things I've missed is having direct contact with patients. This way, I'll be able to find out what their concerns are too.