Xand van Tulleken: 00:02

Hello, and welcome to episode four of Public Health Disrupted, the brand new podcast from UCL Health of the Public. I'm Xand van Tulleken. I'm a doctor, a writer, a TV presenter, and I'm prepared to do pretty much anything to start a conversation on public health. And I do mean anything, whether it's editing medical journals or experimenting on my body for children's television.

Xand van Tulleken: 00:23

And I'm Rochelle Burgess, a community health psychologist specializing in community based approaches to health.

Xand van Tulleken: 00:28

I'm a lecturer at the UCL Institute for Global Health and a self confessed hippie. And I'm here to

Rochelle Burgess: 00:33

talk about pretty much anything related to

Xand van Tulleken: 00:35

community, solidarity, social change, and hugs, and how important they are to public health to anyone who will listen. We're calling this podcast Public Health Disrupted because that's exactly what we want to do. We're going to be breaking down disciplinary, sectoral and geographic boundaries to really understand the diverse, complex issues impacting our health. In today's episode, we're going to be exploring the intersections of law and public health and how law and legal services can help to mitigate these health inequalities.

Rochelle Burgess: 01:07

Our first guest is Sir Keir Starmer, who has been leader of the Labour Party and opposition since 2020. Sir Keer is a former lawyer and has been member of parliament for Holborn and St. Pancreas since 2015, so is UCL's local MP. After qualifying for the bar, Keer acted as a defense lawyer specializing in human rights issues before being appointed as a queen's counsel in 2002. In 2008, he became director of public prosecutions and head of the Crown Prosecution Service, holding these roles until 2013.

Rochelle Burgess: 01:38

For his role as Director of Public Prosecutions, he was appointed Knight Commander of the Order of the Bath in 2014 New Year's Honours.

Xand van Tulleken: 01:47

Our second guest is Professor Dame Hazel Genn a Professor of Sociolegal Studies in the UCL Faculty of Laws and currently UCL Vice Provost, Advancement and International. Dame Hazel is a leading authority on access to civil and administrative justice. Her prize winning scholarship focuses on the experiences of ordinary people caught up in legal problems and the responsiveness of the justice system to the needs of citizens. In 2013 she established the UCL Faculty of Law's Centre for Access to Justice and in 2016 developed its activities into an innovative partnership with a GP practice in East London to deliver free legal advice to vulnerable patients within the practice. She regularly lectures about integrating health and community legal services, and recently published an influential article, When Law is Good for Your Health.

Xand van Tulleken: 02:37

It's lovely to have both of you with us. Hazel, the last time you and I spoke, you said that you're more interested in what the law does than what the law says, which I thought was a lovely way of capturing the kind of range and the impact of your work. First of all, can you just talk to us briefly about the ways in which law affects our health?

Hazel Genn: 03:03

It's a great question. I think it's something that's often missing from discussion when we talk about public health. I think if we think about the things that affect health and well-being, not illness, but what affects health and well-being, things like having enough money to feed your children, having a roof over your head, safe conditions to live in, safe working conditions, appropriate education, decent air to breathe, security at home and elsewhere. If you think of all of those things that actually affect our health, the law is involved in every single major determinant of health and it operates, I would say, at three different levels. And I think one of the problems is in public health we only ever talk about it at the broadest level.

Hazel Genn: 03:38

So at the broadest level, if we're thinking about legislation, so laws passed by Parliament, we pass laws that actually are designed to protect the vulnerable and needy, things to do with benefits, things to do with housing, so we have plenty of law on the books, but once you've got the law on the books that isn't the end of the story, and sadly in Public Health people forget that once you've got a law it doesn't mean that everything automatically happens, because laws have to be implemented. So at the middle range, once the law's been passed, you've got lots of institutions that have to decide how that's going to be implemented. So you may have a law that says no one should be homeless, but how does a local authority decide on their housing policies? And then at the individual level, you can say well individuals of families on low incomes should have enough money, they should be housed, they shouldn't be thrown out of their jobs, but can people get the benefits and services to which they are legally entitled? So, as I say, just having law on the books doesn't mean the vulnerable families and individuals get the protection that they need.

Hazel Genn: 04:40

So I'm not when I'm talking about the relationship between law and health, I'm not necessarily talking about public health law, like things like sugar tax and smoking laws. I'm talking about laws that create the conditions to support health more indirectly. And I think that's the bit that gets left out. And how do we make sure that those protective laws are in practice implemented properly and can be enforced at the level of an individual or families?

Xand van Tulleken: 05:08

I think you've really captured there the barriers for so many people to access, what they're entitled to. So, Keir, bearing in mind the vast impact that law does have on our health, how much is that taken into consideration when you're creating new laws? And I guess you're one of the few people in the country who is in the business of actually making laws. And if it's not taken into account very much, should it be?

Keir Starmer: 05:36

Absolutely fascinating question this, because it goes to the heart of what we actually do in Parliament, where there are very few rules and constraints on what laws we can pass if you've got a working majority in Parliament. We don't have a written constitution, which in other countries would at least put a framework around what laws you can pass. We don't have that, and so the answer to the question is health is sometimes taken into account, but not always. It depends, but there's no checklist. If you're about to pass a law, there's nobody that says, well before you vote for this we better have a discussion about health and the health implications because the law making doesn't work like that.

Keir Starmer: 06:12

Obviously in some areas it's absolutely a consideration if you're passing laws on health and safety, if you're creating the NHS or restructuring the NHS as we're apparently about to do, then health is right in the middle of the consideration. Just as it is, I mean, you know, how timely is this? We've got very very strong laws in place at the moment on Covid-nineteen that are restricting things which otherwise we would be perfectly entitled to do, and at the heart of that is health, and so it's been at the heart of the debate. But is it always at the heart of debate? No it isn't.

Keir Starmer: 06:44

Although we don't have a constitution, there's an emerging, I suppose, view that health does have to, at least severe health impacts have to be taken into account when we look at things like the Human Rights Act and this idea of where there are severe impacts on health, whether legislation actually constrains what we can do. But that's in pretty strong and extreme cases it's not a routine requirement to look at the health implications. I'm very interested just to spin on from this a number of countries have introduced a sort of well-being test for pretty well everything that they do, so they have to assess government action, local government action against well-being and the impact there on health and mental health actually. I'm fascinated by that. I think it's a step in the right direction.

Keir Starmer: 07:28

The best two examples and Hazel will know better than me probably I think New Zealand has got a Well-being Act and Wales has got a Well-being Act. And so arguably there's a move towards in The United Kingdom where well-being becomes more of a factor. The only other thing I'd say just to echo what Hazel says, which is making law is one thing, actually accessing it and making it work is another. So to take health and safety, obviously health is right in the heart of that it's a health and safety set of provisions, but how many people you have on the ground actually enforcing it makes a material difference to whether it works very well in practice. But the simple answer is yes, sometimes health is taken into account, but absent any overriding obligation, Parliament could pass legislation without regard to the health implications.

Hazel Genn: 08:14

Can I just add to that, of course, what the world should have done is to have a health in all policies measure, so that in the way that we do with Equalities Act, when we're passing legislation and we say does it meet, you know, you do an equalities impact assessment so they have a health in so they have to do a health assessment impact on all policies? And I don't think that we do anything like that and it is something worth thinking about because as we both agree, all kinds of legislation have both direct and indirect impacts on health and well-being.

Rochelle Burgess: 08:48

Yeah, I think that's so fascinating. All this discussion about the bi directional relationship and this idea of, you know, we still need to do a lot to make it work. Sort of brings me back to one of the first research projects I worked on many, many moons ago back in Canada. I did a study where we sort of did medical chart extractions, trying to look at the backgrounds of homeless men in the city that I was from, and sort of looking at their experiences of cycling between homelessness and prison experiences. And one of the things that we found in that study was that the majority of these men had histories of head injuries, actually, that sort of like predated their homelessness and then their experiences with criminal justice.

Rochelle Burgess: 09:30

And because both of you have so much rich examples from this, in the world of practice, I just wondered if maybe Hazel and then Keir could give examples of this type of phenomenon.

Hazel Genn: 09:40

I can give you an example. That was a case that we dealt with in the Health Justice Partnership that we set up in Newham, and the partnership was basically free legal advice provided by students and qualified staff to patients in the practice. And we trained the doctors to kind of recognise cases that might benefit from having some legal advice. And one of the cases, which I call Alicia and her baby, was a mother with a baby with breathing problems infections and she was repeatedly going back over and over again to the doctor. She had a sense that her living conditions might be making her child ill or worse because she was living in social housing that had terrible damp insects and, rodents.

Hazel Genn: 10:21

She'd been to the doctor several times, but when we were there on one occasion, he just thought, Hang on. And he said to her, Do you know what? You know, I can give you more medications for the baby, but I really think you should go and see these people downstairs. And of course, we were downstairs and she came down and saw us And we talked to her and then we got in touch with her local authority and we asked for a review and they reviewed her housing and they said, yes, she was living in inappropriate housing and she was re housed. And I have numerous examples like that.

Hazel Genn: 10:47

And that is a case where it shows where you may have a law that says you should be living in decent housing, but the question is, is there the implementation and does the individual know what they have to do? And even if they have a sense of what they might need to do or what they might need to move, do they have the ability to make things change? And I think sometimes you need what I call legal heft and that doesn't necessarily mean kind of very expensive qualified lawyers, just sometimes, social welfare advisors can do that if they are available, but you need those links. The critical things are there, where the doctor recognising that this was a medical issue underlying which was a problem for which there was a legal solution, and we could help with that.

Keir Starmer: 11:26

Let me go into the world of criminal law and give a couple of examples. One is a very real example that we're working on at the moment, and that is in Camden, for a number of years happily, we didn't have any fatal stabbings of young people, And then in the last three or four years, about eighteen months, two years ago, we had a number of them which were very very traumatic obviously for the immediate families but also for the communities involved. And it was young boys and I mean young, know, usually teenagers, and you know we would hear of a stabbing a young boy on the pavement dead, and Georgia Gould, the council leader, and I would go and see the family and the communities very very hard, and we decided to start a piece of work which would look more beyond the immediate policing response to the incident and more at the sort of the wider impact and how we could try to, in Camden, put our arms around this and reduce the likelihood of it happening again, and that took us into a lot of work of law and public health, and the more we went into it the more we discovered the links which I've always believed to be there.

Keir Starmer: 12:29

I think health and education and crime are all mixed up. It's one of the reasons that silos don't work. If you have criminal justice here, education there, health there, mental health there, you're probably not going to get very far with crime reduction. You've got to do it on a cross cutting. The more we went into this issue, there was this issue of trauma, and what we worked out was that both victims and perpetrators of knife crime in Camden boys not always boys but predominantly boys there was usually a trauma incident that preceded the behaviour that they got involved in.

Keir Starmer: 13:00

And sometimes it was perpetrators, sometimes it was victims, but there was trauma. And that led us to then work with our schools in Camden. Then the next question was: do our staff at our schools understand trauma in the health side of crime? Are they talking to children? Do they notice when a child appears to be traumatised because of something that has happened previously in his or her life?

Keir Starmer: 13:20

So that brought Public Health Disrupted right into not only crime but into our schools. It's been an amazing piece of work. But then, and this is linked obviously to your college, UCLH have got now an award they did have an award, whether it's still there in Covid I don't know dealing with children and young people. And what they then began to pick up, but through Red Thread and other things, which is an incredible initiative, was that they realised that they could see some of those that were victims of more serious crime coming in with lesser injuries to start with, and it was this health pathway into crime. And so we started working on that.

Keir Starmer: 13:54

So there are lots of links there. And then I think the final thing I'd like to say here, because I think it is relevant, I don't think we pay enough attention to it, is that because there are health and mental health issues, mental health runs right through the criminal justice system both perpetrators and victims, a huge impact that being a victim of crime has. And so actually I mean certainly for the criminal law, I think it pays off for the civil law as well, trying to suggest that law and health are mutually exclusive is wrong they are absolutely tied up, and I don't believe that we will ever properly reduce crime if we don't tackle the health and mental health issues.

Xand van Tulleken: 14:33

What you're describing is almost a diagnostic pathway for criminality or the determinants of criminality and also the determinants of being a victim of crime. And so in the same way in health care now, we'd say that you need a multidisciplinary team if you're trying to address the underlying causes or trying to address a particular case of criminality or being the victim of a crime, that you need multiple disciplines involved. It's such a nice description. You've talked about the perhaps slightly arbitrary way in which public health may or may not be incorporated into making legislation in parliament. What about the local level?

Xand van Tulleken: 15:12

When we think about things like housing, planning, environmental decisions, I suppose the bits of law that I maybe see materially around me in my neighbourhood affecting specific individual people, how is public health incorporated into those kind of decisions? Kier, can ask you that?

Keir Starmer: 15:29

It is, and obviously I'm not involved in the decision making of Camden Council on planning environmental, but they are making decisions and that can be in planning, it can be in the way a building is going to be put up, and these days environmental and health impacts are taken into account and quite right too. Think if you look at what, for example, Camden Council is doing, there's a wider piece of work which you see on areas like air pollution, which is an obvious public health issue. In and around Camden, the Euston Road, we've got a real air pollution problem and that has to be addressed and taken into account by the council when they're designing not only new builds and planning consent, but also how we use our roads. One of the things that Camden's been trying to do is to get as many cars off our roads as possible. That's why you see the various changes to the traffic systems etc.

Keir Starmer: 16:18

So it is I think now much more central to the council's decisions because if deaths from air pollution were recognised for what they are, they ought to be front page news in terms of the numbers of people that die from things like air pollution, but it isn't in the same way. So I think it is becoming increasingly important and central to what good local authorities like Camden do. It's interesting isn't it, this idea that increasingly the state's job is to ensure our health and our survival and kind

Xand van Tulleken: 16:48

of optimise our health. Hazel, we know that the health of lots of people is very dependent on access to particular services, particular protections like welfare benefits, community support. The legal system has obviously created those benefits and made them available in some way. But what role does it play in enforcing the services that they actually do benefit the most vulnerable? Is that a legal issue?

Hazel Genn: 17:15

It's an issue for individuals in terms of accessing services, benefits, entitlements, which the law provides them with. And the problem for the kind I'm not talking about the whole of the population, but particularly focusing on those groups who have possibly the most complex health, social needs, range of needs. Often they may not be aware of what their rights and entitlements are. Things don't always happen automatically. You need to know, you need to apply for things so people don't know necessarily what they're entitled to or what they have a legal right to.

Hazel Genn: 17:55

And even if they do, they're not always sure. Sometimes it's quite difficult to access those services or to get the thing that you actually need. So the question is, where do you go for help? And this is, we're going keep coming back to this question of kind of integrated services, because I do it's the point that Keah made before and I'm absolutely this is kind of my mission at the moment, is to get things better integrated, having much more of holistic approach to the needs of people. Getting help to the people who have the most complex needs.

Hazel Genn: 18:25

And if we care about things like health inequalities, if we care about life chances of children, you know, the life course of improving things, we need to make sure that people have those protections, access to those services at the earliest possible stage so that we avoid bad things from happening or bad things from getting worse. And what the role is of certainly free social welfare legal services, which is what I've been talking about at the moment, is to provide that kind of advice, information and support if necessary to people who don't necessarily know what their rights are and even if they have some sense of what they are, they don't know how to go about accessing the services that they need. Particularly they get kind of pushback in need initially. So they need those kinds of services and those services need not to be hidden away somewhere where you have to go and find them or queue up in the street. And this is exactly the kind of image that Keir was setting out before.

Hazel Genn: 19:22

It's these what you need a multidisciplinary sense in the places that people go. And the reason that I have focused on getting free legal advice into primary care, but also into hospitals as well, is because those are the places that people go when they don't necessarily know what it is that they need. But the problem that we've got, and we might talk about this later, is that going to those places doesn't necessarily get you to the right kind of advice.

Rochelle Burgess: 19:49

It sort of seems to me that when you enter into these spaces that we would like to see to become multidisciplinary, and you're talking about GP clinics and environments, that a lot of non medical issues are increasingly sort of accounting for a large proportion of GP consultations and sort of engagements in those spaces. I guess this question possibly is better for KIR, really. It's a thinking about how we can get the law, I suppose, better integrated within the NHS or to better support most vulnerable populations at that sort of nexus and that interface and sort of what you would see there?

Keir Starmer: 20:25

I think this is a fundamental question, Rochelle. You led us into this through the inequalities and the poverty and inequality of every sort here. And on Tuesday I was with Michael Marmot, who again is University College, in my view fantastic professor, and he's done, you know, three groundbreaking reports now: the 2010 report into health inequality, the 2020 version of the same report which was compelling in its evidence of greater inequality and the impact of what governments do on inequality. I mean without making a political argument, he's making a profound political argument about what happens if you do X rather than Y. He's now done a third report, as you know, which is the impact of Covid on the inequalities that he had been following in that decade.

Keir Starmer: 21:11

And where we go next, mean, answer your question Rochelle, is for me is informed largely and hugely by that, because as we come out of Covid now, know the vaccine I hope will be the light at the end of the tunnel and therefore we can begin to say well what do we want the future to look like post pandemic?' Is our aspiration to build back to where we started, to go back to as we were a year or eighteen months ago, which is to take us back to the scenario that is painted so vividly by Michael Marmot? Or do we say no, after this we need to go forward to something different and better and actually to conjure up something of the spirit of the post Second World War Labour government to say out of this we have to go forward. We often challenge the Prime Minister on the basis that we've got one of the worst Covid death rates in Europe and the worst recessions because of his indecision, his slowness etc, and the way he's made decisions, and I do believe that. But I think equally, if not more of a cause, is written there in the Marmot reports in the health inequalities, the public health inequalities and the structural inequalities that we've had going into this.

Keir Starmer: 22:16

We had a very very unequal framework. We had underfunding across our public services. We had a fragile health service and that has impacted. So for me, Rochelle, the answer to your question is I think there's actually a fork in the road politically now coming up in the next few months. We have to take the path which is to say you don't build back to business as usual.

Keir Starmer: 22:36

Your aspiration is not to get back to where you started as quickly as possible. Your aspiration now because all of these inequalities have been brutally exposed by this pandemic almost every existing inequality health, disproportionality across ethnic groups, housing, jobs all of

Rochelle Burgess: 22:51

them

Keir Starmer: 22:51

brutally exposed. And so we have to take the path through government, I hope, to a better and different future that actually reflects some of the broader conversation we've had this morning. Because this is going to I think this is going be the issue of our time now, is which path do we take coming out of this pandemic? It'll be a defining moment and a really really important political argument. And health and inequality are right in the heart of it, because if you don't deal with health and inequality it's not just a moral wrong, it actually means that you know the economy won't work properly.

Keir Starmer: 23:22

And it goes back to the thing about well-being. The idea that people's well-being and fulfilment in life isn't measured only in pounds and pence, it is measured in the quality, the broader quality of their lives, and health and mental health are a fundamental part of that. And I hope this becomes a central political question in the coming months.

Hazel Genn: 23:41

Can I say something on that as well? I completely agree with everything that you've said, Kear, but what I will say is that one of my criticisms of kind of discourse in public health has been an absolutely correct focus on documenting, describing health inequalities. We knew about this before COVID. We absolutely knew about it before, and I get frustrated coming in as a lawyer looking at something from the outside and coming in. I tend to get frustrated with kind of endless descriptions of the problem and what I say, partly because of the kind of person I am, is we need to get much more solutions focused.

Hazel Genn: 24:17

What do we do? And not just talking about passing another law that says we need or saying we need less inequality. It's what do we do in practical terms that will have an impact? What will work to have an impact. And I think the point you made before about this requires cross departmental collaboration.

Hazel Genn: 24:35

This is not a problem of the health service or one particular department. This requires collaboration across departmental portfolios and government is not good at working in that cross way. It's a multifaceted problem and it needs multifaceted solutions.

Keir Starmer: 24:52

The cross cutting stuff I completely agree. I mean I saw it when I was working in criminal justice. See it as a constituency MP obviously not at moment but we do walk in surgeries every Friday in Camden, where anybody who lives in Camden can come and see me with any problem that they want help with. 50% of the cases that come are housing overcrowded housing where you've got mum dad and two or three children in a one or two bedroom flat and the children are growing up, and that is a health issue in terms of the living conditions. Very quickly accelerates into an education issue because by the time the child is at secondary school you can almost guarantee that mum or dad is going to come with a letter from the school saying that their son or daughter is now failing at school because they've got nowhere at home to do meaningful work or homework or anything like that.

Keir Starmer: 25:38

It then accelerates into a criminal justice issue because particularly for teenage boys, if you've got three teenage boys and one bedroom, it's intolerable and they go outside and they will then go and accumulate in groups outside on the streets, in squares, in parks, because they can't bear to be cooped up inside a tiny flat, and the next thing you know the code that binds them is not anymore what the rules are at home, but what the rules are on the street, for want of a better word, or in the park or whatever it may be, and suddenly then there's an operation and then you get into health and mental health issues that I was describing earlier. And so the cross cutting is absolutely crucial to this, and it's very hard to see how I can deliver meaningful change without cracking that. It's not the only thing, of course, but it is a huge issue in terms of seeing that link up.

Rochelle Burgess: 26:26

I think you're both alluding to sort of this vision of a future that makes me feel really excited. And I guess a sort of as a question as we sort of come to the end would be a bit more detail on what that vision is. What does the future really look like if we're going to be dealing with these interacting factors and trying to do this cross disciplinary approach between law and health and education, and bringing it all together, what does that look like tangibly? Is it more surgeries? Is it what does it look like?

Keir Starmer: 26:55

Firstly, it has to be a sort of steely determination that that's what we want to achieve. And to be absolutely clear about that, and be realistic about how long that will take and some of the bold steps are going be needed along the way. You do need cross cutting we've already discussed that. You need an economy that works for people. I mean think there are three pillars to this.

Keir Starmer: 27:14

This is very broad term, so just bear with me. The first pillar is zero to 18. If you haven't taken action at ages zero to 18 to deal with inequality, then the chances 18 onwards of doing it are pretty minimal, and that is about brilliant education of course, but also the other stuff that goes around at Sure Start, youth centres etc etc. So that's pillar one. Pillar two is then what happens at work and poor pay and conditions, low expectations, short term economy with low standards builds in inequalities and health and mental health issues, and that is wrong in fundamental terms.

Keir Starmer: 27:51

It's also counterproductive and it's not a good functioning economy, so that needs to be fixed. And then you've got your third pillar which is what happens in older age: a security and dignity for older people, and then you tie that up with issues like social care. All of that has to come together. I actually think the biggest change in our country and I'm looking through the lens of the Labour Party now, so you'll have to forgive me and take it as coming from the leader of the Labour Party I think the Labour Party is at its best when it sees the future and says things can be different. And we don't do that that often.

Keir Starmer: 28:21

We did it in 'forty five, where we were saying if you vote Labour things are really going to change, and this is what it's going to look like. Wilson did it in the 60s with white heated technology. He was saying things are changing and Blair did it in 1997 with different change. I think our challenge now is to present that future, that mission rather than a vision, I think. And that actually does involve, coming bringing it back public health, having a proper appreciation of what the future economy, what the future really looks like, because you know the Turing Centre is just over the road and up the way at King's Cross course from where you are now, which is the centre where they're developing big data.

Keir Starmer: 28:57

I was fascinated when I went there with what they told me you could do with big data for health prevention in terms of to take the strain off your NHS. One way to do it is to grasp the future and understand how big data tech can play a real part in that. So there's a lot of moving parts in this, but I think that with the appropriate changes we could really make significant change, but we're not going to do it by tinkering around the edges.

Hazel Genn: 29:22

I'm thinking of this in more narrow in narrower terms, so what I want to reinforce is the fact that we need to look at people as a whole, particularly of our kind of target groups, the people that we're trying to help, thinking about, Kirst's point, the life course. Think about people as a whole, the life course, the journey that they might be on and say, you know, how do we deal with this at the earliest possible stage to get people on a better course, to get people out of these cycles of deprivation that we see? And I think, this is just repeating what we said, we need cross departmental willingness, determination to do this. We need integrated service delivery. I'm talking about integration of health and social welfare legal services, but we need integrated service delivery in general and a better integration of our public services that look at people and families rather than this is the, you know, this is the job, this is the policy of this department for the next five years, you know, which actually isn't doing it.

Hazel Genn: 30:16

You've got lots of departments doing things in their silos. So, in an integration of service delivery and in the health field that needs to be across primary care, midwifery, A and E, all of those acute care. I also think in health we need social welfare legal services actually integrated into care pathways. So, you know, Macmillan in Cancer Care, has advice about kind of employment rights and things in Care Pathways. We're doing something with dementia rare dementia cases.

Hazel Genn: 30:46

It's that you're thinking when people are ill, aside from the medicines they need, what are the other things that they need? They need these other bits of support that are part of that care pathway, which I think again is just reflecting the idea of integration.

Xand van Tulleken: 30:59

I couldn't agree more. Between the two of you, you've captured the kind of the big picture and the real nuts and bolts of of of what needs to change. We ask everyone who comes on the podcast because we want to disrupt thinking in public health. There are multiple ways into that. Is there what we've called an artifact, a piece of art or music or poetry or a particular event in your life, a particular object maybe?

Xand van Tulleken: 31:25

Is there something that you rely on to keep your perspective disrupted, to shake you up, or to inspire you when you're thinking about these hefty issues? Keir?

Keir Starmer: 31:35

This is not a long term thing. It's not something I've had in the back, but there was something yesterday that really struck me. Because I went to Heathrow to look at the operation at Heathrow Airport. One thing again really really interesting that I've been struck by in this pandemic by the way is the emotional reaction of going to places you haven't been for a long time which you associate with something you're not at the moment allowed to do. And so going to an airport and I had to take my passport in my pocket in order to get airside.

Keir Starmer: 31:59

So arriving at Heathrow, which normally connotes going away traveling and so on, the emotion of seeing the place but of course not being allowed to travel. But what I saw there, just to come back to the question, was the sculpture by Richard Wilson which is called Slipstream. Yes. And so I'm arriving at an airport. There's a piece of sculpture there which it was said was going to be the most viewed sculpture in the world because of the 20,000,000 people going through Heathrow every year, and nobody's going through.

Keir Starmer: 32:25

So they've got this talk about disrupting your thinking, you know, is there, that it's seen by millions of people, but nobody can go past it because or not many people can go past it. You know it's in the middle of a pandemic when a slipstream to an aeroplane, where most aeroplanes are not causing a slipstream because of the pandemic, they're grounded and if anything disrupts us, it's the position we're enough. Because when I saw this question I thought well, you know, the easy thing is to just identify something I've always liked, but actually and that really it did disrupt because I thought, well there's something that on its own terms is being challenged. It's a slipstream of an aeroplane which is grounded, supposed to be seen by millions of people at an airport where nobody's currently going. And it was just the emotion of being there that did actually disrupt my thinking.

Keir Starmer: 33:08

I

Xand van Tulleken: 33:09

love that. It totally changes the meaning of that piece of art. Yeah. Hazel, what about you?

Hazel Genn: 33:14

Actually, I really struggled with this, but then I came up with something which actually has been very valuable during COVID. A few years ago, was quite ill, and I was reading some books about coping with that. I'm not a very zen person, believe me, and I came across some kind of zen ideas. What they say is that most human suffering comes from endlessly wishing that things were other than they are, other than they were. Well, I think we didn't always wish that things were other than they were.

Hazel Genn: 33:40

We wouldn't have progress, know, we'd probably still be, I don't know, living in caves or something. But actually, it is quite helpful in different situations to stop wishing that things that were other than they are when you can't do anything about it, and focus on the now and be grateful for what you have. And I did at that time and it actually did change, it flipped the way I was thinking and I found that extremely helpful at that point. And actually through Covid, you know, when you wake up and you think, oh my god, another day and I can't, and you think, well actually, what can I do? What can I do?

Hazel Genn: 34:07

What can I take pleasure in? And I think, actually, this is something that lots of people have found that we have re found, and I'm gonna sound really folksy, but, you know, we have re found some simple pleasures.

Rochelle Burgess: 34:18

I think that's beautiful. I I think that was perfect.

Xand van Tulleken: 34:21

Thank you so much both for giving that particular question so much thought.

Rochelle Burgess: 34:30

You've been listening to Public Health Disrupted. This episode was presented by me, Rochelle Burgess and Xand van Tulleken, produced by UCL Health of the Public and edited by Carys Bradley. Our guests today were Sir Keir Starmer.

Xand van Tulleken: 34:42

And Professor Dame Hazel Genn. If you'd like to hear more of these podcasts from UCL Health of the Public, subscribe wherever you download your podcasts or visit www.ucl.ac.uk/healthofpublicslash. This podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights, and expertise through events, digital content, and activities that are open to everyone.