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Talk 200 is a new lecture and podcast series from The University of Manchester, launching to mark our bicentenary: 200 years of making a difference.
This year we’re reflecting on our past, celebrating our present and looking to the future – and Talk 200 invites listeners to be part of the journey.
Our podcast host, Manchester aficionado, author, and University alumnus Andy Spinoza will be joined by a diverse line-up of guests from our community – pioneering academics and notable figures, inspiring staff, alumni and students – to discuss topics such as health, digital and AI, climate change, and equality and justice.
Hello and welcome to Talk 200, a lecture and podcast series to celebrate The University of Manchester's bicentenary year. Our 200th anniversary is a time to celebrate 200 years of learning, innovation, and research. 200 years of our incredible people and community, 200 years of global influence. In this series you'll be hearing from some of the nation's foremost scientists, thinkers, and social commentators, plus many other voices from across our University community as we explore the big topics affecting us all.
In this bonus content to accompany the first episode of Talk 200, you�ll hear the full panel discussion that followed Professor Sir Chris Whitty�s live lecture titled �Health inequalities, past, present and future�.
If you haven�t seen Professor Whitty�s lecture yet, head to manchester.ac.uk/talk200 to watch the full talk, along with the accompanying slides, as he discusses the main drivers of inequalities and disparities in health, how these have changed over time, and why addressing them remains a major public health priority.
Continue listening to hear from our panel of experts, chaired by the University�s President and Vice-Chancellor Professor Dame Nancy Rothwell, as they continue the discussion with Professor Whitty.
Thank you very much Chris. I loved the way you brought Manchester into so many of the discussions, very nicely done, but can I, um, first of all invite the other panellists to just introduce themselves briefly. Nicky. Hi everyone. I'm Nicky Cullum. I am Professor of Nursing here at the University, and leading for the University on health inequalities at the moment, which is a major strategic imperative for the University. Jane. I'm Jane Pilkington. Good evening everybody. I'm Director of Population Health for NHS GM. Great, so I'm going to ask a few questions, and then you can be thinking of your questions to follow up in a few minutes. And the first one I'm, I'm going to address to Chris. But first of all, I have to remind you again, if you're online you can go to ww.slido.com and then enter the # Talk200ChrisWhitty. But Chris, we all saw you very regularly on the television during covid. What should we be doing now to prepare for another pandemic, because surely there is likely to be one? So, I think what we shouldn't be doing, is trying to write a plan for the next pandemic. Because, if you think about the last really serious one we had - it was HIV. Different age group, 100% mortality in those who had it, completely different routes of transmission, etc.
So, the idea you can just take a plan off the shelf clearly is incorrect. What we do need to do is have the building blocks ready to address almost any major infectious outbreak. We can have, we will continue to have them for the rest of time. They'll go down different routes of transmission. Some will be oral, some of them will be respiratory, some will be sexual, some will be vector, and so on. But, I also think what we saw really clearly, and I hope that came across in one of the slides I showed earlier on, is a concentration of the worst impacts of covid in areas of deprivation, as has happened with virtually every other infection previously. And what was really clear, and it is, it is a real problem, is that we are not being effective at engaging with certain communities living in deprivation across the board. Not just on infectious diseases, vaccines, and so on, but also on cardiovascular disease, also on mental health, also on, maternal services, and so on. So, we must make much more effort, I think, to engage with communities. And keep that engagement going, rather than just starting to pay attention when a crisis hits. I think they rightly felt that we, in a sense, only woke up to the problems they were facing when there was a crisis. And that isn't, that isn't correct. And I'm sure you've seen the graphs. For example in Greater Manchester, the vaccination rates map precisely onto areas of deprivation. And, and public trust is a big thing. So, Jane, can I just ask you in what way have, in your opinion, healthcare systems adapted, or failed to adapt, to challenges posed by health inequalities? What, what can we do about it? I think, um, health care systems could, and should, do more. However, I do think that integrated care systems are a major step forward really. For the first time, integrated care partnership boards have a statute duty to address health inequalities alongside their functions for population health and promoting social and economic development. And I think the place-based nature of integrated care systems mean that they have to work across traditional health boundaries, but also with non-health partners, and that means that they can focus, not just on inequalities and access to health care, but also actually the drivers of ill health and the wider determinants. And that's really true where you've got, um, mayoral combined authorities, like we have in GM, because we have more of a hand on the levers of the causes of ill health, whether that's transport or housing, etc. But, I think, if I was thinking about reform, the three things I think are really important, I think endurance is one. Health inequalities - it's a really long-term endeavour, and it needs to go beyond kind of political attention spans and planning cycles and leadership tenures. We need to focus on the long term and we need to think about action in in the short, medium and longer term. And we also need to be really clear about what does success look like, and how are we going to measure it. I think my second point would be around partnership approaches. No one agency or sector can do this. It's got to be a multi-agency effort, and we need to do a lot more really to develop the contribution of our communities around that. And then, finally, I guess, for me, a point about disruption if we want, um, upstream healthcare to be a mainstream model for us. And that's really important, you know, if you look at GM, 1.1 million of our population, or four in 10 of our population, live in the most deprived quintiles that you were describing earlier, Chris. Which means we need our health system to respond to their needs properly. So, we need universal health care, but proportionate and targeted to need. And that means a real shift in what the NHS prioritises, values and regulates. And, if we want to hardwire health inequalities and take it seriously in our system, we need to think about endurance, partnership and disruption. Thank you. Nicky, I mean, obviously, a lot of this rests on health service, public health, etc. But what role can we, as an academic institution, or any academic institution, pay in alleviating health inequalities? And this is your day job, so it should be an easy one for you. Well, I think Chris made some really brilliant points far more eloquently than I can in his lecture actually, and some of that's about schools, as academic institutions, and some of it's about universities and, and colleges, I think, actually. So, increasingly we've heard about the, um problems that children and young people have with mental health and wellbeing, and I think schools probably play an important role in identifying that, in spotting that. And we have a major research programme here, based at the University, called BeeWell, which some of you are probably involved with, which is about working with school-age children to really start to understand, on, on a cross-sectional and a longitudinal basis, what are the things that are driving their happiness and their unhappiness and co-designing with them interventions to alleviate some of that. So we've got to understand it better, and that's exactly what, what Chris said in in his talk. So, I think they've got a role in, in sort of some data-driven insights which universities can, and are, helping with, I think. In terms of universities, I think, obviously, we've got a major research role to better understand some of the root causes to better work with, for example, our ICS's, and, you know, help them with identifying what are the best evidence-based policies for early detection, prevention, secondary prevention, and help support those kind of policies in terms of roll out. But obviously, the universities have also got a major role in education and training healthcare professionals. But also, I think, our wider student body in understanding the factors which underpin unfairness and inequalities in society and understanding the more under-served groups and communities and what they need to be supported with in order to be more fully engaged with wider society in health and education. So, I think one of the things that makes me really proud about working at The University of Manchester is the civic responsibility, the social responsibility agenda. And I think we're probably at the beginning of a journey for that really, which is about engaging the wider communities in everything we do, whether it's education or research, or health research. And, by doing more of that, I think it's part of the way in which we can reduce unfairness and inequality. So, I mean, this could be to any of you. Are there health systems around the world that we can learn from, that do it better? I mean, there are many countries without a National Health Service. Some are good. Can we, can we learn from other places? I don't know who wants to answer that. Chris, you must have looked at quite a few internationally, but anybody else can do. I think, I mean, we learn most from countries that do things very differently to us. Or countries that are very similar to us, and doing/taking a different line. So I watch what happens in Scotland, for example, because it's very similar. I'm also very interested in what happens in East Asia and Latin America because they have a completely different approach. And, many of the things that we've learnt, I think, from those countries are, are things which you just think, I wouldn't have thought of that, from first principles, at all, it just doesn't follow the line we're going for. So, those two seem to be the ones we go... There is no single group, country you can look at and say, �this is, this is the answer�. There are many countries that have got particular components that they do very well, including many low- and middle-income countries, which actually address, for example, community provision of healthcare, often in an extremely imaginative way. And, I think we, we should learn from them, as well as learn from high-income countries, which look more obviously our peers, in terms of the, the ability of the health service to respond. So, I think there is a lot to learn. But there isn't a country we can say, �if only we were�... So, any, anybody might want to answer this question as well. Do you think we need to redesign the way we train our health care professionals? I mean, Nicky, you trained as a nurse and I'm not sure what you trained in Jane. Public health, public health as well. Both in public health. Do we need a different sort of health education system to the one we have now? Well, I don't know about the different education systems. We certainly need a system that makes it more attractive for people to come into these professions, and stay in the professions. I think one of the massive, um, challenges we face is a workforce issue across healthcare, and one of the reasons why we absolutely do, I think, need to learn much more from low- and middle-income countries in how we deliver prevention to broader sections of the community, without lots and lots of healthcare professionals. Yeah both of you. Go, go ahead Jane. Can I just add into that. I think, um, I speak to our provider organisations quite a lot, and they're really keen to say �How can we get a skills escalator and local employment pathways so that we make these careers attractive?�. But, we're growing our own, and I think that would, would really help reduce health inequalities. And we need a workforce that is literate in health equity and is fit for the future and can actually deliver services. And, and, you know, work with those communities that we, that we need to work with. Because it's in those communities, at hyperlocal level, where we're going to make the difference. Yeah Chris. I think over my professional lifetime training, all the way through, the system has become more and more regimented and less flexible. That is completely the wrong way to go and I think we should be maintaining flexibility for people around their careers and also maintaining generalist skills, because multimorbidity will only be tackled if we move away from just saying everyone has to be a specialist. You, you can be a specialist and a generalist at the same time and we should celebrate both, but I really think bringing back flexibility to the training system would have multiple benefits. We've talked obviously a little bit about the healthcare system, about universities. What role do you feel that industry can play in this? I mean obviously, in terms of funding and development of new treatments, but actually in their workforces removing health inequality in the workforce. Do we engage with industry enough? I think we are, we've got some good, kind of, private and public partnerships. I mean Health Innovation Manchester is a key part of how we're working, isn't it. And I think those cross-sector partnerships are essential to bringing that additional capacity, the expertise and innovative thinking. And I think if we go back to covid, the kind of partnerships we had with industry there, and the rapid innovation we had in developments of the covid vaccine, its roll out, were incredible. And I think we need to kind of make sure that we sweat that asset and really, you know, we have, we have that capacity building and that knowledge exchange that is really important if we want to be cutting-edge in Greater Manchester and beyond. Chris. Yeah, I think that, leaving aside the ones where it's really obvious, like pharma, and so on, I think there are two groups, bits of industry, that we really, industry in the broadest sense, that we don't engage with as much as we should� The first is engineering, in the broadest sense of that term. If you look at most of early public health - it was engineering-driven. If you want good housing, if you want people to be able to exercise, if you want people to have clean water, and so on - it's engineers. But it's also the way they think through problems, and they have a different approach to people trained in biomedicine. And it is extremely powerful. And actually learning from them and their approach to thinking. And I think universities like Manchester, which have both, strength in both, are in a very strong position. The other way is that, you know most people will live, will work in a private sector environment for 40 years of their life and we've been incredibly unimaginative about using that time to promote health and decrease the chances that long-term ill health occurs. We've been very good at stopping accidents at work and occupational diseases. That's been a phenomenal response. Moderately good at dealing with people who�ve got a fixed form of disability. It's not great, but it's better than it was. But there's, you know, using it as health promotion, dealing with people in a way that allows them to continue a career if they have relapsing, remitting conditions. I think we�ve got a long way to go on that. And I think we really need to have a proper rethink of it. And what role, we know there is already a big role, do we see as digital and AI in helping with the future of health and health inequalities? And along with that goes a big issue of public trust. You know, I had the scary figure that 43% of the population of Greater Manchester are not fully able to use healthcare apps or GPs, and so on. I'm very confident that younger members of your University are using AI a lot more than you are. Absolutely I could, I could absolutely not disagree with that. But we know there are big parts of the community, particularly the older parts, who are completely digitally illiterate. Well, AI is going to transform diagnostic radiology, for example. I think it'll transform diagnostic pathology, for example. Slightly, slightly slower time. Some of the claims for AI, I think, are exaggerated, so no doubt about it. But as an ability to actually support us in what we're trying to do, I think it does have a major role. And I think we currently use it rather cautiously in education. And I think it will have quite a big role in helping people to learn things who aren't necessarily going through formal university, but actually could learn skills which are relevant to health and social care. So, I think there's a lot positively we can do. Of course, all the caveats need to be put underneath that. Yeah we do have, have quite a large and very eminent group in digital trust and we're now looking at broadening that into digital trust and cybersecurity and safety of online data, which I think is going to be a big issue for the future. Well, I'm, I mean, I think, one of the challenges is access to data for research purposes and for using it for doing research with routinely-available data that can then improve health overall. I think things are moving quite fast, in that, in that space. It's still painfully slow, I would say. So the quicker that we can make that smoother, the better. When, when we've done some research here in the past on trust though, people were quite well, people were� We did a citizens� jury and people's decisions about which organisations they would trust with their health data were quite nuanced actually. Or were not equal. So I think there is, you know, yeah there's, there's a job to be done, I think. And also, I mean, one of the things� We all criticize it, but, what is probably a huge and underused asset, is our National Health Service and the data within it. We still haven't really cracked the use of that. When you look at us, you know many companies in the States want to come in here and use our data because they just don't have it. So, Jane you wanted to� I mean, I do think that's one of the important things - is think about a knowledge power NHS so that actually all the data we're gathering around individuals and their interventions, that we're putting that to good use in terms of learning. And I think we do have, we now have a very good longitudinal data set and some, an advanced data science platform, so we've got some unique data architecture here that I think will be really attractive to industry and to researchers around what is possible in terms of understanding patients over a long time. We've got a lot of linked data that would enable us to really, really do some amazing research. Chris, yeah I completely agree with that. We need it for patient management we need it to help make the system better, and we need it for research. But we must take the public with us, and it's absolutely essential that we maintain trust, maintain openness, except when things go wrong, all of those things, because if we don't do that, we'll go ahead of where the public are and then we'll end up with disasters. So, I'm going to open up to the audience in a minute to ask questions, but first I have one question I have to ask each of you - and it's called a golden thread question because it's going to be included across all of our lectures and podcast series - which is what do you hope our third Century will bring us, The University of Manchester, in this area? Who wants to start? I'll go, if I don't go first they'll say the things I do. All right, go on then quick, get in quick. So, well, well I think it's got to be much more about breaking down the walls of the university and being much more part of the community that surrounds us for educational purposes, in a very holistic, broad sense, as well as doing research with our citizens, not on our citizens. So, I think it's, I mean we are a fantastically um civic-minded university, but I think we should take, make a step change in taking that further. So Jane, is Nicky taking your answer? No. So, I think I would value it if we had um a nation where health was really valued as a primary asset for driving the economy and driving happiness, and that we had a preventative state that was foundational so that we're really investing in communities and that the community infrastructure I think that's been lost over time, in terms of we've got very transactional public services now, I think we need a prevention first NHS that's people powered and knowledge powered. And also health promoting environments where we�re using our policies to drive making the healthier choice, the easier choice. Yeah. Chris. Well, I hope that when a CMO in 100 years gives a talk in your 300th year, they'll be able to say this is the century in which we got rid of the great, great majority, if not all, of the diseases of premature mortality, 75, including in the areas of deprivation, that we took away the, the risks and dangers, of many of the treatments for things like cancer that we�ve got at the moment. We�re beginning to see a direction of travel, but there's a long way to go. But above all that, we had shrunk the period of morbidity, not extended it, by the work we've done. And if we'd achieved that, I think we could look back on what we did with some pride. Although, of course, by then we'd be dead, so we wouldn't know. But, you know, the principle is there. Thank you and, and one of the things we've touched on, but not really focused on, is the massive economic impact. I mean I think it was one of your colleagues who calculated, it was Luke, where's Luke, who calculated a third of the gap in productivity between the north and the south is poor health, which is shocking actually. So, aside from wellbeing, and what's socially correct, and all the rest of it, we could dramatically improve the economy of the weaker parts of the country. I'm going to now open up for questions. Can you wait, Matthew and then Aravind� I'm Matthew Moth from The University of Manchester. It, it was really just picking up on the conversation around digital innovation and taking people with you. But it's two aspects to it. There's been a lot of talk about the impact it might have, positive impact it might have on health system reform. But also whether you could talk a little bit more about that, but also on disease prevention. You mentioned it, but that feels like a massive area of opportunity, thank you.
They're having an internal debate here by the way. Once we�ve decided... I'll go first, but I'll be brief. I think we saw in covid a loosening of the rules because we had to. It allowed an acceleration of what we were able to pick up in terms of risk factors for disease, then treatments for disease, then prevention of disease with vaccines. And it also allowed us to learn a lot about the interactions of other diseases that was extraordinary. And I don't think anybody felt that their privacy was being eroded, that they were being done down by this. We need to get that balance right, but it was a demonstration of what we can achieve. And I don't think we should go back to where we were previously because there are so many other diseases, particularly in areas of deprivation, we're getting indirect data, maybe the best data we'll get, to allow us to focus our aims to reduce avoidable mortality and morbidity, particularly in younger age. A big thing that we're focusing on in 24/25 in Greater Manchester is our approach to population health management and particularly important in that is the digital tools that we've been developing around CVD need, and also around risk stratification which Nicky was just talking about then. And they're incredibly important in terms of understanding our need, where it is, and really developing person-centred care that addresses health inequalities and targets resources and effort where it needs to be. So, I think that's going to be a massive focus for us in 24/25. And, of course, one of the areas where digital is already developing some amazing tools is in predicting or diagnosing mental health issues. You know, just a simple video can often� And that, and given it's prevalent in the younger people who are much more digitally literate then that, might be a very big breakthrough. You know, it only takes one, and we know that in dementia you can track it very carefully. So, I think Aravind, you had a question. Thanks. Professor Whitty, you mentioned this very briefly in one of your slides, but for everybody on the panel could you say a bit more about diet and lifestyle. You know, active versus sedentary lifestyles and how that could correlate to health outcomes because naively that may not be such a linear correlation to deprivation.
Okay, I'll go first because you're pointing at me. But I think, I think there are two separate things - diet and exercise are two separate things - and I think we shouldn't fall into the trap of thinking that exercise can undo the effects of an unhealthy diet. It can't. It has, it has a huge risk reduction of multiple diseases of its own, and anybody who goes to areas which are in areas of deprivation will see that getting safe exercise for children, for elderly people, and so on, is harder. That's just a practical reality. It is harder. It is also, often interestingly, harder in rural areas. They look as if you should be able to get out there, but the first mile, there won't be a pavement along the road. You just, if you're not a young person who can leap onto the bank when the car comes around the corner, you actually can have no access to this. So, I think that exercise does tend to correlate with deprivation to some degree. But the dietary problems are much greater. And we have not worked out a way, anywhere in the world in my view, or certainly anywhere in the western world, of identifying how we can have people have a diet that they are enjoying they're having, they're satiated by the diet and they're enjoying it. And a diet that doesn't lead to obesity when they're having to do it on very, very small incomes. And this is really problematic. And I think this is really the key to those shocking data, where the graph showing a gradient of obesity we have to find, kind of, a way of making it affordable and attractive if we are actually to try and reverse this trend. And I don't think we've got a good, a path to this at this point in time. Jane. And, and you might also want to comment on government intervention, you know, taxes on sugar, taxes on fat, whatever, which. I actually think, when you get into the lifestyle factors of alcohol and obesity, that actually is those population level interventions that are really, really important and I think we need a stronger state, and regulation around some of those things. And, you know, childhood obesity is a disease of deprivation. It is very much about the environment and the commercial determinance, and again, I think there's a lot more we need to do around commercial determinants at a national level but also supporting what we can do at a city regional level. And we're doing some work at the moment around restricting junk food advertising. We did some work with our UCA around the advertising that were, that they were exposed to on their way to school. And it's absolutely, kind of, significant. And we can't expect young people to, kind of, want to eat healthier things when they're so exposed to that in their day-to-day environment. So for me, when you're looking at those lifestyle issues we need to think a lot more about what we can do at a population level, and policy and regulation. We haven't even touched on the crisis in dental at the moment, which is multiple, but a very big one, I think. I can see Ashley waving from the back. Is that you Ashley? Yes, it is. Thank you. Hello, so I'm a respiratory physician and I've, in my working career, seen the enormous benefits from reduction in tobacco and, and the related diseases. And part of that's been the prescription of nicotine replacement therapy. And so, we get into a good place with that, but of course now we see uncontrolled use of nicotine therapies. What nicotine vapes, for example, which is giving us a whole new generation of addiction, I think. And I just wondered what the panel thought, especially Professor Whitty, I think, about the balance of benefits here. It's quite, it's not a straightforward� It seems to me it's not straightforward. Thank you, thank you. Well, I mean, I obviously� The absolute ideal is to get to a position where nobody's smoking. And the smoke-free generation will do that over time, we hope. But obviously, it doesn't help people who are smoking now, I think. You know, my summary of it has always been: if you smoke, vape; if you don't smoke, don't vape. And advertising to children is utterly unacceptable. That's the summary. The problem we have is that the vape industry, which was sort of allowed through the door because it is useful to help some smokers who are addicted to nicotine come off smoking, it's a very strong step in the right direction, then chance their arm and extended it out and did exactly what the cigarette industry did - started advertising firstly covertly, and then blatantly to children and to young people to try and get people who are not smokers addicted on nicotine by using colours, flavours, free samples, and so on, all these marketing techniques. So, I think there's a bill coming to Parliament at the moment. I very, I consider it a very major step in the right direction. I don't think it's a panacea. I very much hope that people of all political parties will support it. The public overwhelmingly support both stopping smoking and restricting, very heavily, vaping. And I think we just need to take on the bogus argument that, somehow, being in favour of something which is highly addictive, heavily marketed at children, and then kills them, is somehow pro-choice. That is an unacceptable illogicality, given the extraordinary damage that causes. But I do think that we need to restrict the, the vaping. And what's been interesting to me, when I see this debate, is that people who come from a child health point of view, like the Royal College of Paediatrics, would essentially like to ban everything, pretty well, and those who come from a trying to help smokers to stop, do want to have a range of options to help people stop something which they don't want to do. Their choice has been taken away from them, they're now nicotine-addicted, and this allows them a way off. And getting the balance right between that, will probably take some adjusting. And for that reason, in the bill that's going to Parliament, it's done as, it�s taken as powers. What that means is we can, kind, of sense, dial it up or down, depending on whether we think we've overdone it, or not gone far enough. That's a shortish answer to an important question. But I do think we need to avoid a situation where we go back to arguing about vaping when actually the big prize is getting rid of smoking. That is the number one priority, and we mustn't allow anything to stand in that way. Thank you. I think we've got a question on Slido, have we?
Thank you. Yes, we've got a few questions on Slido that have received a number of up votes. And one of the most popular has been asked by Tom Spate, who has asked the following - British Heart Foundation analysis shows that we have the highest under-75 mortality of coronary heart disease in over a decade. Have we lost progress on previous successes? Who wants to answer that? Jane. I think CVD has been a success story in terms of what we've achieved, but I think some of that has stalled over recent time and we do need to� I think particularly the pandemic has maybe slowed some of our progress and we've gone backwards in terms of our healthy life expectancy, etc. So, I think, we do need to regroup around how we can really get the targeted support out there to people who need it and use some of those things we talked about before, the tools, etc, to really drive more person-centred care to deliver it where, where people need it. So, I think there's a very strong evidence space around CVD and we know what we can do in terms of if we optimise our treatment of high blood pressure and lipids, etc, we can deliver a lot. And that's the kind of thing that we are looking at in Greater Manchester. In our, in our, in GM for next year, is really focusing on CVD prevention and what we can do. Because the evidence base is so strong. And so, that's going to be a really key focus for our total system across primary and secondary care next year. Do you want to add anything? I mean, I mean, I completely agree. We have gone backwards. Not a huge distance, but we shouldn't be going backwards. We should be going forwards. In a sense, I think the first thing we need to do is get back to where we were just pre-pandemic. Getting the primary prevention obviously in place, but the secondary prevention - identifying people with risk factors, addressing those risk factors, and early treatment for those who need it. And both of those have been eroded during covid for entirely predictable reasons really. But then we should also accept that there's still, there was pre-pandemic an enormous burden of avoidable heart disease in populations we were not getting to. And I think this is where, to go back to the point that Nicky and others have made, we need to re-engage with those communities. Because they weren't being engaged for secondary prevention, they weren't being engaged for, indeed, trying to reduce down the societal risk, risks of cardiovascular disease. And, I think, we know where they are. We really must re-double our efforts to engage them in the longer term. Because otherwise, we're going to, kind of, reach a plateau where we know what to do when people are wealthy and they engage in the health service, but we leave a large group of people unengaged and therefore suffering premature mortality that is entirely avoidable.
Another Slido question. Thank you. And another popular question online has come from an anonymous member who's asked how does ethnicity impact on health inequalities and what can be done to deal with this issue, especially in multicultural Manchester? I don't want to hog all the questions, but OK right, yeah, OK fine. Well, within ethnicity it's important to differentiate the effects on ethnic minority groups due to deprivation, where it's simply that there's a concentration of people in certain ethnic minority groups in areas of deprivation, and the things which are biologically associated with having a particular heritage. And, almost every ethnic group has certain things they're more likely to have, and certain things they're less likely to have. For example, people born, who are UK white heritage are more likely to have certain genetic conditions than some of the other groups, of which cystic fibrosis would be a fairly clear one. People of Asian heritage, South Asian heritage, will often have higher rates of diabetes, all other things being equal, at an earlier stage. But a very large amount of the ethnic differences we see in the UK are not that, they are actually a proxy for deprivation, and concentration of deprivation, and we should see it as something where we've really got to tackle the deprivation and that is the principal way in which we will address many of these problems. Jane. I had the privilege of leading the vaccination efforts in Greater Manchester during the covid pandemic and ethnicity was, was a key factor both in mortality around covid, but also in terms of uptake in terms of vaccination. And I think we learned a lot about how we need to co-produce solutions with the, with the community. We need trusted faces, spaces and voices. And we need very different models of, um, provision that reach out and are hyper local for, for some of these, for some of our groups. And we need culturally-appropriate services. So I think we've learned a lot about what we need to do and we've developed our thinking. However, I do think we need to make sure that some of our commissioning and contracting allows us to deliver these different approaches that we learned so much about during the pandemic. I feel we've gone backwards a little bit on that.
Do one more, on Slido. Thank you. Yes. Another question that's come through, just come through from an anonymous member of our online audience has asked a covid-related question. And they've asked - Did Manchester having a devolved healthcare system, have an impact on the city's response to covid-19? That's one for you Jane isn't it, maybe Nicky. Yeah. Yeah, so, I think, I think because we've got such well well-established partnership arrangements, I think we were very, we were more able to, kind of, mobilise a whole system effort - both in terms of the governance we set up and the leadership, and also in terms of how we used our resources. So, I think we were quite agile then in terms of our response and making sure we were corralling all our system resources together. So, I definitely saw that, I definitely saw that difference in terms of how we responded in Greater Manchester on the issue. So, I think, it did make a difference. But the deprivation meant some of the outcomes were worse, so� It definitely counted. Yeah, it did it did make it harder, and there was a lot of challenges to face. But I think we were able to respond quite well. I think. But also we should remember that Manchester closed down in the second wave earlier than almost anywhere else. It was from the October in the second wave, which was much longer than other parts of the country. And that had all sorts of knock-on effects for the economy, and for children, and all the rest of it, so. Um, yes I'll take one more question. Hi. Hi. So, um, I�m thinking about health inequalities, past, present, and future, and thinking about a future of climate change and that impact on health inequalities. Is there any comments from the panel on how we can try and um address those two things together? Hmm, interesting one. Climate change and health inequality. Gosh, well around the world it's going to be tough. I mean there's a whole huge research agenda there isn't, isn't there that we, I know we're grappling with, as are hopefully lots of other people. And the funders are seeing the importance of it as well. A lot of things a lot things that drive health inequalities also drives the climate change crisis, and a lot of the answers are the same. So again, one of the things we've done in Greater Manchester, in our fairer health for all approach, is actually combine the two ambitions, really. Sustainability and our inequalities agenda go hand-in-hand. Yeah, and I think, there's an international answer and a domestic answer. On the international side, unfortunately some of the countries that will be most affected by climate change early, it's going to affect all countries, are some of the ones who have the greatest levels of poverty and the least ability to respond to them. So that's, at an international level, that's a fundamentally problematic and very unfair situation we're in. And then domestically, we know that for some of the effects of climate change, humans but not all other species, can buy their way out of trouble. But only the wealthy can buy their way out of trouble. And so unfortunately, I think this will exacerbate differences in a bad way rather, than anything else. So I think we should, unfortunately, that's one of the many reasons we need to tackle climate change forcefully. So, I'm going to take the privilege of the last question, which is a cheeky question, and it's one just for Chris. But it's a question I bet loads of you want to know the answer to. How on earth did you get through that incredible time of covid, when you on the television nearly every day, I'm sure in meetings, and, by the way, we're not the inquiry, so you can give a short or a bland answer, or a longer one. But for us standing back, it was pretty hard, but for you it must have been an incredibly difficult time. Yeah, I mean I'm not someone who particularly enjoys being on television so, um, you know I didn't, didn't enjoy it. Let's put it that way. But it's the, if you take on these kinds of jobs, you have to accept the rough with the smooth on them. My kind of view was, that's the job I was given, I�ve got to do it to the best of my ability. I was incredibly fortunate to be, um, supported by an incredibly good team. And I think for many people in covid, they were on their own in their environment, working from home. Often with not very good communications. It got better as the pandemic went on� So, counterintuitively, I had the advantage of a team around me, and physical, and contact, human contact, which helped me. At the same time, of course, I did have to have exposure which I wasn't ready for. And I was on a very steep learning curve to be honest, but there you go. But teams make an enormous difference. Yeah. And I think that's true across all of healthcare, whether it's nursing, medicine, science, you really rely on your teams. Building a good team around you makes an absolutely terrific difference when the chips are down. I should add something that Chris said in another venue, it was good working in teams but not going to any parties.
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