Category: School of Public Health

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


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


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

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

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

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

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

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

The economics of universal health coverage

Universal Health Coverage

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


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

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

A teaspoon of salt away from high blood pressure

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


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

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

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


It started by a poolside in Gran Canaria.

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

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

Noël hypothesis: my life as a medical statistician

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

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


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

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

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

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


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

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

What diversity and inclusion at Imperial means to me

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


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

Fighting the next epidemic with the Typo Challenge

Dr Anne Cori and Dr Marc Baguelin explain why they need the public’s help to help make data on epidemics like Ebola and Zika more accurate.


Controlling epidemics relies on key decisions, like how many hospital beds are needed and who should be vaccinated or treated first. These decisions rely on data about people who are infected, but mistakes can be made when entering information, which can lead to incorrect decisions being made.

What is the Typo Challenge?

The Typo Challenge is a fun challenge where you are asked to type dates into an app on your computer, laptop, tablet or phone, which helps us collect information about what kind of mistakes people make when they enter dates electronically. With this information we want to create software for researchers trying to better understand how epidemics spread so when they receive data about epidemics in the future they will be able to automatically check the results for accuracy by using the software. (more…)

(I am not a) Vessel: the importance of women’s reproductive rights

(I am not a) Vessel: The importance of women’s reproductive rights
Rebecca Blaylock is a student on the Master of Public Health programme at Imperial and here makes the case for increased access to reproductive healthcare.


Students from Imperial’s Master of Public Health programme recently organised a screening of the award-winning film “Vessel”. Vessel chronicles the story of Dr Rebecca Gomperts – a former doctor on a Greenpeace ship – who had an innovative idea to provide women with vital reproductive health services. During her time travelling the world with Greenpeace, Gomperts witnessed the unbearable suffering caused by unsafe abortions. She saw women haemorrhage to death, die from sepsis and sustain life-long disabilities, and refused to “stand there and just let that happen”. Around 25 million unsafe abortions take place every year, accounting for between 4.7 and 13.2% of global maternal deaths.

(more…)

Universal Health Coverage in the United Kingdom: past, present and future

NHS staff with a patient at Charing Cross Hospital
NHS staff with a patient at Charing Cross Hospital

On World Health Day, Professor Azeem Majeed takes a look at the past, present and future of the NHS.


In 2018, the United Kingdom’s National Health Service (NHS) celebrates its 70th anniversary. With the creation of the NHS in 1948, universal health coverage was finally implemented in the United Kingdom, with the NHS replacing the previous patchy health coverage schemes that had left many people with limited access to health services. All residents of the United Kingdom were given the right to register with a general practitioner, who was responsible for both providing primary care services and organizing referrals for specialist care. (more…)