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Greg’s passion for improving health and following the evidence

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Greg Fell is Director of Public Health (DPH) for Sheffield, President of the Association of Directors of Public Health (ADPH) and the public health expert member of the UK National Screening Committee (UK NSC).

He grew up in Scunthorpe, enjoyed science at school and studied biochemistry and physiology at the University of Nottingham. After graduating in 1993, Greg realised he did not want to join his peers into careers as biochemists, science teachers or working for pharmaceutical companies. Happily, he found work as a social researcher at Hull University’s Nursing School, investigating smoking and drinking in pregnancy, and sparking his interest and future career in public health.

Greg worked in several NHS organisations before becoming a public health programme manager in a primary care trust where he was encouraged to join the public health training programme.

When I first entered public health training, the trainees were probably 80% from medical backgrounds and 20% non-medical. Now it’s probably about 50:50.

I thoroughly enjoyed myself and have never ever looked back.

The ‘best job ever’

Greg’s traineeship included 9 months with Jenny Carpenter, a senior civil servant and public health consultant responsible for screening and specialised commissioning policy at the Department of Health.

During that time, he worked with former UK NSC director Sir Muir Gray and current incumbent Professor Anne Mackie. He said:

I had always had a bit of an interest in screening, but those 9 months were genuinely fascinating and really got me into it.

After completing his public health training, Greg worked for 7 years as a consultant in public health in Bradford in the primary care trust and then at Bradford council.

I was then persuaded to apply to be DPH in Sheffield. I was thinking there’s no way they’d appoint me. To my surprise they did, and I’ve been there ever since. It’s the best job I’ve ever had. I couldn’t imagine a better job.

Success through teamwork

Greg has been DPH for Sheffield since February 2016 and loves the role’s variety.

Directors of Public Health are responsible for the health of residents in their area. It’s a complex job that involves protecting communities from outbreaks of disease, promoting good health, measures to improve health, health intelligence and data analysis, and collaborating with many people and organisations. The role requires excellent communication skills and the ability to think on your feet.

I was once pretty handy at some of the more technical aspects of public health, such as clinical epidemiology and data analytics. Now, if I’m brutally frank, it is definitely a job of communication. There’s as much in the job that’s about social science as there is about epidemiology.

Greg is particularly proud of the work done to reduce smoking harms.

When I came to Sheffield, smoking prevalence was about 17 to 18%. Now it’s about 12 to 13%. It has happened because people have worked doggedly day in, day out, doing the right thing. It’s a team sport and I’m blessed to have a great team.

That work will save countless people from the misery of heart attacks, strokes, lung cancer, throat cancer and Lord only knows what else in years to come.

Greg’s work involves deciding how to allocate the public health grant for Sheffield on services ranging from sexual health and drug and alcohol treatment to health visiting and Citizens Advice.

I’d love to provide more funding for all our services and there will always be frustrations of working within an ever-decreasing budget, but we shouldn’t forget our many successes.

I can't avoid the fact that health is political and that comes with all sorts of different difficulties and choices. My challenge is to not make it party political but to stick with the evidence and use the evidence to win arguments.

Having previously been a member of the board of the ADPH, Greg was appointed President in October 2023.

My learned colleagues were foolish enough to vote for me. So, by day I’m DPH of Sheffield, by night I’m president of the ADPH.

High evidential bar essential for screening

Greg’s long-standing interest in screening led to him applying for the public health role on the UK NSC and he has thoroughly enjoyed it.

The UK NSC’s biggest upcoming challenges include assessing new technologies such as polygenic scores and multi-cancer early detection tests. Greg said:

There are hundreds of stakeholders saying these things will save lives and the UK NSC will need to steer the right path through that and ensure the right evidence base is built in the right way.

The UK NSC can be seen as a group of pesky people who come up with difficult questions. And if you've not done your homework then it’s so intuitive to think that all screening is good because it will find things early and save lives.

But the evidential bar for screening is set high for a reason. When you do the homework, you realise how more complicated these things are. If you’re inviting millions of people for screening you can harm a lot of people.

Greg follows Sir Muir’s mantra that all screening does harm, some does good as well and some does more good than harm at reasonable cost.

Getting across the reality of screening compared to the perception is one of the trickiest communication challenges in public health. There’s a whole bunch of difficult concepts you must be able to explain eruditely to members of the public.

Home life equally busy

Away from work, Greg is married with 3 children (one now at university), 2 dogs, 3 chickens, a duck and 2 bicycles.

I’ve got a whole house full of things and people. And Sheffield is an amazing place to be. I thoroughly enjoy living here.

Like fellow committee members Anneke Lucassen and Anne Slowther, Greg is a keen cyclist who can be found on his bike at weekends and summer evenings. He said:

I’d probably describe myself as a born-again cyclist. I used to run and climb a lot but not anymore. Kids basically put an end to my glittering climbing career as it’s quite a time intensive thing.

I probably need a new bike to be honest because I’m one of those people who always thinks they need one more bike than they’ve got. Negotiations continue with Mrs Fell about a new bike, but they’re not going very well so far.

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