A6. Health Protection

NHS Education Scotland provides the following summary of #HealthProtection:

Health Protection is a term used to encompass a set of activities within the Public Health function. It involves:

  • Ensuring the safety and quality of food, water, air and the general environment
  • Preventing the transmission of communicable diseases
  • Managing outbreaks and the other incidents which threaten the public health.

This summary of Health Protection work is taken from the first #ScotPublicHealth Storify.

The main legislation in Scotland is the Public Health Act 2008 (also covers sunbeds & more).

#HealthProtection featured prominently during 2015 eg with returning workers


Source: Scotsman article 12 November 2015: Ebola nurse Pauline Cafferkey to return to Glasgow

Public Health work takes a population view. While other clinical staff are managing the index case, Health Protection Teams manage contacts and wider population. Understanding the epidemiology is an important step: describing cases by time, place and person. This example is for legionella (Legionnaires and Pontiac Disease).


Source: Health Protection Scotland website

Public Health teams spend most of their time working with colleagues in other parts of the NHS and other organisations. Health Protection is no exception, including work with labs, environmental health, water authorities, charities (e.g. Meningitis Now) and many others. Roles include investigation, analysis, enforcement, support for patients, research and more.

scottish water

Image: Scottish Water Cryposporidium page

Identifying and managing outbreaks is an important part of Health Protection work, from food borne outbreaks to more unusual situations such as SARS and Ebola. Here is a definition of an outbreak from the World Health Organisation:

A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. An outbreak may occur in a restricted geographical area, or may extend over several countries. It may last for a few days or weeks, or for several years.

A single case of a communicable disease long absent from a population, or caused by an agent (e.g. bacterium or virus) not previously recognized in that community or area, or the emergence of a previously unknown disease, may also constitute an outbreak and should be reported and investigated.

There are several outbreaks of different bacteria and viruses covered in the #APHCentury (1906-2006) Storify (see 1923, 1947, 1963/64, 1983, 1996, 2003 and 2006)

One famous example of an outbreak in Scotland, the Wishaw E coli O157 outbreak (1996) is covered in this Eurosurveillance paper.


Health Protection Teams must expect the unexpected, as illustrated with Ebola, avian flu, rabies, anthrax and multidrug resistant TB. At the same time, teams must take a proportionate and evidence-based approach.


Image: Anthrax case in Borders, BBC website

Emergency Planning is an essential role for all Health Protection teams. See Lancet report on Paris attacks for an example of Emergency Planning being put to the test. This reinforces the importance of resourcing Public Health and emergency services.

paris attacks

Health Protection Teams also have to plan, for example in scheduling routine vaccination and ensuring high uptake. In this way Health Protection work has close links with both Health Improvement and Service Improvement domains of Public Health. See also A1. Surveillance (immunisation rates shown below).


Similarly, Health Protection has an important link to infection control and patient safety (to be added on this website under A7. Quality) as highlighted graphically in this Eurosurveillance article on antibiotic resistance.

antibiotic resistance

There has been a marked reduction in healthcare acquired infections such as Staph. aureus (MRSA/MSSA) through the collective action of the Scottish Patient Safety Programme.


Source: Scottish Government website

Environmental Health forms an important part of the Health Protection function, in association with local Environmental Health teams and national agencies such as Health Protection Scotland, Scottish Water, Scottish Environmental Protection Agency and others.


Source: Health Protection Scotland

Sometimes Health Protection Teams will be asked to explore clusters, where cases of a rare condition (eg a type of cancer) appear to be more common close to a perceived environmental risk (eg pylons). Exploring such “clusters” requires careful examination. Typically “clusters” are due to bias rather than an actual link. Here’s how I tweeted this in the first #ScotPublicHealth Storify:

Good explanation of risk of “Texas Sharpshooter” in investigating alleged cancer clusters http://www.swpho.nhs.uk/resource/item.aspx?RID=9108




Here’s a good cartoon depiction


I found this cartoon on the following website http://rampages.us/bortfeldst/ but original source unknown.

Finally, in common with rest of Public Health, Health Protection work requires research skills (e.g. cohort study or case control study in case of an outbreak). See Academic Public Health page.


Health Protection is one the Faculty of Public Health’s 9 areas of Public Health

Graham Mackenzie 2.1.16 Cynergy_Graham MacKenzie_509 (1)

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