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  • by Jim Pollard
  • Websites Editor
  • Men’s Health Forum

Men don’t go and see their GP as often as women. Now let’s not kid ourselves, as some men doubtless do, that men don’t have as much cause to go as women: at every age group bar one men are more likely to die than women. True, there are more deaths among women over 85 than among men but this is for the simple reason that there are very few men left at this age (1).

The most pronounced difference in GP attendance is in the age group 20-40 when women attend twice as much as men. Can this all be down to child-rearing? The fact that after retirement men tend to visit a GP as often as women suggests that work may well be a factor too.

We know from the most recent Skills and Employment survey that job insecurity in 2012 was higher than at any time in the previous two decades. Job insecurity is implicated in increased mental and physical health problems. For example, it increases the risk of asthma by 60%.

Two years on, it’s unlikely that insecurity has decreased. Given that in the last year the number of UK workers in the UK earning less than £7.69 an hour has increased by 250,000 to over 5 million – one fifth of the workforce, it has probably got a lot worse. Is this a job market in which you would risk asking for time off work to go to the GP? With 87% of men working full-time, perhaps what’s most remarkable is that so many men still do find time to get to the GP!
Image of four figures in descending height order. Text reads Men's health manifesto: in the UK one man in five dies before the age of 65. We can change that.

Men’s Health Forum manifesto cover

Paying the living wage and reducing insecure forms of employment would help but the need for health services that reflect the reality of male lives is also clear. The Men’s Health Forum, in its recently published Manifesto, is calling on local health systems and Public Health England to collect and analyse gender-disaggregated data and to act on it to ensure that services are appropriate for and targeted at men.

For example, NHS Health Checks are primarily about reducing heart disease. Now, men make up 75% of those dying prematurely from heart disease yet only 35% of local authority NHS Health Check providers even know how many men they are reaching with the programme. The evidence from those who do know is that men are far less likely to attend with only 44% of participants male. Similarly, the Forum has just published How to Make Weight-Loss Services Work For Men to help service-providers address the absence of men on such programmes. Two thirds of men are overweight or obese yet only 10-30% of participants on weight-management programmes are male.

Of course, it will always need to be a joint approach which is why the Forum works both with service-providers to make services more male-friendly and with men to enable them to be better informed about their own health and the importance of holding on to it. In its manifesto, the Forum is also calling for improved symptom-awareness and knowledge of the health system – especially how to seek help – starting with boys in school. If boys understand the importance of watching their health before they start work, they may be better empowered to do something about it once in the workplace – and that includes going to the GP.

Reference:

(1) ONS (2014) Mortality Statistics: Death registered in England and Wales, 2013

john middleton

  • Dr John Middleton
  • Vice President
  • UK Faculty of Public Health

By necessities, I understand not only commodities which are indispensably necessary for the support of life, but whatever the custom of the country renders it indecent for creditable people even of the lowest order, to be without

Adam Smith

The UK Faculty of Public Health manifesto calls on all political parties to commit to a living wage strategy over the next five years.

From Adam Smith through to Peter Townsend, the Joseph Rowntree foundation and the Living Wage Foundation of the present day, social commentators have recognized the notion of relative poverty. There are some you cannot do without and still function in the culture of modern society.

I call it the brown bread line. The white breadline represents absolute poverty  – just enough to survive on. The Food Banks charity, Trussell trust, in its, latest publication, suggests we have gone below the breadline. Acute hunger has returned to Britain for the first time in the welfare state.

In our open letter to the Prime Minister published by the Lancet in May, the Faculty of Public Health highlighted three key and catastrophic changes which have combined for a perfect storm of food poverty. Food prices up 12% over five years, double figure price rises in energy costs and a fall in wages by over 7% in five years.  The result has been that some of the poorest people in our society must pay over one fifth of their disposable income to feed themselves.

Poverty kills. In global terms the difference between rich and poor is obvious. In the UK, the sixth wealthiest nation in the world, the gap in income between rich and poor has been getting bigger at least since the mid-seventies and it has accelerated in our latest period of austerity.

The gap in life expectancy between rich and poor has also grown.  The gap in life expectancy between rich and poor grew throughout the 1980s. Large studies from Glasgow and the North of England showed the extent to which poverty and unemployment contributed to the gap. The national Office of Population Censuses and Surveys’ longitudinal study reported in 1984 that unemployment was associated with a 20% higher than national death rates. Whilst the overall life expectancy has improved  for rich and for poor  to the present day, it has not  improved  as much for the poor.

A succession of reports from Black, Whitehead, Acheson and Marmot has highlighted the difference in health between rich and poor. It a cradle to grave story, a life course, as Marmot has described it. The babies of poor are more likely to be born small and more likely to be still born or die in the first year of life.  They are less likely to be breast-fed, grow up shorter and nowadays, fatter, and loose their teeth earlier.

They will perform less well at school – though not through lack of intellect or ability, They will grow up in overcrowded housing and suffer more infectious illnesses. They are more likely to be victims of accidents or violence. Their chances of a university education are very much less and their chances of satisfying, financially rewarding work are slim. They will drift through short-term, unskilled jobs on the edge of the labour market, in more dirty, dangerous, or boring work.

They will develop diabetes, heart disease, cancers and other long-term conditions at an earlier age. Many will die prematurely; those that are propped up with the techno-fixes of modern medicine simply live more years with a disability and the dependency of long-term medical conditions.

Adam Smith’s realization of the idea of relative poverty has been revived. Creditable people, even of the lowest order, according to the Office of National Statistics, face severe material poverty if they cannot afford to:

  • Pay their rent, mortgage, utility bills or loan repayments.
  • Keep their home adequately warm,
  • Face unexpected financial expenses,
  • Eat meat or protein regularly,
  • Go on holiday for a week once a year,
  • A television set,
  • A washing machine,
  • A car,
  • A telephone.

Poverty contributes materially to the burden of ill health in a number of ways. It is easy to see that poor people cannot afford high quality, energy-efficient, safe household appliances, and safety devices, brown bread is more expensive than white, people who are ill carry a large burden of costs for transport to health facilities.

A recent study of the cost of a healthy diet showed that across a basket of 94 foodstuffs cheaper calories came from cheaper more highly processed foods. When you are poor, it’s calories you are thinking about to survive. Fresh foods and foods higher in nutrients minerals and vitamins were more expensive.  When you are making decisions to feed the meter, or feed a family, processed foods are cheaper to cook, but come with the high fat, high transfat, high salt, high sugar cocktail condemning people to early obesity and disease.

Even fast food takeaways are competitive in the fight not to feed the meter. There are also the stress-related aspects of working in a low span of control job, for next to no money.  Employees may benefit from a higher income fit to live on, but employers have also benefitted from a more reliable, content, satisfied and efficient workforce when they have implemented the living wage, as a recent publication by Marmot’s team shows.

The Labour government in 1997 addressed poverty through the minimum wage, working families tax credit, Surestart maternity grant and commitment to eradicate child poverty.  Most of these have been scrapped or reduced in their scope and ambition. The minimum wage is now so far behind what people need to live creditably, that now rightly there is the call for the living wage.

The problems of poverty have been over-complicated through well meaning campaigns from different pressure groups  – food poverty, fuel poverty, housing and other poverty.  All are characterised by the poor needing to spend a greater proportion of their disposable income than the rich on each household item. The living wage campaign begins to address this, being based on a complex set of assessments of household makeup and budget items which came from the minimum income standard (MIS) devised by Joseph Rowntree and Loughborough University.

It is always possible to contest those items  – people are always free to spend their money in other less ‘sensible ways’ but evidence suggests that as people do get better off they will take decisions for more long-term benefit.

It is said that there is all party support for the move. The prime minister and the mayor of London and the other main political parties support it. The living wage this week has been revised to  £9.15 an hour in London and £7.85 an hour in the rest of the UK.  It is a measure, which could vastly improve the health of our workforce and their families and improve our workforce efficiency and economy. For all these reasons the FPH manifesto calls on all political parties to commit to a living wage strategy over the next five years.

  • By Deborah Arnott
  • Chief Executive
  • Action on Smoking and Health (ASH)

In the UK, smoking kills around 100,000 people a year (1). To replace those who quit or die, the tobacco industry has to continually recruit new smokers. As most people start smoking before they’re 18 it is children and young people who the industry must recruit (2). Advertising and marketing has been shown to increase the appeal of cigarettes to children and tobacco manufacturers design their packs to be glitzy and glamorous with often novel designs resembling such things as perfume packaging.

This is a tactic that works: around 207,000 young people start smoking annually in the UK (3) and exposure to tobacco marketing has been shown to increase this risk (4). Children from the most deprived backgrounds, where smoking prevalence is highest, are most likely to be exposed to tobacco packaging (5). Of those who become lifetime smokers, 1 in 2 of will die of a smoking-related disease (6).

Standardised packaging is the best way to protect children from the lure of sophisticated tobacco industry marketing and the FPH’s new manifesto for public health in the next parliament rightly identifies standardised packaging as vital in giving children the best possible chance of achieving a healthy future (7). However, to maximise the public health gains possible from standardised packaging we need to act now to make sure legislation is voted on by this Parliament.

As part of The Children and Families Act, which became law in February 2014, MPs voted in favour of powers enabling the Government to introduce regulations requiring standardised packaging for tobacco products (8). Since then, the Government has published and consulted on draft regulations. To bring the legislation into effect, these regulations need to be put before Parliament for a further vote. The revised Tobacco Products Directive from the European Parliament, which contains a series of measures intended to deter young smokers including larger health warnings, will be implemented in the UK by May 2016 (9). Because measures have a cumulative effect, implementing standardised packaging at the same time will maximise the public health gain; for this to happen Parliament must be given the chance to vote on the regulations to introduce standardised packaging before the next General Election.

The tobacco industry is running a well-resourced and highly misleading campaign against the introduction of standardised packaging in the UK, but the evidence base for the measure’s effectiveness is now well-established. In April this year, Sir Cyril Chantler’s government-commissioned independent and comprehensive review of evidence reported that there is a strong public health case for the policy, concluding that “the body of evidence shows that standardised packaging… is very likely to lead to a modest but important reduction over time on the uptake and prevalence of smoking and thus have a positive impact on public health” (10).

Moreover, despite claims from the tobacco industry that standardised packs will lead to an increase in tobacco smuggling, the proposed packs would contain the same security markings as existing packs and would be no easier to counterfeit. Sir Cyril Chantler stated in his review that he was “not convinced by the tobacco industry’s argument that standardised packaging would increase the illicit market, especially in counterfeit cigarettes” (10).

An industry-commissioned report using sales data from Australia to claim that there has been an increase in tobacco sales since the introduction of standardised packaging has been widely dismissed. Although the industry reported a small (0.28%) increase in sales year on year, they did not report the increase in the Australian population between 2012 and 2013. Adjusted for population, tobacco sales per person have in fact fallen (11).

Tobacco industry efforts have also failed to dent the popularity of standardised packaging, which currently has strong support from the public, politicians across the political spectrum and the public health community (12). A YouGov poll in March 2014 found that overall 64% of adults in Great Britain support or strongly support plain standardised packaging with only 11% opposed to the measure (13) and when Parliament voted to give the Government the power to introduce standard packs through regulations, 453 MPs voted in favour and just 24 against.

Evidence from Australia, the first country to introduce standardised packaging in December 2012, has been encouraging. Soon after standardised packs began to appear in shops, smokers reported that they found cigarettes in these packs less appealing or satisfying (14). Research has also shown that smokers consuming cigarettes from standard packs were 81% more likely to have thought about quitting at least once a day during the previous week and to rate quitting as a higher priority than smokers using branded packs (14).

Every day since the publication of Sir Cyril Chantler’s review in Spring 2014 hundreds of children have started smoking and the public health community has a responsibility to ensure this number stops growing. You can help make the case for standardised packaging by writing to your MP and urging them to encourage the Government to bring regulations to Parliament as soon as possible.

References and notes
(1) ASH Fact Sheet, Smoking Statistics: Illness and death, 2014
(2) Office for National Statistics. General Lifestyle Survey Overview: A report on the 2011 General Lifestyle Survey. 2013.
(3) ASH Fact Sheet, Young People and Smoking, 2014
(4) The packaging of tobacco products. March 2012. The Centre for Tobacco Control Research. Core funded by Cancer Research UK.
(5) Marmot, M. et al. (2010) Fair Society, Healthy Lives: Strategic review of health inequalities in England post-2010 Marmot review secretariat, London
(6) Doll, R. et al. (2004) Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004; 328: 1519
(7) Faculty of Public Health, (2014) Start Well, Live Better – a manifesto
(8) Children and Families Act 2014
(9) Tobacco Products Directive 2014
(10) Standardised packaging of tobacco. Report of the independent review undertaken by Sir Cyril Chantler. Kings College London, April 2014
(11) Is smoking increasing in Australia? The Guardian, June 2014
(12) The Smokefree Action Coalition an alliance of over 250 health organisations including medical royal colleges, the BMA, the Trading Standards Institute, the Chartered Institute of Environmental Health, the Faculty of Public Health, the Association of Directors of Public Health and ASH, all support the introduction of standard packs.
(13) The poll total sample size was 12,269 adults. Fieldwork was undertaken by YouGov between 5th and 14th March 2014. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+). Respondents were shown what a standard pack could look like, including larger health warnings as in Australia.
(14) Wakefield M et al (2013); Introduction effects of the Australia plain packaging policy on adult smokers: a cross-sectional study; BMJ Open 2013

Originally posted on CyclingWorks:

fph-logoThe Faculty of Public Health is the standard-setting body for specialists in public health in the United Kingdom. It is a joint faculty of the three Royal Colleges of Physicians in the UK, and is the home of 3,000 professionals working in public health. For more than 40 years they have been at the forefront of the transformation of the public health profession.

The Faculty sent this letter to TfL outlining the strong public health benefits of the scheme and urging its adoption. The letter points out TfL’s commitments under the Transport Action Plan from February of this year to increase active travel and make streets safe and inviting for all users.

We welcome Transport for London’s proposals for the creation of East-West and North-South cycle superhighways.

The National Institute for Health and Care Excellence (NICE) recommends the facilitation of active travel through improvements to infrastructure. The creation of cycle superhighways incorporates…

View original 543 more words

  • by Madeleine Harris Smith
  • Policy & Advocacy Manager
  • Alcohol Health Alliance

Every single hour a person in the UK is killed by alcohol (1). Every single month, 75,000 violent incidents take place where the victim believes the offender to be under the influence of alcohol (2). Every single year, 1.2 million people are admitted to hospital due to alcohol-related causes (3).

Behind every single one of those statistics is a loved one – a friend, a parent, a sibling, a child.

And alcohol does not just harm the individual drinker; it all too often affects innocent bystanders, through its role in child abuse and neglect, domestic violence, family breakdown and crime and disorder. And as well as the human toll, alcohol costs our country £21 billion every year (4).

The availability of alcohol has increased far beyond the local pub, and is now 61% more affordable than it was in 1980 (5). The majority of alcohol is now sold in supermarkets and off licenses, where it is routinely offered at less than cost price to entice people into stores (6) – a can of super strength white cider, such as Frosty Jack’s, can currently be sold for about 16p. Of all alcohol sold, very cheap products play the biggest part in driving alcohol-related harm (7).

Due to existing health inequalities the cruellest effects of alcohol are felt most by those who can least afford it, due to existing health inequalities. Even though as a group they don’t consume as much alcohol as more affluent groups, people in the most deprived areas of the country are disproportionately more likely to experience the impacts of alcohol-related crime, are more likely to suffer the impacts of alcohol-related health conditions and are more likely to die from an alcohol-caused condition (8).

There isn’t one ‘silver bullet’ to fix this epidemic, but in terms of building an effective alcohol strategy for the UK, implementing a minimum unit price must be the foundation stone. A minimum unit price would allow all alcoholic beverages to be priced based on their strength, with stronger drinks, such as high-strength white cider and spirits priced higher than their lower-strength alternatives. This precisely targets the products that are consumed by young drinkers and people drinking harmful quantities, without penalising moderate drinkers, including those on lower incomes.

Research commissioned by the Government as part of its consultation on the Alcohol Strategy confirms that minimum unit pricing is far more effective at tackling alcohol-related harm than the Government’s current ban on the ‘below cost sales’ of alcohol. A 50p minimum unit price would result in a reduction of 50,700 less alcohol related crimes and a reduction of 35,100 hospital admissions by year ten, alongside an overall reduction in alcohol consumption of 2.5%.

Minimum unit pricing would not adversely impact moderate drinkers, with the price of the majority of alcohol on our shelves and in our pubs remaining unaffected. In fact, moderate drinkers across all income groups would spend just 78p more on alcoholic drinks per year (9).

Minimum unit pricing would play a pivotal role in tackling health inequalities without penalising moderate drinkers on low incomes. As lower income households disproportionately suffer the harms of alcohol, they would see the greatest benefits from minimum unit pricing.

Data from the University of Sheffield suggests that routine and manual worker households would account for over 80% of the reduction in deaths and hospital admissions brought about by a minimum unit price and yet the consumption of moderate drinkers in low income groups would only drop by the equivalent of two pints of beer a year (10).

Minimum unit pricing would also reduce drinking among children and young people, as they are particularly sensitive to price changes, as research into tobacco pricing has demonstrated (11). The affordability of alcohol, and particularly the attractive price promotions in off licenses, supermarkets and other shops, means that it is often cheaper for our children and young adults to drink than to participate in other social activities such as going to the cinema or bowling (12).

We experienced a devastating setback for public health when the Government ‘U-turned’ on implementing a minimum unit price last year, citing a lack of evidence that the level of problem drinking would be reduced without ‘penalising those who drink responsibly’. This is indicative of the misinformation that surrounds the policy and that it is our job, as public health campaigners, to try and dispel.

Alcohol tears apart families and damages entire communities – its impact is felt across the board and there is not a neighbourhood in the UK that remains untouched. We are experiencing nothing short of a national crisis because of alcohol – we must act now to stop this.

1)  ONS, Alcohol-related deaths in the United Kingdom, registered in 2012 – ONS. 2014. Accessed June 19, 2014.
2)  ONS, Focus on: Violent Crime and Sexual Offences, 2011/12. 2014. Accessed June 19, 2014.
3)  Gov.uk. Reducing harmful drinking – Policy – GOV.UK. 2013. Accessed June 19, 2014.
4) HM Government, March 2012 ‘The Government’s Alcohol Strategy’ Cm 8336 201, para 1.3
5) Health and Social Care Information Centre. Statistics on Alcohol: England, 2013. 2014. Accessed June 19, 2014.
6) Bennetts R. IAS Briefing Paper: Use of Alcohol As A Loss-Leader. Institute of Alcohol Studies; 2014.
7) Bennetts R. 2014, Ibid
8) North West Public Health Observatory, Centre for Public Health, Liverpool John Moores University. New Local Alcohol Profiles for England reveal the poorest suffer the greatest health harms from booze culture.; 2012.
9) Holmes, J. et al, Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study’ The Lancet, Published online February 10, 2014  Last accessed 30 May 2014
10)  Holmes, J. et al, (2014) Op Cit.
11)  Zhang, B., Cohen, J., Ferrence, R., and Rehm, J. The Impact of Tobacco Tax Cuts on Smoking Initiation Among Canadian Young Adult. American Journal of Preventive Medicine, 006;30(6):474–479; Rice, N. et al. A systematic review of the effects of price on the smoking behaviour of young people. (London: LSHTM, 2009).
12) The Cinema Exhibitors Association Limited. UK cinema – average ticket prices 2000-2013, Last accessed 18 June 2014; YouGov. Cinema cost concerns mount. Last accessed 18 June 2014

This blog is the first in a series that looks at the story behind each of the 12 priorities in Start Well, Live Better, FPH’s Manifesto for the 2015 General Election. The Transatlantic Trade and Investment Partnership (TTIP) could impact on one of the 12 priorities: the ability of a UK government to provide a universal healthcare system, free at the the point of delivery.

 

  • John Middleton
  • Vice President for Policy,
  • United Kingdom Faculty of Public Health

The Faculty of Public Health is concerned about the damaging potential of the Transatlantic Trade and Investment Partnership (TTIP) for public health, environmental protection and sustainability.

TTIP is being touted as a major benefit for trade between the European Union and America.  But the means by which greater trade is to be gained is through deregulation of standards of health and safety, standards in consumer safety, environmental, and public protection.

The deal is also likely to further add to global warming and climate change.  Alongside the TTIP is a secretive and disturbing quasi-legal instrument known as the Investor State Dispute Resolution scheme (ISDS). This process enables investors to sue governments if they believe their right to profits are being damaged by national policies which may be promoting health, or protecting workers or environments.  The proceedings of ISDS are already evident around the world and should be a concern to all those working for better public health and the environment.

A lot has been written about the TTIP and its implications for the NHS.  Trade unions, politicians, the Royal Colleges and the Lancet have voiced concerns and called for NHS services to be exempted from the trade agreement.  UK government ministers have not shown any inclination to ask for the NHS to be exempted from the agreement, which would be in their powers to ask for.  Why would they? When the stated objectives of the Health and Social Care Act 2012 were to open up competition in the health service? Bizarrely, they have also implied that TTIP will offer a competitive edge for the NHS – a great service that should somehow play on the world stage, subsidised by the taxpayer. We are short of midwives in the UK so how we would sell such services to the US or Europe is a mystery.

European commissioners have issued reassuring statements that the NHS will be exempt. But EC commissioners cannot give such assurances. Once the TTIP is signed and provisions for the Investor State Dispute Resolution (ISDS) are in place these are legal agreements for which grievances and claims for compensation can be pursued in a quasi-court.

Any company with a stake in the NHS now could easily cry foul, take recourse to the dispute scheme and claim compensation if their NHS pickings are not to be protected indefinitely.

TTIP and the ISDS are secretive, policed by a few international lawyers, in a self-serving arrangement, using their knowledge and expertise as the arbitrators, or the advocates. The process, rides rough shod over national law, undermining the entitlement of states to legislate for the improved public health and protection of their citizens.

TTIP presents a much bigger threat to the public’s health, much bigger even than the potentially devastating impact on the NHS, TTIP threatens health and safety conditions, hard-earned workers rights, terms and conditions and protection in employment and threatens local and global environmental safety and controls, carbon emissions and global warming.  It also threatens to dumb-down consumer safety standards – for example through raising permitted levels of antibiotics in foods.

FPH’s manifesto for all the political parties in the next election includes major recommendations for laws designed to protect and improve the public’s health. A sugar tax, minimum unit pricing of alcohol, a living wage, and reducing carbon emissions  – all of these proposals could fall foul of TTIP and its ISDS. If a future government chose say, to accept the overwhelming international and national evidence and implement a minimum unit pricing of alcohol, The Big Alcohol companies could well demand compensation for lost profits, likewise Big Food, on a sugar tax.

It’s easy also to see the ‘chillers effect’ making governments think twice even about implementing such legislation. Multinational companies demand complete freedom to sell their goods whatever the consequences to society. In the case of alcohol, governments pick up the cost of policing violence, and treating disease; other private and public employers pay the costs of alcohol in workplace inefficiency and absenteeism. Big Alcohol pockets the profit.

Strong intellectual property protections afforded under TTIP to pharmaceutical companies may dangerously increase the sphere of influence of big pharma over national regulatory standards. The sovereign power to promote access to medicines and EU transparency requirements over clinical data is at risk.

Supporters of the TTIP quote Obama’s promise of an average $680 per household benefit from the trade agreement. Even if this figure is correct and we take it at face value, would it be a gain worth having? $13 a week gained per household set against potential losses of salary, jobs and working conditions, and the environmental damage of extra consumption for our children to cope with?

And of course, past evidence of major economic change suggests benefits are not delivered equally. There will be big winners and therefore big losers. The narrow margin of benefit is such that gains for bankers, investors, and industrialists will mean loss of money and jobs for many, and destitution heaped on the poor.

Trends towards widening inequalities in income over 40 years in the UK and other parts of the world have been accompanied by widening gaps in the ill health and life expectancy between rich and poor. In 35 years since the Black report, Whitehead, Acheson, Wilkinson and Marmot have all expanded this overwhelming body of knowledge.

Economic inequality causes health inequalities; poverty kills. We can expect widening inequality in health if this trade agreement is signed.

Supporters of the agreement also suggest fears of over use of the ISDS are also unfounded. However, there are recent examples of investor-state disputes which threaten health and the environment which suggest that recourse to these processes is likely to become more common and more damaging to sovereign government’s attempts to legislate for health and the environment.  These were illustrated in the  New Scientist

The most visible at present is the Phillip Morris Uruguay case where the Marlboro man is asking for compensation for lost earnings as Uruguay prepares the most severe health warnings on packs in the world. Surprising perhaps that a tobacco company now says this public health measure will work and will hit them in the pocket when they have denied such measures will be effective throughout the history of tobacco control. Swedish energy giant Vattenfall is taking Germany to the arbitration tribunal for its decision to move away from nuclear power following the Fukushima disaster.

Lone Pine, the multinational oil and mining company, is suing the Quebec government for  $250m over their decision to place a moratorium on fracking.  Occidental was recently awarded over $1.7 billion compensation following their eviction from Ecuador, despite having broken Ecuadorian laws. Achmea, the Dutch health insurance company sued Slovakia for the change of health service policy, which required health insurers to operate on a non-profit basis. Veolia is suing the Egyptian government for raising the minimum wage of water treatment workers.

The potential benefits of TTIP for the UK are projected to be in pharmaceuticals, the motor industry and chemicals- in any objective sense, in the context of global warming, these are all industries we need less of – to protect our environment, to stop poisoning people and, increasingly in the era of big pharmacy, to stop damaging our health.

None of these industries are now major job creators per given investment and could only increase at the margins. None of these have any credibility in terms of social and corporate responsibility.  The whole idea that economic growth for its own sake is a good thing now needs to be seriously challenged.  GDP does not buy us happiness. We need a more sustainable people-centred economy, which supports localism. The very businesses to be sacrificed in this deal are the so-called American  ‘mom and pop’ businesses; the main proponents of this deal are the multinationals. Living within our means in order to protect our children’s future is the new imperative.

For all these reasons, it is right that there is a growing disquiet about this sinister and clandestine negotiation. FPH believes it will damage health, create poverty and damage the environment now and in the future. It will make prospects for laws to protect and promote the public’s health far less likely to happen in the future.

If you are not an advocate for this agreement, it is unlikely the benefits will be coming your way.  It is likely to benefit only a very small proportion of people in the upper echelons of societies on either side of the Atlantic, or in far off tax havens. If you are not for it, you should be against it.  Anybody who is not heading a big multinational company should reject it and campaign vigorously to ensure it never becomes a reality.

This blog is reproduced by kind  permission of  New Scientist,  which published a shorter version  of it on November 1st  2014. This was part of a larger opinion feature about TTIP.

  • by Maya Twardzicki – Public Health Lead Surrey County Council, and
  • John Ryan, comedian, Lift the Lid Productions

There is “growing international acceptance of the notion that participation in the creative arts can be beneficial for wellbeing and health” (1) (2).  Although little of this research has focused on comedy as a creative art form, a review of effective health education approaches with young men showed humour is effective when communicating about sensitive topics such as mental health. (3)

Findings from a recent randomised control study suggest that mental health comedy might generally reduce stigma in people who use affiliative style humour (4). In a series of innovative public health projects in Surrey, post-show evaluation also showed comedy to be an effective way to raise awareness, get people talking and generate more positive attitudes about mental health in both the general and prison populations. (5)

Much stigma still surrounds mental health: 87% of service users reported its negative impact on their lives. (6) Stigma in the military population is also common, (7) more so among those with a mental disorder. It is an important contributing factor to the challenge of engaging military personnel with psychological support (8)   as it is known to be a barrier to seeking help. (9)

The challenge in reducing stigma in both public and military populations, is to achieve lasting attitude change. Although evaluation of the Time to Change public campaign indicates longer term attitude change, several anti-stigma interventions implemented in the UK armed forces have failed to modify stigmatising beliefs at longer follow up.

So together with the Academic Department of Military Mental Health at Kings College London, we tapped into the strong role of humour in military culture to evaluate the short and longer term impact of stand up comedy as a novel stigma-reduction in a sample of Army service personnel.

Focus groups were run with Army service personnel to help inform the mental health comedy show script and explored their experiences of mental health, related attitudes and barriers to help seeking.

“We asked the men how they exercise their most important organ, they were surprised to realise it was their brain and how it benefits from wellbeing.” John Ryan, Comedian.

Personnel viewed a regular comedy show, which acted as a control, or a show containing mental health information and an additional comedian with experience in the military and of mental health problems. `Social contact` between those with and without mental health problems is an effective way to encourage more positive attitudes. (10)

John Ryan: “I said a good way to take control of your anxieties is to always finish what you start.  A lad replied ‘I finished my pint and watched the rest of the football match but didn’t feel any better’ “.

Before the show, immediately after and three months later, measures were taken (using recognised instruments/scales) of: military-based stigmatisation, potential discrimination, mental health related knowledge, self reported help-seeking and coping behaviour, talking about mental health, current mental health and alcohol use. Response rates were high pre and post show, but unfortunately very low at three month follow up due to many of the sample preparing to be or being deployed.

  • Satisfaction with the comedy show format was very high showing that it was an acceptable way to present mental health related messages.
  • Post-show, intervention group participants reported significantly less stigmatisation and were significantly more likely to answer mental health-related questions correctly
  • In the small sample at follow up, neither difference was maintained. However, there was a borderline significant reduction in potential discrimination; and intervention group personnel were statistically significantly more likely to discuss mental health and advise others about mental health. Adjusted analyses suggested that this may have been related to factors other than the show (e.g. greater opportunity to do so as the intervention group had higher levels of common mental health problems)
  • Knowledge of effective coping strategies rose in both intervention and control groups post show, and was significantly higher in the control group at follow up. Although this was encouraging as the project did aim to increase personnel knowledge about help seeking, as this effect was seen in both groups, it may have resulted from both unintentional confounding  (project staff who viewed both shows reported that there was some unplanned overlap in the content of the control and intervention shows), and from low follow up numbers.

In conclusion, embedding mental health awareness within a comedy show format had a short-term positive effect upon military mental health stigmatisation in a sample population of UK Armed Forces personnel and was a well accepted/popular format. The reduction in stigma was not sustained at the longer three-month follow up (a finding reflected in other anti-stigma interventions in military populations using mental health awareness or psycho education). (11)

However, the low rate of follow-up limited our ability to assess whether this effect was lasting. It may also be that the intervention has maximum immediate impact and if the Armed Forces finds a way to reinforce the key messages over time, the positive post show changes may prove more durable. If the longevity of change can be adequately assessed and demonstrated in further research, comedy could potentially form a component of a comprehensive stigma-reduction strategy. (12)

1)  Clift S (2012)  Creative arts as a public health resource: moving from practice-based research to evidence-based practice.  Perspect Public Health 2012 May, 132(3):120-7
2)  Stuckey H L, and Nobel J  The Connection Between Art, Healing and Public Health: A Review of Current Literature.  Am J Public Health. 2010 February, 100(2); 254-263
3)  Lloyd T (2002)  Boys and young men’s health: what works.  Health Development Agency. London
Corrigan P W, Powell K J, Fokuo J K, Dosvluk K A (2014)
4) Does humor influence the stigma of mental illnesses?  J Nerv Ment Dis 2014 May 202(5):397-401
5)  Evaluation reports: Dr Claire Henderson and Steve Wright from the Institute of Psychiatry, Kings College London (2010)  and  from Nottingham University Self Harm Research Group (2009)
6)  Stigma Shout Survey: Time to Change
7) Osorio C, Jones N, Fertout M, Greenberg N (2013)   Changes in stigma and barriers to care over time in UK Forces deployed to Afghanistan between 2008 and 2011. Mil Med (in press)
8)  Kim P, Thomas J, Wilk J, Castro C, Hoge C (2010)  Stigma, barriers to care and the use of mental health services among active duty and National Guard soldiers after combat. Psychiatr Sev 61(6):582-588
9)  Capeda-Benito A, Short P (1998)  Self-concealment, avoidance of psychological services and perceived likelihood of seeking professional help. J Couns Psychol 45:1-7
10)  Pinfold V, Huxley P, Thornicroft G et al (2003) Reducing psychiatric stigma and discrimination: Evaluating an educational intervention with the police force in England.  Social Psychiatry and Psychiatric Epidemiology, 38: 337-344.
11)  Mulligan k, Fear NT, Jones N, Wessely S, Greenberg N (2010) Psycho-educational interventions designed to prevent deployment-related psychological ill-health in armed forces personnel: a review. Psychol Med 41:673-678
12) Jones N, Twardzicki M, Ryan J, Jackson T, Fertout M, Henderson C, Greenberg N (2014)  Modifying attitudes to mental health using comedy as a delivery medium. Soc Psychiatry Psychiatr Epidemiol DOI 10.1007/s00127-014-0868-2 Published online 09 April 2014

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