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  • By Dr Jayne Hutchinson
  • Research Fellow
  • University of York

Active travel, defined as walking and cycling short journeys such as visiting friends, commuting or going to the shops, is high on the policy agenda. In 2010 the Departments of Transport and Health published a joint strategy on active travel and many local authorities have now published their own active travel policies.

Inner city cycling

Active travel: getting more active and healthy

Active travel simultaneously tackles two of society’s big challenges: more sedentary lives and the health concerns associated with that, and environmental changes caused by burning fossil fuels.  Yet, the understanding about its social patterning is limited, particularly in relational to differences in socio-demographic predictors of active travel between urban and rural residents. Understanding variations between rural and urban populations may help local governments to devise policies that are appropriate and tailored to their communities.

Here at the ESRC-funded HOPE project (Health of Populations and Ecosystems) we have undertaken an initial analysis of the active travel of adults using data collected from Understanding Society, the largest UK representative household panel study.

In urban areas (defined as settlements of 10,000 people or more) we found that:
•    Residents were 64 per cent more likely to report that they always or very often walked or cycled short journeys of less than two to three miles.
•    Residents not in full-time employment and with no children are likely to walk or cycle more.
•    High-earners were less likely to take opportunities to travel actively, particularly if they had children, although those educated to degree-level were more likely to cycle or walk short journeys.
In rural areas, we found that:
•    Only seven per cent of the population reported not having a car in their household.
•    There were fewer socio-demographic predictors of walking or cycling short journeys.
•    Rural residents in both higher and lower income brackets tended to use their cars for shorter journeys regardless of education or whether they had children or not.

Although there are fewer opportunities for active travel for rural residents  than for those living in towns and cities, the habit of using cars even for short rural journeys should be challenged. People living in rural areas need to be more pro-active than urban residents in order to meet their physical activity recommendations and to reduce their carbon footprint.

There also seems scope for increasing active travel in urban areas for some groups of people such as women, those with children, or with lower qualifications. We know that people with lower qualifications and lower income are less likely to engage in vigorous active leisure pursuits than those in higher brackets, therefore encouraging more active travel for some could be an important factor in helping increase their everyday physical activity.

In the next phase of this research we will explore relationships between people’s environmental behaviours such active travel, energy use in the home and health behaviours such as fruit and vegetable intake, alcohol and smoking. An understanding of this may influence policies for improving the health of the population and the health of the environment.  

Signatories:

  • Dr Ben Bouquet
  • Dr John Ashton
  • Prof. Amanda Burls
  • Prof. Simon Capewell
  • Sir Iain Chalmers
  • Dr John Middleton

In public health, there is a tendency to focus on numbers and statistics, which can detract from deeper understanding of the human stories involved.  To date, in excess of 1,400 Palestinians have been killed in Israel’s bombing of the Gaza strip.  Around one in five is a child.  The vast majority are civilians.  To date 56 Israeli soldiers have died and three civilians have been killed in Israel (1).

We need all sides in this conflict to work for peace. All forms of aggression, whether they are carried out in the name of Israelis or Palestinians, are harmful to the public health of people living in both countries.

Israel, as an occupying power in Gaza and the West Bank, has a number of legal and moral duties, which include the safeguarding and promotion of public health for the Palestinian population (2). In this regard it has undoubtedly failed.

The blockade of Gaza since 2006/7 has restricted supplies of food, fuel and the materials needed to rebuild communities following previous destruction.  This and the government’s dire financial situation are contributing to massive unemployment, which remains consistently in excess of 30%.

The government’s lack of funds and severe fuel shortages have precipitated a worrying sewage crisis, with raw sewage now passing into the Mediterranean and increasing greatly the risk of outbreaks of infectious disease.  Fresh water supplies have also been compromised and 90% of water supplies are unfit to drink.  Many households are now reliant on bottled water for drinking.

At least 140,000 dunums of land planted with fruit and vegetables are at risk of drought.  The effects on health services from the fuel shortage, the limited supply of medicines and medical equipment and damage from recent bombing are of grave concern (3).

The cause of the present extreme deprivation in Gaza is the Israeli blockade, compounded by the closure of tunnel trade with Egypt, for so long an economic lifeline.   It is in this context that the recent clashes have arisen: many Palestinians do not see any realistic route to achieve restoration and improvement of their daily conditions.They have a shrinking means to protest, to ask the world to listen to their pleas for the reinstatement of their dignity and their autonomy (4).

In the current conflict, there have been allegations of the deliberate targeting of hospitals and civilians (5). Recent reports indicate extensive damage to the health service infrastructure, including hospitals and primary care clinics (6).

The main power plant has been hit which is now further affecting the water supply. Paramedics have been unable to access civilian casualties and lack a safe passage out of conflict areas.  Similarly there is no agreed safe zone for civilians and shelters and two UN schools have been hit.  (7)

In a video seminar with London public health specialty registrars this week Mahmoud Daher of the World Health Organisation in Gaza, described the current conditions, his sleep deprivation amid the sounds of the bombing, and the difficulty of comforting his children in these extreme circumstances.  He stated:

“The international community is suffering from a deficiency of conscience.  The killing of children and targeting hospitals has become a matter of numbers and incidents to report. A state of desensitization to the human aspect of this will be dangerous on humanity, we only see numbers, but there is a story behind each number, a human being. I witnessed today a targeting of the outside wall of Shifa hospital; I was there, about 15 meters from the wall. A few minutes after a bigger bombardment was heard and children arrived – dead bodies to the emergency room of Shifa, that was horrible. 8 children and 2 adults were killed while they were playing in the playground at Shati refugee camp. Can anyone in this world explain why? They are not numbers.”

The public health community has a strong tradition of seeking to save lives and prevent suffering, to analyse the root causes of inequalities and propose solutions, to follow non-violent codes of conduct that transcend narrow political and factional divides and support the cause of common humanity.  We invite the public health community to acknowledge and make links with Palestinian and Israeli human rights and health organisations and to support them in their work (8). We echo these organisations in calling for the following actions:

  • Cease the bombardment of inhabited homes, neighbourhoods and areas in the Gaza Strip (9).
  • Open a safe route for civilians to escape the battle zone and declare a safe shelter zone in the Gaza Strip (7).
  • Ensure the adequate provision of immediate medical and humanitarian assistance to the people of Gaza to ameliorate the consequences of the massive destruction of homes and infrastructure.

There have been calls for consumer and academic and cultural boycotts of the kind seen during Apartheid South Africa and with French nuclear testing in the Pacific.  We call on the international community, including our own government, to implement an arms embargo on Israel and Israel must abide by international law under the conventions it has ratified.

We urge those with influence in the Israeli government to speak out and to call for unconditional and meaningful talks with the Palestinian coalition government.   In this call they are supported across the world in their effort to end conflict and to reach a peace in which all parties can live with dignity, autonomy and freedom from aggression and intimidation.

We express our sympathy with the friends, families and loved ones of all those who have been killed.  Peace is possible, and it starts with talking.  As Nelson Mandela said, “If you want to make peace with your enemy, you have to work with your enemy.  Then he becomes your partner.”

References:

(1) Burke J. (31st July 2014). Gaza ‘faces precipice’ as death toll passes 1,400. The Guardian

(2) Occupation and international humanitarian law: questions and answers (2004).  The International Committee of the Red Cross

(3) Gilbert M. (June 2014) (links to a pdf) Brief report to UNRWA:The Gaza Health Sector as of June 2014.  University Hospital of North Norway

(4) Manduca P., Chalmers I., Summerfield D., Gilbert M., Ang S. and more than 20,000 signatories (23rd July 2014).  An open letter for the people in Gaza.  The Lancet.

(5) Dr Mads Gilbert in an interview with Rania Khalek (23rd July 2014).

(6) Israeli fire kills nineteen in Gaza UN school (31st July 2014).  Al Jazeera

(7) Mahmoud Daher (WHO), direct reporting.

(8) Laub K., Goldenberg T. (28th July 2014).  Gaza’s Al-Shifa Hospital Compound, Nearby Park Hit In Attack. The World Post (a partnership of the Huffington Post and Berggruen Institute on Governance)
(9) Sherwood H. (30th July 2014).  Gaza’s only power plant destroyed in Israel’s most intense air strike yet.  The Guardian

(10) 11 Israeli HR Organizations urgent call: Open a safe route for civilians to escape the battle zone and declare a safe shelter zone in the Gaza Strip (25th July 2014)

(11) Sherwood H. (30th July 2014).  Gaza: at least 15 killed and 90 injured as another UN school is hit.  The Guardian

(12) The eleven Israeli organisations which recently called to open a safe route for civilians to escape the battle zone and declare a safe shelter zone in the Gaza Strip are:

-    Adalah – The Legal Center for Arab Minority Rights in Israel
–    Association for Civil Rights in Israel
–    Bimkom – Planners for Planning Rights
–    B’Tselem – The Israeli Information Center for Human Rights in the Occupied Territories
–    Gisha – Legal Center for Freedom of Movement
–    HaMoked – Center for the Defence of the Individual
–    Machsom Watch
–    Physicians for Human Rights – Israel
–    Public Committee Against Torture in Israel
–    Rabbis for Human Rights
–    Yesh Din – Volunteers for Human Rights

(13)  B’Tselem calls on the Government of Israel to immediately cease the bombardment of inhabited homes, neighborhoods and areas in the Gaza Strip (21st July 2014)

  • Dr Veena C Rodrigues
  • Clinical Senior Lecturer and Head of Year 3 MBBS
  • Norwich Medical School

I have only recently made the transition from ‘lurker’ to ‘active user’ on Twitter. Recently, I found myself following a talk by Dr Jeremy Farrar, Director of the Wellcome Trust via live-tweets from a London meeting for clinician scientists in training (Nurturing the next generation of medical researchers). Dr Farrar cited three challenges to UK science:

(1)    bringing young people into science and finding ways to keep them there;
(2)    addressing the divide between the clinical and research communities and encouraging them to work together; and
(3)    tackling the damaging separation of PH from clinical service delivery.

As a clinical academic in public health medicine (PHM), the last two points resonated strongly with me.  I have held joint academic-service roles in PHM right through specialty training and into my Consultant role. Core to such a role was the need to bridge the gap between academia and the service setting, not only to work efficiently and flexibly across the two, but also to ensure that the skill set developed and enhanced in one role was utilised clearly to benefit the other.

In my case, my clinical academic skills of research methodology, critical appraisal and evidence-based medicine were ideally suited to needs assessments, priority-setting, service specification and clinical policy development, clinical engagement with provider Trusts, evaluation of cost-effectiveness of services at my Primary Care Trust (NHS) employment.

Similarly, my local service provision experiences enabled me to pull out of my tool box examples and anecdotes to liven up any teaching/ training sessions in my educator role. You must remember we are talking about integrating PHM into undergraduate medical education, which is a daunting challenge: ask any UK medical school public health educator! I also had first-hand knowledge and experience of the service setting to inform the writing of research proposals to apply for grant funding, etc.

It is easy to assume that clinicians and scientists would work together naturally but at a time when healthcare provider organisations face increasing scrutiny in terms of meeting targets for service provision, service priorities often trump teaching and research. Addressing this widening divide in the face of conflicting organisational priorities is likely to be challenging but crucial for nurturing the next generation of medical researchers.

The NHS reorganisation following the Health and Social Care Act 2012 resulted in public health departments being moved out of the NHS and into local authorities (LAs). While the advantage of joint working between public health and local authorities to improve and protect the health of the population cannot be underestimated, the benefit of this conscious coupling to local clinical service delivery is much harder to visualise.

Relationships that had been built after years of committed and painstaking nurturing of the clinician/provider-commissioner relationships through clinical dialogue facilitated or led by PH specialists were suddenly stripped away resulting in another layer of bureaucracy (albeit with a ‘core offer’) diluting the relationships between the two organisations (1).

The public health emphasis on health needs assessment, priority setting, fairness, equity, appropriate and effective commissioning in the face of budget restraints. Monitoring and evaluation of services is likely to vary in breadth and depth across the country. It is dependent on whether local authorities have kept local structures in place and the level of commitment of the local authorities to health/ clinical service delivery. A postcode lottery?

A recent publication confirmed that local authorities across England are diverting ring-fenced public health funds and scaling back staffing to plug funding shortfalls caused by government budget cuts (2). It has also been reported that despite a mandatory requirement for Health and Wellbeing Boards to provide public health advice to local clinical commissioning groups (CCGs), sufficient public health input into NHS services to is lacking. This is at a time when CCGs are struggling to balance quality improvement and financial equilibrium (3).

Following the NHS reorganisation in 2013, public health clinical academics and researchers who had honorary clinical contracts with local NHS organisations (PCTs) lost their clinical (NHS) links when the hosting of these contracts moved to PH England, a new non-NHS organisation, still struggling to establish its mark (4). This resulted in the formal separation of a link between academic and service public health that had facilitated joint working, making it nearly impossible to influence the work of local CCGs without getting embroiled in convoluted management links and processes.

So, you might well ask: where does this leave healthcare public health? It is difficult to predict the future but if the government is listening, please could you strengthen the requirement for local authorities to have an appropriately skilled public health workforce to provide adequate input into local NHS services? Supporting the work of CCGs towards effective and cost effective local health services commissioning is after all a key part of the standards for delivery of public health within local authorities! (5)

And pretty please, could you also restore public health academic-service links especially for clinical academics? I am fast running out of new examples to give my medical students to emphasize the clinical relevance of the public health curriculum.

References:

  1.   Department of Health. Guidance on the healthcare public health advice (core offer).
  2. Iacobucci G. Raiding the public health budget. BMJ 2014; 348: g2274.
  3.   Furber A. Public Health: what has worked, what hasn’t, and what’s next? The Guardian, 5th April 2014.
  4.   UK Parliamentary Health Committee. Public Health England: Eight report of session 2013-14. London: The Stationery Office Ltd, 2014.
  5. FPH. Standards for Public Health, 2013.
  • by Miranda Eeles
  • Researcher at London School of Hygiene & Tropical Medicine

“Why are we not more angry?”

That was the question being raised by the participants of Sandwell Health’s Other Economic Summit (SHOES) which brought together academia, doctors, architects, journalists, local government and civil society to discuss issues ranging from sustainable food policy and climate change to the privatization of the NHS.

The Summit, which was held at the Balaji Temple in Tividale on Friday 28th March, is Sandwell Health’s annual event that aims to explore current themes and challenges in public health both at global and local level.

Neo-liberalism, corporate power and an assumption that development equals economic growth were identified as some of the mains reasons behind the problems facing the world today, and the increasing gap in inequalities.

“We need to change the narrative”, said Dr David McCoy, senior clinical lecturer at Queen Mary University, London and Chair of MEDACT.  “We need to demonstrate an alternative system and put forward intellectual and scientific arguments to eradicate poverty and address climate change.”

Corporations, government and the insurance industry were all put under the spotlight as speakers lamented a lack of leadership across the party spectrum.

But as in previous SHOES events, the audience also heard about the achievements at local level which illustrate how change can happen, provided the political will is there.

Urban food growing, investing in community assets and young people, creating a culture of activity and a return to a strong synergy between rural and urban environments were listed as some of the ways in which to address local needs.

This year’s Summit also was a celebration of the exemplary work done by John Middleton, Sandwell’s Director of Public Health, who retired at the end of March after 27 years in the job.

‘Dials’ and ‘levers’ were terms used to describe priorities and actions that have been employed under his leadership to bring different agencies together to improve the health and well being of the local population, including the Police, NHS Trusts, Clinical Commissioning Groups, a Youth Council and different departments of Sandwell Council.

- by Dr John Middleton

-  Vice President, Faculty of Public Health; formerly  director of  Public Health for Sandwell, 1988-2004

When I first came to Sandwell in 1987 it was in the depths of recession. In health services there was no local mental health service, no palliative care and much general practice was single-handed out of shop fronts. Waiting lists for basic elective procedures could be up to four years. Over half the population was living in poverty. There were 120 high-rise blocks and nearly fifty thousand council houses. Less than half of all children were immunized against measles and other childhood immunisations were less than satisfactory.

There have been great advances in health and health services provision. Progress began in the early 1990s and became exponential in the early 2000s.  Even nine-month waits for operations were no longer to be accepted. They had to come down to 18 weeks. And no more than 4 hours in A&E.  Services for people with serious and enduring mental health problems were improved substantially in the early 1990s. Over many years there have been improvements in community based palliative care, with fewer people dying in hospital.

In my final annual public health report for Sandwell, ‘ Public health: a life course’, I have reflected on some improvements in outcome.  Heart disease deaths have gone down by an astonishing 2/3rds. Some of this is reflected in the long-term trends. But those trends have been influenced by the new and evidence based services, which have been implemented across the country over the years. We can point to improvements made in Sandwell, which have reduced deaths faster than the national rate and have reduced our gap in life expectancy with the national rate. Most recently, our GP based risk management system has saved more than 70 lives a year and closed the gap with the national life expectancy. Not a bad result considering heart disease deaths went up in the mid 2000s.  I believe this was a cohort effect. The group of men thrown out of work in the 80s were dying prematurely from heart disease, brought about by a lifetime without work, hope, and probably smoking, drinking and being inactive.

Teenage pregnancy has come down by 44% since 1998. This I attribute principally to rising expectations in education. From 2007, exam results went up and teenage pregnancy came down. Over a number of years, it ceased to be acceptable to attribute poor results and low expectations for our children to  ‘the deprivation’. If one teacher, or one school could make a go of educating children under difficult circumstances, they would all be expected to.  In health, there were also some excellent services built up painstakingly over a number of years, in personal social education, young people’s contraceptive services and morning after pill availability from pharmacists.

The fact that teenage pregnancy has not gone up again in the latest recession is, I think, due to the insulating effect of the Surestart programmes, which began in 1998. Surestarts gave support to parents from deprived backgrounds, Surestart plus gave additional support to teenage mothers and Surestart maternity grant gave some financial support to pregnant mums.  Most recently the Family nurse partnership has provided additional support to young mums. The policy advisory team from cabinet office that came to Sandwell in 1998 expressly set out the idea to support teenage mothers at that time, to break the cycle of babies born to teenage mothers then, becoming themselves teenage mothers 16 years on, I think we are seeing the benefits of that.

There has been an outstanding achievement in improving  Sandwell homes to Decent homes standard. In our local research which we plan to publish,  we have found much larger health effects in reducing cold related deaths and hospital admissions than have previously been reported.

There has also been the excellent achievement of Sandwell probation service in having the lowest reoffender rate in the country.  The health component of crime reduction this has been considerable- in tackling drug and alcohol related crime, responding to domestic violence, providing appropriate care for mentally disordered offenders and supporting community development programmes to combat violent extremism.  The recovery agenda for drugs and alcohol related offences has been a substantial contributor to reducing reoffending.

On a downside, there is much for my successor Jyoti Atri, to pick up on and deal with. Tuberculosis rates remain stubbornly and unacceptably high.  It is normal to be overweight in Sandwell.  Infant death rates have not reduced in the last 15 years. The West Midlands has the highest perinatal and infant deaths in the country and they have not come down as fast as they have elsewhere. The West Midlands has the highest rates of child poverty and the highest rates of obesity in the country both known risks in terms of infant health outcomes. We  also need to review our antenatal policies, particularly with regard to growth monitoring in utero. I have recommended that Sandwell should commission an expert review of infant deaths, preferably with other councils in the West Midlands conurbation. The review would look at how we should prevent deaths, and what might be needed in improving care in pregnancy and childbirth.

  • by Martin Caraher
  • Professor of Food and Health Policy/Thinker in Residence Deakin University, Melbourne (February 2013)
  • Centre for Food Policy, Department of Sociology, School of Arts and Social Sciences, City University London

There has been recent concern in public heath circles with the media reporting that the UK has opted out of the new EU Social Welfare Fund scheme, which began in January 2014. This replaced the ‘Food Aid Programme to the Most Deprived Persons in the Community’, commonly known as the MDP programme ran from 1987 to December 2013. The reporting has focussed on the issue that by opting out of the new scheme that food banks in the UK cannot access food or funds from the new scheme for those in need. While this is true and a consequence of the opting out (Hansard 2012), there are deeper – and maybe hidden – issues to be addressed.

These relate to the role of food banks in our society and the right to food for citizens as well as questioning why such a need exists? While food banks have captured the public imagination and grown from one in 2000 to over 400 today their emergence raises questions over the roll back of the state around food welfare and the role of charity as a replacement. Focusing on the supply of food to food banks while it may be important does not address the fundamental question of the place and role of food banks in a welfare society.

In the UK the methods of operation and funding of food banks varies. However, they generally rely on donations from retailers and to a lesser extent the general public. In the UK Food bank provision is broadly provided by two schemes currently in operation. The key provider of food banks in the UK is the Trussell Trust, a Christian charity which franchises its model to local groups allowing them access to food supply sources and the use of publicity materials. In the three months to the end of September 2013, 356,000 people received three days of free food from one of the 400 + food banks in the Trussell Trust network.

The second major operator is FareShare which collects surplus food from supermarkets and shops and distributes it through 720 charities and organisations to needy families and individuals feeding one million people every month. It itself does not operate outlets but distributes to those who do, some of which might be food banks but others could be homeless charities, shelters or soup kitchens. Aside from this there two schemes there are many other food banks operating on their own either as independent charities or part of existing community groups, see Milestone London for an example of a group setting up a food bank for the Muslim community.

So we are seeing increases in the number of food banks and also a divergence in delivery to specific groups. Such initiatives might be welcomed under the Big Society banner; the PM has praised the work of food bank volunteers, although the Work and Pensions Secretary of State Iain Duncan Smith is on record as accusing the Trussell Trust of expanding by nefarious means when he said:

I understand that a feature of your business model must require you to continuously achieve publicity, but I’m concerned that you are now seeking to do this by making your political opposition to welfare reform overtly clear.

Many contend that the rise in the numbers using food banks is indicative of household food poverty, while the official government line is that there is no evidence that the welfare reforms are contributing to the rise in numbers using food banks. There remain unanswered questions as to the abilities and appropriateness of food banks to tackle food poverty in the long-term and as to their ability to provide healthy food, even in the short term. Underfed people are also likely to be badly fed, leading to long-term health problems. This problem of supply is because of the reliance on donations and surplus/waste food stocks.

There is a body of work examining the mechanics and efficiency of operation of food banks and their contribution to nutrient health outcomes but few, UK focussed, questioning their social relevance. Dowler and colleagues (2001) argued that such schemes perpetuate food poverty by enabling the problems in rich societies to remain marginalised.

Looking to the situation in Canada which has a long history of food banks, Riches, (2002) asserts that those seeking assistance do so repeatedly and become dependent on food aid; as what starts as an emergency response risks becoming entrenched in civic society, a la Big Society model.

Such depoliticisation of food poverty and normalisation of food bank usage can have profound consequences not just for the users of food banks but for society as a whole -‘[T]his is precisely what government wishes to hear and it helps them promote their argument that it is only in partnership with the community that the hunger problem can be solved.’ (Riches 1997)

So while decrying the opting put of the new European Social Welfare Fund it needs to be understood that the UK decision was based on issues of subsidiarity and the right of the UK to determine its own solutions. The principle has much wider implications for the UK in terms of the part it plays in European policy formation.

The debate reported in Hansard (2012) concerning the social fund is nothing more than political mud slinging with MPs, across the political divide, accusing each other of being responsible for the increase in the number of food banks but no discussion on the determinants of food poverty.

In fact, the new The Social Welfare Fund is a cohesion policy justified by Article 174 of the Amsterdam Treaty which allows the Union to promote overall harmonious development by pursuing economic, social and territorial cohesion. It is not exclusively focused on food aid. It might be important to note that the Labour government never partook in the MDP programme or other EU initiatives such as the fruit and vegetable to schools scheme.

Additional supplies of food to food banks in the short-term may help but the long-term issues of ensuring a right to appropriate and nutritious food and needs to be addressed. Key to this is how people access food and without having to resort to emergency food provision through food banks. Food banks were set up to meet failings in the welfare state and to provide emergency assistance not to be the long-term providers of food to those in need.

The elephant in the room is not the food banks but the reasons why people are turning to food banks for help.

This is a combination of welfare reforms, increasing pressure on household budgets as income remains static while food and other prices such as fuel increase. The food banks themselves are beginning to be overwhelmed by the needs and the numbers being referred. The UN Special Rapporteur on the Right to Food, commenting on the UK said the solution was for the government to define social benefits in terms of rights  (Justfair 2013).

Thus we need to see food banks as the failure of government to deliver on the right to food. Winne (2009) in his book on the US food system says: “we must seriously examine the role of food banking, which requires that we no longer praise its growth as a sign of our generosity and charity, but instead recognize it as a symbol of our society’s failure to hold government accountable for hunger, food insecurity and poverty” (p.184).

In exercising the principle of subsidiarity and non participation in the new EU Social Welfare Fund the UK government may have limited access to additional food and resources for food banks in the UK; however this should not stop the public health movement from questioning and debating the role and place of food banks in society and looking to government for solutions to food poverty. Food banks are ‘band aid’ and needed to help people in emergency situations. As to what part they play in the longer term remains to be debated.

References
Dowler, E., Turner, S., with Dobson, B., (2001) Poverty Bites, Food, Health and poor families, London, CPAG.

Hansard. (2012), Fund for European Aid to the Most Deprived [Relevant document: Twenty-second Report from the European Scrutiny Committee, HC 86-xxii.] 18 Dec 2012: Column 806, (Accessed 28th October, 2103).

Justfair (2013) Freedom from Hunger: Realising the right to Food in the UK. Doughty Street Chambers, London

Riches, G., (2002) Food Banks and Food Security: Welfare Reform, Human Rights and Social Policy. Lessons from Canada? Social Policy and Administration. Vol. 36, No. 6, pp.648-663.

Riches, G., (1997c) Hunger, food security and welfare policies: issues and debates in First World societies, Proceedings of the Nutrition Society, 56: 63-74.

by Professor Frank Kelly and Dr Julia Kelly
King’s College London

When the UK passed the Clean Air Act in 1956 to reduce smoke and sulphur dioxide, it led the world in cleaning up air. In recent years air quality improvements have miserably stalled. We have been breaching European Union (EU) limit values every year since 2005 for the modern day pollutants nitrogen dioxide (NO2) and particulate matter (PM). Currently there is no prospect of achieving compliance for NO2 in some areas until 2025.

More worryingly, evidence to support the detrimental short and long-term effects on health has increased substantially over the same period of time. Data for 2008 estimate that air pollution contributes to at least 29,000 premature deaths in the UK each year.

In 2012, the International Agency for Research on Cancer classified particulates in diesel fumes as a known carcinogen. In 2013, a WHO report concluded that the health effects of PM and NO2 can occur at concentrations lower than the their health-based Guideline values which of note, are lower than the EU limits we fail to adhere to.

In addition, other than the well-documented risks to cardiopulmonary heath, increasing evidence exists that air pollution exerts a wider threat, negatively influencing reproductive outcomes and neurological health.

The lack of progress in improving air quality isn’t due to lack of attention by professionals in the field or lack awareness by Government. I and other expert witnesses have given evidence to the Commons Environmental Audit Committee in 2010 and again in 2011 – the ensuing reports were blatant in their conclusions, calling in 2010 for ‘political will’ and ‘committed resources to meet air quality targets.

The 2011 report concluded that ‘the Government has failed to get to grips with the issue’ and ‘must not continue to put the health of the nation at risk’. In February 2014 the European Commission launched legal proceedings against the UK for excessive emissions of NO2. This is the first case by the EU against a member state for breaching limits. One can only hope that this may have the clout to shake political indifference to air quality in this country.

Unlike the powers that be, up until the beginning of last week, it is probably fair to say that the majority of the public was relatively unaware of day-to-day air pollution, the sources and the dangers associated with current concentrations. This is partly because PM can’t be seen by the naked eye and NO2 is invisible and probably owing to a poor understanding of what is undisputedly a complex science.

However on Sunday 30 March 2014 light southeasterly winds began to blow Saharan dust plus polluted air from Europe over the UK. This mingled with our domestic emissions from cars and industry resulting in high levels of rather unusual mix of pollution. Owing to the persistence of easterly winds and dry weather, poor air quality remained with us until the end of the week.

Light easterly winds taking pollutants from continental Europe to the UK where are own fresh emissions are added is not unusual – even dust flows from the Sahara are not uncommon. Instead, what really grabbed the attention of the nation – other than the visible hazy smog – was the prolific reporting of the events in every conceivable form of media.

This was because on the 1 April 2014 the Met Office, our national weather service provider, took over responsibility for forecasting air pollution on behalf of Defra. With that came greater publicity. In comparison, previous episodes have attracted insignificant coverage. Other than registered users of proactive air pollution alert services, you would have been hard pressed to hear about the even worse poor air quality affecting parts of England three weeks ago. This particular event culminated in London recording the greatest concentration of PM10 in 2 years.

The highly charged media coverage did not stop even when air quality improved. This was the result of a change in wind direction to southwesterly, coming in from the cleaner Atlantic, combined with wet weather washing the pollutants out of the air. Sunday’s press covered emerging evidence that traffic-related air pollution may target neurodevelopment and cognitive function as well as holding diesel fumes to account.

British drivers respond to the marketing of diesel cars as the “green” option – on the basis of reduced CO2 emissions and lower fuel costs – such that approximately one half of all new private car registrations in 2012 were diesel. Added to this, in most cities diesel engines power the majority of our buses and taxis. The image however is now tarnished.

Diesel engines emit especially harmful particulate pollution and owing to lenient European testing regimens, NO2 emissions have risen steadily of the past 10-15 years. It was reassuring that this information reached the front pages of the Sunday broadsheets.

This pollution episode has certainly raised the profile of what, to many, has previously been an invisible problem. However the chronic effects of air pollution, owing to year-round exposure, are much more worrisome than the short-term, often transient outcomes. We cannot afford to just focus on distinct episodes. As succinctly put in one online blog earlier this week: ‘We need to reduce air pollution when it isn’t making the headlines as well as when it is.’ Traffic must be reduced and we must ensure a cleaner and greener element to what remains on the road.

This can be achieved through a number of strategies: an expansion of low emission zones, investment in clean and affordable public transport, a move back from diesel to petrol or at least a ban on all diesel vehicles not fitted with a particulate filter and a lowering of speed limits. Focused education and continued evolution of sophisticated information systems can also achieve a durable change in public attitude and in turn behaviour.

But engagement must be blatant and put in the context of other public health risks such as passive smoking and utilise compelling messages such as premature death. There will be costs – but these should be balanced against the economic cost from the impacts of air pollution in the UK that are estimated at £9-£19 billion every year.

Cracking our air pollution problem is a huge challenge. It is highly unlikely that our major cities will ever be able to boast ‘pure air’ especially if strategies focus on small areas of an overall road network – as I have been quoted before: ‘air pollution does not respect any boundaries’. With bold, realistic and moral leadership however, enormous potential exists to reduce air pollution so that it no longer poses a damaging and costly toll on public health.

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