Archive for November, 2009

It could have been a big day for public health in Scotland. It could have been the day when notice was served on Scotland’s ugliest health blight – its rising tide of binge drinking, drunkenness and alcohol-related illness and injury.

On Thursday this week, Health Secretary Nicola Sturgeon introduced the Alcohol etc (Scotland) Bill – a raft of proposals including further restrictions on drink promotions, powers to raise the legal purchasing age to 21 and, most controversially, mandatory minimum pricing to banish all those special offers of ultra-cheap drink at ‘pocket-money prices’ lining supermarket shelves

Everyone knows Scotland has the worst alcohol problem in the UK, indeed in most of Europe. We’ve seen its alcohol-related death rates doubling in the last 15 years, and alcohol-related liver disease rising faster than almost anywhere in the world.

Drink now kills about one person in 20 in Scotland and costs the country at least £2.25 billion in extra services and lost productivity. This toll is nothing less than shocking and amounts to a huge public health crisis that demands to be tackled with steady determination.

The SNP-led Scottish Government’s Alcohol Bill looked set to do just that until it came up against the combined machinations of party politics and the drinks trade.

Just hours before the Bill was launched, the Scottish Labour Party finally decided to join the Tories and Lib-Dems in declaring themselves opposed to the minimum pricing proposal. Unless deals can be done and sensible compromises reached, this element of the Bill will fail, knocking a great hole in the new legislation.

Needless to say this is all a massive disappointment to the supporters of minimum pricing, including all four UK Chief Medical Officers, the Royal Colleges of Nursing, Physicians, Surgeons and GPs, the UK Faculty of Public Health, the BMA, the Association of Chief Police Officers in Scotland and even the Scottish Licensed Trade Association.

We at the FPH have done all we can to bring the arguments to bear, and at our recent Scottish conference have pointed out the potential gains in health, wellbeing and lives saved if the minimum price were set at various levels. Alcohol consumption is closely associated with price – and the higher the minimum is set, the more it would deter heavy drinking. But too high a price would be punitive for the great majority who drink moderately and sensibly – and could encourage crime and smuggling – so a compromise would have to be reached through rational, informed debate.

I hope that the Scottish Parliamentary process will allow such debate to take place. I hope that Labour’s newly declared position is tactical and that they will at least offer enough support to the minority SNP government to permit proper discussion. Their current argument that minority pricing is ‘probably illegal’ under EU law seems very weak when stacked up against the hugely pressing social and humanitarian issue that heavy drinking in Scotland has undoubtedly become.

This week could have seen a major step being taken on the way to better health for the people of Scotland. Despite the latest setback, perhaps it still can be.

Let us have the debate – and let us see if, once again, Scotland can set an example to the rest of the UK by taking a strong, brave and decisive step for public health.

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“Now is not the time for health cuts” –  Rachael Jolley, FPH Head of Policy, on Andy Burnham’s proposed public health campaign cuts in the Guardian online.

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Climate change is so often associated with doom and gloom, so it was a welcome surprise to hear some good news yesterday at the London School of Hygiene and Tropical Medicine. I was attending the launch of the latest publication in the Lancet’s series on health and climate change, which looks at the public health benefits of action taken to reduce the damage we’re doing to our planet.

Ahead of the vital discussions in Copenhagen in two weeks time, it was unsurprising that the event attracted top brass. WHO Director General Dr Margaret Chan, UN Secretary General Ban Ki-Moon and Kathleen Sebelius, Secretary of the US Department of Health and Human Services all recorded video messages of support. Secretary of State for Health Andy Burnham declared it to be the “most important meeting I’ll attend all year”, which hopefully wasn’t far wrong.

The messages presented were no less important. Alongside comprehensive evidence about the severity of the crisis that we are all facing as our planet heats up, the report’s authors outlined the largely positive impacts upon our health that will result from taking decisive action to avert global warming. Professor Sir Andrew Haines and his team looked at four key areas in which strategies are being developed to reduce greenhouse-gas emissions: household energy, urban land transport, low-carbon electricity generation, and food and agriculture.

They found that many of these measures will impact positively on the public’s health. For example, a transport policy that enables people to walk or cycle more will not only reduce carbon emissions, but also result in lower cardiovascular disease as a result of more active lifestyles. Better insulated houses will result in warmer homes, reducing the number of deaths in winter. A reduction in the amount of meat in our diets would not only reduce methane emissions from livestock, but reduce ischaemic heart disease.

The models that the researchers explored included those in developing nations. For instance, the simple carbon stoves used by the poorest half of the world’s households are inefficient and produce airborne particles, including black carbon, and cause respiratory problems in adults and children alike. Replacing the old stoves with new, cleaner and more fuel efficient stoves over a ten year period in India would reduce the burden of these problems by a sixth, the equivalent to eliminating nearly half the country’s entire cancer burden. The message is clear: what is good for the planet is good for health.

It was an unusual feeling to walk out of a climate change meeting feeling positive about the future. It’s very easy to feel hopeless when confronted with the terrifying reality of where our world could be heading, but this event, and the accompanying publication, provides cause for optimism.

Fear paralyses, but hope energises. Let’s make sure that politicians remember these strong messages about health and climate change when they sit down in Copenhagen on 7 December.

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Doctors and other health professionals should look after themselves as well as their families and patients. The fact about swine flu is that there is no way that you can tell whether you will fall ill and become seriously ill or not.

Whilst death rates remain low for normally healthy people, you are likely to be ill for seven or so days (shortened by 1 day with Oseltamivir as NICE guidance states).  Data from the HPA shows that this is ‘proper flu’ in those in whom the disease is confirmed, and it is a debilitating illness as flu always is.

The swine flu vaccine remains a good match against the currently circulating swine flu.  Why would you want to become ill when there is a safe and effective vaccine available?

  • Dr Philip Monk is Consultant in Health Protection and Member of FPH Health Protection Committee

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One in 20 deaths in Scotland is linked to alcohol, said Dr Lesley Graham at the Scottish FPH conference.

Scotland has the fastest growing rate of liver disease in the world, said Graham, public health lead for alcohol and on the policy team for alcohol in the Scottish government.

The estimated cost to Scottish society was £2.25m per year, she added.

Price and consumption were linked, she argued. “Tackling price is so important,” she said.

Education is not powerful enough on its own, she said, putting the argument for minimum alcohol pricing.

Graham’s speech at the annual FPH Scottish conference, being held in Peebles, caused a call for a vote from the floor in support of minimum pricing.

The ad hoc vote was massively in favour of the proposal.


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Sunday 8 November 2009

Early morning in Philadelphia. From my hotel room I watch the sun rising over the Delaware River.

Yesterday I saw a different sun rising – a motif carved on the back of the chair in which George Washington presided over the signing of the Constitution of the United States of America after months of wrangling in 1787. At the time, Benjamin Franklin, sage and polymath, whose knowing presence is everywhere here in historic Philadelphia, observed, ‘now, at length, I have the happiness to know it is a rising and not a setting sun.’

Yesterday I switched on the TV during an ad break. First up was one of the interminable screamers from the NO lobby in the great healthcare reform debate. What about the $800 billion bill? All those inflated taxes? Can they guarantee you can keep your own doctor? Your current insurance company? Can they promise healthcare won’t be rationed? Persuade your congress representative to vote NO for the Public Option.

Then in quick succession: an ad for the statin Crestor to control your cholesterol – ‘if you have difficulty paying for medication, Astra-Zeneca may be able to help;’ and Reddi-Wip real ready-whip cream – dessert just isn’t dessert without Reddi-Wip.

Today I switched on the TV and everything has changed. The House of Representatives has passed its sweeping healthcare reform bill by a narrow margin – 220 votes to 215. Although it still has a few hoops to jump through before it becomes law, the way is now paved for the biggest extension of healthcare insurance coverage since the introduction of Medicare 40 years ago. The vast majority of the 46 million Americans without insurance will, by law, have to be covered. The federal government will offer its subsidised insurance scheme (the Public Option) in competition with the established health insurers. Radical change will happen through a largely market-driven shakedown within a framework set by government.

Later today I will be attending the Grand Opening of the Annual Meeting of the American Public Health Association – a colloqium several thousand strong, held this year in Philadelphia’s magnificent convention centre which, rather like Manchester’s, was once a busy railway terminus.

You can guarantee the place will be abuzz with talk of the healthcare vote. The atmosphere will be electric. It will light up the whole conference. I doubt there’ll be a soul there who isn’t absolutely thrilled at the prospect of such a huge change to US healthcare. It is truly momentous.

Barack Obama’s powerful pre-vote speech invoked the call of history – rather in the same vein as the ringing statements of the Founding Fathers here in Philadelphia.  And, fingers crossed, it seems to have been answered. As Ben Franklin might have said, methinks the sun, at long last, shows promising signs of rising.

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