Archive for December, 2009

In the last couple of months, alcohol minimum pricing has been widely, and often fiercely, debated. To add to the discussion, the Faculty of Public Health decided to conduct a survey of its 3,000 public health specialist members to see what they thought.

Out of the 274 Faculty respondents the vast majority (87%) supported the policy of a mandatory minimum price for alcohol.

59% were in favour of raising the alcohol price to 60p per unit.  A level of 50p per unit was voted for by 35%, and only 5% thought 40p per unit was sufficient.

Professor Alan Maryon-Davis commented: “There’s a lot of evidence showing that cheap drink is fuelling Britain’s booze culture and ruining so many lives.  We need to set a minimum unit price that’s high enough to deter heavy binge drinkers without hitting too hard the much greater number of people who drink sensibly and moderately.”

The noughties saw the ban on smoking in public places.   Perhaps the next decade will witness the introduction of minimum pricing for alcohol.

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… to the Climate and Health Council pledge to protect health through active engagement to limit the causes of human-caused climate change.  http://www.climateandhealth.org/pledge/index.asp

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Doctors, nurses and students highlighted the health benefits of tackling climate change in the lead up to the mass climate change march The Wave on 5 December. Wearing blue scrubs, pushing a hospital bed carrying a ‘sick’ globe and distributing ‘prescriptions’ for a healthy planet the group aimed to raise awareness of the threat of climate change to human health here and around the world.

On the march the Health Wave group also met the Climate Change Secretary Ed Miliband to deliver him the message “what’s good for the climate is good for your health”.

See pictures of the Health Wave event

Read the blog by David Pencheon, Director of NHS Sustainable Unit, on BMJ.com
Read the blog by Tony Waterston, Medact, on BMJ.com

The event was organised by the Medact, the Campaign for Greener Healthcare, the Climate & Health Council, Medsin, the NHS Sustainable Development Unit and the Royal College of Nursing.

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Friday, 4 December 2009.

I’m somewhere over the steppes of Central Asia – on my way back from an international conference in Hong Kong on the theme of emerging issues in public health. Time to sit back and reflect.

It was a good conference – attracting delegates from all over East Asia and beyond. Inevitably, much of the focus was on the ever-increasing burden of chronic disease in this rapidly developing and urbanising region – not just China and India, but Vietnam, Cambodia, Thailand, Malaysia and even Burma.

The same pattern is repeated again and again.  People flock to the cities to find work, the buildings zoom up, the traffic multiplies, the diet westernises and the waistbands expand. Obesity linked to diabetes linked to heart disease and stroke. Not helped by the efforts of the tobacco industry. As a result, the health systems, mostly private sector, creak and buckle. There’s widespread recognition that public health improvement and primary care are vital – but also widespread concern that they are chronically underfunded, patchily organised and poorly linked together.

One key to this is education – linking public health and clinical training -, a recurring theme of the conference and the main thrust of my keynote presentation.

But the real value in my travelling to Hong Kong was undoubtedly in the face-to-face meetings with people who have the power and influence to build up public health and primary care and link them together. There is no substitute for the personal touch in this part of the world – perhaps in any part of the world. Tele-meetings, invaluable though they are for many purposes, simply don’t cut it for forming close working relationships and building camaraderie and trust. Business people know this – to clinch a deal you need to get to know each other.

But, as I fly back across Mongolia and Siberia towards Moscow, St Petersburg and the Baltic, Copenhagen edges into my moving map and gnaws at my conscience. I know that this kind of meeting will have to become a rarity – at least for me. I do not want to be a climate criminal. I do not want to let the planet down. Of course I only fly long-haul to meetings where I feel my being there might make a real difference. But even so, I am determined to be much more selective in future. And I’m sure many others will be making the same resolution.

Yes, it poses awful dilemmas – can I really accept this next invitation to another faraway place? But it’s a nettle the academic world, and the business world, will increasingly have to grasp.

Otherwise Heathrow will need a third runway – and we’ll all need another Earth.

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By Dr Mala Rao

With just days to go for the United Nations Climate Change conference to begin, one can hardly avoid getting caught up with the intense speculation in the media as to what the outcome of the Copenhagen discussions will be.

Scientific evidence that the continued increase in greenhouse gas emissions is resulting in the worst-case IPCC scenario trajectories (or even worse) must form the foundation for a global policy to avert climate catastrophe and to establish a lower carbon economy. We owe this to our youth and to future generations. And this is why I am delighted to have been invited to address the Andhra Pradesh chapter of the Indian Youth Climate Network (IYCN) next week, and to enhance their knowledge of the health impacts of climate change in India.

Founded in 2008, the IYCN, which is part of the Global Youth Climate Movement, is an impressive coalition of young people concerned about climate change and wanting to contribute to climate solutions. It aims to generate awareness but also provides training on practical action. For example, how to establish and lead grassroots groups in their communities to become better informed about climate change and to contribute to measures such as addressing the environmental degradation which merely serves to reinforce the impacts of climate change. The work of the IYCN in cleaning up polluted lakes and helping with the recent relief effort in flood-affected districts of Andhra Pradesh is truly inspirational.

The IYCN is actively supported by the state government’s Chief Conservator of Forests who has established an impressive e-group entitled AP Environment Connect to link civil society groups, the IYCN, government officials and academics such as myself to share ideas and information on climate solutions. The APEC has arranged a three-day camp next week in Hyderabad, to watch telecasts of live coverage from Copenhagen, interact with India’s representatives at the Summit and to attend a series of presentations on the science, the impacts, the adaptation to and mitigation of climate change. I look forward not only to giving my talk on the health impacts at the camp but to learning about the highly innovative solutions being considered to achieve both economic progress and environmental protection. The optimism, enthusiasm and commitment of the APEC group, and the IYCN in particular, has been evident at past events and I am sure that next week’s will not disappoint.

I also look forward to sharing the new evidence published in The Lancet last week, about how India could reduce its greenhouse gas emissions and improve the health of its population at the same time by encouraging the use of cleaner cooking stoves and establishing urban transport policies which encourage walking and cycling and lower car use. I remain convinced that the health and well-being benefits of a lower carbon economy must be the most politically persuasive argument to advocate for change.

Nine years ago, leaders from 192 countries were sufficiently concerned about international health and social inequalities to agree an ambitious range of Millennium Development Goals, to combat poverty, hunger, illiteracy and disease. We must support our global leaders to seize this ‘what did you do in the war, daddy’ moment and demonstrate a similarly collaborative vision at Copenhagen that delivers a blueprint for a lower carbon and a better and more equal world.

  • Dr Mala Rao is Director of the first Indian Institute of Public Health, based in Hyderabad.

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By Jenny Griffiths

The UK will stage its biggest ever demonstration in support of action on climate change – The Wave – just before the United Nations conference commences.  To help to ensure that the health voice is heard loud and clear, health professionals will meet on Saturday 5th December to hear inspirational speakers and share ideas before joining the main event, walking to Parliament, demanding a healthier, low carbon society for ourselves and future generations.

The increasingly unstable climate has been affecting health in the UK for some years: the 2003 heatwave and the 2007 floods being the most dramatic examples.  The fight is on to avoid the tipping point of two degrees of global warming, beyond which catastrophic impacts around the world could trigger food and water shortages, ecosystem and associated economic collapse and mass migrations.  This is a public health crisis: we have only 5-10 years to stabilise greenhouse gas emissions, which rose by a third globally in the last decade.

A growing movement of health professionals is leading the way to a healthy, positive future.  As the Faculty’s Peder Clark notes in his post of 27 November, there is increasingly strong evidence that what is good for the climate is also good for health.  There are many inspirational examples of public health action:

  • Directors of Public Health are taking the lead in explaining to their populations that climate change is a major health issue; see for example Dr Paul Edmondson-Jones’ 2007 Annual Report which was entirely focused on environmental issues
  • Public health staff are involved with community development initiatives, such as Transition Towns which are creating self-supporting, healthy, resilient communities – for example Angela Raffle, who made a presentation at the FPH conference in Scarborough
  • Primary care trusts are working effectively with local authorities to plan and design healthy, sustainable communities – CABE’s recent publication “Future health: sustainable places for health and well-being” has examples
  • Many health organisations have joined the 10:10 campaign to reduce carbon emissions by 10% in 2010 – most health organisations are reducing their consumption of energy from buildings and travel, as well as developing adaptation strategies to cope with heatwaves, floods and energy crises
  • The Sustainable Development Commission and the NHS Sustainable Development Unit have recently launched the new Good Corporate Citizenship Assessment Model to support progress on sustainable development

We have, of course, yet to reach the critical mass of public commitment to resolute action.  A recent Times poll suggested that over 40 % of the population are still in denial that climate change is happening now and is caused by our lifestyles; and it is likely that the Copenhagen summit will not deliver legally binding commitments.

But the health community can be ready with a powerful non-pharmaceutical prescription for post-Copenhagen depression: a public health movement for healthy, sustainable, low-carbon communities.  It is the most important public health movement of our lifetime, its underlying aim being no less than to secure the future for the human species.

Change will be difficult because we are deeply addicted to carbon-dependent ways of living.  But a low-carbon life rewards us with a health dividend: an improved quality of life replacing a focus on materialistic standards of living.

And in public health we have decades of experience to draw on in how to help people to overcome the most intractable behavioural challenges, through an effective combination of policy and practice.

We know what to do.

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“A Stalinist NHS quango” is just one example of the kind of newspaper coverage that the National Institute for Health and Clinical Excellence (NICE) has been hit with according to the Guardian Columnist Polly Toynbee“Notorious for denying life-saving drugs to terminally-ill NHS patients” was another, hardly more measured, journalistic description Toynbee chose to quote in her opening remarks at this year’s NICE Conference.

But behind these often negative headlines, NICE has been quietly issuing high-quality guidance that has acted as a beacon for a number of public health initiatives across England.  The hard work that has been going on in the background in consultation with clinicians, public health experts and, of course, patients, was palpable at the conference sessions.

“Shared Learning: implementing guidance promoting health and wellbeing” plenary highlighted some of the outstanding work that has been making a real difference in local communities around the country.

The first of these, led by Dr Peter Brambleby, Director of Public Health at NHS North Yorkshire and York, looked at the impact that creating close working relationships with both the PCT and the local Council has had on his community. Dr Brambleby stated the case for evidence-based commissioning, breaking down the word to illustrate what he means: co-mission-ing. The ‘co’ reminds that this is collaborative, the ‘mission’ reminds us that we are working together for a common purpose (improving the public’s health), and the ‘ing’ reminds us that this is a verb, an active, ongoing process.

The next two offered more practical examples of public health interventions making a difference in their local communities. Caryn Hall, a Consultant in Public Health at NHS Gloucestershire, outlined the work that they were undertaking with town planners to ensure that built environments are designed to encourage physical activity, helping to tackle the growing obesity problem. Julia Olijnyk, of Addaction Staffordshire, presented her project, a needle and syringe exchange programme for drug addicts in Stafford. She provided real-life illustrations of the helping hand that NICE guidance has provided in terms of engaging pharmacy staff in the project, resulting in positive outcomes and greater engagement with service users.

All three projects were shortlisted in the ‘Health and Wellbeing Category’ of the NICE Shared Learning Awards. Ultimately, the Addaction Staffordshire’s needle and syringe exchange programme triumphed, but all are excellent examples of public health in practice.

“Innovation and Value” was the overarching theme of the 2009 NICE Conference and away from the headlines, these three projects demonstrated those qualities admirably.

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By Dr Alex Gatherer

Consider some of the facts relating to prison health.  The majority of prisoners, some 80% or so, have some form of mental ill health, and between 5-10% have serious mental illness, which requires specialist care in suitable facilities.

Furthermore, in any community, the local prison at any one time will hold a disproportionately high number of non-nationals and minority ethnic groups, of people positive to HIV and Hep C, of people with educational and social skills deficiencies, of those addicted to some form of substance addiction, of those with serious communicable diseases and of those previously hard-to-reach in our cities and towns.

In most countries, including our own, this high needs group will be detained in old premises with inadequate facilities for meaningful activity and recreation and often in overcrowded conditions.

And the majority of prisoners will be out of prison and back in their home environments on the streets in our communities often after only a short time.

‘Statistical compassion’ is one of the unmentioned skills required of top quality public health practitioners.  We must be able to look behind the statistics and see the suffering, the unmet needs and the social injustices amongst the individuals who make up the overall figures that are so central to the reports we write.  Without ‘statistical compassion’, how can we make sure that we take into account, in everything we do, those who are in greatest need?

Public health has a choice. We could ignore the above, as we did for many years and waste any opportunities to help a vulnerable high risk group. Or we could realise that it is in the interests of public health as a whole to prevent our prisons from being focal points of disease.

We could also realise that the right to health applies to all.

  • Dr Alex Gatherer is Fellow of the Faculty of Public Health. In November 2009 he was awarded the American Public Health Association’s Presidential Citation for his work in improving health in European prisons.

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