Feeds:
Posts
Comments

Archive for March, 2010

Very long faces in the West Country this week. Despite much pressure from the health lobby, Alistair Darling has chosen to ignore calls for minimum pricing of alcohol, and instead has imposed a hefty tax hike on cider. In Wednesday’s Budget statement, the Chancellor announced a duty increase of 10% above inflation for cider compared with 2% above inflation for other alcoholic drinks across the board.

In recent years cider has enjoyed something of a tax holiday, making it a firm favourite among young people with little money and big thirsts. Cider has been a cheap way to binge-drink, and the budget hike is intended to bring it back into line on duty and price.

But are above-inflation tax hikes the best fiscal strategy for tackling alcohol misuse – especially binge-drinking by young people? Why the aversion to minimum pricing as an additional measure?

The problem with hikes in duty is that they can be easily absorbed by the supermarkets, which continue to offer cheap drink as loss-leaders to draw people into their stores. Many deeply discounted drinks are currently being offered at less than the cost of VAT, and these tend to be the very lines, such as strong ciders, lagers and alcopops, that are especially popular with young people.

Minimum pricing, on the other hand, has to be passed on to the customer. By fixing a minimum price per unit of alcohol sold – in other words, banning ultra-cheap offers on booze – the government can ensure that no drink can be bought at less than, say, 50p per unit, the figure recommended by England’s Chief Medical Officer as an ‘immediate priority’ over a year ago. This would mean no less than £5.50 for a 2-litre bottle of normal-strength cider (compared with many current offers under £2), £6 for the average six-pack of lager and £4.50 for a typical bottle of wine – more for higher strength versions.

The impact on health could be considerable. Consumption is closely linked to price, and a team at Sheffield University have calculated that, with a minimum of 50p per unit, every year the UK could see: 3,393 fewer deaths, 97,900 fewer hospital admissions, 45,800 fewer crimes, 296,900 fewer sick days, and a total benefit of over £1 billion. The deterrent effect and health benefits would be greatest for the heavier drinkers, especially those with the least disposable income.

With an election in the offing, the tax versus minimum pricing issue has split the parties. The Lib Dems are likely to be for it, Labour against (after Gordon Brown’s flat refusal to accept the CMO’s recommendation last year) and the Tories somewhere in between (on selected types of drink favoured by young people). In Scotland the parties line up differently – perhaps distorted by the distilleries – and the SNP-led efforts to drive through legislation are having a rough ride.

But, after the election, there’ll be all to play for. My guess is that common sense will break out and minimum pricing will soon be on the statute book as a useful adjunct to increases in duty. It won’t be either/or, but both/and. There’s still a chance that, just as it did with smoke-free legislation, Scotland could lead the way.

Or perhaps a fresh lot of Westminster MPs will see the light, and a ban on deep discounting of booze could be one of the early benefits of a hung parliament.

Good news for the nation’s health – but maybe less so for the apple-growers and cider-makers of the West Country.

Read Full Post »

World TB Day

On March the 24th 1882 Dr Robert Koch announced that he had discovered the TB bacillus, the cause of tuberculosis.

Here are a couple of links that highlight the problem that still blights so many people’s lives across the world – almost 130 years on from Dr Koch’s discovery.

A moving and enlightening video about TB in India – how the poorest cannot afford the expensive drugs.

TB in pictures, photographer David Rochkind has documented the disease in Mumbai.

One mother’s story about her struggle with TB in Chechnya.

Read Full Post »

Sir Liam Donaldson, the Chief Medical Officer has published his Annual Report 2009 this week. In the report the CMO highlights the key areas of public health requiring action and looks at progress made since previous annual reports.  One issue that he reflects on is the damage caused by “passive” drinking and the recommendation he made for a minimum price for alcohol in his last Annual Report.

FPH President Professor Alan Maryon-Davis  commented:

We’re strongly behind Sir Liam on this issue. The government should never have bottled out with minimum pricing. It makes total sense to ban ultra-cheap booze. We call on this government and future ones to reconsider all the evidence that is available.

In fact, the CMO’s Report refers to FPH’s public health manifesto calling for minimum pricing earlier this year:

The Alcohol Health Alliance UK brings together the Royal College of Physicians, the Royal College of Surgeons, the Academy of Medical Royal Colleges, the Faculty of Public Health and 20 other such organisations. To see such a group of medical bodies speaking together with one voice is very powerful. They speak in particular of the passive harms of drinking. They, too, call for a minimum price per unit.

Other professionals have echoed this call. The Faculty of Public Health represents 3,000 public health specialists from the United Kingdom and elsewhere. The Royal Society for Public Health has 6,000 members from health-related professions. In January 2010, these two institutions joined forces to publish a public health manifesto. It listed 12 actions that government could, and should, take to tackle a range of public health concerns. The first action on the list was a minimum price per unit of alcohol. (p.16)

The major challenges the Annual Report discusses this year include climate change and health, the benefits of physical activity on health and risk of cold weather on health.

FPH has produced a booklet about climate change and health called Sustaining A Healthy Future – A Special Focus on the NHS .

There is plenty of evidence about alcohol minimum pricing being the best public health intervention to problem drinking, for instance an independent review by the School of Health and Related Research at Sheffield University.

Read Full Post »

By Matthew Day, Public Health Registrar, NHS Wakefield District

When I started my public health training I had a three day local induction to get to know colleagues and learn from a range of speakers in public health from around the Yorkshire and Humber region. I found it useful as it provided inspiring insights and top tips on how things work in the specialty, as well as the time to connect with new colleagues. But while different deaneries strive to bring local trainees together through induction programmes and local events, how would it work nationally?

The idea of developing a ‘corporate identity’ for public health trainees was floated at the recent Public Health Futures event, organised by Sir Muir Gray and the Informing Healthier Choices team. Despite sounding like management speak, the fundamental point is a good one. While we all fight different public health battles at local, regional, and national levels, a better networked public health workforce developed through years of training would only be of benefit.

Sir Muir described his vision of the CMO welcoming all the new trainees personally. I can imagine the event: a handshake and pat on the back each, the CMO maybe throwing in a visionary comment about future public health challenges:

Trainee 1: “Er…hello Sir….

CMO: “Welcome to our specialty, son. Go forth and reduce inequalities…”

And then at the induction dinner that evening:

Trainee 1: “What did he give you?”

Trainee 2: “Coronary heart disease.”

Trainee 1: “You think that’s hard, I got inequalities…”

Jokes aside, rather than a pie in the sky idea, the underlying concept of a ‘national public health bootcamp’ for the new 2010 trainees has some merit.  Trainees 1 and 2 would stay in touch, collaborating, sharing and not duplicating important work on their interrelated subjects. In fact, this vision was already being taken forward after the event in the shape of the new national trainees’ website.

With Sir Liam Donaldson’s video message, and his imminent departure from Westminster, there was also a strong sense of the public health baton being passed on to us. Indeed, the baton we inherit bears the labels of a mix of hefty issues: obesity, alcohol (particularly minimum pricing), sustainability and health inequalities. In a show of hands vote, the majority of trainees in the room voted health inequalities as the single most important issue for our generation.

But very often public health is also about getting the right messages across to an audience, and doing it well. At the event, Sir Muir Gray quipped that “public health is about ‘performance,” and with his keynote speech Sir Michael Marmot gave a master class in how to engage with an audience. Indeed, in the shadow of a forthcoming election where spin-doctors are drawing battle-lines between ‘substance’ and ‘performance’, the message I took from the day as a whole is that we in public health must be experts, world leaders even, at both. We must deliver top-notch quality science and evidence base for our work and continually improve how we communicate that science and evidence base to an audience, be it the public, policy makers or the health sector.

National networking amongst trainees is certainly needed to help develop these skills so perhaps the sooner we’ll be pulling up those boots the better.

  • See the slides from the Public Health Future’s ‘Killer Slide’ competition with some brilliant examples of robust evidence base and great communication skills coming together

Read Full Post »

I went to a breakfast event at the King’s Fund this morning with Conservative Shadow Health Minister Stephen O’Brien MP. He was speaking alongside Sue Slipman, Director of the Foundation Trust Network, and Jonathan Nicholls, who is Research Director for Health and NHS at Ipsos MORI. O’Brien shored up the Conservatives’ public health credentials by outlining some of their policy thinking, should they be elected into Government.

According to O’Brien public health budgets would be ring-fenced by the Tories and he promised “support” for Directors of Public Health. O’Brien is also interested in including public health in all clinical career paths, and floated the idea of doctors spending six months in developing countries during their post-qualification training so that they lean public health principles.

After questions from the floor, O’Brien criticised the use of deprivation indices when calculating public health budgets, arguing that instead they should be calculated on the burden of disease in each area. He also expressed support that some social care interventions e.g. stair lifts for older people should be provided out of public health budgets. The Conservatives also want to change the statutory remit of NICE so that their guidance looks at wider societal costs of treatment, something O’Brien pledged to do in their first Health Bill should they be elected.

Snippets of the conversation are available to listen to at the King’s Fund website.

Read Full Post »