Archive for March, 2018

By Sue Lloyd, Fellow and Board member of Faculty of Public Health

During the past year the Faculty of Public Health (FPH) has been celebrating the contribution of women to medicine and health alongside the Royal College of Physicians. As a woman working in this field it’s been a joy to hear the stories of women’s lives and their work to improve the lives of others, despite the challenges, or maybe because of the challenges, that they faced.

It’s not an accident that woman have been active throughout human history in improving the lot of us all; it’s part of our DNA. Women have always been active as carers whether in an official capacity or not, this being subject to the whims of the cultural orthodoxy of the time. We’re fortunate to have seen great contributions from the likes of Kitty Wilkinson, the Liverpool ‘Saint of the Slums’ who in the 1832 Cholera epidemic offered her boiler to slum families so that they could wash clothes (this killed the bacteria); Josephine Butler who campaigned to end child prostitution; and Anne Bieznak, who opened the first Catholic contraceptive clinic, after she had personal experience of eleven pregnancies by the age of 34 years. These are just a few examples, of many.

Public health historian Virginia Berridge of the London School Hygiene and Tropical Medicine, said: “Women have played a significant role in public health in the past – just think of the work of the Ladies Sanitary Associations in the nineteenth century which were one of the first ways in which women were visible in public life. We must use knowledge of that past history in planning for the future of public health.”

Today, we are joyfully celebrating International Women’s Day. FPH is proud that from its establishment in 1972 women and men have always been equally active partners.
Many of the institutional challenges that FPH’s founders overcame have been removed. Rosemary Rue (President 1986-1989) was expelled from her medical degree when she married and was later sacked from her first job when it was discovered that she had a husband and child. Rosemary pushed against the cultural norms of her time as a woman to improve housing, water supplies and immunisation in Oxfordshire, where she was Chief Medical Officer.

It’s fortunate that these barriers are now somewhat diminished, but as public health professionals we are always vigilant that these barriers don’t transform into something else, something with a different name. We see echos of this in the #MeToo campaign.

As we move forward into a new era where women and men are contributing equally to health and social care we want to celebrate what has gone before and to hope for a truly integrated future.

We look forward to seeing health in all policies and the radical prevention approach integrated into new ways of working.

Dr Catherine Calderwood, Chief Medical Officer, Scotland, celebrates this future with the following words: “Despite the social and cultural obstacles facing women, evidence from across the centuries clearly shows them at the forefront of delivering practical solutions to past public health issues. Although attitudes to women providing healthcare have changed, I am sure that we will continue to make the same positive contribution to drive forward improvements in public health in the future.”

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By Jennifer Mindell, FPH Fellow and Chair of the Health Improvement Committee

Public Health England (PHE) and Department of Health and Social Care yesterday unveiled plans to limit excessive calorie consumption as part of the Government’s strategy to cut childhood and adult obesity. The plans target both consumers and industry, challenging the latter to reduce calories in products consumed by families by 20% by 2024. If the 20% target is met within five years more than 35,000 premature deaths could be avoided. Yesterday also saw the launch of the latest One You campaign, which will encourage adults to use the 400-600-600 calorie guidance for breakfast, lunch and dinner.

This is a very welcome step forward. We know that there are many drivers of obesity, including our environment, our genes, our behaviour and our surrounding culture. This very complexity means that if we are to tackle and prevent obesity, we must mobilise all sectors of society to take action and bring workable solutions to the table, and we are hopeful that PHE’s package of targeted reforms and initiatives will do just that.

We particularly welcome the Government’s focus on solutions that will impact families rather than just individuals. More than a quarter of children aged two to 15 in England are currently overweight or obese and younger children are becoming obese at earlier ages and staying obese for longer. This burden falls disproportionately on children and adults from low-income backgrounds. There are few effective interventions in place at the moment to help children identified as overweight or obese, making the prevention of obesity in children all the more urgent.

At the Faculty of Public Health (FPH) we believe that actions to protect children from obesity must be prioritised. This is why the FPH Health Improvement Committee has been developing policy to protect children from exposure to the advertising of foods high in fat, sugar, and salt (HFSS). We know that marketing greatly influences the food and drink children consume. The promotion of unhealthy food and drink is a significant risk for childhood obesity and the development of diet-related diseases. This is widely recognised by the World Health Organization (WHO) and many other countries. Industry spends 500 times as much on promoting HFSS products as the WHO spends on promoting healthy diets.

We recognise that regulations on HFSS food and drinks in the UK are among the toughest in the world. We are proud that the UK was the first country in the world to introduce scheduling restrictions on food advertisements, when in 2007, the Government banned HFSS product advertisements during or adjacent to ‘children’s TV’ programming or those that are likely to be ‘of particular appeal’ to children aged 16 and under.

However, we think that now is the time for additional progress to reflect modern family life. Children do not just watch children’s TV programmes and their viewing time actually peaks from 6-9pm, during what is called ‘family viewing time’. ‘Children’s TV’ programming generally is not broadcast during family viewing time, meaning that current regulations banning HFSS products make no impact then.

We started developing our thinking on this issue at the FPH conference in June of last year, where delegates discussed and debated how we could implement policy to limit children’s exposure to junk food marketing and encourage healthier behaviours. Around 15 different policy solutions were debated, covering a wide range of interventions. We’ve since refined our thinking; we believe that to protect children and support parents, the Government should take forward the following three interventions as priorities:

1. Strengthen existing broadcast regulations to restrict children’s exposure to junk food marketing by introducing a pre-9pm watershed on all HFSS food and drink advertising
2. Take action to ensure online restrictions apply to all content watched by children
3. Extend regulations to cover sponsorship of sports and family attractions and marketing communications in schools.

We believe that voluntary calorie reduction initiatives and behaviour change campaigns – like the ones launched by PHE and DHSC yesterday — will have the best chance of success if they are complemented by other regulatory measures like the ones we have proposed above.

We continue to be heartened by the progress that the Childhood Obesity Action Plan has made and are hopeful that PHE’s calorie and sugar reduction initiatives will prove to be world-leaders in tackling obesity and its health-related consequences. We believe that action against junk food marketing to children will support those aims and be critical to their success. We look forward to continuing to engage FPH’s membership and other partners in the development of this policy.

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By Alexandra Swaka, WHO Collaborating Centre, Imperial College London

In support of Eating Disorders Awareness Week, an international event that raises awareness on the challenges and stigma associated with various types of eating disorders, I invited clinical nutritionists, Rhiannon Lambert and Sophie Bertrand, to deliver a seminar to resident GPs and fellow academics of the Imperial College Faculty of Medicine to enhance current knowledge on eating disorders in the context of public health.

As the GP is most often the first point of call for the patient, with very little time to address the holistic needs of patients, Rhiannon and Sophie established some of the complex nutritional and psychological factors that are involved in catalysing both the onset and the continuance of disordered eating. The conditions, which include anorexia (the extreme limitation of calorie intake), bulimia (compensating binge eating through subsequent purging), emotional overeating, and orthorexia (a clinical obsession with eating only ‘pure’ food) are fuelled by severely unhealthy relationships with food and are usually exacerbated with prolonged suffering. With social media having more impact on everyone’s daily lives, sufferers of eating disorders are a particularly vulnerable group, facing greater susceptibility to impossible and unrealistic body ‘standards’ which they are bombarded with through mediums such as Instagram. In a study which Sophie was involved in conducting, she found that 21% of young people are referring to social media influencers for nutrition advice, and 44% of young people believe that eliminating an entire food group equals ‘health’. This may include complete elimination of fats, carbohydrates, or animal products. The two pointed out the dangers of turning to social media images for dietary advice.

It is now more than ever crucial for GPs to listen for clues that their patients might be internally suffering from an eating disorder, as body mass index may not always be an indicative factor of the psychological trauma associated with such conditions. While consultation time is limited, it is important to open up the conversation and have a list of resources, helplines, and referrals of nutritionists or charity organisations specialised in the field as an effective option to offer patients while (and if) they are on a waiting list for further clinical help. Like any illness, early intervention is key for successful long-term outcomes, and they recommend that patients are referred to qualified clinical nutritionists with professional experience in working with this vulnerable and impressionable population.

Rhiannon’s book, Re-nourish: A Simple Way to Eat Well, offers readers expert guidance to “eat like a Nutritionist” as well as evidence-based understanding of how nutrition affects the body, and sounds like a great starting point for everyone interesting in learning more about how to love food and feel great.

Links of interest:





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