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Archive for the ‘Asia’ Category

By Claire Beynon MFPH

BACP Travelling Fellowship
Every two years the Faculty of Public Health (FPH) awards a BACP travelling fellowship to assist members of FPH in training to undertake educational travel. This fund was established in 1994, using funds donated by the British Association of Community Physicians (BACP) on its dissolution.

At the FPH Conference in Telford in June I was delighted to receive the travelling fellowship funding based on my application to travel to Japan to experience its culture and make observations about why its levels of childhood obesity were so much lower than those in the UK, and to present my public health work at a conference in Japan.

Observations on Childhood Obesity in Japan
Before I left for Japan I read many articles that explored the differences between childhood obesity rates in the USA and Japan. Their focus was on lifestyle factors including diet and physical activity.

Whilst in Japan I met with several academics who specialised in obesity, physical activity and diet. They were all most welcoming and shared their research and experiences readily.

The key points they raised were:

  • Younger children spend less time in school. As age increases so does the length of the school day. This gives more free time for outdoor play.
  • 90% of children walk to school daily.
  • Children do three hours of physical activity each week in school time.
  • There are no cleaners in Japanese schools; part of a child’s everyday activities includes cleaning their own school – children are active when cleaning.
  • Schools often have before-school sports clubs as well as after-school sports clubs.
  • Between each lesson there is a five-minute break to allow children to run around in the play area. This is in addition to morning break, lunch and afternoon break.
  • There are multiple opportunities in school for competitive sports, with regular competitions and celebrations. Children spend time practising for these with friends.
  • Children have three hot meals a day at breakfast, lunch time and in the evening.
  • Children serve each other a cooked meal at lunch time and sit and eat this hot meal together.

Further Observations
Whilst travelling in Japan I observed a number of additional environmental factors that tip the balance in favour of walking and cycling:

  • Priority is given to the pedestrian, then cyclist, then the motor vehicle. Encouraging walking and cycling. By giving priority to more vulnerable road users speed of motor vehicles is also decreased.
  • Cyclists and pedestrians share the pavement area, which is often separated from the road with a barrier and/or low-level bushes. This makes for a safer cycling experience than the UK where cycle lanes are often shared with buses.
  • There were a number of covered shopping areas, which were accessible only to cyclists and pedestrians and proved very popular thoroughfares.

    Shopping area in Japan

    Covered shopping area where pedestrians and cyclists share space

  • There was consistent and regular signage for cyclists and pedestrians, including details of directions and distances to the nearest public transport options.
Example of road, cycling and walking space in Tokyo

Example of road, cycling and walking space in Tokyo

• The number of employed people working on any urban street was much higher than the UK, with police highly visible, construction staff, cleaners, car park attendants and others all adding to the sense that the street was a safe place.

 

Policeman on the street in Japan

Presence on streets of local police make a space feel safe

• Public art installations make walking and cycling spaces more interesting and appealing.

Street art in Japan

Example of simple art installation

We know from the 2007 Foresight Report that obesity is a complex issue with multiple factors influencing obesity levels in adults and children. My own research looking at the risk factors for obesity in children in Wales using Welsh Health Survey data showed a reduced risk of obesity for children who met the one-hour physical activity guideline.

 

The new experiences and culture that I have experienced from this educational trip make me more determined than ever to tackle childhood obesity in Wales. I am looking forward to being involved in the drafting of an obesity strategy for Wales as part of my placement with the Welsh Government and will share my experiences with other registrars and colleagues at every opportunity.

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By Andy Beckingham FFPH, Fernandez Hospital, Hyderabad

Giggling Girls!

The scope of our profession gives opportunities to branch out. These may not always look at first glance like ‘public health’.

In 2010, working in India on maternal mortality, someone asked over dinner if I thought UK-style midwifery might be useful in India where doctors provided all the care. “Perhaps if you try the bits that work for women,” I said. “And avoid the bits that the NHS got so wrong.” My dinner companion turned out to be the MD of India’s most famous maternity hospital, and I found myself designing her midwifery pilot programme.

The midwife who had run the UK’s most woman-friendly midwifery service (the Albany Practice, which achieved great outcomes for disadvantaged women) was inveigled into joining us as a mentor. Eight anxious trainees found themselves becoming India’s first evidence-based woman-centred midwives (pictured). They began to develop their own profession, promoting choice about labour and supporting and empowering women to have more natural births. They had to challenge established obstetric practice. Our hospital’s maternity care began to change. Babies had been routinely separated from the mother at birth, although this impedes attachment and breastfeeding. The midwives worked with paediatricians to change that. Now most mothers have immediate contact and breastfeed their babies in the first hour.

Now leaders in their own right, those first eight have since mentored other trainees to become strong professional midwives, supporting thousands of Indian women to have better births.

Like most countries, India has unnecessarily high rates of intervention in childbirth. A local public hospital’s c-section rate is 52%. A local private hospital’s is 90%. But thanks to the midwives, ours has come right down. Instead of epidurals being routine, midwives ask women what pain relief they want. They offer choice. Women get continuity of care. The outcomes are better. Satisfaction rates are high.

In 2017, the state government invited us to train midwives to work in their hospitals too. They want c-section rates to come down. But they also want compassionate, respectful maternity care for the large numbers of women who are mostly ‘below poverty line’. So maybe, just maybe, this could become a model for wider public maternal-health improvement in lower-income countries. I have to assess its impact.

Designing a midwifery programme and curriculum doesn’t at first look like a public health role. But it is starting to address unmet needs, inequalities and disadvantage, improve care quality and effectiveness, show that Indian women and their choices matter. Of course, it will need to be part of wider action on social and economic determinants of maternal health.

And now, this alternative to the medical model is available, and the state government is actively promoting compassionate, effective midwifery care and supporting us to roll out professional midwifery more widely, among very disadvantaged women.

Public health, in disguise.

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