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Archive for the ‘Children and young people’ Category

By Professor Aileen Clarke, President of the Society for Social Medicine

A highlight of this year’s UK Faculty of Public Health Conference in Telford is going to be the Society for Social Medicine’s (SSM’s) ‘Research in Action’ session.

The SSM will be hosting this research feast at the always fantastic and hugely enjoyable FPH conference. Last year this session had standing-room only and this year it will be bigger and better than ever – and hopefully will have more chairs!

In our ‘Research in Action’ session, we will be presenting the top-scoring abstracts from SSM’s own annual scientific conference with a variety of public health topics. Last year they ranged from obesity, to housing and health and active commuting. This year we’re including public health advocacy, youth mentoring and immunisation uptake.

You can also expect the presentations to cover a range of research methodologies from epidemiology, cost-effectiveness modelling, systematic reviews and mixed methods to qualitative research.

SSM’s purpose is “advancing knowledge for population health” and in this case we are hoping to advance knowledge by showcasing exemplar public health research. Our session at the FPH conference is an exciting opportunity to promote linkages and future collaborations between public health researchers and practitioners.

I hope I have been able to sell our session to you. Please do come along and get involved.

Please find more information about the FPH conference at Telford on 20-21 June here.

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By Dr Nadeem Hasan

The importance of effective advocacy to achieving public health goals cannot be overstated.
Every day policies and regulations that affect health outcomes for better or worse are put on the agenda and kept off the agenda; discussed and debated; approved and rejected.

Many, if not most of these relate primarily to non-health sectors, such as food and beverages, energy and infrastructure, and alcohol and tobacco. But their impact on health outcomes is very real: all the stop-smoking programmes in the world can’t match the impact of the ban on advertising and smoking in public places on smoking prevalence; and there’s no amount of spending on childhood obesity programmes that can make up for the regulatory vacuum in this area.

Looking more broadly, policy decisions that affect income inequality, carbon emissions, and military action all have serious consequences for health across the world.

If we’re serious about prevention, we need to be serious about advocacy.
Where profits can be affected (almost everywhere), industry lobbyists seek to influence the regulatory environment in their favour. And they are very good at it. In principle, this is quite right – those affected by policy and regulatory shifts should indeed be able to make representations and provide additional evidence to support the decision-making process – and this includes relevant industry actors.
Representing the interests of everybody else is where advocacy organisations come in – acting as sort of ‘civil society lobbyists’ to balance out the discussion – advocating on behalf of the health, wellbeing, and broader concerns of the general population. Notably, this isn’t always an ‘us vs. them’ relationship: health insurance companies are routinely allies on advocating for lower drug prices; and renewable energy companies are more than happy to work with advocacy organisations on climate change regulation.

Put this way, it might sound like a fair playing field, with decision-makers receiving submissions from a range of groups and making balanced decisions to maximise the benefits to all parties. The reality of course is quite different, and much, much messier.
In 2014, there were an estimated 30,000 industry lobbyists in Brussels alone, falling just short of the 31,000 employees for the whole European Commission.

Civil society pockets are not deep enough to come close to matching this (or the salaries of lobbyists), and civil society advocacy and pressure groups are few and far between. Transparency falls short of the ideal, and the revolving door between policy-making and industry remains alive and well. Most recently the former President of the European Commission José Manuel Barroso was appointed Chairman of Goldman Sachs International, a move that has been widely criticised.
Advocacy organisations, then, have a difficult task – but one where even small successes can have far-reaching benefits for public health.
The European Public Health Alliance (EPHA), based in Brussels, is one such advocacy organisation. They bring together a range of health-related NGOs to advocate for better public health in Europe, working across five campaign areas: antimicrobial resistance; food, drink and agriculture; healthy economic policy; universal access and affordable medicines; and trade for health (and specifically the EU-US free trade agreement – TTIP – and the EU-Canada free trade agreement – CETA). Earlier this year, they hosted myself and another registrar in a pilot placement to understand health advocacy at the European level and to develop skills in this area.
So how to sum up the placement?
Invaluable. EPHA track the policy process for each one of their campaign areas and engage at every possible point. They attend every meeting at the European Parliament and the European Commission on these areas and make oral contributions at every opportunity; they submit comprehensive written responses to every relevant consultation; they engage on a daily basis with journalists to publicise their positions and build public support; they engage like-minded actors in the public, private, and not-for-profit sectors on a case-by-case basis to coordinate action; and they do all of this with just a handful of relatively young staff and interns.

They were very welcoming in bringing us into the whole process, allowing me to engage in every one of these steps – from writing position papers and consultation responses to making oral contributions at the European Commission and Parliament on their behalf.
Notably, EPHA also position themselves as an advocacy agency that actors from across the spectrum can engage with – in contrast to, for example, much more vocal organisations such as Greenpeace.

By way of example, the area that I was working on was TTIP. Whilst there are a raft of advocacy organisations across Europe (and the USA) that reject TTIP outright, EPHA’s

approach is to work through the whole agreement and advocate for the protection of public health on a section-by-section basis without rejecting the whole deal. With the European Commission politically committed to getting a deal, this makes EPHA one of the few organisations they can meaningfully engage with on this issue (though recent developments have called into question the likelihood of getting a deal in the near future).

This isn’t to say that their approach is ‘superior’ – every actor plays a particular role, with the more intransigent organisations key in shifting public opinion and providing the space for actors such as EPHA to engage in more balanced discussions. This means that they are invited to closed-door sessions with only a handful of actors, and have much more influence on the process than they otherwise would.
One of the challenges from a ‘public health professional’ perspective was that effective advocacy sometimes involves taking – shall we say – a less balanced view than we would normally as technical experts. From an ethical perspective, this raises a number of questions around whether the ends justify the means. I witnessed first-hand industry lobbyists making quite outrageous claims, including a rather undignified moment where I coughed up half my glass of water in a large auditorium at the European Commission when it was submitted that ‘alcohol is in no way an unhealthy commodity’ .

In a world where climate change denial is alive and well despite the most overwhelming evidence to the contrary, the ‘best’ approach to making our points is perhaps not so easy to discern.
And what of the relevance to the UK, particularly as we now start closing our doors to the EU in a bid to be a more open, global-facing country?
Whether or not the UK is a member, the EU remains a powerful actor that can influence policies related to public health both for its own citizens (which will still number ~450m after the UK leaves), and globally. As a close neighbour, EU regulations will have a strong bearing on public health in the UK too, and so engaging in advocacy at this level will continue to be an effective approach to improving UK public health.

This is true for everything from environmental regulations and air pollution, to pharmaceutical regulations and drug pricing and safety.
Within the UK, whilst it’s true that our policy-making process is not as amenable to advocacy as at the EU level (or remotely as civilised), effective advocacy still has huge potential to improve public health. We have not done well recently, with a watered-down childhood obesity strategy, no resistance to an unfunded ‘7-day’ NHS (that differs from the 7-day NHS that has existed since 1948 in some undefined way), and year-on-year increases in the use of food banks without any policy response (to name just three areas).

At the local level, there are a cornucopia of opportunities for advocacy to improve health, from influencing urban planning (fast food outlets close to schools, street design, cycling lanes) to advocacy around shifting public perceptions e.g. from opposing to welcoming refugees into local communities.
In this context, strengthening the advocacy skills of the UK public health workforce through engaging with and learning from experienced actors such as EPHA should be pursued with vigour – we can ill afford the alternative.

Dr Nadeem Hasan is a Specialty Registrar in Public Health

 

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  • Amy Smullen
  • Policy Officer
  • British Heart Foundation

The nation’s oversized waistline is putting our hearts under increasing strain.

We know that obesity puts people at a greater risk of coronary heart disease and having their lives shortened by a heart attack or stroke. But this isn’t just a problem of the here and now. It’s one that’s already waiting in the wings to devastate future generations as well.

junkfood_image

Watershed? why we need to ban some food adverts before 9pm

Around 30% of children in the UK are now classed as either overweight or obese. (1) Dietary surveys show that children are also eating too much saturated fat, salt and sugar. (2) Together, these factors put too many children at risk of carrying their excess weight and poor eating habits into adulthood, putting their hearts at risk.

That is why the British Heart Foundation (BHF), alongside many other organisations, such as the Faculty of Public Health want to see advertisements for food and drink that is high in saturated fat, salt and sugar (HFSS) banned before the 9pm watershed.

The BHF are acutely aware that obesity is a complex problem that requires action on lots of fronts. We don’t pretend banning junk food adverts is a magic bullet. But the sad reality is that our children are being bombarded with clever marketing encouraging them to eat products that have little nutritional value whether it’s walking to school, surfing the internet or watching TV at home. Banning these adverts before 9pm and tightening online regulation has to be part of the solution.

So why have we focused in on junk food adverts?

Firstly; because children aren’t like us adults. They cannot distinguish between what is harmless entertainment and what is persuasive advertising (3) and are they are therefore classed as a vulnerable group when it comes to advertising. Industry regulator Ofcom (4) states that ‘media literacy develops with age and … it isn’t until after 11 or 12 years of age that children can articulate a critical understanding of advertising.’

Second, research shows that food promotion, such as TV ads, can influence children’s food preferences and consumption. (5) Adverts also encourage general consumption, meaning that an advert for a specific chocolate bar won’t make you more likely to buy just that specific brand but any chocolate bar in general. (6)

And thirdly, on average our children are spending 27 hours either online or watching TV every week. That averages out at just under 4 hours per day. And it’s not just a few children skewing the average. Over 80% of children aged 5-15 watch the TV almost every day (7).

In 2007, the Government acknowledged that HFSS advertising was a problem, and banned any HFSS adverts during children’s programming. (8) But, while reducing the number they saw, this hasn’t stopped children seeing them.

That’s because adverts which are banned during children’s shows can be shown during family programming. Shows such as The Simpsons, X-Factor, and Britain’s Got Talent are technically classed as ‘family programmes’ despite high child audience levels. (The last two programmes made it into the top 20 programmes most watched by children in 2013.) (9) As such, marketeers are allowed to advertise any product they want. An audit by the University of Liverpool in 2013 showed that  almost one in four TV adverts shown between 8-9pm, when children’s viewing peaks, were for food products. (10)

Online, it’s even worse. It’s no secret that our children are online more than ever. Worryingly many of the techniques used to promote food and drinks online blur the lines between persuasion and entertainment, making it difficult for children to identify online marketing. (11)

Take, for example, advergames. These are online games that have a brand or marketing message integrated into them. Where a TV advert may only last for 30 seconds, research has shown that children spend longer engaging with the product message and engage with the brand at a deeper subconscious level. (12)

Adding to this the Committee of Advertising Practice Code, which governs marketing on advertisers own websites and their social media channels, doesn’t distinguish between healthy and unhealthy food.

The code states that “marketing communications should not condone or encourage poor nutritional habits or an unhealthy lifestyle in children’ – but what constitutes ‘condoning and encouraging’ or ‘poor habits’ is not defined.

But isn’t it all down to the parents? Shouldn’t they be policing their children more?

While we agree that parents are responsible for helping children eat a healthy balanced diet, these adverts undermine their efforts to do that. When we asked parents for their views, 70% of them told us that they had been pestered to buy HFSS products that their children had seen advertised on TV and 39% of parents said that these adverts were making it difficult for them to help their children eat a healthy diet. (13)

Over 30,000 people have already signed our petition, which calls on the Government to ban HFSS adverts before the 9pm watershed. Alongside the BHF and Faculty of Public Health the Academy of Medical Royal Colleges, the Royal College of Paediatrics and Child Health, Children’s Food Campaign, UK Health Forum, The Heart of Mersey, the British Dental Association, Family and Childcare Trust, the Association for the study of Obesity and the University of Liverpool also call for a 9pm watershed ban.

The demand for action is getting stronger and louder.

Help us stop these adverts by signing our petition to send a clear message to the Government that they must stop our children from being bombarded with HFSS adverts to protect their health.

1) British Heart Foundation (2013) ‘Children and Young People Statistics’ http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002326
2) Department of Health (2014) ‘National Diet and Nutrition Survey: Headline Results from Years 1, 2 and 3 (combined) of the Rolling Programme 2008/09 – 2011/12.
3)  E.g. Young B (2003) ‘Does food advertising influence children’s food choices?’ International journal of Advertising 22: 441-459. Hastings et al (2003) ‘Review of the research on the effects of food promotion to children.’ Food Standards Agency
4)  Livingstone S (2004) Childhood Obesity – Food Advertising in Context.
5)  Ofcom (March 2006) ‘Television Advertising of Food and Drink products to Children: Options for new restrictions: A consultation’ (para 1.8).
6) Hastings et al (2003) ‘Review of the research on the effects of food promotion to children.’ Food Standards Agency.
7)  Ofcom (2014)
8) Ofcom (2007) ‘Television advertising of food and drink products to children – final statement.’
9) Ofcom (2014)
10) Boyland, E and Whalen E (2014) ‘Analysis of food adverts shown during a sample of primetime television.’
11)  A.Nairn (2009) ‘Changing the rules of the game: implicit persuasion and interactive children’s marketing.’ Berkley Media Studies Group
12) Nairn, A. (2012) ‘Advergames: It’s not child’s play.
13)  British Heart Foundation (2015) survey.

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by Professor John Ashton, County Medical Officer and Director of Public Health for Cumbria

In one of his brilliant short films in the 1960’s, Ingmar Bergman depicts an extravagantly dressed clown, rolling into a small Swedish town, amusing all the children with circus tricks as he passes through. He then goes on to call at a house where he carries out a murder, changes into everyday clothes and strolls out of town unnoticed.

Over the past few weeks, as the scale of Jimmy Savile’s alleged abuse continues to grow, I can’t help but be reminded of Bergman’s character’s wicked genius.

The enormity of Savile’s alleged crimes spanning four decades would seem to be equalled only by the failure of safeguarding and governance at a range of institutions.The apparent breakdown in those systems now extends well beyond the BBC to include local authority adult and children’s social services, the NHS and the media and press who we look to to expose crime and matters of public interest.

But the real lessons of the Savile affair go much wider. They extend to weaknesses in our democratic institutions and processes where powerful men sitting on the top of bureaucratic hierarchies are all too often themselves the product of closed institutions of one kind or another. They lack a 360 degree moral and social compass. This is compounded by systems that we have developed based on over-dependence on professionals and technico-managerial, box-ticking exercises. These systems are not fit for purpose and fail those very people – the young, the frail, the vulnerable – who they are supposed to guard and protect.

If there is to be any kind of a positive side to this major tragedy of epic proportions it is that it has revealed the bankruptcy of our attitude and arrangements to safeguarding the most vulnerable among us to whom we all have a duty of care. It does take a village to raise a child.  We are all our children’s keepers.  If social workers have claimed territory that they are unable to occupy fully we have all colluded in a hideously flawed paradigm.

What is missing is a systematic, three strand, public health approach built on the secure foundations of full public engagement and  involvement rather than an abdication to a small but dedicated cadre of professionals.  Civic society has been squeezed by the professionalisation of everyday life coupled with the growth of an overpowering obsession with individualism and consumerism.  We have all become bystanders watching and waiting for somebody else to intervene.This has to change if we are serious about safeguarding.The voice of the child must be paramount and we all need to listen and act,  not just those paid to do so.

Secondly, the dysfunctional relationships between agencies has to change. Joining up the dots is impossible if front line workers don’t talk to each other. And thirdly those who have safeguarding in their job description must accept their wider responsibility to share it with the whole community. Whether they be social workers, clinicians, teachers, police or professional groups, these professionals need to be accessible and responsive when their unique skills and powers need to be deployed. Safeguarding must move upstream into prevention, into tackling abusogenic environments and into preparing the vulnerable and at risk to be able to speak out.

Yes, bureaucratic tick box arrangements do have their place. We are entitled to ask: who was ‘It’ for safeguarding on the BBC Board and in each of the NHS, Local Authority and other bodies where Savile was apparently able to prey unchallenged?

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by Camila Batmanghelidjh

Founder and Director, Kids Company

I watched a young man biting his arm who believed that, as a bird, he was pulling out feathers. There was no parent to care for him; for a long time he had coped alone. Let me evidence the invisibility of children like him who, at best, survive on leftovers of other people’s care and, at worst, shut down hope to avoid disappointment.

Kids Company supports 17,000 children and young people with psychosocial care. Recently, our work with 668 disadvantaged 16- to 23-year-olds highlighted dark statistics.

Just under 560 were not registered or connected with a GP; 411 required mental health interventions; 87% had experienced multiple trauma; 394 required housing; 365 needed sexual health interventions; 436 had to be registered with a dentist; 363 required an optician’s assessment.

These are citizens of the underbelly whose needs remain invisible and unmet. Young people have little faith in civil society’s ability to reach out to them. As one put it: “The government hates us.”

Young people believe this because the narrative emanating from politicians is often unwittingly derogatory. Tuition fees have increased, the EMA grant has been stopped, housing benefits have been cut. No-one will rent a room to a young man for fear that he may trash their house, and yet he cannot live in his own flat or bedsit, because £70 a week is the maximum allowance for his rent.

During the [2011] summer riots the TV cameras didn’t follow all those children who stole food. Instead they focused on those who took plasma TVs and trainers.  Forty-two per cent of the young people brought before the courts were in receipt of free school meals. But we are too frightened to see need. Instead, we see greed.

So what brought these desperate young people to such extremes of rage? Don’t go looking for big answers. The truth resides somewhere smaller: in that insidious space where human dignity is systematically eroded. The kids describe it as “stress”: the door of possibility slamming in their faces.

They’re told to have aspirations, but noone will pay their college fees. They’re told to get fit, but no-one will give them money for the gym. They’re told to eat well, but they have no more than £10 a week to buy food while on benefits. They’re told to see their doctors but don’t have enough phone credit or patience for the booking queue.

With 1.1 million children and young people having mental health difficulties in the UK, you’d be forgiven for thinking we were organising a nationwide famine in therapeutic support. Children need an integrated approach to wellbeing, taking into account their range of psychosocial needs in the context of sustained care relationships – not this lucky-dipping for healthcare.

Proximity would yield mutual solutions – healing the wounds of the banned age with a  bandage. Bandages support, hold and promote self-recovery. If a piece of cloth can do it, why can’t we?

This article first appeared in the December issue of Public Health Today, FPH’s quarterly magazine.

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