Feeds:
Posts
Comments

Archive for the ‘Health Inequalities’ Category

Natalie Lovell, one of the authors of What makes us healthy? An introduction to the social determinants of health, writes about distilling such a big topic into a quick guide

SOME people might think it’s a bit ambitious to attempt to produce a ‘quick guide’ to the social determinants of health – the social cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age. But, despite the vastness of the topic, we decided to give it a go.

The social determinants of health: what are the key messages?
Firstly, we should care about good health because it’s essential if individuals, society and the economy are to thrive. I recently read that “all members of a community are affected by the poor health status of its least healthy members”. Whether your cause is social justice or economic development, or you’re interested in social cohesion, good health is a relevant piece of the puzzle.

Secondly, health is about more than healthcare. When people are asked about health, their thought process often leads them straight to illness, medicine, and treatment of disease. But many of the drivers of health sit outside health and social care. As Michael Marmot puts it, “Why treat people and then send them back to the conditions that made them sick?”

Thirdly, as individuals, we have less control than we think. The factors that make us healthy sit largely outside individual control, and it is the conditions in which we find ourselves living that make us healthy or unhealthy – consider the greater density of fast food outlets in deprived areas in England. This is echoed in a recent report by Guy’s & St Thomas’ Charity about inner city childhood obesity, which found “it is in these areas in particular where people are bombarded with opportunities to eat high energy food and have less defence against ‘obesogenic’ city environments that promote unhealthy choices”.

Finally, collectively, we need to create the surroundings that give people the opportunity to be healthy. As set out in our quick guide, the evidence shows that many people and sectors have the levers to improve people’s health and reduce health inequalities (the differences in health outcomes that exist between groups in society). These include people sitting across government, the voluntary sector, the private sector, media, advertising and local communities. But if we don’t understand and act on this knowledge, we will never overcome our biggest health challenges.

What is already happening?
Many people can make a difference. It could be a charity that helps a group of people feel less lonely, an employer who decides to become a Living Wage employer, or a councillor who puts cyclists and pedestrians first when coming up with an action plan to tackle congestion. The list of those with the power to influence our daily lives for the better (often through structural changes), and therefore our health, is long.

We uncovered some great examples, particularly at local and regional level, of where, despite the odds stacked against them (such as severe budget cuts in local government), action is being taken that will improve people’s opportunities for healthy lives.

Read our quick guide, What makes us healthy? An introduction to the social determinants of health, to find out more about:

  • how local councils are using innovative inclusive economic growth techniques
  • how local councils are making the most of planning and transport policies to design and create healthy places
  • how charities and businesses can influence health
  • what approaches national governments are taking.

What’s the aspiration for this quick guide?
My hope is that this quick guide will make its way to those people across society who have the potential to influence people’s health, and that they might pick it up and think, “This is about me and the work I do.” Perhaps a public health expert will pass it on to a Director of Economic Development and Planning, who will pass it on to a business leader or employer they are working with, who might then be able to ask themselves important questions such as, “Did the last decision I make have an impact on people’s health?”

The quick guide sits within a broader programme of work at the Health Foundation. It offers a broad overview of the interconnectedness of virtually every aspect of people’s daily lives and their health – and therefore, the dizzying potential that exists for people across society to take action.

Order a free copy of the quick guide now. It will fit right into your pocket.

Oh, and the answer as to how you eat an elephant? Piece by piece.

Natalie Lovell is a Policy Analyst for the Health Foundation

Read Full Post »

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.

Read Full Post »

By Dr Jennifer Mindell, Reader in Public Health, Research Department of Epidemiology and Public Health, University College London

The government is proposing to ban the sale of diesel and petrol vehicles from 2040, to address air pollution in the UK that regularly breaches health-based EU regulations.

There are three main ways to improve UK air quality: reducing emissions from vehicles; driving less; and dealing with other sources of air pollution. The government’s preferred approach seems to be ‘business as usual, but less pollution from existing travel patterns’. Yet, even with this route, they are not committing to a scrappage scheme for diesel. This would produce air-quality benefits in the short-term, instead of in the 2040s – or even the 2050s and 2060s, as some individuals and businesses keep their vehicles for a long time. A scrappage scheme needs to be available to all individuals and businesses, regardless of size, and needs to encompass vehicles of all ages. Although older vehicles are known to be very polluting, no-one really knows about new vehicles! This could be complemented by financial help for retrofitting, particularly for older buses and lorries, if replacement isn’t an option.

Drivers of diesel cars are understandably aggrieved. They were urged to buy diesel engines by previous governments and given financial incentives to do so, because of the lower CO2 emissions per km. The higher emissions of other pollutants were ignored. Those with newer vehicles have no idea what their car really emits, due to the scandalous behaviour of manufacturers. This is yet another parallel with the tobacco industry (1) which designed cigarettes to produce low tar and nicotine in the laboratory but not when used by actual smokers.

Chargeable clean-air zones (low or ultra-low emission zones) are, according to a technical report issued by the government earlier this year, the most effective mechanism, but we understand that the government’s strategy will restrict charging to the last, not the first, resort. This is one of the areas, along with improved infrastructure for transport options other than private car use, that local authorities can contribute to greatly, but they need adequate powers and adequate resources. As air pollution costs the country £20 billion annually (2), the proposed figure of £255million to local authorities is a drop in the ocean.

The government is apparently also going to urge local authorities to speed traffic flows, by amending traffic-light settings and removing speed humps. What is actually needed is more calming, not less, to support smoother driving. It is not speed humps but the marked acceleration and braking that many drivers do that increases pollution. Greater use and enforcement of, and adherence to, area-wide 20mph limits without traffic calming would be better still.

Lower speeds, which would also support more and more pleasant walking and cycling, bring me to the better approach. Instead of persuading (in the next two decades) or requiring (from 2040) people to replace their existing car with an electric car, the health gains would be far greater if people travelled by public transport, walked or cycled whenever possible. As well as reducing pollution and carbon emissions, this generally increases physical activity and can improve wellbeing and reduce obesity and its consequences.

Reductions in pollutant emissions can also be achieved by reducing the need to travel. If people who could do so worked at home once a week, that would reduce their commuting by 20%. Land-use planning that encourages mixed use can shorten journeys sufficiently to make non-car options more feasible, although this will take longer. But as the government proposal for banning sales of diesel and petrol cars is to start in 2040, they are talking longer term anyway.

The government also needs to acknowledge that, although mobile sources are the largest category of pollutants, they are not the only ones. Two major contributors are buildings, including both homes and businesses, and transboundary industrial pollution from mainland Europe. Ministerial engagement with European countries will be necessary to deal with the latter. Local authorities need to be given the powers to address the former.
Air pollution is a major contributor to health inequalities. Poorer people are more likely to be exposed to higher pollutant levels. They are also more susceptible to the harmful effects of pollutants as they are more likely to have circulatory diseases (particularly heart disease and strokes) and respiratory diseases, such as chronic bronchitis or emphysema (now called chronic obstructive pulmonary disease) or asthma. Improving air quality is an important factor in reducing health inequalities.

The other option that we trust the government won’t take is to move the goal posts when (or if?) the UK is no longer bound by EU legislation. That would really be a cynical approach to the population’s health.

************************************************************************************

1. Mindell J. Lessons from tobacco control for advocates of healthy transport. J Public Health Med. 2001; 23:91-7.

2. Royal College of Physicians, Royal College of Paediatrics and Child Health. Every breath we take: the lifelong impact of air pollution. London: RCP, 2016.

Read Full Post »

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.

Read Full Post »

By Dr Uy Hoang, Chair of the FPH Film Special Interest Group

Following the announcement of a General Election, FPH called for the next Government to think more about our long term health, embed health in all policies, and work with people and communities to focus on preventing ill health and easing pressure on our overburdened NHS.

At FPH’s Annual Conference in Telford (20-21 June), FPH’s Film Special Interest Group (SIG) will bring together public health specialists, academics, and film makers to discuss the role that film can play in helping policy makers locally and nationally perform the type of joined-up thinking that health in all policies demands. We’d love for you to join us in Telford as we screen critically acclaimed films, hear from expert panels of film makers and public health professionals, and open to the floor for wider discussion and debate.

Headlining the FPH Annual Conference will be a screening of I, Daniel Blake, the winner of the 2016 Palme d’Or Cannes award and the latest film from legendary director Ken Loach. The film highlights many issues that are in the fore of this election campaign, including how to best support people with complex health and social needs.

With Brexit and the impact of economic migration likely to dominate this election cycle, we will use film to shine a light on a less discussed aspect of the movement of people- human trafficking- to ensure that that story is not missing from the dominant narrative surrounding immigration. We will screen the award winning film Slaved, followed by a debate with representatives from the police force, public health, and NGOs working within the field. The film brings to life the personal stories behind the public health statistics, shows what our public health workforce is contributing now to tackle these issues, and demonstrates how relevant a public health perspective will be to the next Government as it grapples with these complex problems.

Those of you interested in prevention will find the screening of Up for Air particularly engaging. This award winning documentary follows Jerry Cahill, a 60-year old pole-vaulting coach battling cystic fibrosis. Due to his vigorous exercise regime, Jerry is now 20 years past his expected life expectancy and is one of the oldest living patients with the genetic disease. This film is a powerful and stark example of the benefits of exercise, especially for those living with a chronic disease.

The Global Violence Prevention SIG will highlight the work of public health practitioners, especially women on the front lines of care delivery, with a screening of the film Grace Under Fire. The film follows the story of Dr Grace Kodindo, a leading reproductive health advocate and champion of women’s rights, as she works to expose the horrific toll of the conflict in the Democratic Republic of Congo and rebuild health services for women and children.

As you can see we have a full and compelling programme. We hope you will join us for our ‘film festival’ and contribute to the debate.

For details of the conference and to register please visit http://www.fph.org.uk/fph_annual_conference_and_public_health_expo_2017

For FPH’s election briefing please click here

If you are interested in joining the FPH PH SIG or have any suggestions for films that we could screen, please contact Policy@fph.org.uk

Read Full Post »

By Melisa Campbell MFPH, Research Fellow in Public Health, (Out of Programme: SpR Public Health [St4]), Department of Public Health and Policy, University of Liverpool

Melisa Campbell

Telling the story of child inequalities in health and care using big data research has been my passion for the last six months of my Health Education England Academic Fellowship, a focus fuelled by my personal working experiences within public health departments and healthcare systems.

As many of us will be welcoming spring and making plans for the summer, I am at the ‘show how’ phase and planning for my pending PhD application, which builds firmly upon my out of programme academic experience at the Farr Institute and the Department of Public Health and Policy at the University of Liverpool.

During my fellowship so far, I have been fortunate enough to share my work at the recent Lancet Public Health Conference (2016) Swansea and the Society for Social Medicine (SSM) Conference 2016.  I am also currently drafting further papers with colleagues from University of Liverpool, University of Nottingham and University College London.

The first months of the fellowship were quickly consumed by intense technical training, making connections within and outside the university and refining my understanding of theories and methodologies necessary to deliver my proposal, particularly with relation to health inequalities and statistical methods.

On-going learning has appropriately defined my fellowship and considerably expanded my skills, knowledge and practice of research methods including statistical methods for regression analysis, dealing with missing data and longitudinal data. I’ve been learning to undertake these analyses in STATA, and also in R, which is an open source statistical platform that anyone can use for free, and so gaining transferable skills for public health service practice.

Much of my work has been exploring childhood social inequalities using the Millennium Cohort Study data – a nationally representative birth cohort of 19,000 children born at the turn of this century. Within this, I have maintained a special interest in childhood unintentional injuries, but my professional growth from this experience has facilitated a greater breadth of topics relating to child inequalities pertaining to paediatric hospital admissions, smoking initiation and school bullying, drawing on the expertise in the Farr Institute.

This has already been a rewarding experience and I look forward to making the most of my remaining time. My contact details, previous and when ready information on my current and future work can be found at: University of Liverpool: Melisa Campbell

Read Full Post »

By Margaret Whitehead

David Player led the Health Education Council in the 1980s. On April 2 he celebrated his 90th birthday in Edinburgh

I first met David Player in the mid-1970s, when I took up my first public health research job in the Scottish Health Education Unit (SHEU) in Edinburgh, where David was Director. At the time, David had this great idea: to pump-prime academic health promotion by funding academic lectureships in the various relevant disciplines in Scottish universities. As this was a novel strategy at the time, a range of committees had to be convinced, and David taught me how to put a compelling case with different messages for different interest groups. He triumphed in the end, and the fruits of his far-sighted vision can still be seen today, not least in the leaders of public health research that his initiative produced.

One of the first lessons that working under David’s directorship taught me was that everything about public health is political – even the seemingly most innocuous subjects could catch you out. One of my very first tasks was to produce a factual guide to family-planning services in Scotland, which I never dreamt anyone could object to. I was wrong. Somehow it came to the attention of the Scottish health minister with a strongly Catholic constituency in Glasgow, and, before I knew it, objections were being raised and outrage was being expressed. This was the sort of challenge that David cheerfully faced every day – be it about sugar, alcohol or tobacco – as he waged war with what he termed “the anti-health forces”.

It was David’s longstanding passion about unemployment and health and inequalities, however, that shone through for me. David moved from SHEU in the 1980s to take up the post of Director General of the then Health Education Council (HEC). By then I was a freelance researcher and in January 1986, David commissioned me to update the evidence that had accumulated since the publication of the Black Report in 1980 and assess the progress made on the report’s 37 recommendations. My report, entitled The Health Divide, was eventually published in March 1987 as an HEC occasional report, one week before the HEC was disbanded. David did two politically astute things when he commissioned the report: he set up an informal panel of distinguished scientific advisors, including three of the original members of the Black Report working group, and he signed over copyright of The Health Divide to me (as opposed to the commissioning body, HEC), thereby ensuring that the report would be published irrespective of what happened to the HEC.

As the launch date drew nearer, Peter Townsend, a scientific advisor for the report and one of the authors of the original Black Report, suggested that the HEC needed to call a press briefing, backed up by the scientific advisors because, in Peter’s memorable words:

“We can’t let Margaret face the flak alone.”

At the time I was young and so naïve that I hadn’t realised that there would be any flak!  How wrong I was again. After we had all travelled to London on the appointed day, the Chairman of the HEC decided to cancel the press briefing at the HEC offices an hour before it was due to begin. He was quoted in the Independent as saying that The Health Divide was “political dynamite in an election year” and so it was necessary to postpone the press briefing.  Members of the panel, who had already assembled, decided to proceed with the press briefing at the nearby offices of the Disability Alliance – David and his staff were instructed not to attend and so had to watch from the sidelines as the story unfolded. And what a story it turned out to be. As we made our way towards the Disability Alliance in Soho, journalists who were hurrying towards the HEC came across the procession going the other way and joined in behind – a Pied Piper effect. The press, TV and radio swung into action, spurred on by the hint that the report had been suppressed, possibly by the intervention of the department or even government ministers. The fact that this was remarkably similar to the treatment that the Black Report received seven years earlier was not lost on the media. The result was a public relations triumph for health inequalities advocacy (or a public relations disaster for the Chair of the HEC and government).

A health journalist, Peter Davies, recalled how a few days after the event, David Player told him gleefully: “It is going like hot cakes. They were queuing outside in New Oxford Street. We have a bestseller on our hands.” (1).

We had indeed – publishers started queuing up to publish The Health Divide, and it was eventually published in one volume with The Black Report by Penguin and became a non-fiction bestseller (2)

In the hectic aftermath of the press conference, the House of Lords requested copies for all the members as they prepared to debate the NHS, and a re-print had to be hastily prepared. It was, however, when a request for a copy of The Health Divide from Margaret Thatcher’s office landed on David’s desk that things became scary. David told a witness seminar at the London School of Hygiene and Tropical Medicine that, as he signed the complements slip to the PM, “It felt like I was signing my own death warrant.” (3).

The Times fanned that particular flame, by suggesting that the report was a “devastating final salvo from David Player to the government” on the eve of the disbandment of the HEC. That did David a great injustice – at the time he commissioned The Health Divide, over a year earlier, there was no inkling that the HEC would be disbanded, or that the Government would call a snap election, timed not long after the eventual publication.
It meant, however, that David did lose his job with the closure of the HEC and a very difficult time ensued for him. When I think of David during this episode and the battles he fought before and after it, I think of his courage in the true spirt of the great public health pioneers, mixed with his great Glaswegian sense of humour. An unstoppable combination!

1.    Davies P.  Review. BMJ 2003; 326: 169.
2.    Inequalities in Health: the Black Report edited by Peter Townsend and Nick Davidson and The Health Divide by Margaret Whitehead. 2nd Edition. Harmondsworth: Penguin. 1992.
3.    Berridge V, Blume S. (eds) Poor health: social inequality before and after the Black Report. Report of a Witness Seminar.   London: Frank Cass &Co Ltd. 2003.

Read Full Post »

Older Posts »