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Archive for the ‘Health Protection’ Category

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.

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By Dr Emilia Crighton, chair of the Scottish committee of the Faculty of Public Health.

So the government has decided to bring in a ban on pub and club drinking promotions that encourage people to drink fast and furiously. Licensees will face fines of up to £20,000 or face a prison sentence, under this new tougher code of practice.

This is definitely a step forward in attempting to tackle a British drinking culture that encourages people to see drinking large volumes of alcohol as an achievement to crow about to friends, rather than a threat to their health.

The introduction of the mandatory code of practice banning irresponsible promotions; the need for age verification policies; and ensuring smaller measures are available, acknowledges the failure of the voluntary arrangements that have been in place until now.

Making pub and clubs offer free tap water to customers, from April, should also be welcomed. Drinking water could help drinkers slow their consumption of alcohol and tackle dehydration.

As the FPH has regularly argued, alcohol consumption in the UK has doubled over the last 40 years and the average consumption of alcohol in the population is directly linked to the amount of harm. Increases in alcohol consumption have been driven by an increase in off sales, which now represents around 51% of alcohol volume sales, up from 24% in 1980. Consumption is strongly linked to affordability: as price has fallen, consumption has risen. Alcohol is now 69% more affordable than thirty years ago. The increased affordability of alcohol has been driven by the off sales sector.

Tackling price and availability are the most effective alcohol policies aimed at reducing alcohol related harm. Research produced by the team at Sheffield University which modelled the effect of different levels of minimum pricing on alcohol consumption indicates increasing impact on consumption with increases in price. For example the introduction of a minimum price of 40 pence per unit in Scotland would have a very small effect on consumption (-2.7 per cent), while at 50 pence and 60 pence, there would be significant changes in consumption (-7.2 per cent and 12.9 per cent respectively). The higher the price, the lower the consumption, and the lower the harm caused by drinking.

However, the government needs to go further. The introduction of a minimum price per unit of alcohol sold will have the highest financial impact on harmful drinkers.  People who drink within the sensible drinking guidelines will hardly be financially affected.   For example, if a 40p minimum price was introduced, it is estimated that a moderate drinker’s spend on alcohol would go up by £11 per year (21p per week), but that of a harmful drinker, who tends to buy more, cheap alcohol, would go up by £137. The increased prices in alcohol could be offset by lower prices for food and non alcoholic drinks by the supermarkets.

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Doctors, nurses and students highlighted the health benefits of tackling climate change in the lead up to the mass climate change march The Wave on 5 December. Wearing blue scrubs, pushing a hospital bed carrying a ‘sick’ globe and distributing ‘prescriptions’ for a healthy planet the group aimed to raise awareness of the threat of climate change to human health here and around the world.

On the march the Health Wave group also met the Climate Change Secretary Ed Miliband to deliver him the message “what’s good for the climate is good for your health”.

See pictures of the Health Wave event

Read the blog by David Pencheon, Director of NHS Sustainable Unit, on BMJ.com
Read the blog by Tony Waterston, Medact, on BMJ.com

The event was organised by the Medact, the Campaign for Greener Healthcare, the Climate & Health Council, Medsin, the NHS Sustainable Development Unit and the Royal College of Nursing.

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By Dr Alex Gatherer

Consider some of the facts relating to prison health.  The majority of prisoners, some 80% or so, have some form of mental ill health, and between 5-10% have serious mental illness, which requires specialist care in suitable facilities.

Furthermore, in any community, the local prison at any one time will hold a disproportionately high number of non-nationals and minority ethnic groups, of people positive to HIV and Hep C, of people with educational and social skills deficiencies, of those addicted to some form of substance addiction, of those with serious communicable diseases and of those previously hard-to-reach in our cities and towns.

In most countries, including our own, this high needs group will be detained in old premises with inadequate facilities for meaningful activity and recreation and often in overcrowded conditions.

And the majority of prisoners will be out of prison and back in their home environments on the streets in our communities often after only a short time.

‘Statistical compassion’ is one of the unmentioned skills required of top quality public health practitioners.  We must be able to look behind the statistics and see the suffering, the unmet needs and the social injustices amongst the individuals who make up the overall figures that are so central to the reports we write.  Without ‘statistical compassion’, how can we make sure that we take into account, in everything we do, those who are in greatest need?

Public health has a choice. We could ignore the above, as we did for many years and waste any opportunities to help a vulnerable high risk group. Or we could realise that it is in the interests of public health as a whole to prevent our prisons from being focal points of disease.

We could also realise that the right to health applies to all.

  • Dr Alex Gatherer is Fellow of the Faculty of Public Health. In November 2009 he was awarded the American Public Health Association’s Presidential Citation for his work in improving health in European prisons.

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Doctors and other health professionals should look after themselves as well as their families and patients. The fact about swine flu is that there is no way that you can tell whether you will fall ill and become seriously ill or not.

Whilst death rates remain low for normally healthy people, you are likely to be ill for seven or so days (shortened by 1 day with Oseltamivir as NICE guidance states).  Data from the HPA shows that this is ‘proper flu’ in those in whom the disease is confirmed, and it is a debilitating illness as flu always is.

The swine flu vaccine remains a good match against the currently circulating swine flu.  Why would you want to become ill when there is a safe and effective vaccine available?

  • Dr Philip Monk is Consultant in Health Protection and Member of FPH Health Protection Committee

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As widely predicted, swine flu appears to be plateauing and slipping from the headlines – for a while at any rate, helped largely by the school holidays. Time for some well-earned R&R all round.

What have we learned so far? What lessons to help us face a possible second, more virulent wave in the autumn?

I think perhaps the main lesson is that despite about five years of preparation, scenario planning and multi-agency live exercises, we didn’t expect the unexpected.

Whilst flu experts were anxiously monitoring poultry farmers in south east Asia and bird migration patterns across the globe, the pandemic surprised everybody by popping up in Mexico, from pigs.

For reasons still unclear the UK rapidly became the most affected country outside the Americas, with outbreaks centring largely on schools, fuelled by the number of young people returning from trips to America.

When WHO raised the level to 6, despite repeated reassurances that for most people the resulting illness is mild and recovery fairly rapid, a few high-profile deaths and a news-hungry press combined to whip up a huge surge of demand for diagnosis and antivirals that threatened to overwhelm the system. Primary care was swamped and the national flu line was not yet ready to take the load. It became more a pandemic of worried well than swine flu.

Then, with the policy of giving antivirals to anyone whether they were in a priority group or not, we had concerns about wasting them on people who didn’t need them or wouldn’t benefit from them, and worries about developing resistence or unnecessarily risking side-effects.

This gave the press another opportunity, this time highlighting the ‘confusion’ over the official advice for pregnant women  – actually caused more by statements from various professional bodies rather than the Department of Health. Nonetheless, the government got the blame.

And most recently the focus has shifted to whether the vaccine will be deployed in time and whether there are enough intensive care beds and ventilators to see us through a potential double whammy of swine flu plus seasonal flu this coming winter.

So, as we enter a strange lull, there’s lots to reflect on and learn, not just about managing the pandemic, but perhaps mostly about managing public expectations and the media. Thank goodness the virus was relatively mild.

And another lesson, for those who decide these things. Local public health teams and health protection units have been at the forefront of the fight against the pandemic and have thoroughly proved their worth. All the more reason therefore to beef up the public health workforce nationally, increase its capacity and capability, and develop its leadership.

As with the Stanley Royd salmonella outbreak 25 years ago which ushered in a new era for public health, it’s an ill wind that blows nobody any good.

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