Archive for the ‘Obesity’ Category

Baroness Tanni Grey-Thompson talks to FPH’s Suvi Kingsley about the Olympic bid and legacy, and her top tips for parents struggling to get their kids moving.

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Baroness Tanni Grey-Thompson gives the second keynote speech at the Faculty of Public Health Conference on Wednesday 7 July.

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Eleven time Paralympian gold medallist Baroness Tanni Grey-Thompson spoke to the UK FPH conference today (7 July) about the importance of the 2012 Olympics in encouraging physical activity, particularly amongst women and children.

She called for the 2012 budget to be protected from cuts, underlining the potential cost savings to the NHS if it can be used to promote and support people to exercise more often. Inactivity costs the economy an estimated £8.2 billion a year in England, and Grey-Thompson challenged the public health community to find more innovative ways of encouraging participation in sports and exercise.

Physical activity contributes to the prevention and management of conditions including coronary heart disease, diabetes, cancer, mental ill health and obesity. Grey-Thompson said that “Promoting physical activity is integral to the preventative agenda. In a time when budgets are being cut across all public services, the NHS and wider economy cannot continue to bear the increasing financial burden of preventable conditions.”

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19 June 2010

In sultry heat, I join a continuous stream of people making their laborious way up the 392 steps to the mausoleum of Dr Sun Yat-sen. It’s beautifully situated on the slope of a wooded mountainside in a huge park in Nanjing, Eastern China.

Everyone is in holiday mood, stopping frequently to rest, drink and take snaps of each other against the backdrop of the splendid double-eaved sacrificial hall built a few years after Dr Sun’s death in 1925.

But as soon as they reach the sarcophagus, absolute silence descends in an atmosphere of deep awe and respect. Dr Sun is a much revered figure, considered to be the ‘Father of the Republic of China,’ honoured by Chinese people on both sides of the Taiwan Strait.

He qualified in medicine at the turn of the century, but soon gave up medicine for politics, plotting the overthrow of the Qing Emperor and helping to establish the fledgling republic. As its inaugural President he extolled three fundamental ‘Principles of the People’ inspired by Abraham Lincoln: One nation of the people – governed by the power of the people – for the welfare of the people.

Back at the conference I’m attending on public health in Asia and the Pacific Rim by the APRU World Institute, I think about the parallels between Dr Sun’s three principles and Michael Marmot’s basic tenets of a healthy society – one that upholds fairness, social justice and the pursuit of wellbeing.

Certainly, health inequalities is a recurring theme at the conference. There are huge disparities between the rich and the poor across the region – and between the cities and rural areas – and this is reflected in the disease patterns observed.

The conference theme is the epidemic of chronic, non-communicable diseases (NCDs) in the tiger economies of east Asia. This part of the world is now going through the escalation of cardiovascular disease we saw in the West about 40 years ago.

But it’s happening so fast here. Urbanisation is rampant – by 2020 China will have over 200 cities each boasting more than a million population. And this is coupled with globalisation, code for westernisation. Nearly every major city has its MacDonalds, KFC and Pizza Hut. Smoking is on a roll – mostly western brands – and in many Asia-Pacific countries, notably China, it’s still allowed in public places.

As to physical activity, whilst it’s true that cycling is still a common means of transport – here in Nanjing for example there are dozens of pushbikes bunched together at the front of the traffic at every stoplight – nevertheless people are increasingly switching to scooters or cars. Air pollution is a big problem in China – not good for the lungs, especially if you’re on a bike. All in all, there can be little surprise that obesity, diabetes, stroke, coronary heart disease, lung cancer and chronic obstructive pulmonary disease rates are rocketing right across the region.

What’s more, although these health problems were first seen most among the better-off – the early adopters of western lifestyles – in recent years the problems have begun to extend down the social gradient, particularly among the urban poor.

Effective prevention and early diagnosis are clearly crucial – yet many Asia-Pacific countries have health systems skewed to favour hospital and specialist services, with little or no investment in health promotion or primary care. Although China for example has well developed communicable disease prevention and control systems, its approach to non-communicable disease is much less robust and its primary care is largely based on private specialists and a vast unregulated army of traditional medicine practitioners.

This pattern is typical of the whole region, and poorer people thus face the double whammy of unhealthy lifestyles plus inadequate access to preventive, diagnostic or curative care. So, despite the best efforts of policymakers to reduce health inequalities in many of the emerging tiger economies of the Asia Pacific, the headlong rush to the cities has meant that the cards are truly stacked against the less well-off.

As in the West, it will take a multisectoral mix of interventions to halt the rising tide of NCDs in these countries – health education, social marketing, regulation of the food and tobacco industries and, above all, health systems change. Marmot argues that efforts should be applied across the social gradient. But from the workers’ high-rises of China’s cities to the slums of Mumbai and the favelas of Rio, there’s also a clear need to focus on the world’s urban poor.

As the conference closes I think again of Dr Sun Yat-sen. I’m sure that, as a medical man, democrat and visionary, he would wish to see public health of the people, by the people, for the people, applied fairly to all the people, not just those who can afford to pay.

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The Faculty of Public Health today publishes our joint manifesto on public health, alongside the Royal Society of Public Health. 12 Steps to Better Public Health offers a dozen practical recommendations that, if adopted by the next government, will improve the UK’s health and well-being for the new decade.

The joint public health manifesto calls for:

  1. A minimum price of 50p per unit of alcohol sold
  2. No junk food advertising in pre-watershed television
  3. Ban smoking in cars with children
  4. Chlamydia screening for university and college freshers
  5. 20 mph limit in built up areas
  6. A dedicated school nurse for every secondary school
  7. 25% increase in cycle lanes and cycle racks by 2015
  8. Compulsory and standardised front-of-pack labelling for all pre-packaged food
  9. Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
  10. Introduce presumed consent for organ donation
  11. Free school meals for all children under 16
  12. Stop the use of transfats

The full manifesto is available to read here, and the front-page Guardian story, with an accompanying podcast from our President Alan Maryon-Davis, is available to read here.

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“A Stalinist NHS quango” is just one example of the kind of newspaper coverage that the National Institute for Health and Clinical Excellence (NICE) has been hit with according to the Guardian Columnist Polly Toynbee“Notorious for denying life-saving drugs to terminally-ill NHS patients” was another, hardly more measured, journalistic description Toynbee chose to quote in her opening remarks at this year’s NICE Conference.

But behind these often negative headlines, NICE has been quietly issuing high-quality guidance that has acted as a beacon for a number of public health initiatives across England.  The hard work that has been going on in the background in consultation with clinicians, public health experts and, of course, patients, was palpable at the conference sessions.

“Shared Learning: implementing guidance promoting health and wellbeing” plenary highlighted some of the outstanding work that has been making a real difference in local communities around the country.

The first of these, led by Dr Peter Brambleby, Director of Public Health at NHS North Yorkshire and York, looked at the impact that creating close working relationships with both the PCT and the local Council has had on his community. Dr Brambleby stated the case for evidence-based commissioning, breaking down the word to illustrate what he means: co-mission-ing. The ‘co’ reminds that this is collaborative, the ‘mission’ reminds us that we are working together for a common purpose (improving the public’s health), and the ‘ing’ reminds us that this is a verb, an active, ongoing process.

The next two offered more practical examples of public health interventions making a difference in their local communities. Caryn Hall, a Consultant in Public Health at NHS Gloucestershire, outlined the work that they were undertaking with town planners to ensure that built environments are designed to encourage physical activity, helping to tackle the growing obesity problem. Julia Olijnyk, of Addaction Staffordshire, presented her project, a needle and syringe exchange programme for drug addicts in Stafford. She provided real-life illustrations of the helping hand that NICE guidance has provided in terms of engaging pharmacy staff in the project, resulting in positive outcomes and greater engagement with service users.

All three projects were shortlisted in the ‘Health and Wellbeing Category’ of the NICE Shared Learning Awards. Ultimately, the Addaction Staffordshire’s needle and syringe exchange programme triumphed, but all are excellent examples of public health in practice.

“Innovation and Value” was the overarching theme of the 2009 NICE Conference and away from the headlines, these three projects demonstrated those qualities admirably.

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Eating ourselves sick

Our economy is geared towards making us sick, according to speakers at the Big Food Debate in Liverpool.  The roots lie in the war and post-war years when the population was urged to eat more meat, butter and sugar and the farming industry was supported to grow, grow and grow.   

Academics in nutrition, public health and food industry professionals  met here to discuss what was wrong with our current food production and consumption.    

There have been two major messages to take away.

  1. Robin Ireland, Heart of Mersey chief executive argued that food campaigners have to learn from the anti-smoking lobby and push for national reforms like the smoke-free legislation or the vote last week to ban point-of-sale displays and vending machines.
  2. Professor Philip James, International Obesity Task Force Chair, felt obesity was akin to climate change.  Responsibility could not be put on the individual alone, that was just not enough anymore.  We needed to change our toxic environment – food chain, transport infrastructure, urban design, animal and agriculture industry – through wholesale strategic measures.

We clearly need to create a new food chain that benefits people, not just the food industry.  Too much to ask?   Not really, according to Professor Simon Capewell (Professor of Clinical Epidemiology at Liverpool University and Chair of FPH Cardiovascular Committee) who pointed out that the UK is lagging behind other countries and asked why we cannot use legislation to ban the stuff in our food that’s making us so sick – trans fats, salt and saturated fats.  However, Professor Jack Winkler (Director of Nutrition Policy Unit at London Metropolitan University) argued for incremental changes.  He called the FSA’s salt reduction policy the single most successful nutrition policy since the Second World War, exactly because it has been so unobstrusive and incremental.  Professor Philip James said it was necessary to work with the food industry because they had the power to transform the food we choose to eat  

Whatever the view, more must be done or we have a very real obesity epidemic in our hands; not to mention climate chaos because the way in which food is produced and consumed is inextricably linked with the environment. 

Amidst the doom and gloom were positive examples: take the Netherlands which has redesigned its cities to enable easy cycling and walking, transforming the health profile of its population.  In the Caribbean, obesity (and public health) is recognised as a cross-government responsibility, not just one for the health ministry. 

But some englightened  initiatives were to be found closer to home.  Last night at a lovely Italian restaurant in Liverpool’s Albert Dock, we were amazed to find a healthy eating guide attached to the menu, showing the dishes that are good energy boosters, the ones perfect for your daily dose of vitamins and so on.  And this morning, at our hotel, there was a menu card explaining the ‘superfood’ options available at the breakfast buffet.  We’d certainly never seen anything like it in London (apart from in an organic juice cafe perhaps…).   

But as it stands, we’re eating ourselves sick and while we’re at it, devouring the health of the planet as well.

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