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Posts Tagged ‘CMO’

Very long faces in the West Country this week. Despite much pressure from the health lobby, Alistair Darling has chosen to ignore calls for minimum pricing of alcohol, and instead has imposed a hefty tax hike on cider. In Wednesday’s Budget statement, the Chancellor announced a duty increase of 10% above inflation for cider compared with 2% above inflation for other alcoholic drinks across the board.

In recent years cider has enjoyed something of a tax holiday, making it a firm favourite among young people with little money and big thirsts. Cider has been a cheap way to binge-drink, and the budget hike is intended to bring it back into line on duty and price.

But are above-inflation tax hikes the best fiscal strategy for tackling alcohol misuse – especially binge-drinking by young people? Why the aversion to minimum pricing as an additional measure?

The problem with hikes in duty is that they can be easily absorbed by the supermarkets, which continue to offer cheap drink as loss-leaders to draw people into their stores. Many deeply discounted drinks are currently being offered at less than the cost of VAT, and these tend to be the very lines, such as strong ciders, lagers and alcopops, that are especially popular with young people.

Minimum pricing, on the other hand, has to be passed on to the customer. By fixing a minimum price per unit of alcohol sold – in other words, banning ultra-cheap offers on booze – the government can ensure that no drink can be bought at less than, say, 50p per unit, the figure recommended by England’s Chief Medical Officer as an ‘immediate priority’ over a year ago. This would mean no less than £5.50 for a 2-litre bottle of normal-strength cider (compared with many current offers under £2), £6 for the average six-pack of lager and £4.50 for a typical bottle of wine – more for higher strength versions.

The impact on health could be considerable. Consumption is closely linked to price, and a team at Sheffield University have calculated that, with a minimum of 50p per unit, every year the UK could see: 3,393 fewer deaths, 97,900 fewer hospital admissions, 45,800 fewer crimes, 296,900 fewer sick days, and a total benefit of over £1 billion. The deterrent effect and health benefits would be greatest for the heavier drinkers, especially those with the least disposable income.

With an election in the offing, the tax versus minimum pricing issue has split the parties. The Lib Dems are likely to be for it, Labour against (after Gordon Brown’s flat refusal to accept the CMO’s recommendation last year) and the Tories somewhere in between (on selected types of drink favoured by young people). In Scotland the parties line up differently – perhaps distorted by the distilleries – and the SNP-led efforts to drive through legislation are having a rough ride.

But, after the election, there’ll be all to play for. My guess is that common sense will break out and minimum pricing will soon be on the statute book as a useful adjunct to increases in duty. It won’t be either/or, but both/and. There’s still a chance that, just as it did with smoke-free legislation, Scotland could lead the way.

Or perhaps a fresh lot of Westminster MPs will see the light, and a ban on deep discounting of booze could be one of the early benefits of a hung parliament.

Good news for the nation’s health – but maybe less so for the apple-growers and cider-makers of the West Country.

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By Matthew Day, Public Health Registrar, NHS Wakefield District

When I started my public health training I had a three day local induction to get to know colleagues and learn from a range of speakers in public health from around the Yorkshire and Humber region. I found it useful as it provided inspiring insights and top tips on how things work in the specialty, as well as the time to connect with new colleagues. But while different deaneries strive to bring local trainees together through induction programmes and local events, how would it work nationally?

The idea of developing a ‘corporate identity’ for public health trainees was floated at the recent Public Health Futures event, organised by Sir Muir Gray and the Informing Healthier Choices team. Despite sounding like management speak, the fundamental point is a good one. While we all fight different public health battles at local, regional, and national levels, a better networked public health workforce developed through years of training would only be of benefit.

Sir Muir described his vision of the CMO welcoming all the new trainees personally. I can imagine the event: a handshake and pat on the back each, the CMO maybe throwing in a visionary comment about future public health challenges:

Trainee 1: “Er…hello Sir….

CMO: “Welcome to our specialty, son. Go forth and reduce inequalities…”

And then at the induction dinner that evening:

Trainee 1: “What did he give you?”

Trainee 2: “Coronary heart disease.”

Trainee 1: “You think that’s hard, I got inequalities…”

Jokes aside, rather than a pie in the sky idea, the underlying concept of a ‘national public health bootcamp’ for the new 2010 trainees has some merit.  Trainees 1 and 2 would stay in touch, collaborating, sharing and not duplicating important work on their interrelated subjects. In fact, this vision was already being taken forward after the event in the shape of the new national trainees’ website.

With Sir Liam Donaldson’s video message, and his imminent departure from Westminster, there was also a strong sense of the public health baton being passed on to us. Indeed, the baton we inherit bears the labels of a mix of hefty issues: obesity, alcohol (particularly minimum pricing), sustainability and health inequalities. In a show of hands vote, the majority of trainees in the room voted health inequalities as the single most important issue for our generation.

But very often public health is also about getting the right messages across to an audience, and doing it well. At the event, Sir Muir Gray quipped that “public health is about ‘performance,” and with his keynote speech Sir Michael Marmot gave a master class in how to engage with an audience. Indeed, in the shadow of a forthcoming election where spin-doctors are drawing battle-lines between ‘substance’ and ‘performance’, the message I took from the day as a whole is that we in public health must be experts, world leaders even, at both. We must deliver top-notch quality science and evidence base for our work and continually improve how we communicate that science and evidence base to an audience, be it the public, policy makers or the health sector.

National networking amongst trainees is certainly needed to help develop these skills so perhaps the sooner we’ll be pulling up those boots the better.

  • See the slides from the Public Health Future’s ‘Killer Slide’ competition with some brilliant examples of robust evidence base and great communication skills coming together

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