Prevention is better than cure - the importance of the government maintaining its commitment
When the government published Prevention is better than cure - Our vision to help you live well for longer last November, we welcomed its key message - that prevention is crucial to improving the health of the whole population, and helping secure the health and social care services we all value and rely on. It was a message that echoed our own founding vision.
We're now eight months on. Will the government maintain its commitment? Unfortunately question marks are already emerging:
- Boris Johnson, who is likely to be our next Prime Minister, has announced he plans to review so-called 'sin taxes' intended to reduce the risk of illness, despite a) evidence that these taxes work and b) questions about the influence of business lobbyists on his decision.
- Meanwhile Cancer Research UK advises us that the government has recently decided to cut the Public Heath England (PHE) awareness-raising budgets from £34 million to £27 million a year. These budgets are used to fund a range of national health marketing campaigns, including those that aim to encourage people to quit smoking and increase awareness of the signs and symptoms of cancer.
We hope the government will recognise that it makes more sense to prevent people falling ill in the first place rather than wait until they fall ill and then treat them - and look forward to the government publishing its planned Green Paper on Prevention, setting out how it will encourage a preventative approach to maintaining the nation's health.
Reducing the risk of mental ill health
Reducing the risk of mental ill health is a challenge, probably a bigger challenge than reducing the risk of physical ill health. That's because mental ill health often starts earlier in life, so there's less time to take preventative action - and partly because, unlike physical health, people are usually less clear about what can be done to reduce the risk.
However, there's increasing evidence that what happens to us in the earliest years of life can influence our mental health for years to come. So, greater support for new parents, particularly those most at risk, could prove particularly helpful. That was the conclusion from our review of existing research, published in Perspectives in Public Health in May.
Our call for investment in public health
Health Action Campaign is calling on the government to increase investment in public health in England - to prevent ill health, reduce health inequalities, and support a sustainable NHS and social care.
We’re doing this in partnership with 80 other organisations - including Age UK, the British Heart Foundation, the British Medical Association, Cancer Research UK, Dementia UK, Diabetes UK, Macmillan Cancer Support, Mind, the Royal College of GPs, the Royal College of Physicians and the Royal College of Surgeons.
In principle we should be pushing at an open door:
- Less than a year ago the Prime Minister called for a renewed focus on the prevention of ill-health.
- The NHS Five Year Forward View argues “the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health”.
- Prevention is better than cure - Our vision to help you live well for longer. That was the title of a government vision paper published in November.
Public health is clearly on the front line when it comes to preventing illness, helping people grow up in healthier environments and supporting them to make healthy choices. The successful action to reduce childhood obesity in Leeds, which we recently reported on, is a good example of the difference a public health approach can make - while taking a public health approach in Glasgow has even reduced problems like knife crime.
We hope the government will now take appropriate action and make the practical commitment and investment needed to improve the nation’s health.
You can see here the Statement on Public Health which we have signed.
Reducing childhood obesity – a first for the UK
Leeds has become the first city in the UK to see levels of childhood obesity fall, particularly in more deprived areas. It has achieved this by taking approaches that our research has suggested have worked in other countries, including:
- The importance of the early years, rather than waiting till children have started school.
- Training staff working with pre-school children (like health visitors and children’s centre workers) so they can promote health eating.
- Working closely with parents on a sustained basis (in Leeds through the Henry programme, which includes all aspects of family life, including parenting, family relationships, emotional wellbeing, family routines, nutrition and physical activity).
The Henry programme helps parents develop the ability to set and maintain boundaries that matter for their children's health, including what, when and how their children eat, how active they are and how much time they spend in front of screens.
Henry encourages authoritative parenting, where parents make clear they are in charge while providing their children with an element of choice. For example, instead of being asked what vegetable they want with dinner, children might be asked whether they would like carrots or broccoli. Instead of being told to go to bed, they are asked where they want to read their bedtime story.
We hope more cities will follow the example set by Leeds (and the successful examples of programmes in France, the Netherlands, Australia and Denmark) - and that the government will actively support such initiatives.
Is Life Expectancy falling in the UK?
That’s what the media are now reporting. The Guardian, for example, quotes experts as saying that this decline in forecast longevity in England and Wales is ‘a trend as opposed to a blip.’ It notes that last year’s analysis cut forecasted life expectancy by two months. This year it took off another six months. Compared with 2015, projections for life expectancy are now down by 13 months for men and 14 months for women.
We need to be clear that we are talking about forecast rather than actual life expectancy (which is expected to continue to increase but more gradually than anticipated).
This is good news for pension funds (which can now plan to set aside less money to cover long term pension costs) and for the Treasury (as the State Pension age keeps being raised but it now seems that people won’t be around for as long as expected to receive their pensions).
It isn’t good news for ordinary people – and it reinforces the case for a preventative approach to health, to increase the chances of people living longer, healthier lives.
That’s why we’ll be continuing to campaign for this as Health Action Campaign and why we’ll be very interested to see the proposed government Green Paper on Prevention.
New Iniatives to Stop Smoking
In a recent blog we mentioned the potential of a hospital initiative from Canada to reduce the number of smokers. The Ottowa model ensures that everyone who is admitted to hospital who smokes is offered support to quit smoking. We're pleased to see that the government has now decided to adopt this programme in the UK. In the NHS Long Term Plan announced by the Prime Minister on January 7th, there is a target that the Ottowa Model will be embedded in all NHS Trusts by 2023-2024.
Our research into the overlap between mental health and physical health also identified that people with mental illness were more likely to smoke. So we were pleased to see that the NHS Long Term Plan also included support to quit smoking as part of specialist mental health services - including the option to switch to e-cigarettes while inpatients. E-cigarettes aren't perfect but the evidence suggests they are significantly less harmful than cigarettes, so this move is welcome.
If you're not a hospital patient you can still benefit from our advice on quitting smoking.
Healthier Eating - is the food industry at a tipping point?
That's a question we posed in December 2018's edition of Breakthrough.
We know that food high in sugar, salt and saturated fat is implicated in a range of health problems, from obesity and type 2 diabetes to heart disease, stroke, several types of cancer and tooth decay. So is the food industry ready, able and willing to mass produce healthier food to reduce the health risks?
There are some positive signs:
- Consumer research organisations continue to identify a growing desire for healthier food among potential customers.
- Food companies who want to produce healthier food now have a range of options - including substitute ingredients which can reduce sugar, salt or fat content without compromising taste or requiring artificial alternatives; and reformulation of existing products (now a core skill for food companies operating internationally, as they may need to meet different taste and regulatory requirements).
- There is also growing evidence that healthier food is good for business.
Importantly, health concerns don't represent an existential threat to the food industry. People will always need to eat and drink. With increasing public and political pressure for healthier food it makes commercial sense for food companies to be seen as part of the solution rather than part of the problem.
The full article is available on pages 64 - 65 of the Winter 2018 edition of Breakthrough.
Preventing childhood obesity - what we can learn from other countries
If powerful forces are fuelling obesity then we need powerful forces to push back. This was one of the messages from our Director, Michael Baber, in his talk at Food Matters Live at the Excel Centre in London on November 22nd.
He explained how 'whole systems' approaches in four different countries had succeeded in reducing levels of childhood obesity. For example they assembled a powerful coalition of stakeholders and applied a range of approaches, including social marketing and linking prevention and healthcare (something we're not very good at yet in the UK).
The four examples Michael focused on were:
- Romp & Chomp - a 4 year pilot project with 12,000 children in the Australian city of Geelong.
- EPODE (Ensemble Prevenons l'Obesite Des Enfants) - which originated in France but is now being applied in parts of Belgium, Spain, Greece, Australia and Mexico.
- JOGG (Jongeren op Gezond Gewicht) - building on the EPODE model this is now in place in over a hundred towns and cities in the Netherlands, with probably the best known example being in Amsterdam, whose success in reducing childhood obesity has generated significant media coverage.
- TCOCT (The Children's Obesity Clinic Treatment Protocol)- a hospital-based approach, which originated in the Danish town of Holbaek, and has achieved success, in part by giving parents practical suggestions to help their children manage obesogenic environments.
Michael also explained the potential of Elected Mayors to make progress here in the UK, if the government were to make a Tackling Obesity Fund available, and the potential to use social marketing to influence the behaviour of food and drink companies, not just consumers.
Are people in the UK spending more years in poor health?
Public Health England has published its Health Profile for England 2018. There's a range of interesting information about the health of the nation, including some good news. For example fewer people are smoking and more action has been taken to reduce high blood pressure and high cholesterol - resulting in positive health gains.
However, the report also notes that:
- Life expectancy had been increasing but this increase has now slowed
- There has been little increase in healthy life expectancy (the number of years spent in good health)
- The number of people with long term health conditions, most of the most common of which are preventable, has increased.
- People in the richest areas enjoy an average of 19 more years in good health than those in the poorest
If this were an inspection report on the nation's health it would probably conclude that much improvement is still needed, not least to tackle the current health inequalities between rich and poor - and particularly where the causes of ill health are preventable.
This remains very much our view at Health Action Campaign, where we continue to make the case that prevention is better than cure.
Can we reduce the risk of mental illness?
Each year 1 in 4 people in the UK experience a mental health problem - according to the NHS Information Centre on health and social care.
This can have big implications for themselves, their families, their employers, the NHS and society - particularly as Mental Health tends to be a Cinderella service within the NHS, meaning the support needed may not always be readily available.
Most people know what they can do to reduce the risk of physical illness - like not smoking, limiting their alcohol consumption, eating healthy food and getting enough exercise (even if they don't always act on what they know).
However, how many people know what can be done to reduce the risk of mental illness? That's a gap we’re working to fill through two research projects.
Our Mental Health research team is reviewing research into some of the most serious mental illnesses (like anorexia, bipolar disorder, personality disorder, schizophrenia and severe depression) to identify what can be done to reduce the risks.
Meanwhile mental health is part of our Health at Work research team’s remit. Most of us spend a large part of our waking hours at work. So if ways can be found to make that time more positive for our mental and physical health that will be a positive step forward.
Childhood Obesity - Time for action
That's the title of the Health and Social Care Committee's timely new report on tackling Childhood Obesity. You can see what the committee recommends here:
In its report the Committee mentions some of the evidence we provided, about initiatives that have successfully reduced childhood obesity levels in parts of France, Holland and Denmark (see paragraph 13). In fact the Committee agreed with our analysis on three important points:
1. To tackle obesity in the UK we need a 'whole system' approach, along the lines employed in parts of France, Holland and Denmark.
2. Early years intervention is important, including the value of breastfeeding.
3. What people eat is the main issue. Exercise is good for health and should be encouraged but if we want to tackle obesity we need policies to reduce the consumption of products high in sugar, salt and fat.
Scottish government targets cheap alcohol
Scotland has become the first country in the world to introduce minimum pricing for alcohol. The aim is to cut consumption of cheap alcohol, like high strength white cider and own brand vodka and whiskey. For example the cost of a 2 litre bottle of high strength cider will go up from £2.50 to £7.50.
The direct health risks of alcohol abuse, including liver disease, are well known. There are also a range of other harmful effects. For example, according to Dr Christine Goodall, of Medics Against Violence, more than 80% of assault victims in hospital A & E departments had been drinking, as had the people who had assaulted them.
Health campaigners hope that minimum pricing will help reduce excessive alcohol consumption. However, this is for a six year trail period and the Scottish government will evaluate the findings before deciding what to do in the longer term.
Can a healthy lifestyle add 12 more years to your life?
That's the possible conclusion from a big study in the US by Harvard University. The study analysed the medical records of 123,000 volunteers. The five healthy lifestyle factors they researched were never smoking, a healthy BMI, moderate to vigorous physical activity, moderate alcohol intake, and a high quality diet.
The projected life expectancy at age 50 years was on average 14.0 years longer among female Americans with all 5 low-risk factors compared with those with zero low-risk factors; and for men the difference was 12.2 years.
Can physical fitness protect against dementia?
That's the possible conclusion from Swedish study published in Neurology in March 2018.
The health of 191 women was tracked over 44 years, from middle age to old age. What the study found was that the women with high physical fitness in middle age were nearly 90 percent less likely to develop dementia decades later, compared to women who were moderately fit. And when the highly fit women did develop dementia, they developed the disease an average of 11 years later than women who were moderately fit, or at age 90 instead of age 79.
The researchers caution that this shows an assocation between physical fitness and reduced risk of dementia rather than cause and effect - and accept that this was small scale study in one country, meaning more research is needed. However, these initial results are promising.
It's time to get to grips with obesity before obesity takes a grip of the nation
That was the message from a letter published in The Times early in March, which we signed as a member of the Obesity Health Alliance - Time to get to grips with obesity.
Ultra-processed food - an emerging health risk?
That's what a recent French study of over 100,000 people suggests. It found that a 10% increase in the proportion of ultra processed food was associated with an increased cancer risk of more than 10%.
That's particularly important here in the UK, because we consume more ultra-processed food than any other country studied in Europe.
So what are the ultra-processed food we should be wary of? The NOVA food classification system explains they include sweet or savoury packaged snacks; industrialised confectionery and desserts; sodas and sweetened drinks; meat balls, poultry and fish nuggets, and other reconstituted meat products transformed with addition of preservatives other than salt (for example, nitrites); instant noodles and soups; mass produced packaged breads and buns; and frozen or shelf stable ready meals.
Are people now dying younger?
This seems to be a possibility in both the US and the UK.
- In the US life expectancy has fallen, as more people die before the age of 55.
- In the UK, after decades that saw people living longer, life expectancy is now stalling - and has fallen behind most other Western European countries.
- There has been in increase in strokes among younger and middle aged people in both the US and the UK.
A number of reasons have been suggested for this, from rising levels of obesity to government austerity programmes to drug use. At Health Action Campaign our review of the evidence suggests that what goes on OUTSIDE the NHS has a big impact on health, from lifestyle to life chances to social care. That's why we think the government needs to look beyond the symptoms (like stalling life expectancy and the NHS winter crisis) and to start to address the underlying causes of ill health in the UK.
Might keeping your New Year's Resolutions save your life?
That's what the media have suggested recently. It follows research into 343,150 adults registered with the UK Biobank study. This found that each healthy behaviour (not smoking, maintaining a low BMI, regular physical activity, a healthy diet and limiting alcohol consumption) appeared to reduce the risk of cancer - and following all five healthy behaviours appeared to reduce the risk of cancer by about a third. The researchers point out that this is also reported to reduce the risk of diabetes, vascular disease and dementia.
So it seems that making and keeping healthy New Year's Resolutions really could save lives.
Time to stop advertising junk food to children on prime time TV
Aren't there supposed to be restrictions on advertising food high in sugar, salt and fat on children's TV here in the UK? Yes, but there's just one problem. Far more children watch prime time family TV in the evening than children's programmes during the day - and there are no regulations covering evening TV.
A recent study by the University of Liverpool found that in one case children could see nine junk food ads in just 30 minutes. The study was commissioned by the Obesity Health Alliance (which we're a member of here at Health Action Campaign).
We fully support OHA's call for a ban on junk food advertising before the 9 pm watershed - as do 76% of the public, according to recent polling.
Already a number of MPs, from different parties, are recognising the need for action, as seen in January's Westminster Hall debate. Let's hope the government listens and starts to get serious about tackling the preventable causes of childhood obesity.
A first for Scotland
Scotland is set to become the first country in the world to set minimum prices for alcohol. The aim is to reduce the amount problem drinkers consume by raising the price of the strongest, cheapest alcohol., like super strong cider.
This follows a five year legal battle with the Scottish Whisky Association, which had challenged the Scottish government's plans, in the courts. Now the UK's Supreme Court has unanimously ruled that the measure is a proportionate means of achieving a legitimate aim.
The true cost of Obesity
We all know obesity is a big drain on the NHS - £5.1 billion a year according to the Obesity Health Alliance. That's enought to pay for another 85,000 hospital doctors per year.
However, there's an even bigger cost to the UK - the £27 billion to society. We don't often hear about this but obesity has a major impact on the life chances of individuals and families, with knock on effects on the economy and society. For example:
- Emerging evidence from research in the USA, Chile and Spain suggests that obesity slows educational development. For instance a US study found that obese children were slower to recognise when they had made a mistake and slower to correct the mistake.
- The there's the impact on employment prospects. Research indicates that employers are less likely to employ people who are obese and, if they do, it is more often in lower paid jobs.
We hope the government will recognise the true cost of obesity to the UK and step up its action to tackle the problem.
David versus Goliath
Junk food companies are spending 27.5 times more advertising their products than the government spends advertising its healthy eating campaign. That's what the Obesity Health Alliance has found.
This echoes our own, earlier research for Healthy and Wealthy? For example we found that one company spent more advertising a single chocolate bar than the government spent advertising its entire healthy living campaign. That's why we recommended:
The advertising budget for Public Health England should be linked to the UK's commercial advertising expenditure on junk food, to seek to ensure adults are receiving reasonably balanced communications regarding food whose regular consumption increases health risks.
Healthier food - good for people's health and good for the food industry?
New research has confirmed one of the key findings from our 2015 report Healthy and Wealthy?
We identified that producing healthier food wasn't just good for people's health. It was good for the food industry too. That's because consumers are becoming more educated and more health conscious - and more educated, health conscious consumers have greater lifetime value for food companies, because they spend more on food each year and tend to live ( and spend) for longer.
The latest research confirming this trend was a recent study of 12.5 million social media posts from 18 - 35 year olds, an important market for the food industry. This found they
- Want healthy, natural food
- Are less interested in dieting, fat free foods, snacks and convenience foods
- Prefer water and 'better for you' drinks, not carbonated sugary drinks
We hope the food industry will recognise the value of speeding up its work to make mass produced food healthier - with less sugar, salt and saturated fat and more dietary fibre.
Is the UK becoming the Sick Woman of Europe?
Growth in female life expectancy at birth for British women is now the worst in Europe - and the second worst for men. That’s according to the EU statistics body Eurostat.
Until 2010, life expectancy was gradually increasing in the UK, at a rate of an extra year of life almost every four years. However, that increase then started to stall.
Could this be a result of the government’s austerity programme? Possibly, but countries which have experienced greater austerity, like Spain, Greece and Portugal, are doing better than the UK when it comes to life expectancy improvements.
Could it be that life expectancy is reaching its natural limit? Possibly, but a number of other European countries which already have better life expectancy than the UK have seen their life expectancy continue to improve.
What this illustrates once again is the need for the UK (its government, its health services, its businesses and its people) to recognise that prevention is better than cure – and to get serious about tackling the preventable causes of premature death.
'Pre-hab' Health action - the way forward for surgery?
We know that a healthy lifestyle can reduce the risk of serious illness. Might it also help if you need surgery?
That's what an innovative project at Imperial College Healthcare suggests. As the BMJ identifies, having surgery puts a strain on the body, a bit like running a marathon. So why not prepare patients for this, through a 'pre-hab' programme to encourage physical exercise, healthy eating, reducing smoking and alcohol consumption and enhance psychological well-being? That's exactly what Imperial's PREPARE for Surgery did for patients with gastro-oesophogeal cancer.
- Post operative complications down from 70% to 30%
- Pneumonia rates halved
- Patients discharged from hospital after seven or eight days, instead of the usual seventeen days
As a result the programme is due to be expanded to cover patients with liver cancer, pancreatic cancer and lung cancer.
We welcome this initiative and look forward to seeing it become the norm for patients awaiting surgery. Our guiding principle here at Health Action Campiagn is that prevention is better than cure. It now seems that prevention can help even when a cure is needed.
1st July - a significant day for public health?
Today the ban on unhealthy food ads aimed at children was widened - to include social media, cinema and print. The ban was announced last December but takes effect today. There are still loop holes. For example many children watch programmes like Britain's Got Talent - but not enough for it to be classed as a children's programme, so the ban doesn't apply in this kind of situation and similarly with social media. However, it is step forward, we welcome it and hope more steps will follow in the years ahead.
Ten years ago today another significant ban was introduced - on smoking in public places. The ban was controversial at the time, like many public health initiatives - but it is now supported by the majority of people, it has helped reduce the number of people who smoke and in particular the number of young people who smoke - and it has even improved the health of bar staff, previously victims of passive smoking.
A hung Parliament - the implications for public health?
Brexit negotiations and action to ensure the government's survival will obviously be high on the political agenda. We hope public health will also be high on the agenda too. That's because:
- A healthier population will reduce pressure on the NHS and social care.
- A healthier workforce is good for business and good for the economy.
- The UK has the potential to become global market leader in the production, sale and marketing of healthier food.
So that's a win-win for government, for business and for health.
Political will is needed to tackle obesity in the UK
In the run up to the General Election on June 8th, that was the message from Health Action Campaign and other members of the Obesity Health Alliance, in a letter published in The Guardian.
The message is clear: whoever forms the next government cannot afford to neglect the obesity agenda. Obesity is blighting lives, costing the NHS billions a year, jeopardising the health of future generations, and it is entirely preventable.
Health News that caught our eye
Here are a three news stories which suggest positive, achieveable ways of improving public health:
- Amsterdam has found a way to reduce the number of overweight and obese children, particularly in poorer parts of the city. The Deputy Mayor of Amsterdam has led a coordinated approach, from promoting tap water to refusing sponsorship to events that take money from Coca Cola or McDonalds. With the role of elected Mayor taking off here in the UK this is a way they could really make a difference for children’s health.
- A five-year study of 250,000 UK commuters suggested that regular cycling cut the incidence of cancer by 45% and of heart disease by 46%. The full report is in the BMJ. We encourage employers to help more of their employees cycle to work, through simple, low cost options like providing lockers, so people can change from cycling clothes to work clothes.
- The NHS is set to ban the sale of sugary drinks and fatty snacks in hospital cafes and canteens - unless action is taken to drastically cut their sales, health officials have said. Under a national plan, retailers including Marks & Spencer and W H Smiths and Subway have agreed to cut sales of sweet drinks to a maximum of 10 per cent of their drinks output.
Should the Food Industry be part of the government's new Industrial Strategy?
In our report Healthy and Wealthy? we recommended that the government work with the food industry and health experts to make the UK's food industry the global market leader in the mass production of healthier food i.e. lower in sugar, salt and relevant saturated fats and higher in dietary fibre. This would be good for the food industry and good for the nation's health.
However, there's now a risk that the food industry will slip through the net. It isn't included in the government's proposed new Industrial Strategy. Instead the government refers readers to a proposed 25 year plan for Food Farming and Fisheries. However, initial indications are that this is going to focus primarily on the growing of food rather than its processing and retailing.
If you share our view that the government's proposed Industrial Strategy should include a target to become world leader in the mass production of healthier food then watch this space. The snap General Election means this kind of issue will temporarily move to the back of the queue. However, once the Election is over we'll be working to move it back up the agenda again.
Here is the HAC response to the proposed Industrial Strategy.