Saturday, 20 July 2013

Good public health policy takes courage

I was sitting in the Friday afternoon rush hour traffic yesterday and glanced to my right to see the epitome of a public health nightmare sitting in the car next to mine.

A hugely overweight man was driving his executive car with the cabriolet roof down. He looked hot and sweaty and his balding head was bare to the 33 degree heat. He was (I kid you not) smoking a cigarette, occasionally drinking from the large MacDonald’s branded container. The hand that was on the steering wheel was tapping furiously as he was clearly stressed at the crawling traffic. The one safe thing he was doing was wearing a seat belt.

This poor man is a real life caricature of the ‘ticking healthcare time bomb’ so often referred to by healthcare leaders and politicians. I suspect that when my hapless subject got home he poured himself a large gin and tonic or similar to ease the hassle of is day. Diabetes, respiratory problems and heart disease, let alone joint and musculoskeletal issues are knocking firmly at his door as the grim reaper will held at bay by medical professionals who will try to fix him as the inevitable happens.

Is this man a lost cause? Possibly. Does he know that his habits are life limiting? Probably. Will he do anything about it? Who knows.  I am in no position to judge as I am far from saintly when it comes to healthy eating and drinking habits so I do have great sympathy for Mr Cabriolet Man. But how interesting that he has at least vastly increased his chances of surviving a road traffic accident by wearing his seat belt. And why does he wear a seat belt? Because it’s the law.

Of course we can’t make unprotected sunbathing, alcohol, or even getting stressed against the law. But surely those charged with protecting the health of the public should take every reasonable action they can to not only educate us, but strongly guide us towards healthy behaviour. Especially the impressionable young.

We know that educational programmes help enormously as at least the general public now know that smoking kills, excess alcohol ruins lives and healthy eating and exercise are the route to longevity. We also know that despite these programmes, there are generations in the UK making very unhealthy choices.

A study reported yesterday regarding early death rates due to liver disease in young women is truly shocking. For women born in the 50s , the death rate due to alcohol related disease is 8 per 100,000, for those born a decade later the rate rises to 14 per 100,000 and those born in the 70s, women only in their 30s right now, are dying at a rate of 20 per 100,000. Various causes have been cited, but cheap booze must play a part in this yet the government shies away from minimum pricing for alcohol.

Smoking is an equally depressing story as although statistics show that smoking rates are decreasing, we still see young children and teenagers smoking even though they know it’s bad for them.

Controlling the smoking habits of a population is potentially one of the biggest public healthcare challenges a nation can face. We know that, apart from the human loss and suffering, smoking costs the NHS and estimated £2bn a year.

How disappointing, then that the government have decided to postpone a decision regarding plain packaging for cigarettes – a move that had been expected to reduce young smokers. In a strongly worded letter to the Guardian Newspaper, a group of chest physicians, paediatricians and public health specialists make a powerful case for plain packs saying.

The tobacco industry targets young people because it needs to replace the 100,000 people in this country who are killed each year by smoking related diseases. Every day roughly 570 children aged 11-15, nearly 30 classrooms full, start smoking. Tobacco packaging is designed to manipulate perception of risk. For example, even though terms that dishonestly imply relative safety in cigarettes like "light" and "mild" have been banned, research shows that smokers continue to believe that cigarettes in lighter colour packs are less hazardous.The government must now either bring forward legislation or allow parliament a free vote on what is an urgent child protection issue.’

It is equally disappointing that the coalition will also delay a move to introduce a minimum unit price for alcohol.Protecting the health of the public while maintaining their right to personal choice is a tough job. Introducing unpopular measures can a poison chalice for health ministers and legislators. Like the brave move to make the wearing of seat belts in cars compulsory for drivers in 1983. This was a contentious issue for several decades before it finally became law and has saved thousands of lives, while creating a behaviour that is now automatic and part of everyday life.Good public health strategy needs to be backed up by legislation where possible. Legislation that is designed to limit choice and change behaviour takes courage.

We need to see that courage from the government now.




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